Professional Documents
Culture Documents
XX
High Blood
Pressure: The
Science Inside
0-87168-694-5
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TABLE OF CONTENTS
PART 3: CARE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Diagnosing high blood pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Preventing and controlling high blood pressure . . . . . . . . . . . . . . . . 26
Maintaining the right weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Eating properly. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Getting exercise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Avoiding alcohol and tobacco . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Monitoring health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Taking blood pressure medicine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Blood pressure treatment plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
PART 4: RESEARCH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Current lines of research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
The important role of volunteers. . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
APPENDIX 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Taking Part in Research Studies—Questions To Ask
RESOURCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
BIBLIOGRAPHY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
GLOSSARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
INTRODUCTION: HIGH BLOOD
PRESSURE, A CONTROLLABLE
DISORDER
Y our heart is the hardest work-
ing muscle in your body. No big-
ger than a fist, this powerful
pump circulates blood throughout
your entire body, providing the
oxygen and nutrients you need to
live. Unlike most pumps, howev-
er, this pump never stops as long
as you’re alive. In fact, the aver-
age human heart works at a rate
of 100,000 beats a day, or an
incredible 2.5 billion beats over a
lifetime of 70 years!
Every time your heart beats, it down. If you get rid of the block- There are
pumps blood through arteries, age, water will once again flow no clear-cut
symptoms for
exerting pressure (or force) on smoothly through the hose. high blood
the inside of your blood vessels. pressure—which
This is called blood pressure. You can think of high blood is part of the
reason it has
To understand this, think of a pressure, or hypertension, in become known as
water pump and hose. When you the same way. It is a condition in “the silent killer.”
turn the pump on, it pushes which the pressure of the blood
water into the hose, creating inside the arteries is too high. If
pressure against the inner walls the condition is left untreated, it
of the hose and causing the will cause damage to the arteries
water to flow. Now, if you inter- and put strain on the heart. You
rupt the flow of water—for can develop serious complica-
example, by putting a bend in tions of high blood pressure,
the hose—you create a blockage including stroke, heart
that stops up the water. The attacks, heart failure, kidney
water will build up behind the failure, and eyesight problems or
blockage, exerting more pressure even blindness. Developing these
and pushing out the walls of the and other related illnesses can
hose. If you keep the hose bent, lead to a life of considerable suf-
eventually either the hose will fering or premature death.
1
burst or the pump will shut
High Blood Pressure: The Science Inside
Research shows that more than High blood pressure does not affect
50 million Americans over the age all people in the same way. African
of 6 have high blood pressure. Americans and older people are
Roughly 1 in every 4 American particularly hard hit by the disor-
adults has the disorder. In 1999 der. Those with lower incomes and
alone, high blood pressure con- lower educational backgrounds
tributed to the deaths of more also tend to be at greater risk for
than 227,000 Americans. This developing high blood pressure.
number is expected to rise in the In addition, research studies have
years ahead. shown that people living in the
southeastern United States have
Sadly, millions of Americans are average blood pressure levels that
walking around with high blood are higher than Americans living
pressure and don’t even know it. It in other parts of the country. The
seems that most people find out exact reasons for this still remain
they have the disorder only when unclear.
their doctors bring it to their
attention during an office visit. What is clear is that people can
This is due to the fact that there take many actions to reduce their
are no clear-cut symptoms for chances of developing high blood
high blood pressure—which is part pressure. This involves having
of the reason it has become known blood pressure checked regularly,
as “the silent killer.” since high blood pressure is simple
to detect, and making changes in
One basic marker that people can lifestyle, such as increasing physi-
use to keep tabs on their blood cal activity, reducing the amount
pressure is their age. As people of salt consumed, and committing
grow older, their chance of devel- to a lifetime of healthier eating.
oping the condition becomes
greater. Health experts have deter- For those suffering from high
mined that roughly 54% of people blood pressure, medical science
over 60 have high blood pressure and modern research since the
and that two out of three 1940s and 1950s have come a long
Americans will have it by the age way in understanding and treating
of 70. For this simple fact alone, this silent condition. Many med-
it is important for people to ications have been developed and
become more aware of their blood proven effective in helping to get
pressure, have it measured period- blood pressure levels under con-
ically, and learn healthy ways to trol, to limit or avoid further com-
prevent or control this potentially plications, and to prolong life.
2 deadly condition.
Introduction
“High blood pressure can lead to stroke and having problems with the
heart. There are so many things that can come from high blood pressure.”
“I started to feel dizzy and went to the school’s nurse. She took my blood
pressure and said it was high.”
Following health advice is easier said than done, but somehow Prioleau
manages to do it. She keeps her blood pressure under control by getting
exercise, eating healthy foods, and taking blood pressure medications.
She makes sure her shoes are comfortable. Unlike many people who run
and walk for their health, she doesn’t wear a Walkman.
3
High Blood Pressure: The Science Inside
“I like to take time to take an inventory of myself,” says Prioleau. “It gives me
time to think.”
She has banned fried food from her diet except for fish and a special treat of
fried chicken on New Year’s. She makes juice from carrots and apples and
drinks a lot of water.
And does Prioleau eat grits, the porridge-like dish made from corn that
Southerners crave? “Of course,” she says laughing, “but I don’t eat them
with salt.”
Like many people with high blood pressure, Prioleau can’t keep it under
control with diet alone. She was originally prescribed Lotrel, a calcium-channel
blocker, but her blood pressure started going up again. Now she takes Norvasc,
a calcium-channel blocker; Cozaar, an angiotensin II receptor blocker; and a
diuretic.
