A Visual Guide to High Blood Pressure

Reviewed by Louise Chang, MD on February 15, 2011
Source: 2011 WebMD

What Is Hypertension?

Hypertension, or high blood pressure, is a common condition that will catch up with most people who live into older age. Blood pressure is the force of blood pressing against the walls of your arteries. When it's too high, it raises the heart's workload and can cause serious damage to the arteries. Over time, uncontrolled high blood pressure increases the risk of heart disease, stroke, and kidney disease.

Hypertension Symptoms

High blood pressure is sometimes called a silent killer because it may have no outward symptoms for years. In fact, one in five people with the condition don't know they have it. Internally, it can quietly damage the heart, lungs, blood vessels, brain, and kidneys if left untreated. It's a major risk factor for strokes and heart attacks in the U.S.

What Causes Hypertension?

Normal blood pressure readings will fall below 120/80, while higher results over time can indicate hypertension. In most cases, the underlying cause of hypertension is unknown. The top number (systolic) shows the pressure when your heart beats. The lower number (diastolic) measures pressure at rest between heartbeats, when the heart refills with blood. Occasionally, kidney or adrenal gland disease can lead to hypertension.

Prehypertension: A Warning Sign

Almost one-quarter of Americans have prehypertension. Their blood pressure is consistently just above the normal level -- falling anywhere between 120 and 139 for systolic pressure or 80 to 89 for the diastolic pressure. People in this range have twice the risk of developing heart disease than those with a lower reading. Your doctor may recommend lifestyle changes to help lower your blood pressure.

The Hypertension Danger Zone

You have high blood pressure if readings average140/90 or higher -- for either number -- though you may still have no symptoms. At 180/110 and higher, you may be having a hypertensive crisis. Rest for a few minutes and take your blood pressure again. If it is still very high, call 911. A hypertensive crisis can lead to a stroke, heart attack, kidney damage, or loss of consciousness. Symptoms of a hypertensive crisis can include a severe headache, anxiety, nosebleeds, and feeling short of breath.

Who Gets High Blood Pressure?

Up to the age of 45, more men have high blood pressure than women. It becomes more common for both men and women as they age, and more women have hypertension by the time they reach 65. You have a greater risk if a close family member has high blood pressure or if you are diabetic. About 60% of people with diabetes have high blood pressure.

Hypertension and Race

African-Americans are more likely to develop hypertension -- and to develop it at a younger age. Genetic research suggests that African-Americans seem to be more sensitive to salt. In people who have a gene that makes them salt-sensitive, just a half-teaspoon of salt can raise blood pressure by 5 mm Hg. Diet and excessive weight can play a role, as well.

Hypertension and Sodium

Sodium, a major component of salt, can raise blood pressure by causing the body to retain fluid, which leads to a greater burden on the heart. The American Heart Association recommends eating less than 1,500 milligrams of sodium per day. You'll need to check food labels and menus carefully.  Processed foods contribute up to 75% of our sodium intake. Canned soups and lunch meats are prime suspects.

Hypertension and Stress

Stress can make your blood pressure spike, but there's no evidence that it causes high blood pressure as an ongoing condition. However, stress may affect risk factors for heart disease, so it may have an indirect connection to hypertension. Stress may lead to other unhealthy habits, such as a poor diet, alcohol use, or smoking, which can contribute to high blood pressure and heart disease.

Hypertension and Weight

Being overweight places a strain on your heart and increases your risk of high blood pressure. That is why diets to lower blood pressure are often also designed to control calories. They typically call for cutting fatty foods and added sugars, while increasing fruits, vegetables, lean protein, and fiber.  Even losing 10 pounds can make a difference.

Hypertension and Alcohol

Drinking too much alcohol can increase your blood pressure. Guidelines from the American Heart Association state that if you drink alcohol, you should limit the amount to no more than two drinks a day for men, or one a day for women. They define a drink as one 12-ounce beer, four ounces of wine, 1.5 ounces of 80-proof spirits, or one ounce of 100-proof spirits.

