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False: You are more likely to get high blood pressure if it runs in your family, but that doesn't mean you must get it. Your chance of
getting high blood pressure is also greater if you're older or an African American. But high blood pressure is NOT an inevitable part of
aging and everyone can take steps to prevent the disease--the steps are given in answer 1.
3 Young adults don't get high blood pressure.
False: About 15 percent of those ages 18-39 are among the 50 million Americans with high blood pressure. Once you have high blood
pressure you have it for the rest of your life. So start now to prevent it.
4 High blood pressure has no symptoms.
True: High blood pressure, or "hypertension," usually has no symptoms. In fact it is often called the "silent killer." You can have high
blood pressure and feel fine. That's why it's important to have your blood pressure checked--it's a simple test.
5 Stress causes high blood pressure.
False: Stress does make blood pressure go up but only temporarily. Ups and downs in blood pressure are normal. Run for a bus and your
pressure rises; sleep and it drops. Blood pressure is the force of blood against the walls of arteries. Blood pressure becomes dangerous
when it's always high. That harms your heart and blood vessels. So what does cause high blood pressure? In the vast majority of cases,
a single cause is never found
6 High blood pressure is not life-threatening.
False: High blood pressure is the main cause of stroke and a factor in the development of heart disease and kidney failure.
7 Blood pressure is high when it's at or over 140/90 mm Hg.
True: But even blood pressures slightly under 140/90 mm Hg can increase your risk of heart disease or stroke.
8 If you're overweight, you are two to six times more likely to develop high blood pressure.
True: As weight increases, so does blood pressure. It's important to stay at a healthy weight. If you need to reduce try to lose 1/2 to 1
pound a week. Choose foods low in fat (especially saturated fat) since fat is high in calories. Even if you're at a good weight, the
healthiest way to eat is low fat, low cholesterol.
9 You have to exercise vigorously every day to improve your blood pressure and heart health.
False: Studies show that even a little physical activity helps prevent high blood pressure and strengthens your heart. Even among the
overweight, those who are active have lower blood pressures than those who aren't. It's best to do some activity for 30 minutes most
days. Walk, garden or bowl. If you don't have a 30-minute period, do something for 15 minutes twice a day. Every bit helps--so make
activity part of your daily routine.
10 Americans eat two to three times more salt and sodium than they need.
True: Americans eat way too much salt and sodium. And some people, such as many African Americans, are especially sensitive to
salt. Salt is made of sodium and chloride and it's mostly the sodium that affects blood pressure. Salt is only one form of sodium--there
are others. So you need to watch your use of both salt and sodium. That includes what's added to foods at the table and in cooking and
what's already in processed foods and snacks. Americans, especially people with high blood pressure, should eat no more than about 6
grams of salt a day, which equals about 2,400 milligrams of sodium.
11 Drinking alcohol lowers blood pressure.
False: Drinking too much alcohol can raise blood pressure. If you drink have no more than two drinks a day. The "Dietary Guidelines"
recommend that for overall health, women should limit their alcohol to no more than one drink a day. A drink would be 1.5 ounces of
80 proof whiskey, or 5 ounces of wine, or 12 ounces of beer.
12 High blood pressure has no cure.
True: But high blood pressure can be treated and controlled. Treatment usually includes lifestyle changes--losing weight, if overweight;
becoming physically active; limiting salt and sodium; and avoiding drinking excess alcohol--and, if needed, medication. But the best
way to avoid the dangers of high blood pressure is to prevent the condition.
Prepared by the National Heart, Lung, and Blood Institute, National Institutes of Health
False: About 15 percent of those ages 18-39 are among the 50 million Americans with high blood pressure. Once you have high blood
pressure you have it for the rest of your life. So start now to prevent it.
4 High blood pressure has no symptoms.
True: High blood pressure, or "hypertension," usually has no symptoms. In fact it is often called the "silent killer." You can have high
blood pressure and feel fine. That's why it's important to have your blood pressure checked--it's a simple test.
5 Stress causes high blood pressure.
False: Stress does make blood pressure go up but only temporarily. Ups and downs in blood pressure are normal. Run for a bus and your
pressure rises; sleep and it drops. Blood pressure is the force of blood against the walls of arteries. Blood pressure becomes dangerous
when it's always high. That harms your heart and blood vessels. So what does cause high blood pressure? In the vast majority of cases,
a single cause is never found
6 High blood pressure is not life-threatening.
False: High blood pressure is the main cause of stroke and a factor in the development of heart disease and kidney failure.
7 Blood pressure is high when it's at or over 140/90 mm Hg.
True: But even blood pressures slightly under 140/90 mm Hg can increase your risk of heart disease or stroke.
8 If you're overweight, you are two to six times more likely to develop high blood pressure.
True: As weight increases, so does blood pressure. It's important to stay at a healthy weight. If you need to reduce try to lose 1/2 to 1
pound a week. Choose foods low in fat (especially saturated fat) since fat is high in calories. Even if you're at a good weight, the
healthiest way to eat is low fat, low cholesterol.
