Hypertension 7 – Prevention/Treatment

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DASH Diet

 

Hi. This is Dr. Louella continuing our series on hypertension. But first I must mention that I did go out for the Easter long-weekend. I got to be with nature as we hiked to Edith falls in Chaguaramas, Trinidad (breath-taking when dry, I can’t imagine what it would be like with water) and to the Corvine River (we’ll reach the pool next time; it was getting too dark).

With regards to hypertension I would like to remind us just how common this disorder. Current research suggests that 1 in 3 American adults and 1 in 4 Trinidadians have this disease. Remember what it can cause: stroke, heart attack, heart failure, kidney failure, and more. These are all dreadful, debilitating, expensive diseases.

Wouldn’t it be worth your while to prevent yourself developing this silent killer, hypertension? I think so. That’s why I am going to discuss prevention of hypertension, in conjunction with treatment, because much of what can be used to prevent hypertension is used to control it as well.

Now there are certain factors that predispose a person to hypertension, that are beyond our control. These include a family history of hypertension (heredity), increasing age (from 35-40 years onward) and ethnicity, such as being Afro-Caribbean or Afro-American.

This is fairly common knowledge. So if you KNOW you fall into one, two or even three of these categories (oh goodness, I’m in all 3) and are at an increased risk then you have a special responsibility to try to prevent yourself from getting hypertension. This disease is costly.

In preventing/treating hypertension I would first like to remind us to go easy on the salt. Most of us cook with too much salt. Do not add salt to your food when at the table. Decrease your consumption of fast foods; all they care about is the taste. Be wary of canned food, sausages and bacon. The salt is an integral part of their processing but it is way too much for you.

Especially for the Trinidadians, please note that you do not need to decrease the amount of fresh seasonings you add to food because these do NOT raise blood pressure. Fresh herbs and seasonings are encouraged in place of salt. However, packaged seasoning is a different matter, because it usually comes with salt.

Many of us don’t use enough fresh fruits and vegetables (including raw). These have so many health benefits, including lowering blood pressure by increasing potassium. Make a habit of passing by the fruit stall on a weekly basis to get your daily quota of two fruits. Also prepare salads more regularly.

Eat more oats. Have it every morning for breakfast if you can because, remember, this can help prevent hypertension.

Please reduce the alcohol intake. The benefits you will derive will go way beyond reducing hypertension.

What has been shown to work best is a comprehensive diet, where foods are combined to lower blood pressure nicely. These include high fibre foods. Increase your fibre intake with more whole grain products (whole wheat/meal bread, bran, oats etc), as well as, with more peas, beans and nuts. (Nuts are also great for lowering cholesterol. A handful a day is recommended – not too much, because they are high calorie.)

Other measures like lowering the amount of meat in the diet has also been shown to help. This is red meat in particular. You can have generous amounts of fish and some chicken. Dairy products should be consumed but should be low fat. Of course, much less sweets, especially sweet beverages and fat should be consumed.

This healthy diet has been proven to reduce blood pressure. And really, is it so hard? If you need more detail feel free to research the DASH diet. It is the Dietary Approaches to Stop Hypertension.

I’ll talk more on a major factor in hypertension, obesity, next week. I’ve been up way too long for one day. Ciao!!!

Hypertension 6 – Associations

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It’s the Easter long weekend here in Trinidad and Tobago!!! That means church, beach, camp or partying for many. Dr. Louella here, and I’ve got to wrap this blog up quickly because I’ve got to go dance practice for our Glorifest concert of high praise this Saturday. I need to remember all my moves and get them really tight.

But first to continue our discussion about hypertension because it is very important. Before we talk about the treatment of hypertension though, you may have noticed that I omitted a well-known topic in hypertension. That’s salt intake. Everyone knows that hypertension is associated with a high salt intake.

Earlier, in our talk on causes of hypertension, I did not mention salt as a cause. In fact, what I did say is that the real cause of hypertension is not known. And that is true.

But there are a number of important dietary associations of the disease which should be mentioned. For example we know that high blood pressure is associated with a high salt (sodium) intake. It occurs more frequently in those who consume a lot of salt. But it does not occur in all of them.

Researchers have found that those with a high potassium intake have a lower blood pressure. That’s because potassium counters sodium in the body. Whereas the sodium from salt draws more water into the circulation encouraging a higher blood pressure, potassium does the opposite.

Eating oats seems to be a fad these days but it is a healthy one. Eating whole grain such as oats and bran flakes every morning is associated with a lower risk of developing hypertension. Oats also reduces blood cholesterol as well.

An important part of some person’s diet, alcohol, is also proven to elevate blood pressure. I saw this in one of my local alcoholic patients in Cedros. Once he stopped his drinking binge, his blood pressure would go to almost normal.

Also in my practice, I have come to expect, without even realizing it, most obese patients to have an elevated blood pressure, so commonly is obesity associated with hypertension, especially in our almost half African-descended population in Trinidad.

What I mentioned above are the PROVEN associations of hypertension. Note I did not mention highly seasoned food, sweets, fat intake, cholesterol and smoking, a few of the things I have heard people mention, as associations. These may cause other problems, by not hypertension, as far as is currently known.

