This is the seventh in a weekly series of diaries that deal with healthy positive approaches to the process of ageing. They all carry a tag of [ageing gracefully] and can be found by searching on that tag.
Blood pressure and problems with its management becomes more and more an issue of concern for people the older they get.
Blood pressure (BP), sometimes referred to as arterial blood pressure, is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation. During each heartbeat, blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure. The blood pressure in the circulation is principally due to the pumping action of the heart. Differences in mean blood pressure are responsible for blood flow from one location to another in the circulation. The rate of mean blood flow depends on both blood pressure and the resistance to flow presented by the blood vessels. Mean blood pressure decreases as the circulating blood moves away from the heart through arteries and capillaries due to viscous losses of energy. Mean blood pressure drops over the whole circulation, although most of the fall occurs along the small arteries and arterioles. Gravity affects blood pressure via hydrostatic forces (e.g., during standing), and valves in veins, breathing, and pumping from contraction of skeletal muscles also influence blood pressure in veins.This is the current medical diagnostic classification for systemic BP readings.
Most of the people confronted with the problems of BP management are dealing with hypertension.
Hypertension is classified as either primary (essential) hypertension or secondary hypertension; about 90–95% of cases are categorized as "primary hypertension" which means high blood pressure with no obvious underlying medical cause. The remaining 5–10% of cases (secondary hypertension) are caused by other conditions that affect the kidneys, arteries, heart or endocrine system.Hypertension is often referred to as the silent killer. Most people do not have immediate direct symptoms resulting from it that they are aware of. The way they find out about it is through BP checks. Measuring BP with a home monitor is easy and simple and the monitors are fairly inexpensive. For anybody with even borderline BP regular monitoring problems should become part of their personal routine. The frequency of that depends on stability and control.
Hypertension puts strain on the heart, leading to hypertensive heart disease and coronary artery disease if not treated. Hypertension is also a major risk factor for stroke, aneurysms of the arteries (e.g. aortic aneurysm), peripheral arterial disease and is a cause of chronic kidney disease. A moderately high arterial blood pressure is associated with a shortened life expectancy while mild elevation is not.
Dietary and lifestyle changes can improve blood pressure control and decrease the risk of health complications, although drug treatment is still often necessary in people for whom lifestyle changes are not enough or not effective.
As with other chronic health conditions treatment and management involves diet, weight loss not smoking and exercise supplemented with medication as necessary. Not all approaches work equally well in all people. People who are dealing with other chronic conditions such as diabetes need to find approaches that cover all bases. Various approaches to exercise have been shown to be effective in reducing BP. The most effective one for you is likely to be the one that you can manage to do on a very frequent basis. If you have physical limitations such as arthritis that has to be accommodated. Bike riding is my choice.
The first line in dietary modification is the reduction of sodium. That goes beyond just not eating salt. Many other foods contain sodium. The nutritional information on food packages is a helpful guide. Reduction of sodium has a mild diuretic effect which makes a slight reduction in blood volume and thus in BP. For many people with borderline hypertension weight control, regular exercise and sodium reduction may be sufficient to achieve adequate control. For people needing more extensive dietary intervention the DASH diet is an effective approach.
The DASH diet was designed to provide liberal amounts of key nutrients thought to play a part in lowering blood pressure, based on past epidemiologic studies. One of the unique features of the DASH study was that dietary patterns rather than single nutrients were being tested. The DASH diet also features a high quotient of anti-oxidant rich foods thought by some to retard or prevent chronic health problems including cancer, heart disease and stroke.This is the recommended daily balance of nutrients.
Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin II receptor blockers
Calcium channel blockers
Each of these drug groups have several different specific generic drugs. The various types can be used in combination with each other. Most of them have some types of side effects, some annoying, others potentially serious. Anybody who is able to control BP with lifestyle changes alone is well advised to do that as long as possible. The day may come when you need them no matter what you do, but putting it off spares you of some unpleasantness and gets you in the habit of doing things that will limit the amount of medication that you might eventually have to take.