Prioleau says her doctor, Dr. William Bestermann, deserves part of the credit
for her outlook. “On a scale of 1 to 10, I would say Dr. Besterman is a 10.
He promotes a healthy way of life.”
Many of us take our health for granted. We just go along assuming we’ll stay
well or that doctors will be able to treat us if anything goes wrong. Prioleau
sees her health as something she has to work for.
4
Part 1: The Disease
When the specific cause is identi- toms do arise, it means that blood
fied and properly treated, blood pressure is too high, often causing
pressure often returns to normal damage to such critical organs as
levels. the heart or kidneys. In the most
severe cases, when symptoms can
Isolated systolic hypertension arise, they might come in the
(ISH)—This form of high blood form of:
pressure is most common in older headaches
people, affecting over 65% of people excessive perspiration (sweating)
more than 60 years of age. ISH chest pains
comes with no symptoms, so many muscle tremors
people may have it and do not nosebleeds
know it. ISH is characterized by fatigue, weakness
high pressure levels when the nausea, vomiting
heart is beating (systolic), but nor- heart palpitations
malized levels between beats, when vision problems
the heart is resting (diastolic). blood in urine
This large gap between pressure confusion
levels can lead to a straining of
the arteries.
How high blood pressure
affects the body
Symptoms of high blood
pressure High blood pressure affects the
body in a variety of ways. The most
Unlike many other conditions, high
critical effect is the strain it can
blood pressure often causes no
put on the heart. High blood pres-
symptoms. However, when symp-
sure also damages blood vessels
7
High Blood Pressure: The Science Inside
specific risk factors that, when com- much alcohol can also make high
bined, can greatly increase a per- blood pressure medication less
son’s chance of developing high effective.
blood pressure. These risk factors
include: Luckily, as suggested by the “con-
trollable” factors above, there is
Controllable Uncontrollable much that people can do throughout
their lives to keep their blood pres-
high salt intake heredity
sure at a healthy level.
obesity race
Unfortunately, high blood pressure
excessive alcohol use gender
doesn’t affect all people in the same
lack of exercise age
way. For example, African
use of certain
Americans are much more likely to
medications
develop the condition earlier and
drug or chemical use
more severely than whites. Also, in
diabetes
terms of gender, men have a greater
kidney disease
chance of developing it between the
stress
ages of 35 to 55, whereas women
are more likely to develop it after
Salt has been found to be a risk fac-
the age of 75. What is clear, howev-
tor because too much of it can raise
er, is that as people age, they
fluid levels in the bloodstream, forc-
increase their chances of developing
ing the heart to work harder and
high blood pressure.
blood pressure levels to rise. This is
particularly true if the kidneys,
which regulate sodium (salt) and
water levels in the body, are not
working properly. Obesity is anoth-
er key risk factor. When a person
gains weight, his or her blood levels
also increase, causing the heart to
pump more blood. The additional
weight also causes a person’s blood
pressure to elevate because it
increases cholesterol levels, lead-
ing to a further straining and hard-
ening of the blood vessels and
heart. Excessive alcohol consump-
tion can also reduce the heart’s abil-
ity to function properly, increasing Obesity is a controllable risk factor for
blood pressure levels. Drinking too high blood pressure.
9
High Blood Pressure: The Science Inside
can block the proper flow of blood and need of prompt medical attention.
oxygen that the heart, brain, and vital
organs need to work properly. Blood Heart Failure. Another aspect of the
clots may also form in an artery, toll that high blood pressure can have
blocking the flow of blood entirely. on the heart is in the form of heart
While considered a slow and advanc- failure. As previously mentioned, the
ing disease that mainly affects the heart can be forced to work harder
aged, atherosclerosis (also called arte- due to complications of high blood
riosclerosis) may result in a heart pressure and atherosclerosis. Under
attack or stroke if left untreated over these unhealthy, untreated conditions,
time. In addition to high blood pres- the heart begins to stretch and
sure, other risk factors that con- enlarge (either partially or as a
tribute to the progression of this dis- whole). Eventually, the heart fails to
ease include smoking, diabetes, obesi- function effectively—either too much,
ty, and family history. not often enough, or irregularly—and
ultimately results in congestive
Heart Attack. As previously noted, heart failure. This disorder may
hypertension can contribute to the involve a failing of the entire heart or
hardening of arteries, which can lead just one side of it. When the left side
to a heart attack. In order to function of the heart fails, blood and other flu-
properly, the heart muscle itself needs ids get backed up in the lungs. The
a continuous supply of oxygen-rich first signs of this condition are
blood. When arteries become nar- breathing problems, such as shortness
rowed or blocked, this vital flow of breath. When the right side fails,
becomes lessened, causing muscle blood may back up into other areas of
damage and angina (chest pains). the body as the veins fill and leak
Heart attacks result when arteries fluid into the surrounding tissue.
and the flow of blood to the heart Symptoms of right-side failure include
become completely blocked. In gener- fatigue, indigestion, liver damage, and
al, any disruption in the workings of swelling in the legs.
the heart is life threatening and in
12
Part 1: The Disease
DASHing High
Blood Pressure
Doctors at Harvard Medical School developed the DASH diet several years
ago. It emphasizes fruits, vegetables, and low-fat dairy products. The diet
was developed to test whether eating habits could lower blood pressure
as much as blood-pressure pills.
“The results were better than we ever dreamed of,” says Dr. Frank Sacks,
the Harvard doctor who led the DASH diet studies. Sacks says if people
followed DASH it could be a substitute for the “gazillions” of dollars spent
every year on blood-pressure pills.
