Health and Religion

What You Need to Know About High Blood Pressure. Several fairly simple practices can actually help lower your blood pressure.

J. A. Scharffenberg, M.D., M.P.H., has been in the practice of medicine for thirty years. He served for a time as clinician on the secretariat of the Inter-departmental Committee on Nutrition for National Defense and later became director of the International Nutrition Research Foundation. Still later, while professor of applied nutrition at Loma Linda University, he developed a coronaryrisk- evaluation program called Heartbeat, which has had thousands of participants throughout the world. Dr. Scharffenberg is currently associate director of the Health Services Department of the Central California Conference of Seventh-day Adventists.

 

More than one out of each ten Americans has high arterial blood pressure. Many people do not know that they have a problem, because it can frequently exist for years without symptoms. High blood pressure is, however, a problem that needs to be taken seriously because it can, without warning, cause serious disease and even death. Those who do experience symptoms will frequently notice dizziness, headaches, insomnia, weakness, fatigue, and similar problems. Unless treated, high blood pressure can result in stroke, heart disease, kidney disease, and even blindness caused by hemorrhage of the retina of the eye. Persons with high blood pressure have five times the risk of stroke and twice the risk of heart attack compared to those with normal blood pressure.

Arterial blood pressure is measured against a column of mercury and is re corded in millimeters. It reaches its maximum following the emptying of the left ventricle into the aorta immediately after it contracts. This is identified as the "systolic" pressure. It drops during the time the heart is filling with blood and reaches its minimum just before a succeeding ventricular contraction. This is identified as the "diastolic" pressure. For these reasons, usually the pressure is recorded as two figures, such as 120 (systolic) and 80 (diastolic)—120/80.

In general, the lower the blood pres sure, the better. People with lower pressures usually live longer than those with higher levels. The incidence of heart at tacks and strokes increases as the blood pressure increases. There is no point where suddenly the risk increases greatly. Therefore, the figures we term normal or abnormal are arbitrary divisions. A reading of 120/80 is considered to be normal. Lower blood pressures such as 100/60 may result in longer life, however, than 120/80. Normal is considered in adults to be up to 140/90. As mentioned, this is an arbitrary cutoff point. Between 140 and 160 systolic and between 90 and 95 diastolic is termed by physicians as borderline. Anything above 160 systolic and 95 diastolic is considered to be indicative of hypertension.

Since blood pressures fluctuate quite widely, a diagnosis of hypertension is not made unless several readings are taken at various intervals. Slight emotional stresses may elevate the systolic pressure considerably within a few minutes. The diastolic pressure is not elevated to as great an extent under such circumstances. For this reason, a physician finding an elevated diastolic pres sure considers it to be more serious than an elevated systolic pressure if it is the first time he has taken the blood pres sure. If the systolic pressure is consistently elevated, however, it is as dangerous as an elevated diastolic pressure.

In about 85 percent of the cases a physician makes a diagnosis of "primary" or "essential" hypertension. This means the cause of the high blood pres sure is not known. If the cause is known, the condition is termed "secondary" hypertension. That means the high blood pressure is secondary to some specific condition such as adrenal tumor, renal artery constriction, or some such thing. Some of these causes are correctable. Certain specialists in hypertension believe that the cause may be found in an additional 20 percent of the cases if adequate tests are done. These tests may cost as much as $500, but may well be worth the time and money. University hospitals usually have someone who specializes in the diagnosis and treatment of hypertension.

Many controllable factors or conditions contribute to high blood pressure. Should you have any of these problems, be sure to take the proper measures to control them.

1. Obesity

If you are overweight, that factor alone may elevate your blood pressure; you should reduce your weight immediately. The proper way to do this is very simple: exercise more and eat less. If you find reducing to be difficult, here are some hints that may help you.

Do not snack. By stopping your between- meal snacks you can reduce your daily intake by several hundred calories.

Reduce the use of "empty" and refined calories. There are four basic food types that contain calories of this kind: (1) Visible fats. These are fats such as cooking oil, margarines, and similar fats, which are visible in or on your food. (2) Sugar. Eliminate foods that are high in sugar, such as desserts, soft drinks, ice cream, doughnuts, and other between-meal sweets. (3) Refined cereals. Use whole-grain cereals without added sugar. Cooked cereals are probably better than commercial dry cereals. If you like dry cereals, use products such as shredded wheat, which are whole grain and which do not have added sugar. (4) Alcohol can result in a surprisingly high intake of empty calories. It has another side effect—for those on a diet, alcohol can weaken willpower and result in the breakdown of a dietary program.

Reduce the use of saturated fats such as the fat in meat or in whole milk, hard shortenings, hard margarines, and eggs. Butter, of course, is saturated fat.

Eat a good breakfast. If it is necessary to skip a meal in order to lose weight, skip supper rather than breakfast. Breakfast calories are usually burned up in useful work. Calories taken in the evening tend to enlarge the proportions of the eater.

Use foods high in fiber and water content such as greens, carrots, string beans, and so forth, which will fill you up without putting on much weight.

If all else fails, fast one or two days a week. We recommend that if you do this, you do so under a doctor's supervision.

