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What Your Doctor May Not Tell You About Hypertension

Warner Books

Chapter One

A woman lies dead in her hospital bed. The only sound in the room is the ominous whine of a heart monitor, which proclaims to one and all that her heart has, at last, ceased functioning. A fifty-six-year-old man walks briskly down a busy avenue on his way to work. Suddenly his face contorts with pain. He drops his briefcase, clutches his head in agony, and is dead before he hits the ground.

An elderly woman lies in a hospital bed, undergoing kidney dialysis. These thrice-weekly treatments leave her exhausted, but with-out them she would die.

A businessman and father of three sits in an easy chair and sighs as he gazes out the window. He has given up the golfing he loved so much because, with his heart failing, he just hasn't got the energy to play anymore. That's true even if he spends 95 percent of his time in a golf cart.

Although each of these people suffered from a distinctly different disease, in the end they all died of the same underlying problem-hypertension, commonly called high blood pressure. Hypertension is often called the silent killer because it usually exhibits no obvious symptoms until the blood pressure is very high. Its victims don't feel anything out of the ordinary and have no idea that something is amiss until plenty of damage has been done. But make no mistake: Hypertension is a killer. If you have uncontrolled high blood pressure, you also have an increased risk of stroke, heart attack, heart failure, and kidney failure. And with each slight rise in your blood pressure, the risk increases. Depending on how high your pressure goes, you may be as much as seven to ten times more likely to have a stroke; three times more likely to develop coronary heart disease (blocked heart vessels); and six times more likely to develop congestive heart failure than those with normal blood pressure.

It's the utter lack of pain or any other warning signs that makes mild to moderate hypertension so insidious. You would know it if your leg was broken; you couldn't miss the pain, and you'd rush to the doctor to get it X-rayed and splinted. Similarly, if the valve separating your food pipe from your stomach wasn't doing its job, you'd feel the unmistakable sting of heartburn and you'd start rummaging through your medicine cabinet for antacids. And if your bronchial tubes went into spasm, bringing on an asthma attack, you'd be sure to grab your inhaler. But since you can't feel, hear, taste, or see the signs of hypertension, you can easily ignore it.

Far from a rare occurrence (it's third on the most deadly disease list, right behind heart disease and cancer), hypertension strikes one out of every four adult Americans-over 50 million people. It's the disease that doctors see more often than any other and the one that prompts them to write the most prescriptions. Yet it continues to devastate: In 1999 alone, hypertension killed nearly 43,000 Americans and was a major contributing factor to 227,000 other deaths.

But because it's usually symptomless, hypertension is also one of our most under-treated ailments. Almost one third of those with hypertension (15 million Americans) don't even know they have it and are, therefore, doing nothing to prevent or treat it. Even worse, of the 35 million Americans who do know they have the disease, 13.1 million are being inadequately treated, and another 7.4 million are receiving no treatment at all. That's a staggering number of walking time bombs! The bottom line is only 13.7 million of the 50 million Americans with hypertension-a mere 27.4 percent-are both aware they've got the disease and controlling it.

HOW DOES EXCESS PRESSURE HARM US?

Why does it matter if blood pressure rises? After all, the amount of blood doesn't change, the red blood cells keep delivering oxygen, and the white blood cells still maintain their protective vigil. A blood sample taken from someone with hypertension wouldn't look different under the microscope from one taken from a healthy person.

The problem is too much pressure in the cardiovascular system, which consists of the heart and the blood vessels (arteries, veins, and capillaries). The arteries carry blood away from the heart, the veins carry it to the heart, and the capillaries are the tiny blood vessels that actually deliver the blood to the tissues. With hypertension, we're primarily concerned with the arteries, as they bear the brunt of the pressure exerted by each heartbeat. Because of this, the arteries have thicker, elastic, and muscular walls that relax and open wide as the blood courses through them. Veins, on the other hand, have much thinner walls and are not as prone to damage from hypertension because they're not subjected to nearly as much force.

