BLOOD PRESSURE - ARE YOU AT RISK?

Blood pressure - Are You at Risk? We can't see it, touch it, hear it, smell it, or taste it. That makes blood pressure easy to ignore. But we can measure blood pressure, and it's not looking good. The Centers for Disease Control and Prevention estimate that 90 percent of middle aged American adults will eventually suffer from hypertension. And because blood pressure is so easy to ignore, almost 30 percent of people with hypertension are blissfully unaware of their own condition.

Ignorance may be bliss in some cases, but not when it comes to blood pressure. High blood pressure measured at 140 mmHg over 80 mmHg or higher is aptly called "the silent killer." It can lead to stroke, enlarged heart, congestive heart failure, kidney and eye damage, atherosclerosis (hardening of the arteries), mental decline, and early death. In fact, in 2002, hypertension was cited as a leading or contributing factor in 277,000 American deaths.

Hypertension typically has no symptoms, but it packs a wallop.

Paradoxically, hypertension occurs most frequently in developed, Western societies. Our culture of plenty has not resulted in plentiful health. Although the typical Western diet may satisfy our cravings for fat, salt, and sugar, it has left many of us obese and malnourished. Although our Western lifestyle appeals to our couch-potato inclinations, it has made us susceptible to life-threatening illnesses like hypertension. The so-called "good life" may not be so good for us after all.

 Defining Blood Pressure

Blood pressure is the force of the bloodstream against the walls of the arteries as they send blood from the heart to the rest of the body. At the end of each artery, tiny blood vessels called arterioles deliver blood to all the tissues. When the walls of the arterioles tighten, blood pressure goes up. When those walls relax, blood pressure goes down.

What do those blood pressure numbers mean? The higher number refers to systolic blood pressure, which refers to the pressure exerted when the heart contracts. The lower number, the diastolic pressure, measures the rests between heartbeats. Most hypertensive Americans have "essential hypertension," a form of high blood pressure with no clear cause. Rarely, high blood pressure is caused by underlying health issues such as kidney disease or congenital problems. We call this "secondary hypertension." "Gestational hypertension" may occur during pregnancy, and is implicated in low birth weight and early delivery.

Who Becomes Hypertensive?

High blood pressure does not discriminate: It affects every social class, every race, and every age. However, certain groups are especially vulnerable to hypertension, according to the National Heart, Lung and Blood Institute:
    Men over 45 years old and women over 55 face a higher risk of hypertension than younger people.
    Men are more susceptible to hypertension than women.
    African Americans are more likely to experience high blood pressure than white Americans.
    Those living on or near the poverty line are more likely to develop high blood pressure than those who are not poor.
    People with diabetes face a higher risk of hypertension.
    Overweight people are more likely to have high blood pressure.

Watch Out For Prehypertension

Prehypertension typically precedes full-blown hypertension. If your blood pressure is between 120/80 and 139/89, you have prehypertension. While rising blood pressure is usually associated with advancing age, it strikes younger Americans, too.

In a study featured in the Annals of Internal Medicine, researchers examined nearly 20 years of blood pressure readings from 3,560 18- to 30-year-old adults. Almost one in five of these young adults had developed prehypertension.

As they got older, these prehypertensive young adults faced a higher risk of hypertension, diabetes, low HDL ("good") cholesterol, and increased calcium in their coronary arteries. "People with a lot of calcium in their coronary arteries are more likely to have heart attacks and strokes, and these outcomes might be avoidable by keeping blood pressure low when you're young," states study researcher Mark J. Pletcher, MD, MPH.

Risk Factors For Hypertension

We can't do anything about our age, race, or gender. But we can control many of the other risk factors for hypertension, such as obesity, poor diet and lifestyle choices, and lack of proper medical care.

Obesity

We're in trouble. An estimated 65 percent of Americans are overweight, and 31 percent are obese. A plethora of factors contribute to excess weight: unstable blood sugar levels, genetic makeup, childhood obesity, medical problems, a diet high in fat and sugar, and inactivity. Our super-sized fast-food meals and evenings in front of the television or computer are a dangerous combination. In addition, our labor force is increasingly likely to sit behind a desk than do physically active work.

