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by Robin L. Flanigan
Three years ago, Eve Storm Johnson of Las Vegas was stunned to learn her blood pressure measured 190/115 – much higher than a normal reading of 120/80. “I’m young and eat healthy, I don’t smoke, and I grew up an athlete so exercise has always been a part of my life,” says the Angie’s List member, now 39.
When her physician told her she shouldn’t worry, Johnson switched to highly rated Dr. Kimberly Adams, a general practitioner who sent her to highly rated cardiologist Dr. Tali Arik. She underwent a stress test, had her blood tested, and wore a heart monitor for 24 hours before getting a diagnosis.
“Everything was clear, so he deduced it was some sort of adrenaline overdrive,” says Storm Johnson, who has been taking beta blockers, a drug that relieves stress on the heart, for about a year to keep her rate in the normal range. “I tend to be a high-energy person, and his words were that my passion is killing me.” That’s not an overstatement. High blood pressure, also known as hypertension, is a major risk factor for heart attack, stroke and kidney failure, and it contributes to 350,000 deaths every year. According to the American Heart Association, onethird of the adult population suffers from hypertension, yet a September report from the CDC shows more than half don’t have it under control. The ideal blood pressure for a
healthy adult should be 120/80; high blood pressure is defined as 140/90. It has been dubbed “the silent killer” because there are no visible symptoms and few warning signs. In fact, 20 percent of sufferers don’t even know they have it. The alarming numbers have the federal government calling on improved hypertension control through increased efforts from health care systems, doctors and patients alike. While primary care physicians commonly diagnose hypertension and refer to a cardiologist if they can’t get numbers under control, Angie’s List members also report receiving a diagnosis from eye care providers and dentists, and even seek help from dietitians and fitness trainers.
Obesity drives kids’ hypertension spike
Studies show the number of children, ages 2 to 18, hospitalized for hypertension has doubled in the last decade. “The reason for this is the simultaneous increase in obesity,” says Dr. Tammy Brady, assistant professor of pediatrics at Johns Hopkins University. Dr. Howard J. Pratt, highly rated hypertension specialist at Indiana University School of Medicine, studied hypertension in kids ages 10 to 15 and found overweight children are nearly three times more at risk than average-weight children. He also discovered that genetic kidney disorders contribute
Angie’s List® | February 2013
to it. That’s why Clara, daughter of Angie’s List member Christie Parker of Tuscaloosa, Ala., needed drug therapy at 18 months old. Now 3, her hypertension is under control. “She’s always borderline, so they keep monitoring her,” says her mom. The American Heart Association reports childhood hypertension often goes undiagnosed. That may be because measuring it is complicated. “It’s not one number,” says Dr. Sharonne Hayes, director of highly rated Mayo Women’s Heart Clinic in Rochester, Minn. “It varies [by] height, age and gender.” For example, normal blood pressure for
a 6-year-old boy with average height is less than 110/70; for a 6-yearold girl of average height, 108/70. See guidelines from the National Institutes of Health on our website. Hayes says blood pressure should be checked by age 3. However, this isn’t mandated. “Doctors may not check it because [the trend is] relatively new,” Hayes says, adding parents should request the doctor to do it. — by Ian Robinson
Photo courtesty of Johns Hopkins Children’s Hospital | Dr. Tammy Brady checks the blood pressure of Savannah Jones, 8, of Frederick, Md.
Photo by Mona Payne | Eve Storm Johnson of Las Vegas tries to stay healthy by exercising, but she must take medication to keep her blood pressure regulated.