9 You have to exercise vigorously every day to improve your blood pressure and heart health.
False: Studies show that even a little physical activity helps prevent high blood pressure and strengthens your heart. Even among the
overweight, those who are active have lower blood pressures than those who aren't. It's best to do some activity for 30 minutes most
days. Walk, garden or bowl. If you don't have a 30-minute period, do something for 15 minutes twice a day. Every bit helps--so make
activity part of your daily routine.
10 Americans eat two to three times more salt and sodium than they need.
True: Americans eat way too much salt and sodium. And some people, such as many African Americans, are especially sensitive to
salt. Salt is made of sodium and chloride and it's mostly the sodium that affects blood pressure. Salt is only one form of sodium--there
are others. So you need to watch your use of both salt and sodium. That includes what's added to foods at the table and in cooking and
what's already in processed foods and snacks. Americans, especially people with high blood pressure, should eat no more than about 6
grams of salt a day, which equals about 2,400 milligrams of sodium.
11 Drinking alcohol lowers blood pressure.
False: Drinking too much alcohol can raise blood pressure. If you drink have no more than two drinks a day. The "Dietary Guidelines"
recommend that for overall health, women should limit their alcohol to no more than one drink a day. A drink would be 1.5 ounces of
80 proof whiskey, or 5 ounces of wine, or 12 ounces of beer.
12 High blood pressure has no cure.
True: But high blood pressure can be treated and controlled. Treatment usually includes lifestyle changes--losing weight, if overweight;
becoming physically active; limiting salt and sodium; and avoiding drinking excess alcohol--and, if needed, medication. But the best
way to avoid the dangers of high blood pressure is to prevent the condition.
Prepared by the National Heart, Lung, and Blood Institute, National Institutes of Health
Lessening the Pressure:
Array of Drugs Tames Hypertension
Regular Checkups Essential to Catch Symptom Less Condition
by Paula Kurtzweil
The "silent killer"--hypertension, or high blood pressure--snuck up on my mother when she was in her 40s,
making its presence known by causing congestive heart failure and resulting in several lengthy hospital stays.
Though her blood pressure measured as high as 250/150 during those initial touch-and-go days, she's
maintained a much-closer-to-normal blood pressure for the past 30 years, thanks to daily doses of
antihypertensive drugs.
Today's range of drugs for treating high blood pressure makes it possible for people like my mother and the
nearly 50 million other Americans who suffer from high blood pressure to lead normal, healthy lives well into their
senior years. Exercise, regular blood pressure checks, healthy eating, maintenance of a healthy body weight, and
other lifestyle changes can make a big difference, too.
Without these treatments, people with consistently high blood pressure face increased risks for heart attack,
stroke and kidney disease. High blood pressure also can cause blood vessels on the eye's retina to clog,
eventually bursting and possibly damaging parts of the retina and impairing vision.
What Is Blood Pressure?
Blood pressure is the force of blood against the blood vessel wall. High blood pressure occurs when there is
increased tension or pressure in the arteries. The greater the pressure, the harder the heart has to work.
Blood pressure is measured with a device called a sphygmomanometer, which can be either manual or
electronic. The blood pressure reading is written as a fraction: for example, 120/80.
The first number is the systolic pressure, which is the point at which the heart contracts to push the blood out to
the rest of the body. When blood pressure is taken manually, this is the number at which a person taking the
blood pressure first hears a pulse through the stethoscope. When an electronic device is used, the number
appears on the display.
The second number is called the diastolic pressure, which represents the lowest point in the pressure of blood--
right before another squirt of blood enters the arteries. When the blood pressure is measured manually, this
number is the point at which the person listening through the stethoscope stops hearing a pulse. On an electronic
device, this number also automatically appears on the display.
Many people think that 120/80 is the perfect or normal blood pressure. But, says Robert Fenichel, M.D., deputy
director of FDA's division of cardiovascular and renal drug products, "If your pressure is lower than that, good for
you."
Deciding What's High
Elevated blood pressure rarely makes itself known; it usually has no symptoms. That's why it's often referred to as
the silent killer. Feeling nervous or tense, for example, doesn't necessarily translate into elevated blood pressure.
Getting periodic blood pressure checks is the only way to catch high blood pressure early.
According to the National Heart, Lung, and Blood Institute of the National Institutes of Health, a blood pressure
reading consistently higher than 140/90 is a sign that the blood pressure needs to be brought under control.
Most doctors don't diagnose a person with high blood pressure on the basis of only one reading. People who find
a visit to the doctor's office unnerving can have "white-coat hypertension," blood pressure that is only high when
taken in the doctor's office. ("White coat" refers to the ubiquitous white lab coats many health professionals wear.)
Others may have "labile hypertension," blood pressure that gets slightly elevated in certain situations but which is
normal most of the time.
