Hypertension myths and facts: A conversation with Lowell H. Steen Jr., MD

Hypertension affects 45.6% of U.S. adults, according to estimates from the American Heart Association. The burden of hypertension is high and many individuals are unaware that they have high BP.

Cardiology Today spoke with Lowell H. Steen Jr., MD, interventional cardiologist at Loyola University Medical Center, about common misconceptions of hypertension, lifestyle recommendations to maintain normal BP, treatment options and strategies to improve awareness of hypertension.

Question: A common misconception is that high BP is not a concern for young adults. What are the causes of hypertension in young people and what steps can young adults take to prevent hypertension?

Answer: Many have the misconception that high BP only impacts those over the age of 40 years. Although high BP risk increases with age, people can develop hypertension at any time. In fact, nearly 1 in 5 young adults have hypertension.

Age, sex, race and lifestyle all influence a person’s potential for high BP. Unfortunately, some of these causes, such as age and genetics, are out of our control, and even if you follow a healthy lifestyle, you are still at risk for having high BP. However, many people can eliminate high BP by losing excess weight, changing their diet and increasing their physical activity. Adding certain natural foods like cranberries or pomegranate to your daily routine may also help combat the condition.

Q: What is the importance of physical activity and diet for hypertension?

A: Exercise is a critical component to manage hypertension. Hypertension puts strain on your heart; it must beat harder to push blood against the raised pressure. Strengthening your pump helps combat this damage. The common recommendation is 30 minutes of aerobic exercise 5 days a week. Find what works for you, whether it is jogging, swimming or a dance class.

When it comes to diet, I recommend one that is low in sodium. The more salt you eat, the higher your BP will be. I tell my patients to try cooking more homemade meals. You would be surprised at how much sodium restaurants add to their food. Additionally, just because you do not salt your foods, that does not mean you have a low-sodium diet. You need to look at the sodium level for everything you are eating. For example, I have an English muffin every morning for breakfast. This is not a food I would typically think is sodium-packed, but it has more than 200 mg of sodium. Ultimately, it is important to read labels and keep an eye on your sodium levels throughout the day.

In addition to exercise and having a healthy diet, people with high BP should be wary of caffeinated products. Caffeine can raise your BP — whether or not you have hypertension — and those who drink caffeinated beverages generally have higher BP than nondrinkers. Drinking coffee is certainly OK, but if you have hypertension it is important to consult your doctor on whether you should limit your caffeine intake and consider staying clear of lattes, cappuccinos, an excess amount of creamer and energy drinks.

Lastly, another high BP contributor is smoking. The nicotine in cigarette smoke raises BP and heart rate, making blood more likely to clot, and ultimately increases the risk for stroke.

Q: Another common misconception is that hypertension generally affects men more than women. What are the gender differences in high BP?

A: It is a common misconception that high BP typically only impacts men. In reality, men and women are equally at risk for the condition and, after menopause, women face higher risk for developing high BP than men.

While sex differences have a small impact on the likelihood of developing high BP, race/ethnicity is another story. African-Americans are extremely susceptible to hypertension. In fact, as many as 3 in 4 African-American adults may develop high BP by age 55. There are no proven answers as to why African-Americans are more prone to hypertension, but this group is encouraged to monitor their BP regularly to ensure BP levels stay normal.

Q: What are the signs of hypertension? If you can’t feel it, how do you recognize and treat it?

A: High BP is symptomless — hence its nickname, “the silent killer.” You cannot feel the pressure inside your blood vessels because there aren’t nerves there. Rather, it is not until someone suffers one of the effects of hypertension, such as stroke, that it becomes apparent. Unfortunately, by that time, it is often too late. Regular checkups with a physician and monitoring are key to catching hypertension early and managing it effectively.

Q: What are the best treatment options for high BP? What alternatives are there to prescription medications?

A: There are many medications that can regulate your BP. However, some medications are associated with negative side effects such as dizziness, persistent cough, rashes, kidney failure, headaches, allergic reactions, fatigue, constipation, swelling in lower legs and feet, dry mouth, depression and excess potassium.

In most cases, I first encourage my patients to try natural solutions to help lower your blood pressure rather than going straight to prescription medications. These natural solutions include eating a healthy diet, reducing your sodium intake and exercising regularly. Eating nitrate-rich foods proven to lower blood pressure can also help (i.e. beetroot, hibiscus, pomegranate, cherry, etc.). It can be difficult to eat these regularly, but a patient of mine recently developed a new solution called 120/Life, which combines these ingredients in a daily beverage that helps promote normal blood pressure. The company’s founder concocted the drink after he was diagnosed with hypertension and worked with a nutritionist to optimize the healthful benefits and flavor. A holistic solution such as this may help you reduce your prescription medications but consult with your physician before stopping or cutting down on your medicine(s).

Q: How common are these “myths” about hypertension in the medical and patient communities? What can be done to increase awareness?

A: These myths are all too true and common among the patients I see. I think the most common misconception is that high BP has no symptoms. People rarely know what their BP level is. If people feel fine, they assume hypertension does not impact them; however, it can lead to heart attack, stroke and other CV events.

Education and conversations between patients and physicians are ultimately what will shift this course of thinking. Hypertension can only be the silent killer if we never talk about it. – by Melissa J. Webb

For more information:

Lowell H. Steen Jr., MD, can be reached at 2160 S. First Ave., Maywood, IL 60153.

Disclosure: Steen reports no relevant financial disclosures.