Controlling Your Blood Pressure Archive

Hypertension is one of the most common medical problems in the United States; at present, one of every three adults in our country has high blood pressure. It's a shame since many, if not most, cases could be prevented by simple lifestyle measures such as dietary salt restriction, weight control, and moderate exercise.

Hypertension is also one of the most important medical problems in America; it sharply increases the risk of heart attack, stroke, heart failure, and kidney failure. That's also a shame, since excellent drugs are available to lower blood pressure and prevent these deadly complications.

Q. I am a 50-year-old woman with newly diagnosed high blood pressure. As diets go, mine is definitely on the healthy side. I do not exercise at a health club, but I do a lot of housecleaning and gardening, and I do walk a fair amount, which I feel is equal to what I would accomplish at a health club. I weigh 150 pounds and my height is 5 feet, 6 inches. I take Toprol-XL. My blood pressure seems to be normal in the morning, averaging 121/74, but in the afternoon the upper number is often in the 140s to 150s. Is it normal for blood pressure to rise like this as the day goes on, especially while on a medication?

A. It's great that you are paying close attention to your blood pressure readings. Beta blockers like metoprolol (Lopressor, Toprol-XL) are not great medications for lowering blood pressure when used all by themselves. So, as the day goes on, and you eat and exert yourself physically, my guess is that the metoprolol is just not strong enough to control your blood pressure. One option is to switch to another medication, such as a diuretic or an ACE inhibitor. If your doctor thinks you need the beta blocker for some other cardiac condition, adding a diuretic or ACE inhibitor to the beta blocker makes sense. In fact, combining low doses of medications that fight high blood pressure in different ways is probably a more effective way to do it than with a high dose of a single medication.

Caution, attention should accompany routine use of any pain medicine.

For people with cardiovascular disease who need relief from aches and pains, acetaminophen (Tylenol, generic) has long been touted as a safer alternative to aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. A small but important Swiss trial warns that it may not be. This work doesn't mean you should ditch acetaminophen if it helps you, but does suggest you should give it the caution that it — and every medication — deserves.

Cough and ACE inhibitors. About one in nine people (11.5%) who take an ACE inhibitor such as enalapril or ramipril develops a dry cough. That's about 10 times higher than listed in the fine print of the drug's prescribing information or in the Physicians' Desk Reference, a commonly used resource for drug information (American Journal of Medicine, November 2010). For some people, the cough is a mild nuisance. For others, it is so aggravating they stop taking the drug. If you take an ACE inhibitor and are bothered by a dry cough, ask your doctor about switching to an angiotensin-receptor blocker or another medication.

Waist circumference and longevity. A bigger waist isn't a good sign for living to a healthy old age. Among 105,000 middle-aged men and women taking part in the Cancer Prevention Study II, the larger the waist, the greater the chances of dying over the nine-year study. As expected, the connection was seen among individuals who were overweight or obese. But it was also seen in those with healthy weights (Archives of Internal Medicine, Aug. 9/23, 2010). The increased risk of dying was most pronounced in men with waists greater than 43 inches and women with waists greater than 37 inches.

Q. At 80 years old, I am in relatively good health, aside from a recent diagnosis of high blood pressure. Taking a beta blocker and watching my salt has brought my blood pressure down into the normal range. During a period of extreme heat this summer, my ankles were more swollen than usual, and my weight jumped three pounds in just two days. Was that because of the heat, or did salt have something to do with it?

A. Congratulations on getting good control of your blood pressure with a medication and salt restriction. Most people require two or three medications to control high blood pressure, but you are a good example of what salt restriction can do.

Q. I recently had a pacemaker implanted. While the process was going on, I felt a pulsation that I reported to the doctor. I still feel it seven months later. Other symptoms include low blood pressure, an increase in weight, and digestive changes. My primary care doctor thinks that my vagus nerve could have been damaged when the pacemaker was implanted. Is that possible?

A. I don't have enough information to comment on your case. In general, pacemaker placement rarely damages the vagus nerve, which runs from the brain to the throat, voice box, windpipe, lungs, heart, esophagus, stomach, and intestines. Symptoms such as you describe could be caused by a number of problems, including lead perforation or pacemaker syndrome. Here is more information on those problems:

Q. I heard about a study that found that ARBs can cause cancer. I am taking one, Cozaar, because of high blood pressure. Should I stop taking it?

A. ARB stands for angiotensin-receptor blocker, a class of medications that is used to control high blood pressure, treat heart failure, and prevent kidney disease in people with diabetes or high blood pressure. ARBs are often prescribed when an ACE inhibitor isn't effective, or the side effects are intolerable. The generic name for Cozaar is losartan; the generic names for ARBs end in –sartan: candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), and so on.

A simple treatment that involves nothing more than a standard blood pressure cuff could protect heart muscle during a heart attack or improve the outcome of bypass surgery or artery-opening angioplasty. The procedure, called remote ischemic preconditioning, works like this: An emergency medical technician or doctor inflates a blood pressure cuff over the upper arm for five minutes, cutting off blood flow to the arm. He or she releases the pressure, restoring blood flow, then repeats the pressure on–pressure off cycle a few more times. This stress causes the body to release chemical messengers that prepare heart cells to withstand both a period of low oxygen supply and the restoration of blood flow — just what they experience during a heart attack or angioplasty.

Early work on the phenomenon of remote ischemic preconditioning in the laboratory and in animals has led to its application in humans. In a British study, remote ischemic preconditioning improved the results of angioplasty (Circulation, Feb. 17, 2009). In a Danish study, it limited the amount of damage caused by a heart attack (Lancet, Feb. 27, 2010). Clinical trials are under way to confirm these findings and perhaps extend remote ischemic preconditioning to other situations, such as heart transplantation or activities that cause chest pain (angina).

For some people with hypertension, exercise, diet, and three or four pills aren't enough to bring blood pressure under control. A pacemaker-like device called the Rheos system, made by Minneapolis-based CVRx, could someday offer extra help for fighting resistant hypertension.

The device works with the body's baroreceptors. These are sensors that continually monitor blood pressure from their posts on each carotid artery in the neck. When blood pressure rises, the baroreceptors send messages to the brain. It responds by sending signals that lower blood pressure. The opposite happens when the baroreceptors and brain detect low blood pressure.

NutritionSource, a Web site developed by the Department of Nutrition at Harvard School of Public Health, has an in-depth package of articles called "Cutting Salt and Sodium." One of the articles, co-authored by the Culinary Institute of America, a leader in teaching chefs and other food service workers, offers 25 science-based strategies for cutting back on salt. (Click here for a printable version.)

The Nutrition Source

Tasting Success with Cutting Salt: Twenty-Five Science-Based Strategies & Culinary Insights

Developed by the Department of Nutrition at Harvard School of Public Health & The Culinary Institute of America

The Institute of Medicine's newly released report, Strategies to Reduce Sodium Intake in the United States, focuses on big-picture strategies for reining in America's salt habit. (1) Although the report's recommendations represent an essential step forward, there are many things that individuals, chefs, and organizations can do right now to reduce sodium.