To rule these out, doctors may take a patient's blood pressure later during the office visit and ask the patient to
come back for two more visits, taking two readings during each of those visits. Many doctors also ask patients
with elevated blood pressure to have their blood pressure checked in a setting other than a medical one. With one
of the many electronic blood pressure measuring devices that consumers can buy without a doctor's prescription,
patients often can check and record their blood pressure at home. To get as accurate a reading as possible, the
doctor may ask the patient to bring the device in to the office to make sure it is calibrated properly. This can usually
be done by comparing the device's readings with readings taken at the same time with the doctor's blood
pressure equipment.
If a patient has consistently high readings in and out of the medical setting, the doctor will decide what type of
treatment is appropriate: diet modification, increased exercise, medicine, or a combination of these.
Treating Hypertension
Treatment can vary with the level of elevation of the blood pressure, as well as the patient's age and health. (See
"Treating High Blood Pressure.") According to FDA's Fenichel, sometimes lifestyle changes can reduce blood
pressure by 5 points or so. They include stopping smoking, reducing alcohol intake, losing excess weight, and
making certain dietary changes, such as reducing sodium intake and possibly increasing potassium, calcium
and magnesium intake. (See "Diet and Blood Pressure.") Some experts also recommend exercise and relaxation
techniques, such as meditation.
"But," Fenichel says, "treatment with drugs is the only effective approach for attaining larger reductions in blood
pressure."
FDA has approved numerous drugs for treating hypertension. These drugs work in different ways but the end
result--reducing blood pressure--is the same.
Some of the most commonly used drugs to treat high blood pressure are:
• Diuretics. Sometimes called "water pills," these drugs flush excess water and sodium from the body by
increasing urination. This reduces the amount of fluid in the blood and flushes sodium from the blood vessels so
that they can open wider, increasing blood flow and thus reducing the blood's pressure against the vessels. Often
diuretics are used in combination with other high blood pressure drugs. Types of diuretics include thiazides, such
as Diuril (chlorothiazide) and Esidrex (hydrochlorothiazide); potassium-sparing diuretics, such as Aldactone
(spironolactone); and loop diuretics, such as Lasix (furosemide).
• Beta blockers. These drugs slow the heartbeat by blocking the effect of nerve impulses to the heart and
blood vessels, thereby lessening the burden on the heart. Beta blockers include Inderal (propranolol), Lopressor
(metoprolol), and Tenormin (atenolol).
• ACE (angiotensin-converting enzyme) inhibitors. These inhibit formation of the hormone angiotensin II, which
causes blood vessels to narrow, thus increasing blood pressure. ACE inhibitors include Altace (ramipril),
Capoten (captopril), and Zestril (lisinopril).
• Calcium channel blockers. These prevent calcium from entering the muscle cells of the heart and blood
vessels, thus relaxing blood vessels and decreasing blood pressure. Some calcium channel blockers are
Procardia (nifedipine), Isoptin (verapamil) and Cardiazem (diltiazem).
• Alpha-beta blockers. These combine the actions of alpha blockers, which relax blood vessels, and beta
blockers, which slow the heartbeat. The dual effect reduces the amount--and thus pressure--of blood through
blood vessels. Alpha-beta blockers include Normodyne and Trandate (both labetalol).
Often, combinations of two drugs from different classes are used to improve the drugs' effectiveness.
Many doctors begin newly diagnosed hypertensive patients with diuretics or beta blockers. The Sixth Report of the
Joint National Committee (JNC) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure,
released by NIH's National Heart, Lung, and Blood Institute in November 1997, recommends diuretics or beta
blockers as the first line of treatment. However, based on a patient's situation--for example, use of other
medicines--doctors may choose to start treatment with another antihypertensive drug.
Some specifics to JNC's first-line recommendation are noted in the report--for example, it recommends that in
African Americans, one of the groups most at risk for hypertension, diuretics alone should be the first agent of
choice--provided there are not other conditions that prohibit their use--because of this group's increased
sensitivity to salt. For hypertensive people with diabetes or kidney disease, the guidelines recommend that initial
drug treatments include ACE inhibitors.
Finding What Works
Like most drugs, blood pressure medicines can have side effects, ranging from the unpleasant--such as skin
rash, sleepiness and weight gain--to the severe, including depression, hallucinations, heart dysfunction, and liver
disease. Patients who begin a drug treatment and develop symptoms that they did not have before should
discuss them with their doctors. With the great variety of medicines, it is likely that another antihypertensive drug or
dosage level can help control blood pressure with few or no side effects.
In my mother's 30-year history of high blood pressure, she's switched drugs only a few times or varied the
dosages, mainly to gain better control of her blood pressure. But she's never had any qualms about taking the
medicine.
"I had a lot of relatives who probably had the same problem I do, but they died early because they didn't have the
medicines that they do now," she says. "I'm thankful to have them. I wouldn't be around enjoying the good life that I
do."
