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The Silent Killer

Columnist: Steven Levenberg, D.O.
August, 2015 Issue

Steven Levenberg, D.O.
All articles by columnist

Lifestyle changes are recommended for everyone with hypertension.

There’s a silent killer in our midst. High blood pressure is killing us and it doesn’t show. There generally aren’t any obvious symptoms.
Is it just one of those things drummed up by Big Pharma to sell more product? No. High blood pressure, also known as hypertension, is a big, big deal. It’s the major factor in the development of heart disease, stroke and many other cardiovascular conditions. Together with other factors, like diabetes and high cholesterol, hypertension’s risk is multiplied. This is a really bad factor with regard to our health—and it’s not some rare disease.
The Centers for Disease Control and Prevention (CDC) estimates that as many as 67 million Americans—one in three—are affected by high blood pressure. The total health care cost of hypertension is estimated at $51 billion and the numbers are rising. Just having your blood pressure taken once every year, and treating elevated blood pressure, is one of the most powerful positive health behaviors you could adopt, even if you did nothing else.
So what’s hypertension? It’s not having a bad day at the office or too much stress with the kids, although those might be contributing factors. Simply put, hypertension is high blood pressure that’s persistently more than 140/90.
What do those numbers mean, anyway? The first number, the systolic pressure, is basically the maximum pressure with which blood is being pumped through your arteries by your heart. The second number, the diastolic pressure, is the resting tone of the artery or the minimum pressure the heart has to overcome to make blood move.
When systolic pressure is too high, it puts strain on the blood vessels and they get damaged. Low levels of systolic pressure elevation cause slower and subtler damage. But, over time, tears in the blood vessel lining occur, which are sometimes repaired with cholesterol or calcium deposits, and then the vessels get plugged. Extremely high systolic pressures can cause more immediate and catastrophic damage, in effect “blowing out” vessels and depriving vital organs of their blood supply. That’s usually very bad.
Elevated diastolic pressure is somewhat more subtle and insidious, constantly taxing the heart and challenging it to increase systolic pressures to generate enough “pulse pressure” (systolic minus diastolic pressure) necessary to circulate adequate amounts of blood to vital organs. That stress on the heart also produces changes in the way the heart works, causing its muscle to thicken and its chambers to enlarge to try to pump more blood. That cardiac arms race can only go on so long before everything starts to fall apart, bit by bit.
That’s an oversimplification, but it gives a flavor for how widespread the physiologic changes can be with hypertension. This all refers to “essential hypertension,” which occurs without any known cause, like a tumor, kidney disease or chemical imbalance. Essential hypertension comprises about 90 to 95 percent of elevated blood pressure. There’s a hereditary link, but not always. Cigarette smoking and nicotine from other sources are potent contributors to blood pressure elevation. Overweight and sedentary lifestyle are major factors as well. Dietary sodium intake may also contribute.
So, if your blood pressure is consistently more than 140/90, what’s to be done? Lifestyle changes are recommended for everyone with hypertension:
• Weight reduction to ideal levels, including a body mass index of less than 25 percent;
• Daily exercise at a moderate pace of more than 150 minutes per week;
• Reduce sodium in the diet;
• Reduce fat and animal products and consume more vegetables and fruits;
• Stop smoking; and
• Limit alcohol intake to no more than one drink (women) or two drinks (men) per day.
In some cases, these changes alone can bring blood pressure down to acceptable levels, but adherence with these recommended changes is woefully poor. The next step is to start medication.
There are many medications available to treat hypertension, letting us tailor treatment to an individual’s needs. Generally, medications aren’t expensive and have few side effects. The challenge is continuing to adjust the medications and dosage to get adequate control, which is something we only do in about 50 percent of people with hypertension. The CDC also estimates that reducing the average population’s systolic pressure by 12 to 15 points could reduce stroke by 37 percent, coronary heart disease by 21 percent, deaths from cardiovascular disease by 25 percent and deaths from all causes by 13 percent.
So, get your blood pressure checked, start changing your lifestyle to become healthier and, if your numbers are high, get it treated. Don’t get caught by that silent killer.
Dr. Steven Levenberg, a member of Sutter Medical Group of the Redwoods, is board certified in the specialty of family medicine. He’s been in practice for 30 years, in Cotati and Rohnert Park since 1989, and is a native of Santa Rosa.



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