“I think people know that high blood pressure is a serious medical issue, but they don’t seem to see the connection that untreated hypertension is the biggest cause of heart failure,” says American Heart Association spokeswoman Dr. Nieca Goldberg, a highly rated cardiologist at NYU Langone Medical Center. The good news is there are treatments for lowering and successfully managing blood pressure levels, from medication, diet and exercise to complementary therapies such as acupuncture. But patients first need to take an active role in understanding their blood pressure. Experts say patients don’t always ask what their numbers mean, but should. Your systolic blood pressure,
or the top number, represents the pressure in your arteries when your heart beats. The diastolic pressure, or the bottom number, indicates the pressure in the arteries when the heart relaxes between beats. “Both are very important,” says Betty Rabinowitz, a highly rated primary care physician at the University of Rochester Medical Center in New York. She says those over 50 should be most concerned with a high systolic blood pressure reading because it’s the best predictor of future health problems and death. Elevated diastolic blood pressure predicts poor health outcomes in those under age 50. However, some physicians don’t always have the time to thoroughly
address a slightly elevated reading. “Doctors are under a lot of pressure for productivity, and consequently there is pressure to have shorter time for an office visit,” says Dr. Joel Augustin, a primary care physician at A-rated Rush University Medical Center in Chicago. This is a problem because it leaves doctors with little time to fully cover risk factors, prevention and treatment of hypertension, he adds. If you feel your doctor isn’t addressing your high blood pressure or answering questions, Rabinowitz recommends raising the issue with him or her. “Communication is often key ... in the development of longterm helpful, caring relationships,” she says. In response to the Department of Health and Human Services’ Million Hearts Initiative, which seeks to prevent 1 million heart attacks and strokes by 2017, some hospitals are making efforts to lower high blood pressure among patients. In September, the HHS recognized A-rated Kaiser Permanente Colorado in Denver as a 2012 Hypertension Control Champion for improving blood pressure control among patients. They owe their efforts in part to a hypertension registry that helps track how patients are managing their numbers; free blood pressure checks; and reminders to refill prescriptions. Dr. Ann Wells, an internist with Kasier says she and other physicians
also encourage patients to monitor their blood pressure at home. “This has allowed patients ... to e-mail me or call me with their readings, and I can adjust medications without them coming in for a formal office visit,” she says. While medication is common for patients with significantly elevated blood pressure, doctors say noncompliance can be an issue. “They go from having high blood pressure and no symptoms to blood pressure medication with side effects, so they stop taking their medication,” explains highly rated cardiologist Dr. Edward Kasper, director of clinical cardiology at Baltimore’s Johns Hopkins Hospital.
“Untreated hypertension is the biggest cause of heart failure in America.”
Dr. Sharonne Hayes, a cardiologist and director of highly rated Mayo Women’s Heart Clinic in Rochester, Minn., says patients need to talk with their doctor to find ways to limit side effects that can include dizziness, fatigue, decreased kidney function and erectile dysfunction. “Medications get a bad rap,” she says, adding the solution is to use two or three drugs in combination. “It’s more effective and you can have lower doses with lower side effects.” If cost is prohibiting a patient from
Angie’s List® | February 2013
taking their medication, experts recommend talking to your doctor or pharmacist about the possibility of changing to generics, which are likely to be more affordable.
“We can actually look into the eye and see that there’s an issue with blood pressure.”
Hypertension medication and office visits generate $37 billion each year, between insurance, medical assistance programs and out-of-pocket expenses, according to a study published by the AHA. Statistics suggest people spend between $5 to $200 on blood pressure medicine each month.
Some people can control high blood pressure through diet changes alone, depending on a patient’s health habits and history. Rabinowitz, with the University of Rochester Medical Center, says for someone with diabetes, she’d try medication first, because they have a high risk of heart disease and stroke. However, her approach would be different for a healthy person with no other risk factors, such as someone who has intermittently slightly elevated blood pressure, is 25 pounds overweight and loves salty snacks. “I might tell them to replace the pretzels with some baby carrots and to see if they can get an exercise routine going,” she says. Member Carol Mullinax of Columbus, Ohio, works out three
times a week with trainer Simon Davis at the highly rated Fasttrack2 Fitness, in the nearby city of Delaware. By exercising smarter, Mullinax has lost more than 40 pounds, gotten her diabetes under control, and brought her blood pressure down to normal from 180/100. “You have an appointment to meet someone who is going to charge you whether you show up or not, and that’s a huge motivator to get your butt out of bed,” she says. “I’m 63 and I’ve never worked out as hard as I do now.” Lowering blood pressure through healthy eating is important, too, says Jan Adams-Kaplan, a highly rated registered dietitian at The Portland Clinic in Oregon. She uses the DASH (Dietary Approaches to Stop Hypertension) approach to help her clients. Promoted by the National Institutes of Health, the plan emphasizes superfoods such as barley, berries, leafy vegetables, walnuts and fish. But she warns, “You can’t eat a poor diet and take supplements and think it’s going to solve the problem.” People who lose just 10 percent of their body weight can cause a significant drop in blood pressure, adds Adams-Kaplan: “Often, if they lose between 10 to 20 percent, the issue is gone.”
Photo by Mark Wilson | Optometrist David Lampariello, clinical director of eye care services at Fenway Health in Boston, looks for signs of hypertension in patient Margaret Booth’s eyes.