Hypertension and Caffeine

If caffeine can make you jittery, can it also raise your blood pressure? It might have a temporary effect, but studies haven't shown any link between caffeine and the development of hypertension. You can safely drink one or two cups a day, according to the American Heart Association.

Hypertension and Pregnancy

Gestational hypertension is a kind of high blood pressure that occurs in the second half of pregnancy. Without treatment, it may lead to a serious condition called preeclampsia that endangers both the mother and baby. The condition can limit blood and oxygen flow to the baby and can affect  the mother's kidneys and brain. After the baby is born, the mother’s blood pressure usually returns to its normal level.

Hypertension and Medicine

Cold and flu medicines that contain decongestants are one of several classes of medicine that can cause your blood pressure to rise. Others include NSAID pain relievers, steroids, diet pills, birth control pills, and some antidepressants. If you have high blood pressure, talk to you doctor about what medicines and supplements you are taking that may affect blood pressure.


'White Coat' Hypertension

Some people only have a high reading in the doctor's office, perhaps because they're nervous. Some will only have blood pressure readings sporadically. Those people may have a higher chance of developing high blood pressure, a recent study shows. To get a more accurate reading, take your blood pressure at home, chart your readings, and share them with your doctor. It is also a good idea to bring in your home monitor in for a check of the device and your technique.


Hypertension and Children

While hypertension is more often a problem for older people, even children can have high blood pressure. "Normal" blood pressure varies based on a child’s age, height, and sex, so your doctor will need to tell you if there is a concern. Children are at greater risk if they are overweight, have a family history of the illness and if they're African-American.


Treatment: The DASH Diet

You may be able to lower your blood pressure by switching to a better diet. The DASH Diet -- Dietary Approaches to Stop Hypertension -- involves eating more fruits, vegetables, whole-grain foods, low-fat dairy, fish, poultry, and nuts. You should eat less red meat, saturated fats, and sweets. Reducing sodium in your diet can also have a significant effect.


Treatment: Exercise

Regular exercise helps lower your blood pressure. Adults should get about 150 minutes of moderate-intensity exercise every week. That could include gardening, walking briskly, bicycling, or other aerobic exercise. Muscle-strengthening activities are recommended at least two days a week and should work all major muscle groups.


Treatment: Diuretics

Diuretics are often the first choice if diet and exercise changes aren't enough. Also called "water pills," they help the body shed excess sodium and water to lower blood pressure. That means you'll urinate more often. Some diuretics may deplete your body's potassium, causing muscle weakness, leg cramps, and fatigue. Some can increase blood sugar levels in diabetics. Erectile dysfunction is a less common side effect.


Treatment: Beta-blockers

Beta-blockers work by slowing the heart rate, which means that the heart doesn't have to work as hard. They are also used to treat other heart conditions, such as an abnormal heart rate called arrhythmia. They may be prescribed along with other medications. Side effects can include insomnia, dizziness, fatigue, cold hands and feet, and erectile dysfunction.


Treatment: ACE Inhibitors

ACE inhibitors reduce your body's supply of angiotensin II -- a substance that makes blood vessels contract and narrow. The result is more relaxed, open (dilated) arteries, as well as lower blood pressure and less effort for your heart. Side effects can include a dry cough, skin rash, or dizziness, and high levels of potassium. Women should not become pregnant while taking an ACE inhibitor.


Treatment: ARBs

Instead of reducing your body's supply of angiotensin II, these drugs block receptors for angiotensin -- as if placing a shield over a lock. This blockade prevents the chemical's artery-tightening effects, and lowers your blood pressure. ARBs can take several weeks to become fully effective. Possible side effects include dizziness, muscle cramps, insomnia, and high levels of potassium. Women should not become pregnant while taking this medication.


Treatment: Calcium Channel Blockers

Calcium channel blockers slow the movement of calcium into the cells of the heart and blood vessels. Since calcium causes stronger heart contractions, these medications ease the heart's contraction and relax the blood vessels. They can cause dizziness, heart palpitations, swelling of the ankles, and constipation. Take them with food or milk and avoid grapefruit juice and alcohol because of possible interactions.


