Most common heart-related conditions
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Hypertension

Hypertension, or high blood pressure, is often called a "silent killer" because many have it for years without realizing. However, all along damage is silently being done to the brain, the heart and the kidneys. Click on one of the programs below to find out more on hypertension and how to keep your blood pressure in check

• What Is Hypertension?
• What Are the Recommended Medications and Diet for Hypertension?
• Erectile Dysfunction & Hypertension
• ASK YOUR DOCTOR: About High Blood Pressure

What Is Hypertension?
Millions of Americans have hypertension, also known as high blood pressure, without knowing it. Tune in to learn more about this silent killer.

Participants:
Jamie B. Conti, MD
Adolph M. Hutter Jr, MD, MACC, FAHA, FESC
Past President and Editor-in-Chief Conversations with the Experts American College of Cardiology
Suzanne Hughes, MSN, RN
Education Coordinator, Center for Family Medicine, Akron General Medical Center, Akron, Ohio
Robert S. Schwartz, MD, FACC
Director of Preclinical Research, Minneapolis Heart Institute,
Minneapolis, MN

Webcast Transcript:

ANNOUNCER: Hypertension is the medical term for high blood pressure. In the United States alone, as many as 65 million adults have high blood pressure, and the older you are, the higher the risk for developing hypertension.

SUZANNE HUGHES, MSN, RN: It's very common to develop hypertension later in life. If one makes it to age 55 with normal blood pressure, their risk of developing high blood pressure yet in their lifetime is around 90 percent. It's an important thing for people to realize that, particularly in the early stages, there are no symptoms of hypertension or high blood pressure and that's why the condition has gotten the name "the silent killer," because damage is being done to the end organs in the absence of any symptoms at all.

ANNOUNCER: Blood pressure is measured by two numbers. The larger number, known as systolic pressure, and the smaller number, which is called diastolic pressure. An ideal blood pressure reading would be equal to or less than 120/80. A reading of 140/90 or higher would be considered hypertension. If left undiagnosed or uncontrolled, hypertension can cause a multitude of medical conditions.

JAMIE B. CONTI, MD: High blood pressure can cause several major problems, including stroke, kidney failure and heart disease, both coronary artery disease and heart failure. And the relationship is in the arteries. And the longer the arteries are under high blood pressure, the more the other organs are affected. So ignoring one's blood pressure over the long term is a really bad idea.

ANNOUNCER: Fortunately, once diagnosed, hypertension can be controlled through lifestyle changes and medication.

ADOLPH M. HUTTER, JR., MD: One of the basic treatments for hypertension is a low salt diet. If you get rid of the extra salt, you get on a low salt diet, that in itself will help lower your blood pressure.

SUZANNE HUGHES, MSN: We know that it's very important for people that have been identified as having hypertension to avoid or quit tobacco products. Additionally, following what we call the DASH diet: Dietary Approaches to Stop Hypertension. This is a diet that's low in fat, it's high in fruits and vegetables and it also has two to three servings a day of low-fat dairy products.

ROBERT S. SCHWARTZ, MD: Many drugs are available that can lower the blood pressure. Or possibly lowering the amount of water in a person's body through giving agents that are diuretics, that is, causing water to be lost through the urine. Other classes of drugs do things such as relax the heart or slow the heart rate down, all of which can lower the blood pressure directly.

SUZANNE HUGHES, MSN, RN: I think the important thing that people need to remember is, if one has hypertension, it will take an average of 2.7 medications to manage that high blood pressure.

ANNOUNCER: No matter how healthy you feel, there is still one sure-fire way to find out if you suffer from hypertension: Visit your physician on a regular basis

ADOLPH M. HUTTER, JR., MD: Hypertension can be without any symptoms. You may have hypertension and not know it because you don't have headaches or flushing, and you feel wonderful. So you need to get your blood pressure checked.

Medications and Diet for Hypertension
Hypertension or high blood pressure is a risk factor for heart disease, stroke and other cardiovascular conditions. Fortunately, it can be controlled. Tune in to find out how.

Participants:
Suzanne Hughes, MSN, RN
Education Coordinator, Center for Family Medicine, Akron General Medical Center, Akron, Ohio

Editorial Consultant:
Suzanne Hughes, MSN, RN

Webcast Transcript:

ANNOUNCER: If you’ve been diagnosed with high blood pressure, also known as hypertension, you’re not alone

SUZANNE HUGHES, MSN, RN: In the summer of 2004, we saw the release of new data that told us that what we previously knew was the number of Americans with hypertension, 50 million, had risen to 65 million since the last reporting period. So we know now that one out of every three adult Americans has hypertension or high blood pressure, which is a risk factor not only for heart disease, but, importantly, for stroke.

ANNOUNCER: As blood pressure rises, the risk of developing adverse cardiovascular conditions increases, so it’s important to control high blood pressure immediately to avoid further complications. Fortunately, there are many treatment options available to help get your blood pressure back on track.

SUZANNE HUGHES, MSN, RN: There are certain lifestyle changes one can make, particularly in the early stages of prehypertension, that might be able to lower the blood pressure adequately enough to not even require medication, and these would be following what we call the DASH diet. DASH stands for Dietary Approaches to Stop Hypertension. It’s a diet that’s very high in fruits and vegetables, it’s low in fat, and it also has two to three servings per day of low-fat dairy products. That, combined with lowering the sodium in the diet, can make a big difference in the blood pressure.