Wagner just wanted to avoid taking pills, period. “I don’t like taking
medicines for anything. I will take an aspirin for a headache but that is
about it.”
they can track their progress. So far, about 1,000 EMC employees have
participated.
Before he started the DASH diet, Wagner’s eating habits were…well, in his
words, he was “pretty much a junk food junkie.” Burger King Whoppers on
the way home. A real weakness for Twinkies.
Besides eating more fruits and vegetables (“vegetables for breakfast some-
times, believe it or not,” he says), breakfast cereal made from whole grain,
and a lot less meat, Wagner does not snack so much between meals. At work,
he chomps on sugarless gum instead.
But Wagner says the DASH diet worked for him partly because it is “not really
that severe.” It even allows for some sweets and fatty food. Every once in a
while he gives into temptation and has a big bowl of ice cream.
The e-mails have worked to encourage him to stick with it. He feels like he has
a bit more energy. His clothes fit better, too.
But Wagner’s eight-year-old son isn’t too happy about his dad’s diet. “He hates
it, laughs Wagner. “Before DASH, I used to take him out to Burger King and
McDonald’s.”
14
Part 2: The Impact
15
High Blood Pressure: The Science Inside
who have high blood pressure do not sure will continue to be a serious and
know how to manage or control it threatening public health concern for
effectively. the United States.
16
Part 2: The Impact
high blood pressure have a much Another key group that is more
greater rate of stroke, heart failure, likely to develop high blood pres-
and other diseases than whites. In sure is older people, since levels
the area of kidney failure alone, tend to rise as people become older.
African Americans between 25 and Over 50% of Americans over 60
44 years old are 20 times more like- years old have high blood pressure,
ly than whites to develop this and over 65% older than 75 suffer
hypertension-related disease. On from the condition. This is because,
the positive side, African Americans as people age, the arteries become
are considered more “salt sensitive” harder and less flexible, causing the
than other groups and can substan- heart to work harder to pump blood
tially improve their blood pressure throughout the body. When this
levels by losing weight and reducing takes place, only the systolic blood
their sodium intake. pressure increases, causing what is
called isolated systolic hypertension
17
High Blood Pressure: The Science Inside
(ISH). In general, doctors have to be Geography may also play a role in the
careful when monitoring the blood development of high blood pressure in
pressures of older people because the United States. For example,
readings can vary greatly within the research has shown that African
first several minutes of an office visit. Americans and whites living in the
southeastern U.S. have a higher risk
On a positive note, older adults who of high blood pressure and stroke
lead stable, active lives may be able than Americans living in other
to sustain normal blood pressures regions. Part of the reason for this
throughout life. For those who are discrepancy is that people living in
inactive or have unhealthy lifestyles, this area are more likely to be from
studies have shown that medical lower economic and educational back-
treatment for high blood pressure has grounds, which make people in gener-
proven to be effective in lowering the al more susceptible to anxiety, depres-
risk of heart attacks, strokes, and sion, and diets that are high in salt
other complications in older patients. and poor in nutrition. In fact, many of
the states within this region have
18
Part 2: The Impact
19
High Blood Pressure: The Science Inside
Percent of persons who were ever told they had high blood
pressure, Adults aged 20 years and older, 2001
20%–24.3% 26.1%–27.8%
24.4%–26.0% 27.9%–32.7%
ment) is particularly common with look is the fact that how they live
minorities who have poor educations today can affect their health when
and come from low-income families. they become adults. Eating poorly,
Many immigrants also remain unin- avoiding physical activity, smoking,
formed or indifferent about the disor- and drinking can cause them to pre-
der, since they may have come from maturely and unnecessarily develop
countries or cultures with poor health high blood pressure—not to mention a
care standards and facilities. They number of other serious conditions or
may also dispute the effectiveness of illnesses. These and other barriers
medicine, be afraid of doctors, or con- make it harder for the medical com-
sider prevention efforts to be either a munity to reach and inform teenagers
luxury or a waste of time. about the wisdom of prevention and
proper treatment.
When it comes to health, teenagers
are often perceived as coming from a High blood pressure will continue to
different culture than their parents or have a disproportional effect on the
adults in general. With their energy people of the United States until all
and unbridled youth, many teenagers major groups are given the proper
often take for granted that they will support, information, and access to
always be healthy and will live long health care on an ongoing basis.
lives. What they tend to miss or over-
22
Part 2: The Impact
His research has helped show that some blood pressure medications are
more effective than others for African Americans. He helped start an
organization called the International Society on Hypertension in Blacks.
“Why waste time and effort prescribing just one drug when in most
cases it won’t work?” asks Saunders.
The attitude about blood pressure started to change after the results
of a study by the Veterans Administration were published in 1970. The
study included people with what was then considered moderately high
Saunders, continued on next page
23
High Blood Pressure: The Science Inside
blood pressure. The results showed that lowering even moderately high levels
lessens your risk of having a heart attack or stroke.
Those early studies didn’t include many African Americans, but others that
came after did. Saunders worked to push the problem of African American
hypertension into the spotlight.
But Saunders says progress has been made. More doctors are aware that they
must pay extra close attention to the blood pressure of their black patients.
Drug companies make a point of including African Americans in their studies.
The federal government has paid for large studies of blood pressure medica-
tions, including one that cost about $100 million.
He notes, “A funded study like that would have never happened if it hadn’t
been for the noise me and my colleagues made.”
