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How to lower high blood pressure

Dr. Drew Werner

EAGLE COUNTY – “It’s always that high.” “It’s up because I had too much coffee this morning.” “Whenever I come to the doctor’s office, it’s too high. It’s fine when I am home.” “No one ever told me it was too high before.” “I feel fine.”What is it? Blood pressure of course!Dear Doc: Have to have some surgery and I’ve been told my blood pressure is a little bit high. My doctor said I may need medication, but I hate taking pills. Is there anything else I can do? Is it really that bad?- I Feel Fine (in Eagle)Dear Fine: Hypertension. Is it time to get serious? Want to know what to do? Is your blood “boiling over”? The news is good and bad. The good news is you can make a difference and don’t have to live with hypertension or its deadly consequences. The bad news is that like everything worth doing it takes some work! Every year it seems the guidelines for normal blood pressure get lower. That is for good reason. The dangers and risks of high blood pressure are well known. Here are some numbers to think about:n 120/80 or less is normal (pat yourself on the back and keep up the good work).n 121/80 to 140/90 is prehypertension this represents 23 percent of the population and places you at twice the normal risk of heart disease!n 141/91 or greater is hypertension and places you at four or more times the normal risk of heart disease!Another way to think about it is for every 20-point rise in systolic blood pressure (the top number) above 115 or every 10-point rise in diastolic blood pressure (the bottom number) above 75 the risk of heart disease doubles! So, what can you do? First, think diet and exercise. It is amazing how difficult something that sounds so easy can be. Despite that challenge, diet and exercise are a very good place to start when we want to keep our blood pressure healthy. We are what we eat. This is perhaps nowhere more true than when it comes to our blood pressure. A diet low in fats and high in fruit, vegetables and fiber can make real differences. Known as the DASH diet, it stands for Dietary Approaches to Stop Hypertension. Here is a link and free download of the DASH diet: http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/The important thing about this diet is that it helps regardless of whether you are losing weight! Weight is still important – too much and the heart has to work harder to pump blood through all those extra pounds. Exercise, especially when combined with healthy eating, is like gilding the lilly. It turns us into finely oiled machines. We work more efficiently, and our blood pressure correspondingly drops. Doing healthy things does not negate the bad effects of unhealthy habits, however. It goes without saying that smoking and high blood pressure are a bad combination. It is like adding 1 plus 1 and getting 3.Unfortunately genetics still plays a role and despite whether you exercise or not, are obesity or have the perfect BMI, your blood pressure may still be too high. In that case, medications are what your doctor will prescribe. I generally recommend waiting three to six months for moderate hypertension, less if severe, to see what effects diet, exercise and weight loss will have. Be honest with yourself. If changes aren’t possible or sufficient in that period of time, waiting just increases your risk of problems down the road. As far as what medicine to use, the options are as unique as you are. The right medicine is the one you remember to take, has no side effects, and works like it is supposed to! When I first was in practice, the trend was to start a particular medication, raise it to the highest dose to lower the blood pressure, and only if that wasn’t enough add something else. Today, the recommendations are shifting to lower dose combinations of medications. It is felt that lower doses decrease side effects and combinations work on the different causes of high blood pressure, thus increasing effectiveness.Side effects vary from one type of medication to another. Not all are bad, however! Some medications have been proven to not only reduce blood pressure, but also to protect our kidneys from damage, reduce the risk of heart failure and stroke and help us actually live longer. Types of anti-hypertensive medications include diuretics, beta-blockers, calcium channel blockers (called CCBs), angiotensin receptor blockers (called ARBs), angiotensin converting enzyme inhibitors (called ACE inhibitors), alpha-blockers and some others. The only way to know for sure which one is right for you is to talk to your doctor. Learn about why one is good for you and what the beneficial and possible adverse side effects are. Don’t forget to ask about that important side effect in your back pocket or purse! These medicines can range from a few cents to a few dollars a day in cost. That is important information, too.First things first. Know your blood pressure and recheck it periodically. Second, do what you can to get it down! You know the drill, eat right (remember the DASH diet), exercise, lose weight and quit smoking. Third, if you need medication, talk to your doctor. Learn about positive and negative side effects, decide which one is for you, and take it regularly. Remember, hypertension isn’t called the silent killer for nothing!Dr. Drew Werner of the Eagle Valley Medical Center writes a weekly column for the Daily. He encourages health questions. Write him by e-mail to editor@vaildaily.com or c/o Editor, Vail Daily, P.O. Box 81, Vail, 81658.Vail, Colorado


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