Obesity gets the blame for at least two-thirds of hypertension cases. Reasons include the effects of obesity on insulin sensitivity, kidney health, and hormone levels.

    Being overweight contributes to insulin resistance, a metabolic disturbance that can lead to full-fledged diabetes. Insulin resistance is also implicated in hypertension.
    Being overweight can cause or worsen kidney disease, and the kidneys help regulate blood pressure. High blood pressure can damage the kidneys, kidney damage further raises the blood pressure, and the vicious cycle continues.
    Our fat tissue and kidneys generate a complicated system of hormones. These hormones determine the width of the arteries and therefore the pressure of the blood in the arteries. In addition, abdominal fat leads to a heightened production of the hormone insulin.

The expanding girth of the American public has led to expanding rates of hypertension, as well as insulin resistance and chronic kidney disease. Sadly, this trend of obesity shows no signs of abating. From 1999 to 2004, The National Health and Nutrition Examination Survey (NHANES) found a significant increase in excess weight in children and adolescents, as well as rates of obesity in men.

An estimated one in three American adults is now afflicted with hypertension, and the Center for Human Nutrition has made some disturbing projections. Based on NHANES studies from the 1970s to 2004, if we don't change our ways, 86 percent of American adults are likely to be overweight or obese by 2030. That figure is predicted to reach 100 percent by 2048.

Metabolic syndrome

Also known as Syndrome X or insulin resistance, metabolic syndrome is one of the unfortunate by-products of our ever-fatter culture. The result of our radical change in diet, physical activity, and social structure, Syndrome X refers to a cluster of conditions that travel in packs: obesity, high blood pressure, high triglyceride levels, and low HDL ("good") cholesterol.

Insulin is a critical hormone responsible for balancing blood sugar levels. The pancreas releases insulin when blood sugar levels get too high. Insulin pulls the excess glucose (sugar) into the liver for short-term storage, or into fat tissue for long-term storage. When insulin attaches to a cell, it sends a message to glucose transporters to push glucose into the cells and out of the bloodstream.

In metabolic syndrome, however, those glucose transporters start ignoring insulin, so the cells are unable to pull sufficient glucose from the bloodstream. As a result, more insulin barges into the bloodstream, damaging the cardiovascular system and raising blood pressure. It's like screaming at someone who's stone deaf: you're not getting your message across, but all the noise you're making is upsetting the whole neighborhood.

Stress

Our bodies were built for a world in which most of us no longer live. Stress releases adrenal hormones that produce our primitive "fight-orflight" reaction: They sharpen our senses, tense up our muscles, and prepare our cardiovascular system for increased exertion. Certainly, a moderate level of stress can be useful, providing an edge that helps us give a livelier speech, take a better exam, or approach our employer for a well-deserved raise.

Unfortunately, our "fight-or-flight" response often gives us more of an edge than we need. It prepares us to face a charging bull or escape a burning building. However, our stress is more likely to revolve around an unhappy spouse, overdue bills, or the oldest daughter getting her eyebrow pierced. The body's exaggerated response to these ordinary stressors is like the fire department crashing through the front door to put out a birthday candle.

How does stress affect blood pressure? The body responds to mental, emotional, physical, and environmental stress by generating a powerful hormone called cortisol. Cortisol pushes stored reserves of sugar, fat, protein, vitamins, and minerals into the bloodstream to the areas of the body that need them most. If stress is extreme and/or prolonged, cortisol levels rise.

We need cortisol to survive, but extended high levels of this hormone contribute to a host of bodily ills, including hypertension. Cortisol triggers the secretion of insulin and speeds up the metabolism of fat and carbohydrates for quick energy. A heightened appetite results, typically leading to weight gain. Interestingly, cortisol-related weight gain seems to accumulate around the abdomen. Abdominal fat is associated with metabolic syndrome, which includes high blood pressure. In fact, abdominal fat is known as "toxic fat" because it has been linked to heart attacks and strokes.

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