Remember too, that we already discussed physical and emotional states that elevate blood pressure. Next we will determine what is the best approach to a diet that helps to lower blood pressure. But it won’t be from scratch. This wheel has been invented before.

So, we have a four day weekend here in Trinidad. Whatever you’ve got wherever you live, I hope you enjoy it! Till next week. Dr Lou is out!

Hypertension 5 – Complications

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Hi there. Dr Louella here, finishing up the discussion on complications of high blood pressure. Remember, this is to answer the question, why do we treat hypertension, especially when it has no symptoms? We already identified how hypertension causes both ischaemic heart disease, which can lead to heart attack, and heart failure. We now continue to other complications.

Hypertension is the major cause of stroke, which occurs in the same fashion as heart attack, by blockage of blood flow to parts of the brain. We can use the same picture below to demonstrate.

From: cdc.gov

From: cdc.gov

Hypertension damages the inner lining of blood vessels allowing cholesterol to enter the wall and form a plaque that partially blocks blood flow. If it a blood clot forms at the site it seals up the blockage long enough for no blood to flow and permanently damage brain cells. Persons are unable to use parts of the body which are controlled by the affected regions of the brain.

Narrowing of the small blood vessels of the kidneys leads to chronic kidney disease and in some, renal failure. In the eyes it causes eye disorders such as cataract, glaucoma and bleeding in the back of the eye (retinal haemorrhage). Less common occurrences are the deadly aneurysms (ballooning of blood vessels due to weakened walls) which can occur especially in the abdomen.

Once you have untreated or inadequately treated hypertension some amount of organ damage is bound to take place. Nowadays most people end up with complications due to poorly treated hypertension. Stroke, for example, is way too common in Trinidad. I often ask my patients if they don’t mind having a stroke and give a visual demonstration to remind them what it’s like.

Many years ago, I came home from school in the third form (9th grade) to find my granny (fond name for grandmother) in the local hospital with a stroke. Of course, life for me was never the same as she couldn’t walk or talk after that. At 83 she had been a really active woman. She was said to be bringing in the goats when it happened (yeah we had goats and I loved them; no it wasn’t a farm and none of the neighbours had; we just happened to have goats).

Granny survived four years after that. Though we never admitted it, it was a burden to care full time for her although it was also a joy. She needed caretakers when we were out to work and school.

The moral of the story is, especially for those with hypertension in the family like me, don’t get hypertension! Don’t get a stroke! Or heart disease, or cataract!

We will learn how to prevent this silent killer and its awful complications in the next talk. Ciao kids!!!

Hypertension 4 – Complications

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Hi guys. It’s Dr Louella again. We need to wind up on hypertension but first I must report that I did not make it to Cedros (Trinidad) for the holiday, as I had no company for the two hour drive. But there’s gonna be a next time!

Well so far we’ve been through the symptoms, causes and diagnosis of hypertension and it’s time to get to the bottom line of how to treat it. But not quite. Because the problem with many people is that they don’t fully understand WHY we treat hypertension.

And why is that so? … If you recall, hypertension has no real symptoms. It does not make you feel sick. So in many people’s minds they do not really see the need to take medication when they are not sick. Many of them only take meds when they think their blood pressure is high. But there is no way to know without testing and you cannot test 24/7.

Once your blood pressure is higher than the ideal level of 120/80 your blood vessels are traumatized by the pressure of the blood flow and gradually, over months and years, the inner lining of the blood vessels is damaged. This can lead to thickening of the blood vessel walls by increase in the muscle content in smaller blood vessels and by cholesterol-filled atherosclerotic plaques in larger vessels.

Atherosclerosis is hardening of the blood vessel walls by the growth of plaques which are filled with cholesterol. The picture below shows the progression.

From: cdc.gov

Once thickening of blood vessels occurs, the lumen or passageway of the blood vessel narrows so less blood can flow through it. This especially affects blood vessels in the heart and brain causing ischaemic heart disease, which may lead to heart attack, and stroke.

People with ischaemic heart disease usually suffer with recurrent chest pain due to poor blood supply to the heart.  During a heart attack the blood supply is cut off completely and part of the heart dies. This may result in sudden death of the individual or they may have to live with a severely weakened heart.

There are other ways hypertension can damage the heart. The high pressure of the blood can put a strain on the chambers of the heart as they contract leading to thickening of the muscle of the largest chamber, the left ventricle. This becomes stiff and less able to contract. It is further weakened by the poor blood supply in the narrowed arteries. Finally, the heart muscle starts to stretch and can no longer perform its function.

The description above is that of heart failure and is usually accompanied by an enlarged heart. The heart muscle in heart failure does not have its full strength and the heart cannot properly perform circulation of the blood without the help of medication. The individual often suffers with extreme fatigue, shortness of breath and/or swelling of the feet.

Ok! That’s a mouthful. As we can see, hypertension causes some major problems in the heart. Next week we’ll finish these complications. We have not yet spoken about a big one, stroke. I will share my own personal experience with this awful disease. See you then!