2. Exercise

Exercise helps some individuals lower their blood pressure. This is true even of people who are not overweight or under stress. The type of exercise is important, however, since not all exercise is useful for lowering blood pressure. Calisthenics and muscle-building exercises, for example, may be good for flexibility, but they do not really help with the problem of hypertension. To lower blood pres sure, one needs continued exercise of at least twenty minutes' unbroken duration. Probably the best such exercise is walking. Work up to the twenty minutes gradually and, as you become used to it, increase the speed and the distance you cover in that twenty to thirty minutes each day. If you are quite overweight, increase your exercise very gradually. Before doing any vigorous exercise have your physician do an electrocardiogram stress test to be sure your heart can take it.

3. Stress and tension

Stress and tension may also elevate blood pressure. A good exercise pro gram helps relieve stress. Also take regular vacations, stop bringing home you work in the evenings, consciously try to relax several times a day. Noise of any type may increase tension and stress. Keep the TV and radio off except for the few good, non-tension-producing pro grams. Trusting in God's care for you should help you not to worry over the many problems of the day.

4. Salt

It may be necessary to reduce sodium in your diet in order to get your blood pressure under control. Salt is the source of most of our sodium. The average American uses about fifteen grams (more than three teaspoons) a day. Approximately two and one-half grams comes from the processed and packaged foods he purchases at the store. But the largest amount comes from the salt he puts into his food when he cooks it at home or when he uses the salt shaker at the table. In northern Honshu in Japan the average salt use is twenty-eight grams or seven teaspoons a day, and 40 percent of the adult population have high blood pres sure. The body needs only about one eighth of a teaspoon of salt a day. It may be well to avoid salty foods such as salted peanuts, olives, soy sauce, and salt from the saltshaker at the table.

Some physicians do not tell you to decrease your use of salt, because they feel the medicine they are prescribing for you will help to handle this problem without your having to lower your use of salt. But certainly it would be well for most of us to decrease our use of salt as a possible preventive measure.

5. Diet

Recent studies have shown that high blood pressure may be related to meat in the diet. Vegetarians have been shown to have a tendency to less high blood pres sure. Some researchers now suggest that reducing or eliminating the use of meat in the diet may be the best therapeutic approach to high blood pressure. Al though atherosclerosis (arteriosclerosis) is not the cause of high blood pressure, it may be associated with it. High blood pressure accentuates the atherosclerotic process and so, as a rule, one who has had hypertension consistently over an extended period of time probably has developed some atherosclerosis.

For several reasons; then, it is well to be on a diet that tends to prevent atherosclerosis—in other words, a diet that is low in saturated fats and cholesterol. Since meats, particularly beef, contain high amounts of saturated fats and cholesterol, a vegetarian diet can help over come several problems related to heart disease and high blood pressure.

The total amount of fat in the diet should be lowered for most Americans. We should switch to nonfat milk, for example, instead of using whole milk or low-fat milk. Other things that can be done to reduce fat in the diet are to reduce the use of egg yolks to no more than three a week and to avoid bakery goods that may have these substances in them.

6. Tobacco

Smokers are more apt to have hyper tension. Those who smoke and have high blood pressure certainly need to kick the habit. The Seventh-day Adventist Five- Day Plan to Stop Smoking has been effective for many.

7. Estrogens

Commonly used by women in the menopause and by those taking birthcontrol pills, estrogens do cause high blood pressure in some individuals. If the high blood pressure came on after you started using these pills, it may be advisable to discontinue them. You'll need to consult your doctor about this.

8. Tyramine

Some people are sensitive to tyramine, a substance commonly found in cheese. This may result in high blood pressure. But since there are so many possible causative factors for high blood pres sure, it is important to see a physician and attempt to determine the cause of the hypertension. The physician will order a number of tests to evaluate your condition.

It would be well to purchase a sphygmomanometer and stethoscope and learn how to take blood pressures. If a family member has the problem, a continual monitoring of the pressure each day can be done without going to the doctor's office. This would help your doctor determine just what medication and how much of the medicine to prescribe for you.

The treatment for primary hypertension is regular taking of specific medications. The doctor may prescribe only a diuretic to help you eliminate the fluid that your body is retaining, in an attempt to lower your blood pressure. Frequently he will give you this with another medication also. It is very important to take the prescribed medicines. Lowering the blood pressure will help to prevent stroke, heart attack, blindness from retinal hemorrhage, and kidney disease. If you have adverse side effects from the medications, see your physician, and he will attempt to find the right medication, one that works for you without any serious side reactions.

Summary

1. Have your blood pressure checked regularly. If it is high, follow your doc tor's instructions carefully. 2. Develop a regular exercise program. 3. Substitute good health habits for bad ones. Stop using tobacco, tea, coffee, and alcohol. 4. Get your weight down to normal. 5. Learn how to handle stress and tension. 6. Take your prescribed medicines regularly. 7. Eat a good diet, avoiding salt and saturated-fat foods.

Note:

Published simultaneously in Life & Health.


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J. A. Scharffenberg, M.D., M.P.H., has been in the practice of medicine for thirty years. He served for a time as clinician on the secretariat of the Inter-departmental Committee on Nutrition for National Defense and later became director of the International Nutrition Research Foundation. Still later, while professor of applied nutrition at Loma Linda University, he developed a coronaryrisk- evaluation program called Heartbeat, which has had thousands of participants throughout the world. Dr. Scharffenberg is currently associate director of the Health Services Department of the Central California Conference of Seventh-day Adventists.

December 1978

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