Managing Your Hypertension -- Nancy Valone, RN. -- 01/21/03

WebMD Live Events Transcript

What can you do to manage your high blood pressure (hypertension)? Let us help. Nancy Valone, RN, our expert from the WebMD Hypertension message board, answered our members' questions when she joined us on WebMD Live.

The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome to WebMD Live. Today Nancy Valone, RN, our expert from the WebMD Hypertension message board, will answer your questions about managing your high blood pressure.

Member: Is there a link between hypertension and high cholesterol?

Valone: There is no link. They are not really related. If you eat a high saturated-fat diet and high sodium you will very possibly end up with high cholesterol and hypertension. We see lots of patients with high cholesterol or hypertension and vice versa.

Member: I notice the BP reading taken from the left arm is different from the reading of the right arm. The variation can be about 10 mmHg lower by the left arm for both the systolic and diastolic readings. So, which arm should we take to test the BP reading?

Valone: Take the reading with the higher measurement. There is very often 10 to 15 mmHg difference between right and left arm and it's really of no concern.

Member: My doctor prescribed that I start on a low-sodium diet. I've never done this before. I've been reading cans and boxes and such trying to figure out exactly what percentage or number of milligrams "low sodium" is. What do you recommend/suggest?

Valone: I suggest DASH (Dietary Approach to Stop Hypertension), which has volumes of information regarding a low-sodium diet. Consider that most or all processed foods in cans, frozen, or otherwise pre-prepared contain a lot of sodium. Stick with fresh fruits and vegetables and low-fat diet. Avoid using salt at the table. Avoid salting water you boil pasta in. Avoid salt in recipes in cooking. Cooking methods such as this plus avoiding pre-processed foods will help lower the sodium in your diet.

Member: I am taking Ziac for high blood pressure, usually around 160/90 in the morning, but lower in the evening 137/84. Is there anything I can do to lower the morning BP? I take Ziac and an aspirin in the morning and my Zocor and vitamins in the evening.

Valone: I would suggest you keep a record of your blood pressure readings, morning and evening for several days, or even a week. And take those readings into your doctor. From that information it may be he or she will change your prescriptions or change something to help you lower that early morning blood pressure. But again, this should be discussed with your physician.

Member: Are the blood pressure machines in the drugstores accurate?

Valone: Those machines are used by hundreds of people for screening only. The cuff is one size fits all, which is inappropriate for everyone. If you have a very large arm or very small arm they will be inaccurate. If you are looking for an accurate reading, have someone trained do it, like in your doctor's office with a stethoscope and an appropriately sized cuff. If you are attempting to follow your blood pressure at home, I suggest you buy your own arm cuff and monitor. Omron makes one that I recommend. Always avoid the monitors that use a wrist or finger cuff, as those are generally inaccurate.

Member: I take Toprol-XL for blood pressure and pvc's. At times I can feel my heart beat in my head (pounding). Is this blood pressure or something else?

Valone: I recommend you see your physician to illicit his or her help in determining this.

And perhaps it's time for a complete physical evaluation as well. There's no way to know for sure without a physical exam.

Member: What is a reason that a person's blood pressure becomes erratic? My mother's would be very low, like 100/48, and after the doctor took her off the water pill, 189/0.

Valone: If that's the only change that was made, then I would have to assume the diuretic was holding her blood pressure down, in which case it was doing what it was designed to do. I can't be sure if she was taking the diuretic for some other reason or not, but perhaps it was masking the high blood pressure while she was on it. I recommend you speak with her physician to get some input to the question.

Member: My husband's blood pressure with him taking medication runs 136/94. Sometimes the top number is a little higher, but this is an average. Should his physician be trying to get it lower?

Valone: Current research suggests that blood pressure be treated to bring it into range preferably below 140/90 but preferably below 135/85. Not all physicians have jumped on board this philosophy but gradually more and more physicians want to bring blood pressure into the lower ranges, realizing what we know now, that it really helps to have it below 135/85. That's usually alright, as long as it does not go above 135/85. Generally young adults have it in a range as low as 100/60, but really as we get older we want to keep it 135/85 and below that.

Moderator: What about the person who has a usually low blood pressure? What if their blood pressure rises above their norm but still in the general range?

Valone: It may be a temporary diet change or just extra stress in your life.

Moderator: What role does stress play in hypertension?

Valone: We know that people under a great amount of stress, or lasts over a long period of time, are at risk for developing high blood pressure. It puts your body in the mode of "fight or flight." There is no fight and then it still stays in that mode. Blood pressure goes up to accommodate that.

Member: If I went from two packs of cigarettes a day to four cigarettes a day, would the withdrawal itself cause high blood pressure?

Valone: Even if it did, it's probably a better tradeoff than to smoke as much as you are smoking. Smoking is the number one worst thing you can do for your health, in my opinion, and in the opinion of many other physicians.

Member: How important is following a salt-restricted diet when the medications are doing a great job?

Valone: It's still important. Over time your blood pressure can creep up and require more medication. Whereas if you work on exercise, lowering stress, and improving diet, you can prevent the need for more medication and avoid more elevation in your blood pressure.

Member: Does taking extra calcium supplements help to lower blood pressure?

