University of Maryland cardiologist and hypertension expert Elijah Saunders, M.D., offers advice on controlling your blood pressure and protecting your heart.
Get answers to your heart disease prevention questions.
The heart, a muscle about the size of a fist, is one of the hardest working organs in our bodies. Over the course of an average life span, it beats about two and a half billion times without ever taking a break. The daily choices we make about how we live our lives determine our hearts' ability to function optimally.
According to the American Heart Association, cardiovascular disease is the number one killer in the United States. More than 2,600 people die of heart disease every day, which translates into one cardiovascular death every 33 seconds.
Despite the seriousness and prevalence of heart disease, cardiovascular problems aren't inevitable. There are steps you can take -- eating a healthy, low-fat diet and getting plenty of exercise -- to reduce your risk. On the other hand, bad habits such as smoking and drinking too much alcohol overburden our already busy hearts and cause them to break down.
"Cardiovascular disease is a real problem in the United States," said Elijah Saunders, M.D., Head of the Hypertension Section of the University of Maryland School of Medicine's Division of Cardiology. "The average American diet is high in fat, cholesterol, calories and salt, and our lifestyles are far too sedentary."
Hypertension or high blood pressure is often a precursor to heart disease. High blood pressure that goes undetected or isn't properly controlled can lead to heart attack, heart failure, kidney failure, stroke or premature death. Because hypertension has few early symptoms, many people aren't aware they have it.
"Only about half of the people in this country who have high blood pressure know they have it," said Saunders. "Of those who know they have it, only about half are being treated for it. And of those being treated for it, only about half actually have their blood pressure under control. Nationwide, that translates into about 25 percent of hypertensive patients who are controlling their blood pressure."
According to Saunders, many people shy away from taking the medications that could help them manage their blood pressure because they are concerned about their side effects. Treatment methods, however, have improved over the years, and some of the old fears are unfounded.
"The way drugs are being used to control high blood pressure today is much more effective than in the past," Saunders said. "Doctors are using ACE inhibitors, Calcium channel blockers, Beta-blockers, Angiotensin-receptor blockers (ARBs), Alpha-blockers and low-dose diuretics in ways that don't cause the sexual complications and other side effects of older therapies. Also, these new drugs only need to be taken once a day, instead of two or three times a day. This is a lot easier for patients."
Saunders, who has served on the Advisory Council of the National Heart, Lung and Blood Institute, has lectured extensively on hypertension. Throughout his career, he has focused on hypertension among the elderly and African American populations.
Statistics show that African Americans are 50 to 100 percent more likely to
develop high blood pressure than their white counterparts. African Americans
also develop hypertension at younger ages than whites, have a harder time keeping
it under control and die from it at much higher rates.
Saunders is currently working with the National Institutes of Health to understand any possible genetic factors that increase hypertension in African Americans.
"Unlike sickle cell, I doubt that we're going to discover a single gene that predisposes African Americans to hypertension," Saunders said. "More than likely, it is a combination of environmental factors such as diet, obesity, physical inactivity and stress that contribute to the increased rates of high blood pressure we see in the African American community."
It is important to keep your blood pressure under 140/90 mm Hg. Blood pressure higher than that is considered dangerous. Below is a list of high blood pressure risk factors. People with any of these risk factors should have their blood pressure checked every time they visit their doctor. For those who fall into several risk categories, experts recommend purchasing a blood pressure cuff and a stethoscope and taking your own pressure reading every week.
The average adult has about five liters of blood flowing through the body via an intricate network of blood vessels called arteries, veins and capillaries. Blood is essential to life for it delivers oxygen from our lungs to our body tissues, and carries harmful waste to the kidneys to be removed. Blood also transports hormones from our glands to various parts of our bodies, as well as vitamins and nutrients from our digestive tracts.
When our blood vessels become clogged due to a plaque buildup of cholesterol and fat, our hearts must work twice as hard to pump enough blood to our vital organs. This is what causes our blood pressure to surge.
As the pressure increases inside of our arteries, veins and capillaries, our hearts become even more overworked. Over time, our hearts grow larger in an effort to compensate for the extra workload and eventually they become weaker.
When you add obesity, smoking, or diabetes to the mix, the risk of heart attack, stroke or kidney disease for those with high blood pressure increases dramatically. This is why it is important to know what your blood pressure is.
Experts recommend that you maintain a blood pressure lower than 140/90 mm Hg at rest. The higher number represents the maximum pressure exerted when the heart contracts (systole). It reflects the stiffness of the large arteries near the heart, and the volume of blood pumped into them. The lower number represents the pressure exerted when the heart begins to relax between beats (diastole), just before the next contraction. It measures the amount of constriction of the body's smaller arteries or arterioles.