Too much pressure within the cardiovascular system can hurt you in several ways. The excess force generated by the coursing of the blood against blood vessel walls can damage their all-important lining (the endothelium). This is more dangerous than it sounds because the cells that make up the endothelium secrete hormones and substances that help control the blood pressure, stickiness of the blood, growth of the blood vessel wall, and other factors vitally important to cardiovascular health. Damage to the endothelium speeds up what's called hardening of the arteries (atherosclerosis), a process that affects all of us as we age. These stiffened, narrowed arteries have a hard time supplying the body with enough oxygen and nutrients, which means the tissues and organs that they serve can be damaged. For example, if the arteries in your eye are afflicted, your vision may suffer. If the arteries in your kidneys are damaged, you may develop kidney disease or kidney failure and wind up on dialysis. If the arteries supplying your heart muscle are damaged, you can develop blockages that can cause a heart attack. And if the arteries in your brain are affected, you may form blockages that can trigger a stroke.

HOW DO I KNOW IF MY BLOOD PRESSURE IS TOO HIGH?

Since you usually don't feel pain or any other symptoms, you probably won't know you've got a problem. That's why regular medical examinations, complete with blood pressure checks, are vital.

Your physician or nurse will usually read your blood pressure with a sphygmomanometer, that familiar cuff connected to a measuring device that looks something like a big thermometer. The cuff is wrapped snugly around your upper arm and inflated until it stops the blood flow in one of your arm's major arteries (the brachial artery). Then the cuff is slowly deflated while your physician or nurse listens with a stethoscope for the faint but clear tapping sound that indicates the blood is coursing through the artery once more. When this sound begins, the physician notes the reading on the sphygmomanometer, which is measured in millimeters of mercury (mm Hg). This first reading is the systolic blood pressure (SBP), the pressure exerted by the blood on the artery walls each time your heart beats.

The sounds change as the cuff continues to deflate, and when they are no longer heard, another measurement is noted. This is the diastolic blood pressure (DBP), the pressure exerted by the blood on the walls of your arteries when your heart is at rest between beats. The overall reading is expressed as a fraction, with the systolic on top and the diastolic underneath, as in 120/80. Hypertension is a condition in which the blood pressure exceeds normal limits most or all of the time. A reading of less than 120/80 mm Hg is considered normal, 120-130/80-90 is prehypertensive, a systolic pressure of 140 mm Hg or higher and/or a diastolic pressure of 90 mm Hg or higher is considered hypertensive.

Essential hypertension is high blood pressure that has no definite or known cause, which is the case 90 to 95 percent of the time. Although the cause is unknown, there is clearly a genetic component, as it tends to run in families. Secondary hypertension is high blood pressure due to another condition such as kidney disease, tumors, diseases of the endocrine system, blockages in the arteries of the kidneys, obesity, coarctation (narrowing) of the aorta, a variety of uncommon or rare disorders, and the use of certain prescription or nonprescription medications.

SOUNDING OUT YOUR BLOOD PRESSURE

There's more to reading blood pressure than listening for the first and last sounds; it's not just "sound on, sound off." As the physician releases the pressure on the cuff wrapped around the arm, the sound evolves through five phases, which are known as Korotkoff sounds.

Phase I-The doctor hears faint but clear tapping sounds, which gradually become more intense.

Phase II-The doctor begins to hear a swishing sound, or murmur.

Phase III-The sound becomes crisper, more intense.

Phase IV-The sound becomes muffled and soft; there's a blowing quality to the sound.

Phase V-The sound vanishes.

WHAT'S NORMAL AND WHAT'S NOT?

Here's the official word on blood pressure readings for those age eighteen and older, straight from the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, a prestigious group of experts gathered together to set standards for the treatment of hypertension.

Normal blood pressure-Systolic pressure less than 120 and diastolic pressure less than 80.

Prehypertension-Systolic pressure 120-139 or diastolic pressure 80-89.

If either the systolic blood pressure is above 139 or the diastolic pressure tops 89, you have hypertension. There are two stages of hypertension:

Stage 1 hypertension-Systolic pressure 140-159 or diastolic pressure 90-99.

Stage 2 hypertension-Systolic pressure greater than or equal to 160 or diastolic pressure greater than or equal to 100.