24
Part 3: Care
High
26
Part 3: Care
than those who are at or maintain high blood pressure. The key to losing
their healthy, desirable weight weight is to take in fewer calories
levels. (energy) than you burn up. It is
important to steer clear of weight loss
It is worth noting another factor that pills or the newest, most popular
can influence the likelihood diets, because they can be dangerous
of a person developing high blood and are usually ineffective in keeping
pressure. This has to do with where weight off over the long term. The
an overweight person carries fat on best way to reduce or keep blood
their body. For example, there is evi- pressure levels healthy over the
dence to suggest that people who are course of one’s life is to develop and
“apple-shaped,” storing extra weight commit to a new lifestyle plan that
around their waists, are more at risk starts with eating better and getting
for health problems than those who more physical activity. In general,
are “pear-shaped,” storing excess maintaining the right weight
weight around their thighs and hips. throughout life will not only help to
lower blood pressure, but will reduce
Weight and shape aside, what is cer- the likelihood of developing other ill-
tain is that weight loss can greatly nesses like cancer, heart disease,
reduce the possibility of developing stroke, diabetes, and kidney disease.
28
Part 3: Care
Eating properly
MONITOR LABELS: Foods
The golden rule for living a long
and healthy life is maintaining a with High Salt or Sodium
balanced diet that includes fruits, Hot dogs
vegetables, grains, and fish along Canned soups
with limited amounts of salt, fat, Ketchup
and sugar. This is especially impor- Saltines
Sausages
tant for people with high blood
Canned vegetables
pressure who are also striving to Mustard
lose weight. Pretzels
Ham
As mentioned earlier, more than Pickles
half of all Americans are over- Cheese
Potato chips
weight. A natural consequence of
Smoked meat/fish
this fact is that Americans eat more Sauerkraut
salt and sodium than they should. Soy sauce
As a rule, many medical organiza- Packaged frozen dinners
tions recommended that people con- Canned meat/fish
sume no more than 1 teaspoon Olives
Tomato sauce/juice
(2,400 milligrams) of sodium a day.
Packaged cakes/pastries
Americans, on average, take in
between 4,000 to 6,500 milligrams a
day! This is why more Americans—
as compared to people in other
countries—have a greater risk of
developing high blood pressure.
(African Americans and the elderly
are particularly sensitive to sodi-
um.) There are many reasons for
this health disparity, as well as
many healthy actions that people
can take to improve their diets,
lifestyles, and blood pressures. like canned soups, smoked meats,
seasonings, and many packaged and
One critical change that people suf- processed foods. This is why it is
fering from high blood pressure important to read the “Nutritional
need to make is to reduce the Facts” labels on most goods at the
amount of salt and sodium they supermarket in order to determine
consume. This includes table salt how much sodium per serving a
and foods that are high in sodium, food item contains.
29
High Blood Pressure: The Science Inside
30
Part 3: Care
31
High Blood Pressure: The Science Inside
Monitoring health
Another important aspect in pre-
venting and treating high blood
pressure and other related condi- between doctor visits. Home monitor-
tions involves keeping track of and ing also helps in cases where a
being informed about your health patient’s blood pressure levels or
on an ongoing basis. This involves medications change frequently.
meeting with your doctor for regular Overall, it is normal for blood
check-ups and having your blood pressure readings to fluctuate
pressure measured on a regular 20 to 30 mmHg at different times
basis, particularly if you have high of the day, particularly after per-
blood pressure or prehypertension. forming some form of physical
Again, it is recommended that people activity or while experiencing
have their blood pressure checked at moments of excitement. It is suggest-
least once a year. For those with ed that patients do not become over-
hypertension, it is important to ly concerned about these fluctuations
monitor, treat, and control the disor- or become obsessive about their
der on an ongoing basis. readings in general.
pressure may need to take vasodila- Once a patient’s blood pressure has
tors—which lower blood pressure by improved and stabilized for at least
opening up vessels—along with a 12 months, doctors typically imple-
diuretic or other anti-hypertensive ment what is called “step-down”
medication in order to help lower therapy. This approach allows doc-
fluid retention. tors to gradually lessen either the
number or dosage of the medications
35
High Blood Pressure: The Science Inside
tive medicines you may be taking. some time to get used to and will
Just because an alternative medicine either be implemented in the hospi-
is considered “natural” does not tal, at home (while under close
mean that it is safe. Some herbs may supervision), or both. Most plans
lower the effectiveness of your med- may involve a number of lifestyle
ication or actually raise your blood changes, medication, and an ongoing
pressure. monitoring of blood pressure levels.
38
Part 3: Care
There are five major types to choose from: ACE inhibitors; angiotensin-
receptor blockers; beta blockers; calcium-channel blockers; and diuretics.
It gets even more complicated. There are subtypes within those five types.
And different medications are combined into a single pill. Lotensin HCT is
one example. It is a combination of an ACE inhibitor and a diuretic.
To see what one doctor does, we spoke with Dr. Sandra Taler. Taler is a
physician at the Mayo Clinic, the world-famous medical center in
Rochester, Minnesota.
Taler says the first type of drug that she usually prescribes is a diuretic:
“I have always been a big fan of diuretics.”
She is right in step with new government guidelines that say most people
with high blood pressure should try a diuretic first.
Diuretics work by helping the kidneys get rid of sodium (a chemical that is
part of salt) and water from the body. That decreases the volume of the
blood, so there is less blood pounding against the walls of your blood ves-
sels, creating high blood pressure.
There are two main types: loop and thiazide (pronounced THIGH-ah-zide).
Most people taking a diuretic to control high blood pressure take a
thiazide diuretic.