Paula Kurtzweil is a member of FDA's public affairs staff. Judith Willis, also a member of FDA's public affairs staff,
contributed to this article.
Who's at Risk?
Those at greater risk for high blood pressure, according to the National Heart, Lung, and Blood Institute, include:
• African Americans
• people with a family history of high blood pressure
• people who drink alcoholic beverages excessively
• people who are physically inactive
In addition, as many as 65 percent of people with diabetes have high blood pressure.
--P.K.
Diet and Blood Pressure
If you are overweight and have high blood pressure, a first step is to lose weight, usually through a combination of
calorie reduction and increased physical activity. Eating certain kinds of food and avoiding others also may help
you reduce your blood pressure or keep it from getting high in the first place.
Some dietary factors to consider in preventing and treating hypertension are:
Salt and Sodium
Many studies in diverse populations have shown that a high-sodium intake is associated with higher blood
pressure. The National Academy of Sciences, the American Heart Association, and the federal government's
"Dietary Guidelines for Americans" recommend limiting sodium intake to 2,400 milligrams a day.
For cooking at home, low-salt and low-sodium cookbooks abound. Or simply spare the salt and, if you like,
substitute other spices and flavorings, such as pepper, garlic, ginger, onion, or lemon juice. Watch out for some
flavorings and ingredients, such as monosodium glutamate (Accent, for example), soy sauce, and some spice
mixtures that contain large quantities of sodium.
Also, many processed foods are high in salt and other sodium-containing ingredients.
You can tell how much sodium is in packaged foods by reading the Nutrition Facts panel on food labels. There,
manufacturers must list the amount of sodium (in milligrams) in a serving of the food and show (as a percentage)
how that amount contributes to the daily reference value for sodium, which is 2,400 milligrams.
To quickly identify foods with lower sodium contents, look for products with label claims like "no salt added," "low
sodium" or "two-thirds less salt." These claims must meet government-enforced definitions, so that they mean
the same for any product on which they appear.
If you eat out a lot, you may want to ask restaurants to hold the salt in your orders. Some may already offer lower
sodium foods on their menus, so look for menu items with claims like "low sodium." Nutrition claims on menus
must mean the same as they do on packaged food. (See "Today's Special: Nutrition Information" in the May-June
1997 FDA Consumer.)
Before using salt substitutes, which contain potassium chloride, check with your doctor just to make sure they're
all right for you. In general, an increase in potassium can help attain a normal blood pressure, but there may be
other factors, such as medicines you are taking and other health factors, that need to be considered.
(For more on salt in the diet, see "A Pinch of Controversy Shakes Up Dietary Salt" in the November-December
1997 FDA Consumer.)
Alcohol
Some studies show that low to moderate consumption of alcohol, especially wine, may help reduce heart
disease risks. But excessive amounts of alcohol are known to raise blood pressure. Also, if you're trying to lose
weight, you need to remember that alcoholic beverages are calorie dense, providing about 100 to 145 calories a
drink but little nutritional benefit. Ask your doctor what is best for you when it comes to alcohol consumption.
Calcium and Magnesium
Some studies have shown that people whose intakes of calcium are low are more likely to have high blood
pressure, but a link has not been proven. The same is true of magnesium. Though the science is uncertain at this
time, it can't hurt to eat a diet with sufficient calcium and magnesium. Good sources of calcium are dairy products,
such as milk, yogurt and cheese. Choose low-fat or nonfat versions of these foods. Other sources of calcium are
canned salmon, collard greens, broccoli, soy milk, tofu, and calcium-fortified orange juice and grain products.
Good sources of magnesium are whole grains, green leafy vegetables, nuts, and legumes.
Check the Nutrition Facts panel on food labels to learn how much calcium is in a food. The amount of calcium in a
serving and how that amount contributes to the daily reference value for calcium must be listed for all foods.
Information about a food's magnesium content may be offered voluntarily.
DASH Diet
In 1997, the National Heart, Lung, and Blood Institute of the National Institutes of Health released an eating plan
that was found in clinical studies to lower systolic blood pressure by 5.5 points and diastolic pressure by 3.
According to researchers, blood pressure reductions were seen within two weeks of starting the meal plan and
maintained for the rest of the eight weeks of study by men, women, whites and minorities alike. This meal plan,
called Dietary Approaches to Stop Hypertension, or DASH for short, calls for a food intake similar to that
recommended in the federal government's "Dietary Guidelines for Americans."
More information on the DASH diet is available on the Internet from the National Heart, Lung, and Blood Institute,
which is part of the National Institutes of Health.
This meal plan is based on 2,000 calories a day. Depending on your calorie needs, your number of daily servings
may vary from those listed. Consult your doctor or a dietitian to determine your calorie needs.