Treatment: Other Medications

Other medications that relax the blood vessels include vasodilators, alpha blockers, and central agonists. Side effects can include dizziness, a fast heart beat or heart palpitations, headaches, or diarrhea. Your doctor may suggest them if other blood pressure medications are not working well enough or if you have another condition.


Treatment: Complementary Therapies

Meditation can put your body into a state of deep rest, which can lower your blood pressure. Yoga, tai chi, and deep breathing also help. These relaxation techniques should be combined with other lifestyle changes, such as diet and exercise. Be aware that herbal therapies may conflict with other medications you take, and some herbs actually raise blood pressure. Tell your doctor if you take herbal or other dietary supplements.


Living With High Blood Pressure

Hypertension is often a life-long condition. It's important to take your medications and continue to monitor your blood pressure. If you keep it under control, you can reduce your risk of stroke, heart disease, and kidney failure.

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Sleep Disorders

What Are Sleep Disorders?

Sleep disorders are conditions that affect how much and how well you sleep. The causes range from poor habits that keep you awake to medical problems that disrupt your sleep cycle. If you don't feel rested in the mornings, see your doctor. Insufficient sleep is a serious problem that poses a threat to your health and safety.

The Dangers of Poor Sleep?

Lack of sleep can take a toll on nearly every aspect of daily life. Research has linked sleep deprivation to car accidents, relationship troubles, poor job performance, job-related injuries, memory problems, and mood disorders. Recent studies also suggest sleep disorders may contribute to heart disease, obesity, and diabetes.

Symptoms of Sleep Disorders

Symptoms vary depending on the type of sleep disorder but may include:

• Excessive sleepiness during the day
• Trouble falling asleep or staying asleep
• Snoring or episodes of stopped breathing during sleep
• Urge to move your legs at rest or an uncomfortable feeling in the legs at night.

The Sleep Cycle

There are two forms of sleep: REM sleep and non-REM sleep. REM stands for rapid eye movement and is associated with dreaming. It accounts for 25% of normal sleep, coming in longer periods toward morning. The rest of our sleep time is spent in NREM, which consists of four stages from light sleep (stage 1) to deep sleep (stage 4). Sleep disorders interfere with normal sleep cycles, preventing a good night's rest.

How Much Sleep Is Enough?

Sleep needs vary widely from person to person, but general guidelines are:

• 16 hours for infants
• 9 hours for teenagers
• 7-8 hours for adults

Keep in mind that some adults do fine with 5 hours of sleep and others need as many as 10 hours per night.

Insomnia

Most people have trouble sleeping once in awhile, but when the problem lingers night after night you may have insomnia. People with insomnia may lie awake for hours before falling asleep. They may wake up too early and be unable to drift off again. Or they may wake up repeatedly throughout the night. Insomnia is the most common sleep disorder in the U.S., affecting a third of adults at some point in life.

Insomnia and Sleep Hygiene

In many cases, insomnia is related to poor sleep hygiene. This refers to bad habits that interfere with sleep. Examples include drinking coffee in the afternoon or evening, smoking or eating heavy foods before bed, going to bed at a different time each night, or falling asleep with the television on,

Insomnia and Mental Health

Mental health problems can lead to insomnia. These include depression, anxiety, and posttraumatic stress disorder. Unfortunately, some of the medications used to treat these conditions may also cause sleep problems. If you suspect your medication is disrupting your sleep, talk to your doctor about adjusting your treatment.

Insomnia and Medical Conditions

Insomnia is often related to medical problems, including:

• Arthritis
• Heartburn
• Other causes of chronic pain
• Asthma
• COPD
• Heart failure (due to breathing problems)
• Thyroid problems
• Neurological disorders, such as stroke, Alzheimer's or Parkinson's

Other Causes of Insomnia

Insomnia can occur during pregnancy, especially in the first and third trimesters. The problem may return during menopause, when hot flashes can interrupt a good night's sleep. Both men and women tend to have more sleep problems over age 65. And shift workers and frequent fliers can develop a circadian rhythm disorder. In this case, a sort of "internal body clock" that controls sleep, hormone production, and other body functions is disturbed.