Many patients worry that the pills will make them have to go to the bathroom
more often. At first, a thiazide diuretic does increase urination. But after sev-
eral weeks, most people’s bodies adjust and levels return to normal.
Taler takes a different approach with her patients who have had a heart
attack or experience the chest pain called angina that comes from the heart
pumping without enough blood. For them, she’ll prescribe a beta blocker.
Beta blockers slow down the heart, so it is not pumping blood through your
blood vessels with as much force. Slowing down the heart helps if you’ve had
heart trouble, because it means the heart isn’t working as hard and can get by
with less blood.
If someone has diabetes, Taler says she orders some kidney tests. Depending
on the results, she would prescribe an ACE inhibitor. ACE inhibitors affect
blood pressure by relaxing blood vessels but are less effective with excess
sodium and water levels.
But treating high blood pressure with pills is no substitute for avoiding it in
the first place. People get high blood pressure for many reasons, but weight
gain and eating too much salty food are two of the main ones. Salty food rais-
es blood pressure, and Taler says people don’t have any idea just how salty the
food is when they eat out.
“That’s true at fancy restaurants,” she adds. “It is not just McDonald’s.”
40
Part 4: Research
Current lines of research it affect African Americans and the Over the
As science, technology, and the field elderly more than other groups of
people? How can the medical com- years, many
of medicine have advanced over the
centuries, so has humankind’s munity more effectively educate the researchers
understanding about the mysteri- public about this potentially deadly
condition? Research conducted in have dedicated
ous nature and widespread effects
of high blood pressure. Over the all areas and fields of science is their lives to
years, many researchers have dedi- helping to build upon the reservoir
of knowledge that we presently investigating
cated their lives to investigating
and discovering more effective ways have about high blood pressure. and discover-
of identifying, diagnosing, treating, The following are examples of the
types of research that are currently ing more
and reducing the complications of
high blood pressure in all kinds of and actively taking place: effective ways
people with all types of conditions.
Population Studies. By studying of identifying,
We read or hear about many of
these exciting discoveries in the a group of people over time, diagnosing,
news. While much has been researchers learn a great deal
about the nature and mechanics of treating, and
learned, many questions remain to
be answered. The progress so far the disorder. One such study is the reducing the
has helped to improve—if not Jackson Heart Study (JHS), which
has been focusing on cardiovascular complications
save—the lives of millions of people
who have developed hypertension. disease among African Americans of high blood
As with other life-threatening dis- from Jackson, Mississippi. Starting
in the fall of 2000, the JHS began pressure in all
eases and disorders, the hope is
that explorations in the area of to study 6,500 African-American kinds of people
high blood pressure will one day men and women between the ages
of 35 and 84. Through question- with all types
lead to a cure.
naires, lab tests, and other investi- of conditions.
Today, there are still many ques- gations, the researchers hope to
tions about high blood pressure determine how the common disor-
that researchers are trying to deter- ders of high blood pressure, dia-
mine. They include: How can high betes, and obesity influence the
blood pressure be prevented or development of cardiovascular
more effectively treated? Why does disease in African Americans.
41
High Blood Pressure: The Science Inside
42
Part 4: Research
low-cholesterol eating plan that was meal planning. As with the DASH
clinically proven within weeks to sig- diet and other nutrition-based efforts,
nificantly reduce blood pressure levels researchers work to find better
and weight in men and women of all ways for people on both sides of the
ages, races, physical conditions, and hypertension fence to eat healthy
medical backgrounds. Studies have and manage their eating habits more
shown that the DASH diet also lowers effectively.
“bad” (LDL) cholesterol and homocys-
teine (an amino acid), which has Roughly 20 to 30 percent of all
shown to cause a greater risk for Americans are considered “physically
heart disease. In addition to sample inactive.” Inactivity increases a per-
menus and recipes, the DASH diet son’s chances of developing high blood
plan also provides a form to document pressure (as well as diabetes, heart
eating habits before starting the diet disease, and countless other health
and a chart that will help manage problems). Research continues to
and guide a person’s shopping and uphold and reinforce the benefits of
46
Part 4: Research
exercise, weight loss, and lower blood ical community more effectively
pressure. One recent study investi- identify, test, and treat individuals
gated the effects of aerobic exer- who, for example, are more likely to
cise on blood pressure by examining develop high blood pressure or who
54 previous exercise trials involving will not respond well to certain types
2,419 physically inactive adults. of medication.
47
High Blood Pressure: The Science Inside
Researchers When different subgroups or commu- during the course of a study is often
nities participate in a research study, very high and very beneficial.
and medical they are able to take advantage of the Volunteers also benefit from knowing
science in most current and perhaps effective that their participation may one day
medical treatment for, in this case, help others who are suffering from or
general high blood pressure. The quality of affected by high blood pressure.
would not care that volunteer patients receive
be able to
understand
or make
inroads
against
high blood
pressure
and other
diseases
without
the help of
thousands
of volunteers
in the last
century
alone.
48
Part 4: Research
Forecasting New
Medications’ Effect
on the High Blood
Pressure Front
Statistics can be confusing—and be used
on purpose to cause confusion. But Dr.
Lemuel Moyé says they are also something
else: the truth.
Moyé was an important member of the research team that showed high
systolic blood pressure increases your risk for heart attack and stroke.
Systolic blood pressure is the first, or top, number in a blood pressure
reading. So if your blood pressure is 140/90, your systolic blood pressure
is 140.
Doctors used to think that it was natural for older people to have a high
systolic blood pressure because their arteries got stiffer.
Moyé says, “Just because you are older doesn’t mean you don’t have to
worry about systolic blood pressure.”