Food Group Daily Servings Serving Size
Grains and grain products 7 to 8 1 slice bread
1/2 to 1-1/4 cup dry cereal
1/2 cup cooked rice, pasta, or cereal
Vegetables 4 to 5 1 cup raw leafy vegetables
1/2 cup cooked vegetable
6 oz vegetable juice
Fruits 4 to 5 6 oz fruit juice
1/4 cup dried fruit
1 medium fruit
1/2 cup fresh, frozen or canned fruit
Low-fat or nonfat dairy foods 2 to 3 8 oz milk
1 cup yogurt
1-1/2 oz cheese
Meats, poultry, fish 2 or fewer 3 oz cooked lean meat
(skinless white meat ), or fish
Nuts, seeds and dry beans 4 to 5 per week 1/3 cup nuts
2 Tbsp seeds
1/2 cup legumes
Fats and oils 2 to 3 1 tsp soft margarine or butter
1 tsp regular mayonnaise or
1 Tbsp low-fat mayonnaise
1 Tbsp salad dressing or
2 Tbsp "light" salad dressing
1 tsp oil (olive, corn, canola, safflower, or other)
Sweets 5 per week 1 Tbsp maple syrup, sugar or jelly
1/2 cup sherbet
3 pieces of hard candy
(Source: National Heart, Lung, and Blood Institute)
For More Information
National Heart, Lung, and Blood Institute
Information Center
P.O. Box 30105
Bethesda, MD 20824-0105
1-800-575-WELL (1-800-575-9355)
www.nhlbi.nih.gov/hbp/index.html
American Heart Association
7272 Greenville Ave.
Dallas, TX 75231
1-800-AHA-USA1 (1-800-242-8721)
www.americanheart.org
Hypertension Network
www.bloodpressure.com [Note, 11-18-2005: The URL for this organization is no longer active.]
Questions concerning the editorial content of FDA Consumer should be directed to FDA's Office of Public Affairs.
Array of Drugs Tames Hypertension
Regular Checkups Essential to Catch Symptom Less Condition
by Paula Kurtzweil
The "silent killer"--hypertension, or high blood pressure--snuck up on my mother when she was in her 40s,
making its presence known by causing congestive heart failure and resulting in several lengthy hospital stays.
Though her blood pressure measured as high as 250/150 during those initial touch-and-go days, she's
maintained a much-closer-to-normal blood pressure for the past 30 years, thanks to daily doses of
antihypertensive drugs.
Today's range of drugs for treating high blood pressure makes it possible for people like my mother and the
nearly 50 million other Americans who suffer from high blood pressure to lead normal, healthy lives well into their
senior years. Exercise, regular blood pressure checks, healthy eating, maintenance of a healthy body weight, and
other lifestyle changes can make a big difference, too.
Without these treatments, people with consistently high blood pressure face increased risks for heart attack,
stroke and kidney disease. High blood pressure also can cause blood vessels on the eye's retina to clog,
eventually bursting and possibly damaging parts of the retina and impairing vision.
What Is Blood Pressure?
Blood pressure is the force of blood against the blood vessel wall. High blood pressure occurs when there is
increased tension or pressure in the arteries. The greater the pressure, the harder the heart has to work.
Blood pressure is measured with a device called a sphygmomanometer, which can be either manual or
electronic. The blood pressure reading is written as a fraction: for example, 120/80.
The first number is the systolic pressure, which is the point at which the heart contracts to push the blood out to
the rest of the body. When blood pressure is taken manually, this is the number at which a person taking the
blood pressure first hears a pulse through the stethoscope. When an electronic device is used, the number
appears on the display.
The second number is called the diastolic pressure, which represents the lowest point in the pressure of blood--
right before another squirt of blood enters the arteries. When the blood pressure is measured manually, this
number is the point at which the person listening through the stethoscope stops hearing a pulse. On an electronic
device, this number also automatically appears on the display.
Many people think that 120/80 is the perfect or normal blood pressure. But, says Robert Fenichel, M.D., deputy
director of FDA's division of cardiovascular and renal drug products, "If your pressure is lower than that, good for
you."
Deciding What's High
Elevated blood pressure rarely makes itself known; it usually has no symptoms. That's why it's often referred to as
the silent killer. Feeling nervous or tense, for example, doesn't necessarily translate into elevated blood pressure.
Getting periodic blood pressure checks is the only way to catch high blood pressure early.
According to the National Heart, Lung, and Blood Institute of the National Institutes of Health, a blood pressure
reading consistently higher than 140/90 is a sign that the blood pressure needs to be brought under control.
Most doctors don't diagnose a person with high blood pressure on the basis of only one reading. People who find
a visit to the doctor's office unnerving can have "white-coat hypertension," blood pressure that is only high when
taken in the doctor's office. ("White coat" refers to the ubiquitous white lab coats many health professionals wear.)
Others may have "labile hypertension," blood pressure that gets slightly elevated in certain situations but which is
normal most of the time.
