High blood pressure, known in the clinical setting as hypertension, is often called the "silent disease" since it has no primary symptoms. However, it does have very serious health consequences. Blood pressure is measured in two readings: one for systolic and one for diastolic pressure.

The systolic pressure is measured first and is the highest number. It measures the maximum pressure generated by the contraction of the heart muscle. Diastolic pressure, the lower value, is measured second and represents the pressure as the heart muscle relaxes. Normal, average blood pressure is about 120 systolic and 80 diastolic, or 120/80. (See the chart below for normal and abnormal values.)

The incidence of hypertension increases with age and is more common for blacks than for whites. Men are more likely to have hypertension in young adulthood and middle age than are women; thereafter, the reverse is true. You're also more likely to develop hypertension if you're overweight. Following are some special circumstances affecting women:

1. Birth control pills: hypertension has been reported to be 2 to 3 times more common in women taking oral contraceptive pills for 5 years or longer, and the risk appears to increase with age.
2. Pregnancy: hypertension during pregnancy can be dangerous, so be sure you are under a doctor's care.
3. Hormone replacement therapy (HRT): while HRT treatment may have a beneficial effect on blood pressure and cardiovascular risk, a few women may develop hypertension as a result of taking HRT.

Since uncontrolled hypertension requires the heart to work harder and puts added stress on arteries, it has a negative effect on a woman's health. In fact, the higher your abnormal blood pressure, the more likely you are to develop cardiovascular disease (which causes heart attacks and strokes), kidney disease and certain eye problems. Hypertension currently has no cure, but it can be controlled through medication and the lifestyle changes described below.

CLASSIFICATION OF BLOOD PRESSURE FOR ADULTS OVER 18 YEARS

Your Physician or Nurse Practitioner

Your physician or nurse practitioner will carefully evaluate you if your blood pressure reads high on at least two separate office visits. They will take a health history to evaluate your lifestyle habits, stress profile, family history, past personal history with hypertension, heart disease, stroke, diabetes or kidney problems, as well as any medications you may currently be taking. Certain medications can actually increase blood pressure. You will also receive a thorough physical exam, including weight check, further blood pressure checks, heart exam and sometimes an EKG, eye and neck exam, exam of the abdomen and the extremities to check for swelling or abnormal pulse.

If you are diagnosed with high normal hypertension, your physician or nurse practitioner will make some lifestyle recommendations and follow up with you at your next annual exam. If you have Stage 1 hypertension, you may be able to try some lifestyle modifications for three to six months to see if your blood pressure will come down without medication. Lifestyle modifications include:

1. Lose weight if overweight.
2. Eliminate or limit alcohol intake.
3. Get regular, aerobic physical activity.
4. Reduce sodium intake to less than 2 to 3,000 milligrams per day.
5. Get adequate dietary potassium, calcium and magnesium.
6. Stop smoking.
7. Reduce dietary saturated fat.

If you have Stage 2 through 4 hypertension, your physician or nurse practitioner will likely prescribe medication in addition to lifestyle changes. They will monitor you closely to be sure the medication is effective with the minimum of side effects.

Although many women don't like the idea of having to take medicine, anti-hypertension drugs have contributed to the 50-percent reduction in heart attack and stroke rates over the past 2 decades in the U.S. It can be dangerous to alter or discontinue your medication without your physician or nurse practitioner's supervision.

Traditional Chinese Medicine (TCM)

Your TCM practitioner can provide you with the most effective therapy for High Normal and Stage 1 hypertension. Therapy would include herbal or tea formulas as well as twice-weekly acupuncture treatments. The TCM practitioner will also recommend dietary changes such as those already mentioned. They will also recommend special meditation techniques such as Tai Gi or Qi Gong, which are potent stress-reducers.

Nutrition

A diet rich in vegetables, fruits, whole grains with moderate amounts of lean protein and unsaturated fat and very limited quantities of saturated fat, salt, sweets and alcohol will not only help you control your hypertension, but also your weight. Special considerations:

1. Get adequate potassium, calcium and magnesium. Good sources for: potassium: winter squash, potato, pinto & kidney beans, spinach, melon, banana and broccoli magnesium: spinach, tofu, black-eyed peas, shrimp, broccoli, beans, wheat germ, beets, figs, baked potato calcium: nonfat dairy products, greens, spinach, fish canned with bones, soybeans, tofu, fortified orange juice.
2. To reduce your sodium intake: do not use salt at the table and only lightly in cooking; avoid salt-preserved foods such as salted or smoked meat or fish; avoid highly salted snack pretzels and chips; read soup, rice and pasta mix, sauce and other processed food labels carefully for sodium content; limit use of salty condiments including bouillon cubes, soy and Worcestershire sauce, seasoning 'salts'; limit cheese and peanut butter.
3. To limit saturated fat intake: use only lean cuts of meat, skinless poultry and fish; use unsaturated oils such as olive, safflower or canola instead of butter or margarine (or use fat-free butter substitutes); avoid baked goods such as doughnuts, cookies and cakes, as well as chocolate and caramel candies. Instead, try eating more potassium-containing fruit!
4. Don't forget to limit your alcohol intake. If you're watching your weight, limit alcohol to special occasions. If weight is not a problem, one or two cocktails or glasses of wine or beer on any given day is within your limit. Remember, though, that even this modest level can cause other health problems.
5. Garlic can help reduce blood pressure. To avoid strong breath, try taking a garlic capsule once per day.

Physical Activity

Regular, aerobic exercise will not only directly work to lower your blood pressure over time, but it will help you control your weight. However, it is important that your blood pressure be controlled (at least not above 160/109) before it is safe to begin or continue your exercise program. This is because blood pressure rises with your heart rate while you're exercising, and you don't want blood pressure to get dangerously high. Once you have received your health care practitioner's clearance, resolve to make exercise a regular part of your life.
The best prescription is regular, moderate aerobic exercise most days of the week. A walking, cycling or swimming program for 30 to 60 minutes 4 to 5 days per week will actively work to reduce your hypertension. You may want to invest in a piece of stationary equipment (cycle or treadmill) when you can't get outdoors during short days or inclement weather. Supplement your regular program with active housework, gardening, tennis, dancing or other fun activities.

Stress Reduction

There are no large-scale research study results indicating that stress reduction techniques have a significant effect on hypertension. However, smaller studies are beginning to show benefits of some forms of stress-relieving activities such as meditation, yoga and tai chi. Since the overall health benefits of stress-reduction techniques are many, why not make these a part of your life? Following are a few of the many techniques you may wish to learn more about:

Deep abdominal breathing--induces a state of peace and relaxation and counteracts the shallow breathing that can often be induced by stress. Progressive relaxation--helps you discover and relax tense, tight muscles. Affirmations and visualizations--create the mind-body connection to enhance relaxation and natural healing. Meditation--calms the mind and relaxes the body. Massage--loosens tense muscles and enhances a feeling of relaxed wellbeing.
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Contributors: Carolyn Coker Ross, MD, MPH; Barbara Whiteside, RN, CNP; Julie Martin, MS; Jacqueline Zhang, LAc, OMD

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