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High blood pressure a silent danger in postmenopausal women

APR 2013

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Millions of American women have soaring blood pressure that's putting their health at serious risk. Are you among them?

Millions of Americans are harboring a secret. That secret is high blood pressure—an often silent, symptomless condition that can damage our blood vessels and overwork our heart, leaving us prey to heart disease, stroke, and premature death.

A report released in September 2012 by the Centers for Disease Control and Prevention found that nearly a third of American adults have high blood pressure, and half of these don't have their high blood pressure under control—even when they are under a doctor's care and have health insurance. Forty percent of people with uncontrolled high blood pressure don't know they have the condition.

"Part of the problem is there is a time when people are feeling great, yet their blood pressure is elevated and taking its toll on their blood vessels and they don't realize it," says Dr. Deepak Bhatt, professor of medicine at Harvard Medical School, and director of the Integrated Interventional Cardiovascular Program at Brigham and Women's Hospital.

"Blood pressure is really a tricky disease," he adds. "The risk of developing high blood pressure over a lifetime is extremely high if a person lives long enough." That's especially true in women after menopause, when blood pressure may rise. By the time they reach their 60s and 70s, 70% of women have high blood pressure. After age 75, that figure rises to nearly 80%, according to the CDC.

Living with high blood pressure

Living with high blood pressure over time puts added strain on your blood vessels and on your heart. The added force of blood surging through your arteries damages the artery walls and encourages the formation of cholesterol-filled plaques. These plaques can lead to heart attacks and strokes.

High blood pressure also forces your heart to work harder to pump blood throughout your body. As it works harder and harder, the heart muscle can become stiff and enlarged or weakened. Over time, the heart cannot do an adequate job of circulating blood. This is called heart failure. "The risk of heart failure is markedly increased if the blood pressure is left unchecked over many years," Dr. Bhatt says. "The heart doesn't pump as effectively from years of trying to pump against very high pressure."

Beyond stroke and heart failure, having long-term high blood pressure can also contribute to dementia, kidney failure, vision problems (especially when you also have diabetes), and sexual dysfunction.

Because high blood pressure is a condition that can sneak up on you without symptoms, having your pressure checked regularly is essential. Dr. Bhatt recommends getting your blood pressure tested at your doctor's office once a year—even if you're feeling fine. Some people purchase a home blood pressure monitor to keep an eye on their blood pressure. If you decide to do this, have the monitor calibrated at your doctor's office before using it.

New directions in treatment

There was a time when doctors recommended their patients try reducing blood pressure with lifestyle approaches (such as diet and exercise) for six months, before starting medication. "By the time all that was done it would be a year, potentially, before the blood pressure was under control. That was definitely the wrong approach," Dr. Bhatt says. "Blood pressure therapy has changed in the last decade or so, in terms of our being more aggressive about bringing it down."

Here are a few general guidelines for taming high blood pressure:

  • Your doctor will consider prescribing medicines if your blood pressure is 140/90 or higher—the threshold for high blood pressure.

  • Which drug your doctor recommends will depend on several factors, including what other health conditions you have (see table).

  • You'll begin by taking the lowest effective dose of medicine. The doctor will increase the dose if your blood pressure isn't responding.

Finding the right blood pressure treatment is often a matter of trial and error. If one drug isn't working or is causing side effects, don't just stop taking it. See your doctor for a re-evaluation. "There's no one-size-fits-all answer. There's a lot of science, some of it new, and a fair amount of art to treating high blood pressure," says Dr. Bhatt.

Blood pressure medicine comparison

Class of blood pressure drugs

Examples
(generic and brand names)

How they lower
blood pressure

Side effects

ACE (angiotensin-converting enzyme) inhibitors

benazepril (Lotensin),
captopril (Capoten),
lisinopril (Prinvil, Zestril),
ramipril (Altace)

Reduce the amount of angiotensin, a chemical that causes the arteries to narrow, thereby widening blood vessels

Rash, dry cough, loss of sense of taste, fluid retention, high potassium levels

Angiotensin-receptor blockers

candesartan (Atacand),
losartan (Cozaar),
valsartan (Diovan)

Block the effects of angiotensin II, a compound that narrows the arteries

Dizziness, muscle cramps

Beta blockers

atenolol (Tenormin),
metoprolol (Lopressor),
metoprolol succinate (Toprol-XL),
propranolol hydrochloride (Inderal)

Reduce the heart rate and decrease the workload on the heart

Fatigue, insomnia, wheezing, dizziness, depression, reduced exercise tolerance; can mask the warning signs of low blood sugar in people with diabetes

Calcium-channel blockers

amlodipine (Norvasc, Lotrel),
diltiazem (Cardizem, Dilacor),
nisoldipine (Sular)

Slow the movement of calcium into the smooth muscle cells of the heart, which makes the heart contract less forcefully and relaxes blood vessels

Heart palpitations, swollen ankles, headache, dizziness, constipation

Diuretics

chlorthalidone (Hygroton),
bumetanide (Bumex),
chlorothiazide (Diuril),
furosemide (Lasix),
spironolactone (Aldactone)

Remove excess sodium and water from the body; often used together with another blood pressure drug

May decrease potassium, which can cause weakness, fatigue, and leg cramps (potassium-sparing diuretics like spironolactone don't have this side effect); may cause gout or raise blood sugar level

How to control blood pressure

Controlling your blood pressure is up to you—in partnership with your doctor. Have your blood pressure checked, take your medication as prescribed, and follow these blood pressure–lowering lifestyle recommendations:

  • Take a 30-minute walk (or three 10-minute walks) on at least five days of the week.

  • Limit the salt, fat, and cholesterol in your diet. Add a couple of extra fruit and vegetable servings each day.

  • If you're overweight, aim to lose at least five to 10 pounds.

  • If you smoke, ask your doctor for help in quitting.