To rule these out, doctors may take a patient's blood pressure later during the office visit and ask the patient to
come back for two more visits, taking two readings during each of those visits. Many doctors also ask patients
with elevated blood pressure to have their blood pressure checked in a setting other than a medical one. With one
of the many electronic blood pressure measuring devices that consumers can buy without a doctor's prescription,
patients often can check and record their blood pressure at home. To get as accurate a reading as possible, the
doctor may ask the patient to bring the device in to the office to make sure it is calibrated properly. This can usually
be done by comparing the device's readings with readings taken at the same time with the doctor's blood
pressure equipment.
If a patient has consistently high readings in and out of the medical setting, the doctor will decide what type of
treatment is appropriate: diet modification, increased exercise, medicine, or a combination of these.
Treating Hypertension
Treatment can vary with the level of elevation of the blood pressure, as well as the patient's age and health. (See
"Treating High Blood Pressure.") According to FDA's Fenichel, sometimes lifestyle changes can reduce blood
pressure by 5 points or so. They include stopping smoking, reducing alcohol intake, losing excess weight, and
making certain dietary changes, such as reducing sodium intake and possibly increasing potassium, calcium
and magnesium intake. (See "Diet and Blood Pressure.") Some experts also recommend exercise and relaxation
techniques, such as meditation.
"But," Fenichel says, "treatment with drugs is the only effective approach for attaining larger reductions in blood
pressure."
FDA has approved numerous drugs for treating hypertension. These drugs work in different ways but the end
result--reducing blood pressure--is the same.
Some of the most commonly used drugs to treat high blood pressure are:
• Diuretics. Sometimes called "water pills," these drugs flush excess water and sodium from the body by
increasing urination. This reduces the amount of fluid in the blood and flushes sodium from the blood vessels so
that they can open wider, increasing blood flow and thus reducing the blood's pressure against the vessels. Often
diuretics are used in combination with other high blood pressure drugs. Types of diuretics include thiazides, such
as Diuril (chlorothiazide) and Esidrex (hydrochlorothiazide); potassium-sparing diuretics, such as Aldactone
(spironolactone); and loop diuretics, such as Lasix (furosemide).
• Beta blockers. These drugs slow the heartbeat by blocking the effect of nerve impulses to the heart and
blood vessels, thereby lessening the burden on the heart. Beta blockers include Inderal (propranolol), Lopressor
(metoprolol), and Tenormin (atenolol).
• ACE (angiotensin-converting enzyme) inhibitors. These inhibit formation of the hormone angiotensin II, which
causes blood vessels to narrow, thus increasing blood pressure. ACE inhibitors include Altace (ramipril),
Capoten (captopril), and Zestril (lisinopril).
• Calcium channel blockers. These prevent calcium from entering the muscle cells of the heart and blood
vessels, thus relaxing blood vessels and decreasing blood pressure. Some calcium channel blockers are
Procardia (nifedipine), Isoptin (verapamil) and Cardiazem (diltiazem).
• Alpha-beta blockers. These combine the actions of alpha blockers, which relax blood vessels, and beta
blockers, which slow the heartbeat. The dual effect reduces the amount--and thus pressure--of blood through
blood vessels. Alpha-beta blockers include Normodyne and Trandate (both labetalol).
Often, combinations of two drugs from different classes are used to improve the drugs' effectiveness.
Many doctors begin newly diagnosed hypertensive patients with diuretics or beta blockers. The Sixth Report of the
Joint National Committee (JNC) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure,
released by NIH's National Heart, Lung, and Blood Institute in November 1997, recommends diuretics or beta
blockers as the first line of treatment. However, based on a patient's situation--for example, use of other
medicines--doctors may choose to start treatment with another antihypertensive drug.
Some specifics to JNC's first-line recommendation are noted in the report--for example, it recommends that in
African Americans, one of the groups most at risk for hypertension, diuretics alone should be the first agent of
choice--provided there are not other conditions that prohibit their use--because of this group's increased
sensitivity to salt. For hypertensive people with diabetes or kidney disease, the guidelines recommend that initial
drug treatments include ACE inhibitors.
Finding What Works
Like most drugs, blood pressure medicines can have side effects, ranging from the unpleasant--such as skin
rash, sleepiness and weight gain--to the severe, including depression, hallucinations, heart dysfunction, and liver
disease. Patients who begin a drug treatment and develop symptoms that they did not have before should
discuss them with their doctors. With the great variety of medicines, it is likely that another antihypertensive drug or
dosage level can help control blood pressure with few or no side effects.
In my mother's 30-year history of high blood pressure, she's switched drugs only a few times or varied the
dosages, mainly to gain better control of her blood pressure. But she's never had any qualms about taking the
medicine.
"I had a lot of relatives who probably had the same problem I do, but they died early because they didn't have the
medicines that they do now," she says. "I'm thankful to have them. I wouldn't be around enjoying the good life that I
do."
Paula Kurtzweil is a member of FDA's public affairs staff. Judith Willis, also a member of FDA's public affairs staff,
contributed to this article.
Who's at Risk?