Medications often include side effects
Medications to control hypertension are quick and effective, but they may come with side effects. Talk to your doctor about putting you on a combination of prescriptions at lower doses, which has been proven to help. According to doctors, some of the most common drugs include: NORVASC: a calcium channel blocker that relaxes blood vessels. Side effects include headache, dizziness and heart palpitations. AVAPRO: an angiotensin II inhibitor that widens blood vessels but may cause mood changes, vomiting and weight gain. ZESTRIL: an ACE inhibitor, which blocks a compound that constricts blood vessels and increases blood pressure. It can cause fever, chest pains and depression. LASIX: a diuretic that works differently than other drugs. It flushes excess sodium and water out of your body and reduces pressure on the arteries. Diuretics offer fewer side effects and are generally limited to loss of appetite and body aches. LCZ696: This new drug has scientists hopeful. The drug combines a new class of hypertension medication with a commonly prescribed one called Diovan, which relaxes blood vessels. Recent studies show these drugs work in combination to double the effectiveness of Diovan, while slashing its side effects such as muscle cramps and dizziness. — Ian Robinson
Angie’s List® | February 2013
Experts say if you tend to visit a dentist more often than a primary care physician, ask about receiving a blood pressure check. The American Dental Association recommends against dentists providing treatment, including regular cleanings, if a reading is too elevated. “The teeth are connected to the rest of the body, so we don’t want to treat somebody who’s not healthy,” says Dr. Matthew Messina, a highly rated dentist in the Cleveland suburb of Fairview Park, Ohio, and an ADA spokesman. Member Thanh Thibodeaux of Houston discovered she had hypertension from her dentist, Dr. Vanida Wongchukit. Thibodeaux knew her parents and grandparents
“I want to live to a ripe old age.”
had the problem, but that didn’t prepare the petite non-smoker for a diagnosis last summer at 39. “I was just in shock,” she recalls. Since then, she has received two medications and has gone from seeing her highly rated cardiologist, Dr. Eric Barrington Davis, twice a week to once every three months. She says she spends between $75 and $100 a month on medical copays and medication, and is also now looking into meditation and yoga as a way to relieve stress. Simply getting an annual or biannual eye exam can also pinpoint a hypertension problem. “Most people don’t realize there’s a link, but we
can actually look into the eye and see that there’s an issue with blood pressure,” says optometrist David Lampariello, clinical director of eye care services at highly rated Fenway Health in Boston. Using the latest technology, Lampariello dilates pupils to view the back of the eye, which includes the optic nerve, retinal tissue, macula, veins and arteries, all of which can be impacted by hypertension. High blood pressure in its early stages typically doesn’t affect sight. More advanced cases can damage the retina, leading to hypertensive retinopathy, when blood vessels without enough circulation begin to narrow. Severe cases can lead to vision loss. Studies have shown people with changes in their retinal blood vessels from high blood pressure are two to four times more likely to have a stroke. Researchers have also found that people with hypertensive retinopathy have a higher risk for heart failure —– and that the link tends to be strongest in women. If someone other than your primary doctor discovers your blood pressure is high, experts say to make an appointment with your general practitioner. Collaboration is an important aspect of treating hypertension, one that takes quite a bit of cooperation on the part of the public, says AHA spokesman Dr. Vincent Bufalino, senior medical director of cardiology for Advocate Health Care in Chicago.
Photos by Trent Penny | Al Harris uses a portable machine to check his blood pressure daily. He tries to keep his numbers down by walking with his wife Patt, often outside their local Walmart before going inside to shop.
Member Al Harris of Jacksonville, Ala., found out he had hypertension about a decade ago and proactively works with his doctors to try to manage it. “Controlling my blood pressure continues to be a long, arduous journey that frequently has its frightening moments,” he says. In November, a splitting headache from a sinus infection sent the 60-year-old to the ER at midnight with a reading of 210/105. Doctors got his number down to 160/80, he says, and he received a referral to highly rated primary care physician, Dr. Venugopala Bheemanathini. “Dr. Bheem increased my dosage of one of my medications and encouraged me to become even more aggressive about eliminating salt hidden in prepared foods,” he says. “No more packets of snack crackers ... no more
popcorn. Ditto on canned chicken soup, which I had been slurping while suffering from the infection.” Harris continues to take his blood pressure at home, and says his regular reading is 115/60, in part due to medication. The medication costs him around $120 a month; his insurance covers 80 percent. He avoids fried foods and secondhand smoke, and nearly every day walks the perimeter of his local Walmart a few times with his wife, Patt. “There are a lot of things that I love about my life in retirement, and they all hinge on keeping a close watch on my blood pressure,” Harris says. “I want to live to a ripe old age.”B
Please submit a report if you’ve seen a health provider who’s diagnosed or helped to control your hypertension.
Angie’s List® | February 2013
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