Sleep Apnea

People with this sleep disorder have episodes when they stop breathing many times while they sleep. The breathing pauses last several seconds and trigger a switch from deep sleep to light sleep. These interruptions can lead to daytime sleepiness. Many people with sleep apnea don't know they have it. Snoring is a common warning sign, and a spouse may notice breathing pauses followed by a snort or gasp.

Risk Factors for Sleep Apnea

Sleep apnea is most common in people who are male, overweight, and over age 65. Hispanics, African-Americans, and Pacific Islanders also have a higher risk of developing the condition. While it is more common in adults, sleep apnea sometimes occurs in young children who have enlarged tonsils.

Restless Legs Syndrome

People with restless legs syndrome experience discomfort and the urge to move the legs at rest. The problem is usually at its worst during the evening and night. This can make it tough to fall asleep. Others experience twitching motions during sleep that may cause brief awakenings.

Narcolepsy

Narcolepsy causes extreme sleepiness during the day. People may find it hard to function without naps, despite spending enough time in bed at night. Other warning signs include:

• Being unable to move when you first wake
• Losing muscle control with strong emotions
• Dreaming during naps
• Dream-like hallucinations as you fall asleep or wake up

People with narcolepsy enter REM sleep almost immediately, without the NREM sleep stages that normally lead up to dream sleep

Sleepwalking

People with this sleep problem can literally get up and walk while they are sleeping. The episodes occur during the deeper stages of NREM sleep, and the person may do a variety of activities without waking up. Sleepwalkers typically don't respond to questions and won't remember what they did once they wake up. Sleepwalking is most common in children but can last into adulthood.

When to Call the Doctor

There are steps you can take to fight sleep disorders on your own, but some situations require medical attention. Call your doctor if you snore loudly or gasp during sleep, if you think a medical condition or medication is keeping you up at night, if you're tired all the time or if you fall asleep during daytime activities.

Sleep Diary

Charting your habits for 1-2 weeks can provide valuable information. Include:

• Your bedtime and wake time
• How long and well you slept
• Time awake during the night
• Caffeine or alcohol consumed and when
• What/when you ate and drank
• Emotion or stress
• Drugs or medications

Diagnosing Sleep Disorders

To diagnose a sleep disorder, your doctor will ask about your sleep habits and medical conditions. Next, you may be referred to a sleep clinic for testing. A polysomnogram, also called a sleep study, records brain activity, eye movements, and breathing while you sleep. These patterns can indicate a disorder like sleep apnea or a less common type. Research has identified more than 85 sleep problems, including sleep terrors, REM sleep behavior disorder, and sleep starts.

Treating Sleep Disorders

For sleep apnea, a CPAP device increases air pressure to keep airways open so you can rest more soundly without the breathing pauses that interrupt sleep. Narcolepsy and restless legs syndrome can be treated with lifestyle changes and prescription medication. There are also effective medications for insomnia. However, many people can beat insomnia without medication by changing poor sleep habits and taking care of related conditions.

Cognitive-Behavioral Therapy

Several methods can ease sleep anxiety, which makes insomnia worse. Relaxation training and biofeedback help to calm your breathing, heart rate,  muscles, and mood. Talk therapy can help replace bedtime worries with positive thinking, so your mind can settle down at night. Cognitive behavioral therapy (CBT) works as well as prescription drugs for many people with chronic insomnia.

Sleep Hygiene: Exercise

Adopting habits that promote sleep is known as good sleep hygiene. Regular exercise should be part of the plan, but the timing is important. Exercise in the late afternoon can make it easier to fall and stay asleep – just don't let it get too late. Exercise within a couple hours of bedtime can make it harder to fall asleep.

Sleep Hygiene: Problem Foods

Certain foods and drinks should be avoided in the 4-6 hours before bed:

• Caffeine, including coffee, tea, and soda.
• Heavy or spicy foods.
• Alcohol. (While alcohol helps some people fall asleep, it leads to nighttime awakenings.

Sleep Hygiene: Helpful Foods

A light evening snack of complex carbs and protein can lead to better sleep. Cereal with milk or crackers and cheese fit the bill, but they should be eaten at least an hour before bed. Warm milk and  chamomile tea raise body temperature and make many people feel sleepy.

