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Millions of women may have a potentially life-threatening condition and not know it. Uncontrolled high blood pressure, or hypertension, has declined among men over the past decade but increased among American women -- about 25 percent of us now have it. And it contributes to more deaths in women than any other preventable factor, according to a 2009 Harvard University study. While you should be concerned if your cholesterol is high, having hypertension is much more likely to kill you than high LDL cholesterol is, says Michael F. Roizen, MD, chief wellness officer at the Cleveland Clinic and a member of the LHJ Medical Advisory Board.
More young women are being stricken with high blood pressure because of rising obesity and stress in their lives. Also, hypertension can hit during pregnancy and pose grave health consequences for expectant mothers and their babies. Genetics plays a role, too: If hypertension runs in your family, your risks are higher.
Because hypertension has almost no symptoms, and so many women aren't seeing a doctor regularly, it often goes undetected for years. Yet the excessive pressure of blood coursing through your arteries can cause stretching, weakness, scarring, increased risk of blood clots, and other damage. It can harden your arteries, which may lead to a stroke or heart attack. Weakness in the blood vessel walls can create an aneurysm (abnormal ballooning of a portion of an artery), which is life-threatening if it ruptures. Because of hardening of the arteries, or the increased volume of blood from too much salt, the heart has to work harder to pump blood, which could eventually result in heart failure. Since high blood pressure limits blood flow, organs don't get enough vital nutrients, so your kidneys might fail and your brain won't function as well, causing problems with memory and learning.
Ignoring high blood pressure is a recipe for disaster. "The chronic wear and tear on your blood vessels is like driving a car with tires at too high a pressure," says Mary Ann Bauman, MD, an internal medicine specialist in Oklahoma City and spokesperson for the American Heart Association. "Eventually they're going to blow or simply not last as long as they should."
That's why it's vital to get tested regularly throughout your life and practice prevention. "Now is the time to be vigilant. The younger you are, the easier it is to make corrections," says Suzanne Oparil, MD, director of the Vascular Biology and Hypertension Program at the University of Alabama in Birmingham. Here's what you need to know to prevent lasting damage.
The Salt Connection
In many cases doctors aren't sure what causes hypertension, but age, family history, and lifestyle factors all play a role. And for many women eating too much salt plays a part, too. Your kidneys, which normally control your sodium level, become overloaded, so the extra salt spills into your bloodstream. Because salt makes you retain fluid, it bulks up the volume of blood flowing through your blood vessels. This increases the pressure pushing against the walls of your arteries and boom -- you now have hypertension.
Unfortunately, the average American woman eats about 3,000 milligrams of sodium a day, double the recommended dose of up to 1,500 milligrams (about two-thirds of a teaspoon). The salt shaker at home usually isn't the problem. Most sodium intake comes from fast foods (like burgers and pizza), restaurant dishes of all kinds, and processed foods, such as pickles, ham, bacon, salsa, cheese, cold cuts, olives, canned soups, even bread and meat.
The effects can be even worse for the more than two out of three adults who are ultrasensitive to sodium. This group includes everyone over the age of 40 (blood vessels lose their elasticity as you get older) and African Americans, who experts believe are genetically programmed to be more sensitive to salt.
Researchers have shown that if Americans managed to cut their sodium intake in half, it could save at least 150,000 lives a year. But consumption is going up. In 2010 the Institute of Medicine called for the FDA to regulate salt in processed foods. "Sodium is so prevalent in all food groups it's almost impossible for consumers to manage the situation on their own," says Jane E. Henney, MD, professor of medicine at the University of Cincinnati.
Still, food makers think regulating sodium isn't the best solution since salt helps create structure in bread, encourages browning of baked goods, and acts as a food preservative. A voluntary plan is a better strategy, argues Melissa Musiker, a registered dietitian and director of science policy, nutrition, and health for the Grocery Manufacturers Association in Washington, D.C. "The food industry should provide more low-sodium products, and consumers need to be aware and monitor their intake."
Natural Ways to Reduce Your BP
Lifestyle changes can shrink your risk of high blood pressure by a whopping 78 percent, research shows, even if you have a family history.
- Lose weight: Extra pounds are the top predictor of high blood pressure in women, says a 2009 Harvard study. The more you weigh, the more blood your body needs to supply oxygen and nutrients to your tissues. This increases the volume of blood circulating through your blood vessels, which boosts pressure on your artery walls. Getting to a healthy weight, meaning a BMI under 25, cuts your risk of high blood pressure by 40 percent. (If you're 5-foot-4 and 140 pounds or less, that puts you in the healthy zone.) Not even medication affects blood pressure as much as losing weight. For every 20 pounds you trim, you can drop blood pressure by up to 20 points.
- Get moving: Doing 30 minutes of vigorous exercise every day can make a big difference. After all, your heart is a muscle. The more you work out, the more efficiently it pumps blood, which keeps vessels flexible.
- Eat smart: The DASH (Dietary Approaches to Stop Hypertension) diet can significantly reduce blood pressure in as little as two weeks. This eating plan is low in sodium and rich in fruits, vegetables, nuts, and legumes. It also recommends low-fat dairy products, whole grains, and nutrients that help control blood pressure, like potassium, calcium, magnesium, and fiber.