A great way to lower your blood pressure and combat the corrosive effects of plaque buildup is to exercise. Studies have shown that sedentary lifestyles tend to elevate blood pressure, while regular exercise can reduce it.
According to Saunders, exercise is so effective at controlling blood pressure because it stimulates a substance within our bodies called nitric oxide. Nitric oxide is produced by our endothelial cells, which live on the inside layer of our blood vessels.
"Nitric oxide is a substance that helps to keep our blood vessels open," said Saunders. "During the early stages of plaque buildup or arteriosclerosis, one of the first things we see is a reduction in the amount of nitric oxide in the blood vessels. When we exercise, the accelerated pumping of our hearts forces more blood to flow through our vessels. As this blood pushes its way along the lining of our vessels, the endothelial cells release more nitric oxide."
You don't have to spend hours in the gym to reap the healthy benefits of exercise. Walking the dog, taking the stairs instead of the elevator, even vacuuming briskly can increase the blood flow from your heart and through blood vessels.
In addition to regular exercise, a heart-friendly diet is also important, said Saunders. Broiling foods instead of frying them and trimming the skin and fat off of meat all add up to less artery-clogging plaque in your blood vessels.
So, you avoid foods high in fat and cholesterol and are exercising on a regular basis, what else can you do to stay healthy? Saunders suggests staying away from foods that contain a lot of sodium.
Sodium plays an essential role in regulating fluids in the body. Studies of diverse populations have shown that a high sodium intake is associated with higher blood pressures.
Although the human body requires only about 500 mg of sodium a day, the average
American ingests between 6,900 mg and 9,000 mg of sodium a day. For people sensitive
to sodium, such as those with a family history of hypertension, African Americans,
diabetics and the elderly, the accumulation of too much salt in the body can
be particularly risky.
Saunders recommends doing away with your salt shakers. Adding extra salt to most foods is unnecessary since many of the prepackaged, prepared foods that you buy in the grocery store already contain a lot of sodium.
"A good rule of thumb is that if you can taste the salt in your food, then there is too much of it," said Saunders. "Canned foods, snack foods, fast foods and other prepared foods are loaded with sodium. It is much better to prepare your own low-sodium meals. You may also consider using some salt substitutes (with approval by your doctor) or various condiments and seasonings that may add to the taste without excess salt. When eating out, insist that the food be prepared without sodium and you can then control the amount consumed."
If you don't have time to cook your meals from scratch, Saunders advises that you pay close attention to the amount of sodium listed on food labels. Since 1986, the Food and Drug Administration has required manufacturers to list sodium content on their products.
Another way to improve your overall cardiovascular health is to quit smoking and drinking a lot of alcohol.
While drinking in moderation doesn't seem to have much of an impact on your heart, having more than three drinks a day may contribute to high blood pressure. Alcohol has been shown to raise blood pressure by interfering with the flow of blood to and from the heart. When alcohol courses through your bloodstream, it pushes blood rich in nutrients away from your heart.
Studies have shown that it is much more difficult to control blood pressure if you drink heavily. Conversely, a reduction in alcohol consumption can help lower blood pressure.
Smoking also takes a heavy toll on the heart. According to the American Lung Association, over 400,000 Americans die of smoking-related illnesses each year. This figure includes those affected by secondhand smoke and babies born prematurely due to prenatal, maternal smoking.
Nicotine, one of thousands of chemicals found in cigarettes, causes the blood vessels to constrict. This narrowing of the vessels increases blood pressure.
Nicotine is an extremely addictive chemical. Studies show that nicotine activates the circuits in the brain that regulate pleasurable feelings. It does this by increasing the levels of a chemical found in our brains called dopamine. The U.S. Surgeon General warns that nicotine addiction is similar to heroine and morphine addiction. In fact, when smokers inhale, the nicotine reaches the brain faster than drugs that enter the body intravenously.
Kicking a smoking habit may not be easy, but it is worthwhile. About 1.3 million people quit smoking each year. The benefits of quitting are numerous. They include improved tolerance for exercise, and a reduction in the risk of developing lung cancer, bladder cancer and heart disease.
Three years after giving up nicotine, Saunders said that ex-smokers have a 65 percent reduction in deaths from heart disease relative to those who continue to smoke.
Experts urge the public to break those habits that threaten cardiovascular health. Adopting a more heart-healthy approach to life now can have a positive influence on future generations.
"We are all getting too fat in our society and we need to turn things around," said Saunders. "Physical inactivity among our youth is a real problem. We need to make sure that we eat eight servings of fruits and vegetables a day, and get more exercise. We need to get ourselves and our children away from the television sets and the computers, and start them exercising early in their lives."