cardiac
HEALTH ON TIME
TM
SPRING 2014
high blood pressure: a public health emergency HIGH BLOOD PRESSURE IS BECOMING A CONCERN FOR MANY
D
octors have known for years that high blood pressure increases the risk for heart disease, stroke, kidney failure, and other serious illnesses. Blood pressure is easy to measure. A wide variety of drugs can effectively lower it. Yet dangerously elevated blood pressure, or hypertension, continues to pose a serious health threat to Americans. Some 77.9 million Americans, or roughly 1 in 3 adults, suffer from hypertension, a number that grows year by year. According to findings from the Framingham Heart Study, 9 out of 10 people will develop high blood pressure at some time in their lives. The problem is serious for all Americans, but especially worrisome for African-Americans, who are at unusually high risk for dying from complications of the condition.
ORGAN DAMAGE DUE TO EXTREME HIGH BLOOD PRESSURE
9 out of 10
people will develop high blood pressure at some time.
Tragically, hypertension often goes unrecognized or untreated. An estimated 17 percent of people with hypertension are unaware they have the condition. Of those with high blood pressure, approximately 75 percent are being treated. About half of those being treated have their high blood pressure under control, while half do not. To understand why high blood pressure is a danger, think of what happens when you put your finger over the end of a garden hose. The pressure of the water increases significantly as the opening narrows. With hypertension, the force of blood pressure against blood vessel walls increases in much the same way. The increased pressure can damage many organs, including the kidneys, brain,
Normal
Hypertension
Brain
The brain swells and has multiple areas of hemorrhage.
Kidney
The vasculature of the kidney is dramatically constricted and urine output is reduced.
Heart
The heart is enlarged and in cardiac failure.
heart, eyes, and the lining of blood vessels. Blood pressure is measured by two numbers, which indicate pressure when the heart is beating and between beats. Normal blood pressure should fall below 120/80 mm Hg. Studies show that an increase of just 20/10 mm Hg doubles a person’s risk for dying of heart disease. The good news: High blood pressure can be effectively controlled.
Protect your heart!
To schedule an appointment with a cardiologist, call 706-721-2426. To schedule a $100 calcium screening, call 706-721-9729 or visit gru.edu/cardio.
calcium scanning: your heart’s future revealed GET ON THE RIGHT TRACK FOR LIFELONG HEART HEALTH
Y
ou may already know the basic rules for heart-healthy living: exercise, a healthy diet, no smoking, limiting alcohol consumption, and controlling your blood pressure and cholesterol. But you still may not know if you have coronary artery disease, or heart disease, because it often has no outward symptoms. “For many, the first sign is a heart
attack,” said Sheldon Litwin, MD, chief of cardiology at Georgia Regents Medical Center. “Coronary calcium scanning can reveal the health of your arteries before a clot can threaten your life.”
What Is Coronary Calcium Scanning? Coronary calcium scanning is a short and easy test that includes a CT (computed axial tomography) scan of your heart. The scanner takes X-ray pictures of your heart and coronary arteries as you lie on a table that slowly slides through the donut-shaped opening. The entire procedure typically lasts less than five minutes. A cardiologist or radiologist—a physician specifically trained to read cardiac CT scans—will examine the pictures of your heart and arteries. Plaque in your arteries—which can narrow these
blood vessels and lead to a heart attack—often contains calcium in addition to cholesterol. On a scan, calcium looks like bright, white spots; typically, the more white spots of calcium, the more disease there is in the vessel walls and the higher the chance of having a heart attack. If your calcium score is zero (no detectable calcium), your chance of having a heart attack in the next five years is very low. But if you have significant coronary calcification, additional testing or treatment may be appropriate. The good news is that these results can motivate you to take control of your health and prevent further plaque build-up.
