Hypertension: A Lifestyle Disorder Needs a Lifetime of Attention

(Huffington Post) — The term “lifestyle disorder” had to be invented to describe hypertension. Almost no aspect of daily life — diet, sleep, exercise, work and stress — can be implicated. Your blood pressure responds to these things quite sensitively. This implies an optimistic attitude, because for many sufferers, a change in lifestyle serves as good prevention. But optimism is lost if lifestyle changes are not kept up for a lifetime. For millions of patients, the arrival of high blood pressure as they get older comes at a stage when prevention may be too little, too late.

It took a while before lifestyle disorders were recognized for what they are, a product of “normal” living that turns out not to be normal so far as the body is concerned. To previous generations of doctors, a creeping rise in blood pressure, for example, was considered normal with each decade of life. It was overlooked, or shrugged off, that hypertension needs a long span of years to cause damage and that even marginal hypertension — blood pressure on the border of being high — threatens the body almost as much as the full-blown disorder.

Because every cell is affected by the fluid pressure inside your body, let’s look at how a necessary condition turns damaging. Hypertension is publicized as the “silent killer” for its absence of symptoms detected by the afflicted person. The condition may go unnoticed for years, with few if any signs of discomfort — unlike the cartoon character sending his blood pressure through the roof, steam doesn’t come out of your ears, your face doesn’t turn red and you don’t swell up. Generally speaking, nothing hurts.

Hypertension often isn’t seen as the culprit until a serious medical problem appears. It is a dangerous disease in its own right, however, with multiple complications. Hypertension can permanently damage the eyes, lungs, heart or kidneys. Malignant (i.e., highly elevated) blood pressure is deadly: Without treatment fewer than 10 percent of people with malignant hypertension survive for more than 1-2 years.

As to its frequency, high blood pressure is extremely common in the U.S. and throughout the developed world. About 30 percent of adults aged 18 or older in the U.S. have hypertension, about the same percentage as in other developed nations. African Americans have higher levels (42 percent) than non-Hispanic whites (29 percent) and Mexican Americans (26 percent). With the rise in childhood obesity, lack of exercise and poor diet, the age at which blood pressure begins to rise has gotten younger. (There isn’t a simple target blood pressure reading that indicates high blood pressure in children, because what’s considered normal blood pressure changes as children grow.) About half of adults with hypertension don’t have their blood pressure under control.

Blood pressure is the force of circulating blood against the inner walls of blood vessels. The amount of pressure is determined by how much blood your heart pumps, how forcefully your heart is pumping and the amount of resistance to blood flow in your arteries. Arteries are flexible, capable of narrowing or expanding. This isn’t the same, however, as the flexibility of a plastic hose, which responds mechanically to pressure inside it. Arteries are living tissue, and they can expand or contract due to stress or changing emotional states. Blood pressure isn’t steady, either — it normally fluctuates throughout the day. Hypertension is diagnosed as persistently high pressure in the arteries.

Measurement

Blood pressure is generally expressed as two numbers. The first or top number represents the pressure when your heart contracts: the systolic pressure. The second or bottom number represents the pressure when your heart rests between beats: the diastolic pressure. A single high reading isn’t enough for a diagnosis of hypertension. Health care practitioners will generally take a number of readings over several different days before making a diagnosis. Normal blood pressure is considered to be <120 systolic and <80 diastolic. Prehypertension is 120-139 systolic or 80-89 diastolic. High blood pressure, stage 1, is 140-159 systolic or 90-99 diastolic. Stage 2 is >160 systolic or >100 diastolic. Pressure of >180 diastolic or >120 systolic is a hypertensive emergency. This level of hypertension can permanently damage organs, so medical help must be sought immediately.

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