Controlling Your Blood Pressure Archive

Average life span goes down; rehospitalization rates go up.

A silent condition like high blood pressure is sneaky. You don't feel it, and it generally doesn't cause any outward signs or symptoms. Yet it relentlessly causes problems in the arteries, heart, kidneys, and elsewhere.

When starting drug therapy to fight high blood pressure, a two-drug combination may work better than a single blood pressure drug.

A team of Colorado researchers compared drug prescriptions written for more than 160,000 men and women with newly diagnosed high blood pressure, also known as hypertension. The percentage of those people initially treated with two drugs rose from 22% in 2002 to 45% in 2007, and is likely higher now.

People with prehypertension (systolic blood pressure from 120 to 139 or diastolic pressure from 80 to 89) go on to develop full-blown high blood pressure more often than people with normal blood pressure. Race seems to influence the pace of that progression.

In a study of nearly 19,000 people — about 30% black and 70% white — blacks progressed from prehypertension to truly high blood pressure a full year sooner than whites who followed that same path (Hypertension, published online Sept. 12, 2011).

Strategies that protect blood vessels also fight aging-related memory loss.

Like a slow, invisible thief, Alzheimer's disease steals memory and so much more. Its partner in crime, vascular dementia, has long lurked in the shadows. A scientific statement from the American Heart Association and American Stroke Association puts the spotlight on vascular dementia and offers recommendations for preventing it.

Q. My blood pressure has wide swings each day. It can go as high as 210/110 with even minor stress like grocery shopping, then fall to 100/50, which makes me tired and needing rest. I take 15 mg of isosorbide dinitrate and a slow-release nitrate for angina. I also take 10 mg of atenolol (Tenormin) to slow my heart rate. My doctor says I'm just a "reactive person." My diet is excellent, and I try to keep active. Could my adrenal glands have anything to do with this?

A. You certainly do have some big swings in blood pressure, which makes it risky to add more blood pressure medications to control those moments when your pressure is high. There are some conditions in which the adrenal glands pour out large amounts of adrenaline, which can cause surges in blood pressure. But that is unlikely to be precipitated by minor stress. More likely is the effect of the isosorbide dinitrate (a generic version of Isordil). When it kicks in, it could suddenly drop your blood pressure, causing the swings you see. Isosorbide dinitrate is also a slow-release nitrate, and it usually isn't a good idea to take two of these at once. I suggest you ask your doctor to review your medications, including dosages and timing.

Another reason to avoid foods made with a lot of sugar.

The human body handles glucose and fructose — the most abundant sugars in our diet — in different ways. Virtually every cell in the body can break down glucose for energy. About the only ones that can handle fructose are liver cells. What the liver does with fructose, especially when there is too much in the diet, has potentially dangerous consequences for the liver, the arteries, and the heart.

When it comes to salt and food, the sodium in table salt gets most of the attention for its role in boosting blood pressure and contributing to cardiovascular disease. Potassium should get equal billing for its role in keeping blood pressure in check. Before processed foods became widely available, humans consumed much more potassium than sodium. Today, we get almost twice as much sodium as potassium. A new report from the National Health and Nutrition Examination Survey suggests that this imbalance — more sodium than potassium — contributes to heart disease and premature death. Here are some foods rich in potassium and low in sodium. Note the huge differences between unprocessed foods and the processed or salted foods marked in italics. (A more extensive list of potassium in foods, ranked high potassium content to low, is available from the US Department of Agriculture.)

Taming resistant hypertension requires extra attention from you and your doctor.

Among the 60 million Americans who know they have high blood pressure (also known as hypertension), fewer than half have it under control. Some of them haven't made the necessary lifestyle choices or aren't taking medicines to lower their blood pressure. Some of their doctors aren't prescribing the right medicines at the right doses. But some people with hypertension (about one in eight) are doing all the right things yet still can't manage to control their blood pressure. They have what's known as resistant hypertension — blood pressure that lingers above a preset target despite the use of three medications, or control achieved only with the use of four or more medications.

Problems in arteries supplying the legs, kidneys, and elsewhere pose problems for the heart, too.

The arteries that supply the heart (coronary arteries) and the brain (carotid arteries) get far more attention than the vast network of arteries below the heart. These so-called peripheral arteries are often overlooked — and a study suggests that problems in these blood vessels are often undertreated — even though they cause as much mayhem as problems in the coronaries and carotids.

Whether it is best to aim for "normal" or float a bit above remains to be determined.

Blood pressure isn't a bad thing. Quite the contrary — the heart needs a certain amount of pressure to deliver oxygen-rich blood to the farthest reaches of the body and the brain. Blood pressure becomes a problem only when it rises too high or falls too low.