Also, adherence to the recommendations of 30 minutes of exercise every single day can also make a nice difference in the blood pressure.

Very important that people with hypertension or pre-hypertension absolutely avoid tobacco products. And if they do choose to drink alcohol, that that be kept to one drink per day for women and two drinks per day for men.

Now, should lifestyle measures alone not be enough to normalize blood pressure, medication may indeed be necessary.

The good news is, we have a wonderful, large armamentarium of medications now that lower blood pressure. We do know, however, that if one has hypertension, it will require an average of 2.7 medications to get that blood pressure to normal. And that surprises a lot of people. A lot of people will be started on a blood pressure medication, go back and follow up with their physician maybe a few weeks or months later and find out that that one medicine alone isn’t enough, and then another medication is introduced. And I think sometimes patients perceive that that’s a failure on their part or on their health care provider’s fault, when at the outset we know that it may indeed require several medications.

When several medications are used, each of those medications can be then used in smaller doses, which helps to minimize the side effects.

A very important group of medications to lower blood pressure are diuretics, and these are medications that lower blood pressure by kind of lowering the circulating fluid volume in the body. These are very important, and in many cases, when there’s more than one medicine needed, a diuretic will be one of those.

A second important group of medications are the beta blockers. These are particularly important in a group of patients that have already suffered from a heart attack. They’re very important players in our toolbox against hypertension.

We also have what we call the calcium channel blockers, a group of medicines that actually work on the arterial wall to relax the wall and drop the blood pressure.

We have a group of medications called the angiotensin converting enzyme inhibitors -- a big name -- the ACE inhibitors that lower blood pressure.

And we also have the angiotensin receptor blockers, or the ARBs group. So those are kind of the main groups of medications that lower blood pressure.

And what your particular health care provider may choose to use in your case can be dictated by several different things, whether or not you have diabetes, whether you’ve already had a heart attack or heart disease. Sometimes whether you’re a man or a woman, what age you are, what race you are. So all these things kind of play in. But we do know that the actual lowering of the blood pressure, no matter what agent, has profound impact on the development of heart attack, on the prevention of stroke, as well as the prevention of heart failure.

Erectile Dysfunction & Hypertension
Hypertensive patients worry about which medications are safe to take, including erectile dysfunction (ED) drugs. Find out how ED medication affects hypertension.

Participants:
Franz H. Messerli, MD
Clinical Professor of Medicine; Tulane University School of Medicine

Webcast Transcript:

ANNOUNCER: Many patients with hypertension want to know if it's safe to take drugs that treat erectile dysfunction.

FRANZ MESSERLI, MD: Now, one has to consider in this context that basically from a physiologic point of view, sex has to be considered a form of exercise. It increases heart rate. It increases cardiac output. So it puts a burden on the heart.

But in general, this burden is very well-tolerated by the hypertensive patients, because we do let our hypertensive patients exercise. They should engage into regular exercise. We told them to do so. So there's nothing wrong with them having sex.

Now, when you look specifically at the drugs that improve erectile function, such as Viagra, such as Cialis, such as Levitra, if anything, they actually lower blood pressure a little bit. And if anything, they have a positive effect on the coronary flow in the heart. So to my way of thinking these drugs are rarely contraindicated in hypertensive patients. And even if—and I see a lot of complicated hypertensive patients who are on triple and quadruple and quintuple therapy—even in these patients, I have no hesitation to prescribe one of these drugs.

ANNOUNCER: Although it is generally acceptable to take erectile dysfunction medication if you have hypertension, there is one major caution: If you are taking nitrates for coronary disease or angina, erectile dysfunction medication should be avoided. This combination of drugs can cause dangerous dips in blood pressure.

Read ASK YOUR DOCTOR: About High Blood Pressure

The following is a list of questions to ask your doctor about high blood pressure, as well as tips for preparing for these conversations.

1. What is blood pressure?

Blood pressure is the force of the blood pushing against the walls of the arteries. Blood pressure is expressed in two numbers. The top number is the systolic pressure, the pressure produced in the arteries when the heart beats. The lower number, the diastolic pressure is the pressure in the arteries between heart beats. Both numbers are important.

2. What is high blood pressure?

High blood pressure (also called hypertension) is known as the "silent killer" because over time it can cause serious damage to the heart, brain, and kidneys without any symptoms. In most people with high blood pressure, a single specific cause cannot be identified. One in three adult Americans have high blood pressure, and even if you reach your mid-50's with normal blood pressure, your risk of developing high blood pressure in your lifetime is nine in 10.

3. Why should I care about high blood pressure?

Elevated blood pressure increases your risk for heart attack, stroke, heart failure, and also kidney failure.

4. How can I lower my blood pressure?

You can lower your blood pressure by making changes in your eating and exercise habits and by quitting smoking. There are many medications available that can effectively lower blood pressure. These medicines are very often used in combination.

5. What are the current standards for blood pressure levels?

Categories for Blood Pressure Levels in Adults (in mm Hg, millimeters of mercury)a

6. What are the key questions to ask my health care provider about my blood pressure?

• What is my blood pressure?
• Is my blood pressure considered normal?
• Would it be helpful for me to measure and record my blood pressure at home?
• What changes could I make in my eating habits and activity levels that would help to lower my blood pressure?
• Do I require medication?
• How do my medications work? Are there side effects I should watch for?

Reference:

NHLBI http://www.nhlbi.nih.gov/health/dci/Diseases/Hbp/HBP_WhatIs.html