The American Heart Association and the American College of Cardiology recommends coronary calcium scans for people at intermediate risk of heart disease. To find out if this test is right for you, call 706-721-2328. GRU-010
Georgia Regents University 1120 15th St., AD 1114 Augusta, GA 30912
NONPROFIT U.S. POSTAGE PAID GEORGIA REGENTS UNIVERSITY
pressure drop
are you off the chart? Guidelines issued by the National Heart, Lung and Blood Institute’s Eighth Joint National Committee (JNC 8) are important to know because high blood pressure affects 1 in 3 adults in the U.S. and predisposes those affected to a variety of conditions. The guidelines, shown below, also include a category called “prehypertension.” This category includes people with a systolic pressure of 120 to 139 mm Hg or a diastolic pressure of between 80 and 89 mm Hg—numbers once considered within the healthy range. Recent research shows prehypertension may be an indicator of future high blood pressure; therefore, it requires diagnosis and treatment, usually in the form of lifestyle changes, which include diet and exercise.
THE STROKE FACTOR Patients who have HEMORRHAGIC STROKE hypertension are four to six times more likely to Occurs when a have a stroke than patients blood vessel who have their blood bursts in the brain. pressure under control. Bleeding in Types of stroke include the brain hemorrhagic stroke and damages brain tissue. ischemic stroke.
Systolic pressure is measured when the heart contracts
Hypertension
Prehypertension
Normal Vessel
ISCHEMIC STROKE
Occurs when an artery to the brain is blocked by a blood clot, leading to death of brain tissue.
Diastolic pressure is measured when the heart relaxes, between beats
Normal Prehypertension Blood Pressure
Pressure
Stage I Hypertension
Stage II Hypertension
SYSTOLIC
< 120
120-139
140-159
> 160
DIASTOLIC
< 80
80-89
90-99
> 100
HIGH BLOOD PRESSURE IS A MAJOR RISK FACTOR FOR STROKE, HEART ATTACK, HEART FAILURE, AND KIDNEY FAILURE
Source: National Heart, Lung, and Blood Institute
American adults have high blood pressure.
Only a small fraction of people with high blood pressure take the medicine they need to control it. The risk is highest among poor people.
Among people over age 19 35%
Bars are arranged by income: Low Near Middle High Income Poverty Income Income
Controlled with medication
30
Drug Treatment Certain medications used in the treatment of high blood pressure can affect the central nervous system. Be sure to talk to your doctor.
Controlled with medication
25 20 15
If your blood pressure is borderline high, you may be able to bring it down by being more active and making a few changes in your diet. Your doctor can talk to you about a plan. If lifestyle changes aren’t enough to bring your blood pressure all the way down, remarkably effective drugs can bring it under control. Here are some of the kinds of drugs that are often prescribed.
Heart High blood pressure damages your blood vessels, increasing your risk for heart disease, heart attack, and heart failure.
1 in 3
HYPERTENSION OFTEN GOES UNTREATED
TREATING HYPERTENSION
Diuretics, sometimes called water pills, flush extra water and sodium, reducing the amount of fluid in blood, which reduces blood pressure. Studies show that alone or combined with other medications, diuretics are still among the most effective options.
Heart
Beta-blockers cause the heart to beat slower and with less force, reducing arterial pressure.
Spinal cord
Kidney
10
Not controlled
Alpha-blockers allow blood to flow more easily by blocking nerve signals that constrict blood vessels.
Not controlled
5 0
MEN
WOMEN
Kidneys High blood pressure can injure the kidney and its blood vessels, ultimately leading to kidney failure.
Hypertension increases the risk for heart disease and stroke, the
No.1
and
No.3 causes of death in the United States. Source: Centers for Disease Control and Prevention
ACE inhibitors block the production of a hormone called angiotensin II, which normally constricts blood vessels. As blood vessels relax, blood pressure goes down. Angiotensin receptor blockers prevent the hormone angiotensin II from attaching to blood vessels. Calcium channel blockers keep calcium from entering muscle cells, which relaxes blood vessels. Vasodilators widen blood vessels by directly relaxing the muscles in vessel walls.
Alpha-beta blockers combine the effects of alpha and beta-blockers, keeping blood vessels open and slowing heartbeat. Most people with hypertension need to remain on medications for the rest of their lives to prevent pressure from climbing. Eating a healthy diet and getting plenty of exercise can help reduce the amount of medication needed.
how much do you know about blood pressure? 1. Which of these lifestyle factors has been linked to high blood pressure? A. sedentary lifestyle B. being overweight or obese C. consuming too much alcohol D. eating overly salty foods E. all of the above 2. Hypertension increases the risk for which of these conditions: A. stroke B. diabetes C. kidney failure D. cancer E. heart failure F. eye damage
Getting Active Improves Your Quality of Life!
