YOUR HEALTH
Here’s what the doctor ordered to help you steer clear of the "silent killer"
High blood pressure doesn’t hurt. Often, you can’t feel it at all. But this silent killer can lurk for years and cause serious diseases. We spoke to Dr. Sheldon Tobe, chair of the Canadian Hypertension Education Program and a staff nephrologist at Sunnybrook. As an expert in kidney disease, Dr. Tobe sees the benefits of managing high blood pressure (or hypertension). “Lowering blood pressure is a relatively low-hanging fruit for risk reduction,” he says. “We know how to do it.”
What is blood pressure?
It’s the pressure of the blood on the walls of the arteries as it passes through the body. The top number (systolic) is the pressure exerted when your heart contracts and pushes blood outwards. The bottom number (diastolic) is the lowest pressure created when the heart relaxes in between beats. Optimal blood pressure is around 120/80 mm Hg. Increased pressure on the arteries, if left unchecked, can eventually damage arteries and force the heart to work harder.
Why is hypertension the silent killer?
“People don’t know they have it,” says Dr. Tobe. The only way to find out if your blood pressure is normal is to have it checked by a health care practitioner. Untreated, high blood pressure is a major risk of heart attack and stroke, kidney disease and dementia. “Know your numbers,” he says. “Work with your doctor to keep your blood pressure under control.”
How many Canadians have it?
High blood pressure affects 20% of the adult population. “That has not changed over the last 20 years,” says Dr. Tobe. What has changed, he says, is that there have been great strides
in the awareness and treatment of hypertension. “People who are aware of their hypertension and are being treated has gone from 13% in 1990 to 66% today. It is a huge success story for Canada.”
What puts me at risk for hypertension?
You may be at higher risk for high blood pressure if one or both parents have high blood pressure, you are obese, you lead a sedentary lifestyle, you drink a lot of alcohol or you smoke.
What can I do to delay or prevent hypertension?
Here’s what Dr. Tobe suggests:
- Reduce your sodium intake to a level recommended by Health Canada. That means less than 2,300 mg/day, and preferably less than 1,500 mg.
- Exercise. Do 40 minutes a day of brisk walking or a physical activity with an equivalent intensity, four days a week.
- Lose weight. Keeping your weight in the normal range reduces the risk of hypertension.
- Cut back on alcohol consumption to not more than 14 drinks a week for men and 10 drinks a week for women.
- Smoking cessation is very effective in preventing cardiovascular disease.
- Relax! Relaxation therapies are effective in controlling high blood pressure.
So I have hypertension. What now?
If your blood pressure is very high, or you have other illnesses such as diabetes, kidney disease or previous strokes, you may start medication right away. If not, you may be asked to modify your lifestyle and have your blood pressure monitored regularly.
The good news, according to Dr. Tobe, is “we have enormously effective treatments” for hypertension. There are five classes of medications -- diuretics, calcium channel blockers,
ACE inhibitors, beta blockers, and angiotensin II receptor blockers. Within each class, there are many different agents. Your doctor will assess your situation and figure out which medication is best. Proper prescribing results in fewer deaths, fewer heart attacks and fewer strokes, says Dr. Tobe. “While any medication may have side effects,\ the benefits outweigh the risks. Early treatment means hypertension is usually brought under control with fewer medications. “If you wait many years, it may take more medications,” he says.
Tell me some good news.
Doctors are using chronic disease management to treat hypertension and information technology systems assure the best information gets to doctors and patients efficiently. “This is unbelievably effective,” says Dr. Tobe. “What I’ve seen as a kidney doctor with an academic career in hypertension, is that every year, many Canadians are not getting end stage kidney disease. Good medical care including blood pressure control is certainly responsible for that.”