The type of research that Moyé does is called a clinical trial. Many of the
medical studies you hear about are clinical trials. They are done to test
whether a new medication is safe and effective.
In a typical clinical trial, the researchers give half of the people who volun-
teered to be in the trial an experimental medication. They give the other
half a pill that looks and tastes like the experimental medication but, in
reality, contains no medication. This “dummy pill” is called a placebo.
Objectivity and large numbers of patients are the reasons that clinical trials
are so important to medical research, notes Moyé.
Moyé has slightly high blood pressure. Although he has studied blood pres-
sure medications, his goal is keep his blood pressure under control without
any pills. He keeps his weight down, doesn’t add salt to his food, and gets
his blood pressure checked regularly.
“High blood pressure is like rain on a picnic. Everything about your health
is worse with it,” he says.
50
Conclusion: Let’s bring down
high blood pressure
We do not have to continue to let with your family, friends, and
high blood pressure slowly and community.
silently creep up on millions of peo-
ple each year. This life-threatening Eat healthy and stay fit. Eating
trend can be changed or improved well and being physically active
upon, but it takes greater aware- have always been the golden formu-
ness and a lifelong commitment to la for a long, healthy, and positive
healthy living. life. The lives of those diagnosed
with high blood pressure may
Below are a number of suggestions depend on these simple and smart
and resources that can help every- changes. Adjusting to a low-fat, low-
day people steer clear of this debili- sodium diet has shown to improve
tating condition and educate others blood pressure levels, not to men-
about this serious public health tion all the other lifelong benefits
problem. Look on page 57 for fur- that can come with weight loss.
ther resources. The local library is Getting out, exercising, and doing
also a good source of information on things you enjoy help lower blood
high blood pressure. pressure. The trick is to continually
think about and take time to com-
Educate yourself about high mit to this healthier way of living.
blood pressure. Reading this book Help friends and loved ones who are
is a great start. It is important to
continue to educate yourself on high
blood pressure, particularly as you
get older and as new information
and research from the medical com-
munity arises. Good sources of
information are the library and the
Internet. Ask a librarian for help in
your search, if necessary. Make sure
to share the interesting and poten-
tially lifesaving insights you have
learned here and in the future
51
High Blood Pressure: The Science Inside
less active and healthy to become bet- ple, this may involve self-monitoring
ter informed, since they are likely to your blood pressure and quitting
face the kind of hypertensive treat- smoking. Sticking to your treatment
ment options explained in this book. plan is the best way to lower your
high blood pressure and fend off other
Quit smoking and avoid alcohol. serious illnesses.
High blood pressure aside, quitting
smoking and limiting alcohol con- Educate others in the community.
sumption are just good ideas. The Share what you have learned about
benefits are countless—from short- high blood pressure with your family
term financial savings to long-term and friends. You can also get involved
health benefits. Getting these two in high blood pressure prevention pro-
areas under control, if you do drink or grams or volunteer for any research
smoke to excess, will help to improve studies, particularly if you have the
your blood pressure (and many other condition. It may also be worthwhile
areas your life). If you know people to find out if your local schools are
who smoke or drink too much, make adequately addressing the problem in
time to talk about it with them and terms of lunch menus, physical activi-
support their efforts if they ultimately ties, and general student awareness
try to quit their use. about high blood pressure. Getting
involved on the educational side of
Monitor your health. In addition to this “silent killer” will ensure that
watching your diet and getting you and those you care about stay
enough exercise, it is recommended informed over time and continue to
that all people have their blood pres- work at maintaining a healthy
sure checked at least once a year. For lifestyle.
those with the disorder, checking your
blood pressure may be something you
need to measure and record several
times a day. Taking this initiative will
help you and your doctor better con-
trol, treat, and ultimately lower your
blood pressure. Monitoring other
related aspects of your health and
diet are also an important part of life.
52
Appendix 1: Questions to Ask Your
Doctor about High Blood Pressure
If you have not been diagnosed with high blood pressure…
• Am I at risk for high blood pressure?
• Should I be tested for high blood pressure?
• What is my body mass index?
• Do I need to lose weight?
• Do I need to make changes in my lifestyle to prevent high blood pres-
sure?
• What help is available for making those changes?
• Have you or others done this type of study ever before? Around here? What
did you learn?
3. How can people like me share their ideas as you do this study?
• How will the study be explained in my community?
• Who of people like me will look at this study before it starts?
• Who of people like me are you talking to as you do this study? A Community
Advisory Board?
• Who from the study can I go to with ideas, questions, or complaints?
• How will people like me find out about how the study is going?
54
Appendix
The questions above are from a pamphlet developed by Project LinCS (Linking Communities
and Scientists), Community Advisory Board (Durham, NC), and Investigators (University of
North Carolina Center for Health Promotion and Disease Prevention) in cooperation with the
Centers for Disease Control and Prevention, Atlanta, GA. hivmail@cdc.gov For copies of this
brochure: CDC National Prevention Information Network 1-800-458-5231
55
Resources
American Heart Association
A privately funded, non-profit health organization providing basic informa-
tion, news, personal stories, and health tips on various medical diseases and
conditions including high blood pressure.
American Heart Association—National Center
7272 Greenville Avenue
Dallas, TX 75231
800-AHA-USA-1
www.americanheart.org
ClinicalTrials.gov
A web-based resource for finding clinical trials in need of volunteers.
www.clinicaltrials.gov
Select the “hypertension” topic to search for high blood pressure–related tri-
als.