Although they don't agree exactly where the lines between one category and the next should fall, the major health organizations agree on the seriousness of the problem. The American Heart Association, for example, has three classifications: blood pressure of less than 120/80 is normal for adults; a reading of 120-139/80-89 signals prehypertension and requires careful watching; elevated hypertension is a reading of 140/90 or above. But don't breathe a sigh of relief and decide that you don't have much to worry about if you have, say, stage 1 hypertension.

The latest studies indicate that even those who fall into the stage 1 category have a 31 percent greater risk of heart attack, almost twice the risk of stroke, and a 43 percent increase in death rate, compared to those in the normal to high-normal category. In fact, 60 percent of the disease, disability, and fatalities caused by hypertension occurs among those with stage 1 of the disease, and 32 percent of the deaths due to hypertension-related heart disease occurs in those with a systolic blood pressure of less than 140 mm Hg.

WHY CAN'T WE SOLVE THE PROBLEM?

With over 50 million victims in this country alone, hypertension is clearly a major health problem. It's no wonder, then, that pharmaceutical companies have spent billions of dollars developing numerous drugs to decrease elevated blood pressure, and that the federal government funds many research studies investigating new approaches. Yet less than one third of those with hypertension have it under control. Awareness of the problem is one factor, but a staggering number of people who know they have high blood pressure either don't take their medications properly or simply do nothing at all. In fact, about 50 percent of hypertensives never even fill their prescriptions.

A large part of the problem is the high cost of hypertension drugs and their potential side effects, which include fatigue, depression, sexual dysfunction, sedation, dry mouth, cough, dizziness, headache, nausea, diarrhea, constipation, rash, itching, flushing, and swelling of the ankle or leg. But whatever the reason, tens of millions of people are walking around with uncontrolled hypertension, as the silent killer weakens their arteries, taxes their hearts, corrodes arteries in their brains, threatens their eyesight, and eats away at their kidneys. But all of this is unnecessary, because the hypertension medications actually do a very good job of controlling the disease.

THE SAFE, NATURAL, AND EFFECTIVE ALTERNATIVE

Yet as good as the medications are, they really aren't the best answer to the hypertension problem. We need a new approach, something safe, natural, effective, comprehensive, and yet easy to tolerate. Something that not only lowers blood pressure, but also improves the health of the arteries, without side effects. And something people can stick with forever. That something is the Hypertension Institute Program that I developed at the Hypertension Institute, where I've treated thousands of patients with high blood pressure over the past thirteen years. Not too long ago, I was like any other hypertension and internal medicine specialist, routinely prescribing the latest medicines for my hypertensive patients. I was doing everything right: I was (and continue to be) an Associate Clinical Professor of Medicine at the Vanderbilt University School of Medicine, and Director of the Hypertension Institute in Nashville, Tennessee, where I practice at Saint Thomas Medical Group and Saint Thomas Hospital. I personally conducted over seventy-five research studies on hypertension, published over 120 medical articles, and wrote two handbooks that health care providers use as guides for treating hypertension and understanding vascular biology. I also served as a consulting reviewer for the editorial board for numerous peer-reviewed medical journals such as the Journal of the American Medical Association, the New England Journal of Medicine, the Archives of Internal Medicine, the American Journal of Hypertension, and Human Hypertension.

Despite my firm footing in standard medicine, I began looking into the alternative literature because I wanted to design a healthy-heart, healthy-blood-vessel, and age-management program for myself-something that included nutrition, dietary supplements, and nutraceuticals (components of foods or dietary supplements that have medicinal or therapeutic uses).

But since I knew that traditional medicine didn't adequately address these issues, I turned to complementary and integrative medicine, figuring I might be able to pick up a few tips there. As I began to read more and more, I was astonished to find a wealth of convincing basic science and clinical studies showing that certain vitamins, minerals, nutraceuticals, dietary supplements, and other food-related substances could do exactly what I wanted. I was especially impressed with the research on hypertension.

Continues...

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Excerpted from What Your Doctor May Not Tell You About Hypertension by Mark Houston Barry Fox Nadine Taylor Copyright © 2003 by Mark Houston, M.D., Barry Fox, Ph.D., and Nadine Taylor, M.S., R.D.. Excerpted by permission.
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