Sleep Hygiene: Television

Late-night television may be part of your routine, but chances are it is not helping you sleep. Television engages the mind and can increase alertness, keeping you awake. Playing video games before bed or surfing the Internet may have the same effect. The National Sleep Foundation recommends removing televisions and computers from your bedroom altogether.

Sleep Hygiene: Bedtime Rituals

You can signal your mind and body that it's time for sleep by creating a bedtime ritual. This may include a warm bath, reading a chapter of a book, or practicing relaxation techniques, such as deep breathing. It's also important to stick to a firm bedtime and wake-up time, even on the weekends. If you still have trouble sleeping despite improving your sleep hygiene, check with your doctor.

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Alzheimer's Disease

Reviewed by Brunilda Nazario, MD on January 21, 2010
Source: 2010 WebMD

Could It Be Alzheimer's?

It's normal for our loved ones to become a bit forgetful as they age. So how can we separate a harmless "senior moment" from a more serious problem like Alzheimer's disease? One in eight people 65 and older have this devastating form of dementia. In its first stages, Alzheimer's may not be obvious to friends and family. But there are some early warning signs to watch for.

Warning Signs: Memory and Speech

In early Alzheimer's, long-term memories usually remain intact while short-term memories become sketchy. Your loved one may forget conversations you had. He or she may repeat questions that were already answered. The disease also disrupts speech, so patients may struggle to remember common words.

Warning Signs: Behavior

In addition to memory loss, Alzheimer's can cause confusion and behavior changes. Your loved one may get lost in familiar places. Mood swings and poor judgment are also common, as is poor hygiene. People who once dressed with style may resort to wearing stained clothes and unwashed hair.

Don't Ignore the Signs

While it's difficult to face the possibility that a loved one could have Alzheimer's, it's better to consult a doctor sooner rather than later. First, the diagnosis might not be Alzheimer's after all. The symptoms could be caused by a highly treatable problem, such as a thyroid imbalance. And if it is Alzheimer's, today's treatments work best when they are used early in the course of the disease.

Diagnosing Alzheimer's

There is no simple test for Alzheimer's, so the doctor will rely on you to describe the changes in your loved one. A mental status test, sometimes called a "mini-cog," or other screening tests can help evaluate the patient's mental function and short-term memory. In addition, neurological exams and brain scans may be used to rule out other problems, such as a stroke or tumor — and they can help provide other information about the brain.

Alzheimer's and the Brain

Alzheimer's disease leads to nerve cell death and tissue loss throughout the brain. As the disease progresses, brain tissue shrinks and the ventricles (chambers within the brain that contain cerebrospinal fluid) become larger. The damage disrupts communication between brain cells, crippling memory, speech, and comprehension.

Alzheimer's Progression: What to Expect

Alzheimer's disease takes a different path in every patient. In some people the symptoms worsen quickly, leading to severe memory loss and confusion within a few years. In others, the changes may be more gradual with the disease taking 20 years to run its course. The average length of survival after a diagnosis of Alzheimer's is three to nine years.

How Alzheimer's Affects Daily Life

Because Alzheimer's affects concentration, patients may lose the ability to manage ordinary tasks like cooking or paying the bills. A study suggests difficulty balancing a checkbook is often one of the first effects of Alzheimer's. As the symptoms worsen, your loved one may not recognize familiar people or places. He or she may get lost easily, or use utensils improperly, such as combing hair with a fork. Incontinence, balance problems, and loss of language are common in the advanced stages.

Alzheimer's and Driving

Poor coordination, memory loss, and confusion make for a dangerous combination behind the wheel. If you feel your loved one should not be driving, explain why. If he or she won't listen, ask the doctor to step in. If the patient still insists on driving, contact the Department of Motor Vehicles for an assessment. Then make an alternate plan for your loved one's transportation need.

Alzheimer's and Exercise

Exercise can help people with Alzheimer's maintain some muscle strength and coordination. It also improves mood and may reduce anxiety. Check with your loved one's doctor to learn which types of exercise are appropriate. Repetitive activities, such as walking, weeding, or even folding laundry may be the most effective at promoting a sense of calm.