MEDLINEplus
A comprehensive source of health information provided by the National Library
of Medicine.
www.nlm.nih.gov/medlineplus/highbloodpressure.html
58
Resources
PHCentral.org—Pulmonary Hypertension
Founded in the effort “to be the definitive internet resource for Pulmonary
Hypertension related information for Patients, Caregivers and Medical
Professionals.”
www.phcentral.org
60
Bibliography
American Association for the Advancement of Science (AAAS). “Gene Mutation May
Boost Risk of Heart Arrhythmias,” Science 2002 August 23.
www.sciencemag.org
www.sghms.ac.uk/depts/gp/Science%202002%20News.pdf
Centers for Disease Control and Prevention, National Center for Health Statistics.
Hypertension. www.cdc.gov/nchs/fastats/hyprtens.htm
Fact Sheet: High Blood Pressure.
www.cdc.gov/od/oc/media/pressrel/fs020531.htm
Table 68. Hypertension among persons 20 years of age and over,
according to sex, age, race, and Hispanic origin: United States…
www.cdc.gov/nchs/products/pubs/pubd/hus/tables/2002/02hus068.pdf
High Blood Pressure Fact Sheet. Data based on Behavioral Risk Factor
Surveillance System, 1999.
www.cdc.gov/cvh/fs-bloodpressure.htm 61
High Blood Pressure: The Science Inside
Healthy People 2010. Fitness & Nutrition. Catherine Baker, editor. 2002
Humana.com. Humana and NitroMed Form Program to Expand Clinical Trial Access to
Minorities Press Release, August 8, 2002
www.humana.com/corporatecomm/newsroom/releases/PR-News-
20020808-150024-NR.html
KidsHealth.com. Hypertension.
www.kidshealth.org/PageManager.jsp?dn=KidsHealth&lic=1&ps=107&cat_id=1
41&article_set=20233
Los Angeles Eye Institute. High Blood Pressure and Your Vision.
www.laei.org/pressure.htm
National Heart, Lung, and Blood Institute Information Center. Your Guide to
Lowering High Blood Pressure. www.nhlbi.nih.gov/hbp/index.html
Design, Rationale, and Objectives.
www.nhlbi.nih.gov/about/jackson/2ndpg.htm
Limiting Alcohol Intake.
www.nhlbi.nih.gov/hbp/prevent/l_alcohol/l_alcohol.htm
Quitting Smoking. www.nhlbi.nih.gov/hbp/prevent/q_smoke/q_smoke.htm
63
High Blood Pressure: The Science Inside
National High Blood Pressure Education Month. Fact Sheet: Systolic High Blood
Pressure. hin.nhlbi.nih.gov/nhbpep_kit/systolic.htm
USA Today.com. Humana and NitroMed Collaboration Will Increase African Americans’
Access to a Unique Heart Failure Trial. Press Release, August 8, 2002.
funds.usatoday.com/custom/usatoday-com/html-tory.asp?guid=%7BABE038AD
-64B6-4DFE-B27A-A5086C56A98E%7D
U.S. Food and Drug Administration. FDA Consumer Magazine. Lessening the Pressure:
Array of Drugs Tames Hypertension.
www.fda.gov/fdac/features/1999/499_hbp.html
64
Glossary
ACE (An•gi•o•ten•sin- car•bon di•ox•ide: a gas that is
Con•ver•ting En•zyme) formed during respiration and released
in•hi•bi•tors: a group of medications upon exhaling (breathing out).
used to treat hypertension by causing
blood vessels to relax. car•di•o•vas•cu•lar: term that
describes the heart and blood vessels.
aer•o•bic ex•er•cise: activities that
increase breathing and heart rates. car•di•o•vas•cu•lar dis•ease: ill-
ness of the heart and blood vessels,
an•gin•a: a painful tightening in the including high blood pressure, heart
chest, which may spread to the jaw or attack, angina, stroke, and heart fail-
arms. ure.
ar•rhyth•mi•a: an irregularity in the car•di•o•vas•cu•lar sys•tem:
rhythm of the heartbeat. (also called the “circulatory system”)
The body network made up of the heart
ar•ter•ies: any of the muscular elastic
and blood vessels.
tubes that form a branching system and
that carry blood away from the heart to cho•lest•er•ol: a waxy substance
the cells, tissues, and organs of the produced by the body and taken in with
body. food. The body needs cholesterol for
certain body functions, but too much
ar•ter•i•oles: the small terminal
cholesterol can lead to atherosclerosis,
branches of an artery, especially those
or “hardening of the arteries.”
that connect with capillaries.
chron•ic: long-lasting and on-going.
ath•er•o•scle•ro•sis,
ar•ter•i•o•scle•ro•sis: a condition clin•i•cal tri•als: research tests,
involving the build-up of fatty deposits performed using people, that determine
inside the arterial walls. the success of a medical treatment,
medicine, or prevention strategy.
be•ta block•ers: a group of medica-
A clinical trial usually is conducted only
tions used to treat hypertension by
after the test has been successful in the
reducing the work load on the heart.
laboratory and on animals.
blood pres•sure: pressure of blood
com•pli•ca•tions of high blood
against artery walls. Recorded as two
pres•sure: problems that occur
numbers: systolic and diastolic.
because of hypertension. These include
blood ves•sels: the pipelines through stroke, heart attacks, heart failure, kid-
which blood travels to all parts of the ney failure, and eyesight problems.
body.
con•ges•tive heart fail•ure: a condi-
cal•o•ries: small units of energy that tion marked by weakness, swelling, and
are contained in food and released upon shortness of breath that is caused by
digestion by the body. the inability of the heart to maintain
enough blood circulation in the lungs
cap•il•lar•ies: the tiny blood vessels and body tissues.
that connect arterioles and venules.