17.3%
The American Heart Association recommends 30 minutes a day of moderate activity, five days a week, but three 10-minute periods of activity are as beneficial to your overall fitness as one 30-minute session. This is achievable! Physical activity may also help you spend some time outdoors. Sunlight on your skin helps your body produce vitamin D, which brings many added health benefits.
of people with
high blood pressure don’t even know they have it.
3. Which of these readings is considered normal blood pressure? A. numbers below 140/100 B. numbers below 120/80 C. numbers below 100/60 4. What are the most common symptoms of hypertension? A. fatigue B. anxiety C. lightheadedness D. unexplained weight loss E. none of the above 5. High blood pressure only shows up in people ages 45 and older. A. true B. false
!
In 90 to 95 percent of high blood pressure cases, the cause is unknown. In fact, you can have high blood pressure for years without knowing it. That’s why it’s called the
silent killer.
ANSWER KEY: 1 . E—All of the above; 2. A, C, E, F; 3. B—120/80; 4. E—None of the above: Hypertension is called the “silent killer” because it usually has no symptoms; 5. B—False: Hypertension among children, particularly overweight kids, is on the rise.
YOUR BLOOD PRESSURE HEALTH LIFELINE
0-25 YEARS
25-40 YEARS
Get plenty of exercise and eat right. Obesity rates and resulting high blood pressure are on the rise in young folks. Easy on the caffeine. Cut back on caffeine intake if you are at risk for developing high blood pressure.
40-55 YEARS Watch your weight. Being overweight or obese increases your risk for developing high blood pressure. If you are overweight, losing even 10 pounds can lower your blood pressure.
Check food labels. What you eat affects your chances of getting high blood pressure. Eat foods that are low in saturated fat, total fat, and cholesterol. Don’t overdo the alcohol. Drinking too much alcohol can raise blood pressure. If you drink, do so moderately — one drink a day for women, two drinks a day for men.
55-75 YEARS Watch your blood pressure. For people ages 50 and older, systolic pressure (the top number on your reading) gives the most accurate diagnosis of high blood pressure.
Reduce sodium. Using less sodium keeps blood pressure at healthy levels.
DIABETES
Check over-the-counter drugs. Some drugs, including dietary and herbal supplements, can raise blood pressure.
75+ YEARS Stay physical. Combine everyday chores with moderate- level activities, like walking or swimming.
Take prescribed drugs as directed by your physician. Watch out for possible drug interactions if you’re taking more than one medicine.
blood sugar screening every 3 years after age 45
BLOOD PRESSURE AND BODY MASS INDEX screening at each regular health care visit CHOLESTEROL screening every 5 years
more often for men over 45 and women over 50
HEART DISEASE
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People who have excess body fat—especially if a lot of it is in the waist area—are more likely to develop heart disease and stroke even if they have no other risk factors. If you can lose as little as 10 to 20 pounds, you can help lower your heart disease risk.
For more information, call 706-721-2426 or visit gru.edu/cardio.
on our heart and vascular team
Dr. William Maddox Cardiovascular Electrophysiology Dr. Maddox’s clinical interests include catheter ablation of complex arrhythmias, atrial fibrillation, and device implantation for arrhythmia and heart failure management. He is also researching emerging technologies for catheter-based mapping and ablation of arrhythmia, and stroke prevention in atrial fibrillation.
Dr. Paul Poommipanit Coronary and Vascular Interventional Cardiology Dr. Poommipanit’s research and clinical interests include coronary artery disease, peripheral vascular disease, renal artery stenosis, and structural heart disease.
Dr. Robert Sorrentino Interventional Cardiology Dr. Sorrentino’s clinical interests include management of complex arrhythmia and devices. He is currently researching devices and antiarrhythmic drugs to help treat abnormal heart rhythms.
Check out videos of our physicians and heart healthy tips at gru.edu/cardio.
Q&A Why do blood pressure measurements include two numbers?
