Dear Dr. Garner:
I am a 58-year-old woman, who has always been in good health. On my last visit to the doctor, he told me that my blood pressure was a little elevated, 140 over 90 and that it needed to be addressed. What do you think? It does not sound that high to me, and I hate to take medications.
I really enjoy your column. I live in Allentown, Pa., but my sister sends me The Tablet every week. I am looking forward to your answer.
High Blood Pressure Problems in Pennsylvania
 
Dear Allentown,

Before I address your problem, I want you to know that I have great memories of Allentown, as I went to Muhlenberg College, and really enjoyed my stay there.

Your question is an extremely important one, particularly for women. Until a major study was released recently, doctors considered blood pressure to be normal, if it was 120 over 80, and high normal if it was between 121-140 over 81-90. The study demonstrated that for women, there was no such thing as “high normal,” as mild elevation of blood pressure often proved deadly. In fact, postmenopausal women with elevation of their blood pressure, but less than 140 over 90, had a 76% increase in heart attacks, and a 93% increase in strokes. The risks for these two diseases were more from the “pre-hypertension” blood pressure than it would have been from cigarette smoking.

Doctors must now begin to treat mild elevation of blood pressure seriously. This does not mean that everyone will need blood pressure medication. There are lifestyle changes and other techniques, which may lower the blood pressure to acceptable levels without pills.

Let us review some of the approaches:

•  Weight loss may be all that is needed to control blood pressure.

•  Quit smoking.

• DASH Diet – this stands for the American Heart Association’s Dietary Approaches to Stop Hypertension diet. It emphasizes fruit, vegetables, whole grains and low-fat dairy while limiting saturated fat and red meat.

• Regular exercise.

• Tai chi or yoga may reduce blood pressure as much as aerobic exercise.

• Limit salt to less than two grams a day

• Use stress management techniques.

Quiet Disease 

Most of the time a person with high blood pressure has no symptoms and feels well until the catastrophic event of a heart attack, stroke or kidney damage occurs. Occasionally the following symptoms will occur:

- Fatigue
- Nosebleeds
- Headaches
- Dizziness

In women, high blood pressure does not usually manifest itself until after age 50. The woman’s hormones before menopause seem to play a protective role. After 50, however, there is a dramatic rise in the number of cases of hypertension.

In fact, using the new criteria, 40% of women over 50 will have pre-hypertension, 35% will have hypertension, leaving only 25% with normal blood pressure. This is a very serious problem and one that should be addressed early on when a woman is in her teen years. By adopting healthy lifestyles and diet early on, it is possible to prevent elevated blood pressure from occurring. The issue of high blood pressure and women has received a lot of attention in the medical literature recently.

Here are some interesting facts that have been reported as a result of these studies:

• Women who take more than one Extra Strength Tylenol a day doubled their chance of high blood pressure. This does not mean to avoid Tylenol all together, but to use moderation when possible, and check your blood pressure frequently if you do require daily Tylenol.

• Lack of Vitamin D is linked to high blood pressure. This is a good topic to discuss with your doctor, as Vitamin D also plays a crucial role in healthy bones.

• Hot flashes are linked to high blood pressure – another wake-up call to check your blood pressure.

• Young women (15-20) who are sedentary double their chance of high blood pressure later on in life compared to those who exercise.

• A happy marriage decreases a woman’s blood pressure – a marriage counselor might work better than a blood pressure pill.

• A stressful job causes a sustained rise in blood pressure – as always, keep work issues in proper perspective and don’t let them carry over into your home – relaxation techniques might be useful.

• African-American women have an 85% increased risk of high blood pressure compared to Caucasian women.
 
In summary, the fact that your blood pressure is up does not necessarily mean you will require blood pressure medication. There is a good chance that with adequate exercise, a proper diet, and appropriate weight loss that you will lower your blood pressure. The main point I wish to make is that there is no such thing as “high normal.”  If a blood pressure is more than 120 over 80, then it is not normal and needs to be addressed. If not, it can be a real killer. I wish you luck and please let me know how things work out.

Next week we hear from a reader with digestive problems. Until then, have a great week and be well.

Dr. Steven Garner, MD, is affiliated with New York Methodist Hospital, Park Slope. He also is a Fidelis Care provider and hosts the popular cable TV call-in show “Ask the Doctor” seen locally on The Prayer Channel.