Those at greater risk for high blood pressure, according to the National Heart, Lung, and Blood Institute, include:
• African Americans
• people with a family history of high blood pressure
• people who drink alcoholic beverages excessively
• people who are physically inactive
In addition, as many as 65 percent of people with diabetes have high blood pressure.
--P.K.
Diet and Blood Pressure
If you are overweight and have high blood pressure, a first step is to lose weight, usually through a combination of
calorie reduction and increased physical activity. Eating certain kinds of food and avoiding others also may help
you reduce your blood pressure or keep it from getting high in the first place.
Some dietary factors to consider in preventing and treating hypertension are:
Salt and Sodium
Many studies in diverse populations have shown that a high-sodium intake is associated with higher blood
pressure. The National Academy of Sciences, the American Heart Association, and the federal government's
"Dietary Guidelines for Americans" recommend limiting sodium intake to 2,400 milligrams a day.
For cooking at home, low-salt and low-sodium cookbooks abound. Or simply spare the salt and, if you like,
substitute other spices and flavorings, such as pepper, garlic, ginger, onion, or lemon juice. Watch out for some
flavorings and ingredients, such as monosodium glutamate (Accent, for example), soy sauce, and some spice
mixtures that contain large quantities of sodium.
Also, many processed foods are high in salt and other sodium-containing ingredients.
You can tell how much sodium is in packaged foods by reading the Nutrition Facts panel on food labels. There,
manufacturers must list the amount of sodium (in milligrams) in a serving of the food and show (as a percentage)
how that amount contributes to the daily reference value for sodium, which is 2,400 milligrams.
To quickly identify foods with lower sodium contents, look for products with label claims like "no salt added," "low
sodium" or "two-thirds less salt." These claims must meet government-enforced definitions, so that they mean
the same for any product on which they appear.
If you eat out a lot, you may want to ask restaurants to hold the salt in your orders. Some may already offer lower
sodium foods on their menus, so look for menu items with claims like "low sodium." Nutrition claims on menus
must mean the same as they do on packaged food. (See "Today's Special: Nutrition Information" in the May-June
1997 FDA Consumer.)
Before using salt substitutes, which contain potassium chloride, check with your doctor just to make sure they're
all right for you. In general, an increase in potassium can help attain a normal blood pressure, but there may be
other factors, such as medicines you are taking and other health factors, that need to be considered.
(For more on salt in the diet, see "A Pinch of Controversy Shakes Up Dietary Salt" in the November-December
1997 FDA Consumer.)
Alcohol
Some studies show that low to moderate consumption of alcohol, especially wine, may help reduce heart
disease risks. But excessive amounts of alcohol are known to raise blood pressure. Also, if you're trying to lose
weight, you need to remember that alcoholic beverages are calorie dense, providing about 100 to 145 calories a
drink but little nutritional benefit. Ask your doctor what is best for you when it comes to alcohol consumption.
Calcium and Magnesium
Some studies have shown that people whose intakes of calcium are low are more likely to have high blood
pressure, but a link has not been proven. The same is true of magnesium. Though the science is uncertain at this
time, it can't hurt to eat a diet with sufficient calcium and magnesium. Good sources of calcium are dairy products,
such as milk, yogurt and cheese. Choose low-fat or nonfat versions of these foods. Other sources of calcium are
canned salmon, collard greens, broccoli, soy milk, tofu, and calcium-fortified orange juice and grain products.
Good sources of magnesium are whole grains, green leafy vegetables, nuts, and legumes.
Check the Nutrition Facts panel on food labels to learn how much calcium is in a food. The amount of calcium in a
serving and how that amount contributes to the daily reference value for calcium must be listed for all foods.
Information about a food's magnesium content may be offered voluntarily.
DASH Diet
In 1997, the National Heart, Lung, and Blood Institute of the National Institutes of Health released an eating plan
that was found in clinical studies to lower systolic blood pressure by 5.5 points and diastolic pressure by 3.
According to researchers, blood pressure reductions were seen within two weeks of starting the meal plan and
maintained for the rest of the eight weeks of study by men, women, whites and minorities alike. This meal plan,
called Dietary Approaches to Stop Hypertension, or DASH for short, calls for a food intake similar to that
recommended in the federal government's "Dietary Guidelines for Americans."
More information on the DASH diet is available on the Internet from the National Heart, Lung, and Blood Institute,
which is part of the National Institutes of Health.
This meal plan is based on 2,000 calories a day. Depending on your calorie needs, your number of daily servings
may vary from those listed. Consult your doctor or a dietitian to determine your calorie needs.
