Building Healthy Communities through Medical-Religious Partnerships

5. Hypertension

5 Hypertension Hypertension, or high blood pressure, is generally defined as a systolic pressure of 140 mm Hg or higher or a diastolic pressure of 90 mm Hg or higher. In more recent years, “prehypertension” has been recognized as a diagnosis among adults with systolic blood pressures in the 120–139 range, and diastolic blood pressures in the 80–89 range. Prehypertension often precedes the development of hypertension, but even at these lower levels, blood pressure accelerates damage in the normally elastic arteries. Also, by increasing the work of the heart pumping against high blood pressure, hypertension can ultimately lead to heart failure—even in the absence of atherosclerosis. Hypertension affects approximately 50 million Americans, but only about half know they have this condition. The prevalence of hypertension increases with age. It is estimated that approximately 60 percent of Americans aged 60 or older have hypertension. Hypertension is more common among men than women before age 55, is roughly equivalent for men and women during the next two decades, but becomes a greater risk for women after age 74. It is most common in African Americans. Obese individuals and those with a family history of hypertension also are more likely to be affected by hypertension. The Risks of Ignoring Information on Hypertension Although hypertension frequently produces no symptoms, it can have many harmful consequences, including severe disability and death. Hyper- 56 suggested topics for congregational programs tension damages large and small arteries directly. This damage leads to disease in the tissues and organs receiving blood from the arteries. People with hypertension are at risk for stroke, heart disease, and kidney failure leading to dialysis. Longstanding hypertension can initially cause the heart to hypertrophy (or become overdeveloped and thickened), resulting in reduced pumping action, and eventually to dilate and weaken. This condition is called heart failure. People with heart failure tire easily and experience shortness of breath with minor exertion. What Can Be Done to Prevent Hypertension and Its Complications? The development of high blood pressure can likely be delayed through a number of lifestyle modifications including weight loss, regular exercise (both aerobic and low intensity), consumption of a diet low in salt and animal fat and rich in vegetables and fruit, and lowered alcohol intake. Studies have not shown that stress reduction programs or use of dietary nutritional supplements (e.g., fish oil, magnesium, fiber) can effectively prevent development of hypertension. Because high blood pressure is an independent risk factor for the development of cardiovascular disease, prevention programs should also address other lifestyle modifications, including smoking cessation and control of hypercholesterolemia. Hypertension often goes undetected because it may produce no symptoms until it seriously damages the heart, brain, or kidneys. Some people with hypertension report headaches, but generally hypertension is discovered during routine checks or medical examinations. Fortunately, the assessment of blood pressure is easy and inexpensive. The major challenge health professionals face is persuading people that they should have their blood pressure checked on a regular basis and that they should seek treatment if they are found to have hypertension. Given the increasing numbers of young adults and children with obesity, assessment of blood pressure should be done even for younger individuals on a regular basis. The good news about hypertension is that the interventions that can be used to prevent it also treat it. Once diagnosed, lifestyle modifications are frequently effective in controlling blood pressure. These include weight loss, restriction of salt intake, and exercise. Reduced alcohol consumption and potassium supplementation may also be useful interventions. Lifestyle hypertension 57 modifications are generally recommended as an initial method of controlling blood pressure, but if such modifications are insufficient to bring blood pressure under control, numerous medications are available. Often more than one medication is required, and achieving successful control can take a number of weeks or months and multiple visits to your doctor. Poor compliance with recommended interventions is a significant problem in the treatment of hypertension. Studies have shown that as many as half of patients who begin treatment for hypertension fail to continue . There are many reasons for this problem. Because many people do not have any symptoms associated with their high blood pressure and because the benefits of blood pressure control accrue over many years, an individual may have little tangible daily motivation to continue with the lifestyle changes or medication. Regular education about the benefits of maintaining healthier living patterns and being compliant...