Alzheimer's Medications

There is no cure for Alzheimer's disease, and no known way to slow the nerve damage within the brain. But there are a variety of medications that appear to help maintain mental function and slow the disease progression. If these treatments are given during the early stages of Alzheimer's, your loved one may be able to remain independent and carry out daily tasks for a longer period of time.

The Caregiver's Role

As the caregiver of someone with Alzheimer's, you will probably wear many hats — cook, chauffeur, accountant. While you may have to handle the meal planning and finances, encourage the patient to do some activities independently. It may help to label cabinets with their contents and put up sticky notes with reminders of daily tasks. Be sure to buy a weekly pill box for medications.

Challenges in Caregiving

In the early stages of Alzheimer's, patients often understand what is happening and may be ashamed or anxious. Watch for signs of depression because this can often be managed with medication. In the more advanced stages, your loved one may become paranoid or violent and could even turn on you. Remember that the disease is responsible for this change. Alert the doctor about violent behavior promptly.

Sundown Syndrome

Some people with Alzheimer's become distressed when the sun goes down. This agitation tends to last through the evening and sometimes all through the night. The cause is not known, but there are some strategies to ease the tension. Keep the house well lit and close the drapes before sunset. Try distracting your loved one with a favorite activity or TV show. And restrict caffeine after breakfast.

When Your Loved One Doesn't Know You

Many people with Alzheimer's have trouble remembering names — even those of close family members. A temporary fix is to put up pictures of friends and relatives with names printed underneath. Eventually, the patient may no longer recognize faces and may react to loved ones as if they are strangers. This can be a distressing time for family members, especially the primary caregiver.

Warning Signs of Caregiver Stress

Caring for someone with Alzheimer's can be physically and mentally taxing. Signs of caregiver stress include:

• Anger, sadness, and mood swings.
• Headaches or back pain.
• Difficulty concentrating.
• Difficulty sleeping.

Taking Care of the Caregiver

To avoid caregiver burnout, make sure you take at least a few minutes to do something you enjoy every day. Stay in touch with friends and keep up with hobbies whenever possible. Find a friend or relative to be your support person. You can also join an online or local caregiver support group through the Alzheimer's Association.

Essential Documents

While your loved one is still able to make important decisions, contact an attorney about drafting advance directives. These are legal documents that spell out the patient's preferences for medical treatments and end-of-life care. The patient should designate someone to make health care decisions and manage finances on his or her behalf. This can avoid confusion when your loved one is no longer able to state his or her wishes.

Home Health Care

Many patients express a desire to stay in their own homes as long as possible. Unfortunately, they may have trouble getting dressed or using the bathroom on their own as the disease advances. A home health aide can assist with personal hygiene and other daily tasks. You can also look into local services that deliver meals or provide transportation to the elderly. Most communities have an Area Agency on Aging that provides such services.

Assisted Living Facilities

There may come a day when your loved one can no longer be cared for at home. If he or she does not need 24-hour nursing care, an assisted-living facility may be an appropriate choice. ALFs provide housing, meals, and activities, but are much less expensive than nursing homes. Look for a facility with an Alzheimer's special care unit, which delivers 24-hour supervision and personal care to meet the needs of people with dementia.

End-Stage Alzheimer's

People with advanced Alzheimer's may lose the ability to walk, talk, or respond to others. Eventually, the disease can hinder vital functions, such as the ability to swallow. Patients in this stage may benefit from hospice care, which provides pain relief and comfort for the terminally ill.

Helping Children Cope

Children may feel confused, afraid, or even resentful when a family member is affected by Alzheimer's. Let the child know these feelings are normal and answer his or her questions about the illness honestly. Help the child celebrate happy memories of the patient — for example, by creating a scrapbook.

Reducing Your Risk of Alzheimer's

If you're caring for a relative with Alzheimer's, you might be wondering if there's anything you can do to reduce your own risk. Research in this area is ongoing, but diet and exercise appear key. Studies indicate a lower risk among people who eat a Mediterranean diet rich in vegetables, fish, and nuts. Research also suggests those who are the most physically active are the least likely to get Alzheimer's.

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