High Blood Pressure

High Blood Pressure

A Woman's Problem, Too

You feel fine. You look fine. But if you're one of those stoic types who has to be sick as a dog before she'll see a doctor, you could be walking around with a life-threatening medical condition without knowing it.

Long called the silent killer, high blood pressure can lead to heart disease and stroke--conditions that kill more women than all other diseases combined. The tragic part is that while it's easy to detect and control, most women don't even know they have high blood pressure unless they have it checked at the doctor's office during a routine visit.

Estrogen Protection

Until menopause, we have a natural advantage over men when it comes to matters of the heart, thanks to the sex hormone estrogen. Besides regulating the menstrual cycle, estrogen keeps our cholesterol in check, reduces the formation of artery-clogging plaque and generally keeps our hearts running smoothly.

It also keeps our blood pressure down. One in ten women between 35 and 44 has high blood pressure, compared with one in five men.

But knowing we've got such a powerful ally can give us a false sense of security. If you think high blood pressure is a man's problem, something women don't have to worry about, consider this statistic: By age 45, one in nine women shows signs of cardiovascular disease, a condition that kills half a million women a year. By the time we're in our fifties, we're just as likely to have high blood pressure as men are.

Once it strikes, high blood pressure damages the heart in two ways: It enlarges and weakens the organ and contributes to atherosclerosis, clogging your blood vessels with plaque and setting the stage for a heart attack.

The sooner high blood pressure is detected and controlled, the less time it has to wreak havoc. Once your blood pressure is brought down to normal--either with medication or through weight loss, exercise or cutting your salt intake--your risk of heart attack approaches that of a person whose pressure has always been normal.

Playing by the Numbers

A blood pressure reading consists of two numbers: The top one, for systolic pressure, indicates the maximum pressure in your blood vessels, which occurs when your heart contracts. The bottom one, for diastolic pressure, represents the minimum pressure while your heart is resting between beats.

Normal blood pressure for women is usually between 110/65 and 140/90, though it may vary depending on the time of day. It's normal for blood pressure to go up when you're stressed or excited, but it should return to normal quickly. A consistent reading of 140/90 or above is considered high.

Keeping on top of blood pressure is simple. Have it checked at every doctor's visit, which should be at least once a year, suggests James Reed, M.D., professor of medicine at Morehouse School of Medicine in Atlanta. "Once a year is fine if you've always had normal blood pressure. If you've had high readings in the past or are on high blood pressure medication, your doctor will want to see you more often."

Regular screenings are particularly important for women with a family history of high blood pressure, since the condition has a genetic link.

Researchers don't know why, but African American women are far more likely to develop high blood pressure than white women and tend to experience more severe complications.

Being overweight--even by as little as ten pounds--can also contribute to high blood pressure.

The Stress Factor

While many doctors believe that stress plays a role in high blood pressure, the relationship is difficult to prove. "The problem is defining what you mean by stress," says Peter Schnall, M.D., assistant professor of public health at Cornell University Medical Center in New York City, who's been studying the relationship for 15 years.

Dr. Schnall's research focuses on a particular type of stress at work known as job strain, typically experienced by workers in demanding jobs who have little control over their work environments. "Job strain is greatest in women who must work at a rapid pace set by someone else, with little say over how the job gets done," says Dr. Schnall.

No matter what the cause, once it's detected, high blood pressure is easily controlled. And reducing blood pressure even a little can add years to your life. For each point you shave from the top or bottom number of your blood pressure reading, your heart attack risk drops 2 to 3 percent, says JoAnn Manson, M.D., co-director of women's health at Brigham and Women's Hospital in Boston.

While blood pressure can be controlled with medication, a growing body of research shows that nondrug approaches like weight loss, regular exercise, cutting back on sodium and reducing or eliminating alcohol also can be effective.

In fact, studies show that if you're overweight, achieving and maintaining a normal weight may be enough to get your blood pressure under control.

Your doctor will also recommend reducing the amount of salt in your diet. A high-sodium diet causes the body to retain more water, which increases the volume of blood traveling through blood vessels and adds to the burdens on the heart and kidneys.