Food Group Daily Servings Serving Size
Grains and grain products 7 to 8 1 slice bread
1/2 to 1-1/4 cup dry cereal
1/2 cup cooked rice, pasta, or cereal
Vegetables 4 to 5 1 cup raw leafy vegetables
1/2 cup cooked vegetable
6 oz vegetable juice
Fruits 4 to 5 6 oz fruit juice
1/4 cup dried fruit
1 medium fruit
1/2 cup fresh, frozen or canned fruit
Low-fat or nonfat dairy foods 2 to 3 8 oz milk
1 cup yogurt
1-1/2 oz cheese
Meats, poultry, fish 2 or fewer 3 oz cooked lean meat
(skinless white meat ), or fish
Nuts, seeds and dry beans 4 to 5 per week 1/3 cup nuts
2 Tbsp seeds
1/2 cup legumes
Fats and oils 2 to 3 1 tsp soft margarine or butter
1 tsp regular mayonnaise or
1 Tbsp low-fat mayonnaise
1 Tbsp salad dressing or
2 Tbsp "light" salad dressing
1 tsp oil (olive, corn, canola, safflower, or other)
Sweets 5 per week 1 Tbsp maple syrup, sugar or jelly
1/2 cup sherbet
3 pieces of hard candy
(Source: National Heart, Lung, and Blood Institute)
For More Information
National Heart, Lung, and Blood Institute
Information Center
P.O. Box 30105
Bethesda, MD 20824-0105
1-800-575-WELL (1-800-575-9355)
www.nhlbi.nih.gov/hbp/index.html
American Heart Association
7272 Greenville Ave.
Dallas, TX 75231
1-800-AHA-USA1 (1-800-242-8721)
www.americanheart.org
Hypertension Network
www.bloodpressure.com [Note, 11-18-2005: The URL for this organization is no longer active.]
Questions concerning the editorial content of FDA Consumer should be directed to FDA's Office of Public Affairs.
| Blood Pressure Facts |
BLOOD PRESSURE FACTS
| Copyright 2008 ::Blood Pressure In The News |
Blood Pressure News Articles
Check Your High Blood Pressure Prevention IQ
1 There is nothing you can do to prevent high blood pressure.
False: High blood pressure can be prevented with four steps: keep a healthy weight; become physically
active; limit your salt and sodium use; and, if you drink alcoholic beverages, do so in moderation.
2 If your mother or father has high blood pressure, you'll get it.
1 There is nothing you can do to prevent high blood pressure.
False: High blood pressure can be prevented with four steps: keep a healthy weight; become physically
active; limit your salt and sodium use; and, if you drink alcoholic beverages, do so in moderation.
2 If your mother or father has high blood pressure, you'll get it.
Latest News about Blood Pressure
If you have low or high blood pressure, staying up to date on the current and latest news regarding it is very
important.
Researchers within the United States have found that drugs called statins, used in the lowering of levels of
cholesterol can now prevent complications of high blood pressure by lowering it as well.
Using skills for management of stress has also been shown to lower high blood pressure and help seniors lower
and manage their blood pressure. Exercises on breathing deeply and meditating with sessions of response
relaxation tapes being listened to every day for about 15 minutes have had positive outcomes for levels of blood
pressure returning to good ranges in participants.
Being married happily is also showing highly positive results in controlling blood pressure with more negative
results in unhappy couples
Women in the United States are increasingly within the rates of uncontrolled blood pressure, while the rates of men
have been decreasing over the last few years. Suggestions are being made to physicians to start taking a few extra
minutes to pay more attention to their patient’s level of blood pressure readings upon every exam. These slight but
serious problems are often overlooked because the patient is in for other problems not related.
A new wonder type vaccine is being worked on which will help to block receptors of angiotensen II, which lets blood
vessels relax and blood pressure stabilize and could eventually take the place of medications.
Staying current on new research and studies is important. You can meet with your physician and discuss possible
new ways of controlling and maintaining healthy blood pressure rates. Every year more and more medications and
solutions are found for many of our health problems which in the past were not even a reality.
If you have low or high blood pressure, staying up to date on the current and latest news regarding it is very
important.
Researchers within the United States have found that drugs called statins, used in the lowering of levels of
cholesterol can now prevent complications of high blood pressure by lowering it as well.
Using skills for management of stress has also been shown to lower high blood pressure and help seniors lower
and manage their blood pressure. Exercises on breathing deeply and meditating with sessions of response
relaxation tapes being listened to every day for about 15 minutes have had positive outcomes for levels of blood
pressure returning to good ranges in participants.
Being married happily is also showing highly positive results in controlling blood pressure with more negative
results in unhappy couples
Women in the United States are increasingly within the rates of uncontrolled blood pressure, while the rates of men
have been decreasing over the last few years. Suggestions are being made to physicians to start taking a few extra
minutes to pay more attention to their patient’s level of blood pressure readings upon every exam. These slight but
serious problems are often overlooked because the patient is in for other problems not related.
A new wonder type vaccine is being worked on which will help to block receptors of angiotensen II, which lets blood
vessels relax and blood pressure stabilize and could eventually take the place of medications.
Staying current on new research and studies is important. You can meet with your physician and discuss possible
new ways of controlling and maintaining healthy blood pressure rates. Every year more and more medications and
solutions are found for many of our health problems which in the past were not even a reality.