These blood vessels form an intricate cor•o•nary ar•ter•y dis•ease: a
network throughout the body for the stage of atherosclerosis involving fatty
interchange of various substances, such deposits inside the arterial walls.
as oxygen and carbon dioxide, between
di•a•bet•es: a set of illnesses charac-
blood and tissue cells.
terized by improper amounts of glucose
(sugar) in the blood.
65
High Blood Pressure: The Science Inside
66
Glossary
ret•i•na: the part of the eye that senses stroke: damage to the blood vessels in
light. the brain because of loss of blood flow,
which can result in the inability to speak
ret•i•nop•a•thy: a disease of the eye’s
or move part of the body.
retina that can lead to blindness. It is one
of the possible complications of high symp•tom: a sign of a problem, such as
blood pressure. a disease.
salt: common table salt or sodium chlo- sys•tol•ic pres•sure: maximum pres-
ride. sure in the artery produced as the heart
contracts and blood begins to flow.
sec•ond•ar•y hy•per•ten•sion:
also referred to as “non-essential hyper- treat•ment plan: a strategy put togeth-
tension,” this is a form of high blood pres- er by a doctor or team of health care pro-
sure in which a definite cause can fessionals working with a patient. The
be determined. It accounts for only 5 patient is responsible for following the
to 10 percent of all high blood pressure plan, with the goal of lessening or delay-
cases. ing the complications of high blood pres-
sure.
so•di•um: a mineral that can contribute
to high blood pressure in some people. It vas•o•di•la•tors: a group of medica-
is found in baking soda, some antacids, tions used to treat hypertension by caus-
and the food preservative MSG ing blood vessels to expand, lowering
(monosodium glutamate), among other blood pressure and reducing the work
items. load on the heart.
sphyg•mo•ma•nom•e•ter: a device veins: any of the membranous tubes that
used to measure blood pressure. form a branching system and carry blood
to the heart.
steth•o•scope: a medical instrument for
listening to the sounds generated inside ven•ules: small veins, especially ones
the body. that join capillaries to the larger veins.
Acknowledgements
Project Advisors Beatrix (Betty) Ann Hamburg, MD
Cornell University Medical College
Philip Abelson, PhD
American Association for the Advancement of Marcia Harrington
Science (AAAS) District of Columbia Public Library
Acknowledgements, cont.
Marsha Lakes Matyas, PhD Photo Credits:
The American Physiological Society
Cover: EyeWire Images and Eric Nevin
Sandra Negro Page 1: Custom Medical Stock Photo (CMSP)
Senior Librarian, Wheaton Library, Maryland
#Z264-TTT-239
Delores Parron, PhD 3: Willie Joe Rice
Scientific Advisor for Capacity Development 5: MEDLINEplus
Office of the Director, National Institutes of
Health 6: Eyewire Images
8: http://ww.adam.com/Well-
Joseph Perpich, MD, PhD
J.G. Perpich, LLC Connected/doc03risks.html
9: Custom Medical Stock Photo (CMSP)
Marcy Pride, MLS, MA
#Z400-MM-108
Director, Oyer Memorial Library
Washington Bible College and Capital Bible 10: Indian Health Service
Seminary, Lanham, Maryland 11: www.photoresearchers.com
Josefina Tinajero, EdD 13: Joe Wagner
Associate Dean, College Of Education 15: Eyewire Images
University of Texas at El Paso 17: Omni Photo Communications
18: Eyewire Images
Hypertension Content 21: Custom Medical Stock Photo (CMSP)
Reviewers/Advisors #Z218-TTT-487
22: Omni-Photo Communications
Sharonne N. Hayes, MD, FACC
Director, Women’s Heart Clinic, #G10-03769
Mayo Clinic, Rochester, Minnesota 23: Courtesy University of Maryland
Ruben Pamies, MD Medicine
Vice Chancellor for Academic Affairs, Dean 25: PhotoDisc
for Graduate Studies 27: PhotoDisc/Fitness and Well-Being
University of Nebraska Medical Center #67011
28: www.nlm.nih/govmedlineplus/ency/
Project Staff and Consultants imagespages/19265.htm
Shirley M. Malcom, Principal Investigator 30: Custom Medical Stock Photo (CMSP)
Maria Sosa, Co-Principal Investigator and #Z400-MM-116
Project Director
32: PictureQuest
Kirstin Fearnley, Project Manager 38: Indian Health Service
Mary Chobot, PhD, Library Consultant and 39: Mayo Foundation
Project Evaluator 42: www.photoresearchers.com #3P8134
Ann Williams, Art Director 43: Courtesy of Norma Rodriquez
44: www.photoresearchers.com #S6192
Susan Mahoney and Associates,
Peter Wehrwein, Writers 45: PhotoDisc
46: Custom Medical Stock Photo (CMSP)
Tracy Gath, Writer, Editor
#Z171-C-22
Betty Calinger, Editor 48: Custom Medical Stock Photo (CMSP)
Maggie Sliker, Photo Researcher #Z071-MM-1344
Heather Beecheler, Chickona Royster, 49: Courtesy Dr. Lemuel A. Moyé, PhD
Project Associates 51: Custom Medical Stock Photo (CMSP)
#Z194-GG-715
Special thanks go to Nathan Bell, Harriet 52: Courtesy Association of Black
Pickett, Catherine Baker, and Lisa Boesen for
their assistance with the development of this Cardiologists, Inc.
68 book series.