Excess sodium doesn't cause high blood pressure, but it does aggravate the problem in about half of all patients, according to W. Dallas Hall, M.D., professor of medicine and director of the Division of Hypertension at Emory University in Atlanta. To find out if it's a problem for you, cut back on salt for several weeks and then have your blood pressure tested.

Going the Medicine Route

If your blood pressure is very high (over 105 diastolic) or doesn't improve with lifestyle changes, your doctor will prescribe medication to bring it down. The most commonly prescribed blood pressure drugs fall into four categories: diuretics, beta-blockers, angiotensin converting enzyme (ACE) inhibitors and calcium channel blockers.

Diuretics have been used since the late 1940s to reduce blood pressure by increasing the excretion of excess salt and water, leading to reduced blood volume and less work for the heart. Beta-blockers reduce blood pressure by slowing the heart and central nervous system. ACE inhibitors stop the body from producing angiotensin, a chemical that tightens the arteries and increases blood pressure. Calcium channel blockers relax the arteries, easing blood flow and reducing pressure in the blood vessels.

Each type of drug comes with its own benefits and risks, says Dr. Reed. Your doctor will want to see you regularly to judge the drug's effectiveness and guard against possible side effects.

How to Get It Down

Doctors agree that there's a lot you can do to prevent or control high blood pressure. Here are some suggestions.

Lose a little weight. "Almost any overweight woman who successfully loses weight will see her blood pressure come down," says Dr. Hall. Your doctor can help you determine a healthy weight for you and offer tips to help you get there. Even a small weight loss--as little as ten pounds--can have a beneficial effect on blood pressure.

Get off the couch. "It takes about six months of a regular exercise program--15 to 45 minutes a day three to five times a week," says Dr. Hall. "If patients stick with it, they can expect a decrease similar to what we see with sodium restriction: about seven points off the top figure and seven points off the bottom," says Dr. Hall.

Be careful with sodium. It's not enough to swear off the salt shaker. Up to 80 percent of the sodium in the American diet comes from processed foods. Cheese, lunch meats and snack foods, as well as canned soups and vegetables and vegetable juice, are often very high in sodium. Check food labels for sodium content, and look for lower-sodium versions of foods you can't do without. Try to limit your intake to 2,400 milligrams a day, says Patrick Mulrow, M.D., chairman of the Department of Medicine at the Medical College of Toledo in Ohio and chairman of the American Heart Association's Council for High Blood Pressure Research.

Cut back on alcohol. Exactly how it works isn't clear, but even moderate drinking can raise blood pressure in some individuals, says Arlene Caggiula, Ph.D., associate professor of nutrition and epidemiology at the University of Pittsburgh School of Public Health. Reduce or eliminate alcohol and see if your blood pressure comes down.

Include minerals. Potassium and magnesium may help keep blood pressure down, according to researchers. Try to get 3,500 milligrams of potassium and 350 milligrams of magnesium a day, says Dr. Caggiula. Good sources of potassium are potatoes, spinach, bananas, orange juice, corn, cabbage and broccoli. Nuts, spinach, lima beans, peas and seafood are high in magnesium. You can usually achieve adequate levels through a good diet, so don't take supplements of either mineral without consulting your doctor.

Get off the Pill. Oral contraceptives containing estrogen, like the majority of those sold in the United States, can sometimes cause an increase in blood pressure. And while progestin-only pills, the so-called minipills, aren't believed to increase blood pressure, their effect hasn't been thoroughly studied. "I would never recommend any oral contraceptive to a woman who already has high blood pressure," says Dr. Hall. "The best advice is to use another form of birth control."

Seek support. If you think job strain is sending your blood pressure through the roof, research shows that maintaining close, supportive relationships with co-workers may be your best bet for reducing the pressure and keeping it down. "Talking about your work experiences with other people actually acts as a buffer against the effects of job strain," says Dr. Schnall. "If you're in a demanding job and have nobody to talk to, you're in much worse shape."

Avoid dueling prescriptions. Certain nonsteroidal anti-inflammatory drugs (NSAIDs), such as those used to treat arthritis, can undermine the effectiveness of some blood pressure medications. To avoid drug interaction problems, be sure to tell your doctor about any medicine you're taking, whether it's a prescription or an over-the-counter drug, says Dr. Hall.