Controlling Your Blood Pressure Archive

Eliminating four risk factors can reduce PAD cases.

When it comes to peripheral artery disease (PAD) among men, common risk factors have a strong cumulative effect. That's among the findings of a recent Harvard study published in The Journal of the American Medical Association. "The more risk factors one accumulates, the higher the risk, and the severity of risk factors increases risk," says author Dr. Ken Mukamal, associate professor of medicine at Harvard Medical School.

PAD and its risks

PAD is caused by plaque buildup in the walls of the arteries in your limbs, especially your legs. These clogged arteries put you at risk for ulcers and even gangrene. In addition, people with PAD are at an increased risk for heart attack or stroke.

Q. Does chelation therapy work for heart disease? I have a friend who swears it will help him avoid having a second heart attack.

A. The benefits of chelation are unclear but the procedure has real risks. The Centers for Disease Control and Prevention estimates that over 100,000 Americans have used chelation in the past year (although not only for heart disease). The therapy involves intravenous infusions of a chemical called EDTA, which binds to minerals like calcium and removes them from the body. Proponents believe the chelation shrinks calcium-rich blockages, called plaques, found in the blood vessels of people with heart disease.

Manage chest pain with medications first, guidelines advise.

New guidelines for evaluating and treating stable heart disease emphasize that an invasive treatment may not be always be necessary. Developed by a joint task force of the American College of Cardiology, American Heart Association, and five other prominent medical societies, the guidelines were published on Dec. 18, 2012, in the Journal of the American College of Cardiology.

In the past, many people with stable heart disease were advised to undergo invasive treatments—bypass surgery or angioplasty—in the hopes that this would reduce their chance of suffering a heart attack in the future. The guidelines reflect new knowledge that this is generally not the case.

Q. I'm 71 and my systolic pressure is usually in the 150s to 160s, which is high, but my diastolic is usually in the 80s, which is normal. Do I need treatment?

A. A blood pressure measurement includes two numbers: systolic pressure (the upper number) and diastolic pressure (the lower number). Your systolic pressure is high: 140 or over is high. And your lower number is not normal: normal diastolic pressure is below 80. However, even if your diastolic pressure were truly normal, say 70, you would still benefit from treatment. You would have a condition called isolated systolic hypertension (ISH). Many studies have shown that treatment of people with ISH lowers their risk of heart disease and stroke.

Drugs may not be enough to lower stubborn high blood pressure.

Approximately half of the 67 million Americans with high blood pressure are unable to bring their blood pressure down to desired levels with medications. When taking the maximum-tolerated doses of at least three medications—one of which is a diuretic—fails to work, these people are said to have resistant hypertension. It's a huge concern.

People who take in at least 2% of their calories from yogurt have lower blood pressure and are about 30% less likely to develop hypertension than people who do not eat yogurt, scientists reported at the American Heart Association's High Blood Pressure Research meeting in Washington, D.C. The yogurt finding is from a study in which researchers followed nearly 2,200 adults for 15 years and assessed their diets periodically with a questionnaire.

Eating at least one 6-ounce serving of yogurt every three days would provide the 2% "dose" cited in the study. Yogurt by itself does not lower blood pressure or prevent hypertension. But a diet that includes nutrient-rich foods like low-fat yogurt instead of less healthy foods does combat high blood pressure. The Dietary Approaches to Stop Hypertension (DASH) plan calls for two to three servings of low-fat dairy per day.

Blood pressure medicines can reduce heart attacks, strokes, and deaths in people with moderate to severe high blood pressure, but according to one study, they may not significantly reduce heart disease, heart attacks, strokes, or deaths in those with milder elevations in blood pressure. Women with mildly elevated blood pressure may want to try nondrug interventions for lowering blood pressure—such as diet, exercise, and stress management—before turning to medications.

There's time to take action if you're among the masses.

The news in September was alarming: A third of all Americans have high blood pressure (hypertension), and the majority of them don't have it under control, according to the Centers for Disease Control and Prevention (CDC). "It's a tragedy. In my view, uncontrolled hypertension is probably the biggest public health problem in the United States," says Dr. Anthony Komaroff, editor in chief of the Harvard Health Letter and professor of medicine at Harvard Medical School. Luckily, hypertension is usually something you can fix.

A recent study found an additional benefit to angiotensin-converting–enzyme (ACE) inhibitors, which help relax blood vessels and can help lower blood pressure. Researchers found that ACE inhibitors are also associated with a significant reduction in pneumonia risk.

Q. I am 72 years old, and have had diabetes and high blood pressure for about 15 years. I thought these problems were pretty well controlled, but I recently learned that my kidney function is declining. My creatinine level is now 2.2 milligrams per deciliter (mg/dL). How serious is this?

A. Kidney damage is one of the most common and serious consequences of both diabetes and hypertension. Ask your doctor what your glomerular filtration rate (GFR) is. This test measures how much blood your kidneys filter every minute. If your GFR is 60 or higher, your kidney function is still normal; a lower GFR level means your kidney function bears close watching.