Valone: It could not hurt within reason. But generally a multivitamin with a mineral supplement once per day is generally all that's recommended as far as vitamins go. The addition of potassium (like in bananas) can help, too. Many years ago, all we had to treat high blood pressure was potassium.

Member: I was recently diagnosed having high blood pressure -- I am on Atenolol 50 mg. I sometimes forget to take my tablets, as I still need to get into the routine. I would like to be able to recognize the symptoms when my BP is high. I am noticing some signs, e.g., ringing in my ears, tearful eyes for no reason, feeling a facial hot flush, strong palpitation, slight dizziness, pain at the back of my neck -- are these signs of high blood pressure?

Valone: Good question. The reason the medical community is so concerned about high blood pressure and hypertension is that generally there are NO symptoms. This is why we call it the "silent killer." The symptoms you mentioned may or may not be related. So I suggest you talk with your physician. And figure out some way to be sure you are taking your medication daily.

Member: Does co Q10 help lower blood pressure?

Valone: I could not say yes or no. Individuals vary in their response to medication and to supplements. If it were to help at all, it probably would not make a significant difference in your blood pressure.

Member: I am being treated for hypertension (under control). I am 59 years old and slightly overweight. Is it possible to be able to cure hypertension?

Valone: It's possible that should you lose the weight and return to a normal weight that your blood pressure would come down some -- perhaps a lot. Generally we don't look at hypertension as something that can be "cured" but just something that can be controlled.

Member: I am 29 and was diagnosed of high BP five years ago. Started off with amlodipine and enalapril maleate. Discontinued the latter during pregnancy, and was recommended amlodipine twice a day, and aquazide once a day. Took this medication regularly for about a month, after which I discontinued it out of sheer boredom, and also because I wasn't feeling the high BP symptoms any more. It is now nearly a year since I have had any medication for BP. I know that it is dangerous to do this, but am just feeling disinclined to pop pills. What should I do? I am scared to approach my doctor lest he get upset, so, can I just go back and have amlodipine twice a day and aquazide once a day, as he advised a year ago? I monitor my BP at home and it ranges between 155/135 to a perfectly normal 120/80. Please advise.

Valone: I advise you see your physician, admit what you did (come clean), and go from there on his recommendation. Do take your readings so he can see the trend and design a plan for you to follow. For most there are no symptoms of hypertension. You may have had some in the past, but you can't rely on symptoms to tell you. It is so important you get back on your doctor's plan and discuss any concerns with him, especially changing medications.

Member: How does grief affect high blood pressure?

Valone: Grief is an intense emotional response, which is also a huge stress. That transitional time at a period of the death of someone you love can elevate stress and therefore blood pressure. It does not happen to everyone, but grief can increase blood pressure due to the stress.

Moderator: What are the five most important lifestyle changes we should make to manage our blood pressure?

Valone: My top five ways to decrease your blood pressure:

  1. Quit smoking.
  2. Exercise.
  3. Lose weight.
  4. Increase fruits and vegetables in your diet.
  5. Decrease the sodium in your diet.

Moderator: Sounds like a plan for a healthy life.

Valone: Pretty simple!

Moderator: Are some people still going to need medication even with lifestyle adjustments?

Valone: Fewer will need medication if they do lifestyle adjusting BEFORE they end up with hypertension. It's always best to prevent rather than treat later. But even despite people's best intentions, there will be those who have a genetic predisposition to hypertension and may still need to be treated medically.

Member: Can meditation help lower blood pressure?

Valone: Absolutely. I highly recommend meditation. It costs nothing. It's the best stress reliever I can think of besides exercise. And studies have shown that meditation can help in lowering blood pressure.

Member: Exercise -- does it have to be aerobic to help lower the blood pressure or can it be something like yoga?

Valone: Yoga is excellent. But we also prefer some aerobic activity in the week if at all possible. It's important to keep that heart muscle in good shape. Consider a walk on your lunch hour.

Moderator: What are the best drugs for treating hypertension?

Valone: The only best drug for treating hypertension is the one that works for you with the least number of side effects. There are many medications on the market now for the treatment of hypertension, but it can take time to find the one that works best for you. Often it's a little of trial and error, experimentation, and even luck. So for those who have difficulty finding a medication that works: Be patient, work closely with your doctor, and work on your lifestyle management decisions.

Member: Is it more common for men or women to get hypertension?

Valone: Hypertension shows no preference for men or women. Although most cases occur over the age of 50, there are a growing number of much younger folks who are hypertensive.

Moderator: Nancy, we are almost out of time. Before we wrap up for today, do you have any final comments for us?

Valone: I would like to stress how important it is to follow a healthy lifestyle, not just for prevention or treatment of hypertension. In terms of overall life fulfillment it's essential to find time for ourselves, eat right, and put ourselves first as far as finding time to take good care of ourselves.

  1. Don't smoke.
  2. Lose weight.
  3. Eat a healthy diet.
  4. See your physician once per year for a checkup.
  5. Have fun! It's a great stress release.

Moderator: We are out of time. I'm sorry we couldn't get to all of your great questions. Thank you, Nancy Valone, and thank you members for joining us today. For more information, please visit Nancy on the hypertension message board here at WebMD.

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