Three Fast Diet Fixes
SYSTOLIC
The first number—systolic pressure—is a measure of the force of blood against inner artery walls when the heart is contracting. The second number—diastolic pressure—shows the force when the heart is resting between beats. The two numbers show blood pressure at its highest and lowest levels.
/90
140
Can poor sleep affect blood pressure? In 2012, researchers at the Henry Ford Center for Sleep Disorders in Detroit reported that insomniacs were more likely to have hypertension than those who fit into normal sleep patterns. The researchers found that the longer it took subjects to fall asleep at night, and the more times they woke during the night, the more severe their hypertension.
DIASTOLIC
The DASH diet, which can help lower blood pressure, includes: • fruits • vegetables • low-fat dairy • whole grains • fish • poultry • nuts
Will my child develp hypertension? A study presented in 2013 followed 1,117 healthy adolescents for 27 years and found a correlation between childhood obesity and later incidence of high blood pressure: Overweight children double their risk of developing high blood pressure later, while obese children have a quadrupled risk. The results suggest heart disease may start in childhood and they underscore the importance of maintaining a healthy diet, lifestyle, and exercise routine.
breaking news Getting it down
New guidelines
New figures released in February 2014 by the U.S. Centers for Disease Control and Prevention (CDC) show that 64 percent of Americans enrolled in health plans have their blood pressure “under control,” at or below 140/90. The CDC’s comparison of figures for 2010 and 2013 showed “modest improvement” in blood pressure readings in the three-year period, but the readings still fall short of the Department of Health and Human Services goal for 2017 of having 70 percent of the population in the target range of 140/90 or below. CDC experts believe the goal is achievable, particularly with strong support from health care providers, and would prevent an estimated 1 million heart attacks and strokes.
A report published in the Dec. 18, 2013, Journal of the American Medical Association says that patients over age 60 might not have to take blood pressure-reducing medications if their pressure is 150/90. This raises the “acceptable” range for this age group from 140/90. The recommendation was based on data that showed no significant benefits to patients who had the lower number. The recommendation has not been unanimously accepted, however. Some physicians feel that “relaxing” the standard will give some patients a green light to ignore their blood pressure readings, which could lead to dangerous cardiovascular problems. People with high blood pressure are urged to discuss the guidelines with their health care provider.
A HEART-HEALTHY EATING PLAN FOR TODAY’S LIFESTYLE
M
oms (and dads)—take heart. Eating a hearthealthy diet that is also family-friendly is easier than you may think: All it takes is a little preparation. Here are three quick ways that you can incorporate healthy eating into your family’s daily lifestyle, according to Sarah Schmidt, a registered dietitian with expertise in nutrition education and wellness at the Georgia Regents Heart & Cardiovascular Center. 1. Add color to your plate. At every meal, fill half your plate with a colorful variety of fruits and vegetables for maximum health benefits. These can be fresh, frozen, dried, or canned—just aim for low sodium and no added sugars. Other easy ways: Grab a piece of fruit for a quick snack as you head out the door, try fresh veggies with hummus or lowfat dressing, or add a handful of roasted vegetables to pizza, pasta, or rice. 2. Don’t think diet—think moderation. Variety, after all, is the key to any healthy diet. So if you love donuts, they can still be part of your diet. Just make sure to moderate your portions and read labels. Remember, the goal is to have fewer foods with sodium, saturated fats, trans fats, cholesterol, added sugars, and refined grains, and to include more fruits, vegetables, whole grains, fat-free and low-fat dairy products, and seafood in our diets. 3. Make it a habit. This can be as simple as changing your shopping patterns. When you go to the grocery store, visit the produce section first and stock up on healthy fresh fruits and vegetables, then continue around the perimeter of the store so you can add lean protein and whole grains.
NEED A DIET RX? The Georgia Regents Heart & Cardiovascular Center has professional dietitians who can help design a diet plan that works for you. Call 706-721-CARE (2273) to schedule an appointment.
For more information on our services and physicians, visit us online at gru.edu/cardio.
Copyright © 2014 GLC, Northbrook, IL 60062 U.S.A. This publication is not meant to replace professional medical advice or service. Personal health problems should be brought to the attention of appropriate medical professionals.
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