- Help shake your salt habit by cooking more whole foods at home and avoiding the drive-through. Check labels of canned, frozen, and packaged foods and pick ones that are the lowest in sodium. When you cook, use flavorful herbs and spices or a squeeze of lemon or lime instead of reaching for the salt shaker.
- Calm your stress. Juggling your career, your family, and your social life can make you feel frazzled. When you're stressed your body produces a surge of hormones, like adrenaline and cortisol, which helps you conquer deadlines. But this may also cause a temporary spike in blood pressure by making your heart beat faster and your blood vessels narrow. Relaxation techniques like deep breathing and meditation can help reduce the pressure.
- Log enough sleep: Getting less than six hours of sleep a night dramatically increases the risk of high blood pressure, especially in the childbearing years, according to a 2010 study in the Journal of Hypertension. Sleep keeps stress hormones in check and helps your nervous system remain healthy by recharging your batteries.
Sodium can really add up over the course of your day. It's not hard to imagine eating these three meals, which deliver more than three times the recommended daily sodium intake of 1,500 milligrams.
2 slices whole wheat toast with jam: 307mg
2 slices bacon: 370mg
2 large eggs: 358mg
2 slices deli turkey: 508mg
1 slice provolone cheese: 249mg
2 slices whole wheat bread: 292mg
1 tablespoon light mayo: 78mg
1 teaspoon mustard: 57mg
1 cup minestrone: 698mg
Spaghetti and Meatballs
1 cup spaghetti: 325mg
1/2 cup marinara sauce: 527mg
4 meatballs, made with seasoned bread crumbs: 743mg
2 tablespoons low-fat ranch dressing: 330mg
How Low Should You Go?
Blood pressure is expressed as a ratio.
Systolic, the top number, is the pressure in your blood vessels while your heart contracts to pump blood to your body.
Diastolic, the lower number, represents the pressure when your heart relaxes between beats.
If your blood pressure is 90/60 to 119/79, that's considered normal. If you're 120/80 to 130/89, that's called pre-hypertensive and you should be monitored carefully. Once you hit 140/90, you officially have hypertension and need treatment.
You can add years to your life by reducing your blood pressure. Current guidelines say 120/80 is optimal, but many experts believe 115/75 is even better. You should aim for 115/75, says Dr. Roizen. That's backed up by the results of a landmark study involving more than 20 million people in 52 countries. "The good news is that we can get almost everyone to 115/75 now using a combination of lifestyle changes and medication," he says.
Hypertension and Pregnancy
Up to 8 percent of pregnant women get hypertension, which can be extremely dangerous for mom and baby. It's increasing as women are getting heavier and having babies later.
- Gestational hypertension, which usually develops after the 20th week of pregnancy, can cause premature delivery and puts you at risk for stroke or cardiac arrest. It also makes you more likely to develop heart or kidney disease later in life. It's usually controlled with medication or by delivering the baby.
- Preeclampsia, a more serious condition that can happen if you're over 40 or carrying twins or triplets, prevents the placenta from getting enough blood, depriving the fetus of oxygen and vital nutrients. Besides premature delivery, it can lead to rupture of your liver, kidney failure, hemorrhage, stroke, or even death. The only cure is delivery.
Hometown: Bronx, New York
Occupation: Executive assistant at a media company
Her highest numbers: 190/120
"I was a walking stroke." Tisha Dixon-Williams isn't exaggerating. Four years ago, when she experienced bouts of dizziness and blurry vision for a few days, she paid a visit to her family doctor. That decision probably saved her life: He discovered her blood pressure was a staggering 190/120.
Her physician immediately treated her with blood pressure medication. "He told me, 'If this doesn't work, you're going to the hospital,'" recalls Dixon-Williams, who had just celebrated her 31st birthday. "I was terrified. When you're young, you think you're invincible and that something like this could never happen to you."
Although she had a penchant for junk food, she was otherwise in good shape. But Dixon-Williams discovered that high blood pressure can run in families, especially among African Americans. Her grandmother had a history of heart disease, her father had recently had a heart attack, and her mother had been diagnosed with hypertension at age 33.
In addition to taking medication, Dixon-Williams made some changes in her everyday routines. She stepped up her exercise program and decided to lose some weight. She started ballroom dancing three times a week. "It was important to do something I loved so I'd stick with it because I get bored easily," says Dixon-Williams, who lost about 20 pounds. She's also more vigilant about her diet, checks food labels for salt content, and has mostly given up fast food. Now her blood pressure is in the normal range. "It's better to be proactive," she says, "because heart disease is preventable."
Hometown: Scotch Plains, New Jersey
Occupation: Kindergarten teacher
Her highest numbers: 160/90
Callen Bonaventura's pregnancy had been uneventful until she went in for her final checkup three days before her due date. She learned that her blood pressure was sky high -- in one week it had shot up to a perilous 160/90 from her normal 110/77.
"I was shocked," recalls Bonaventura, who had been scrupulous about watching her weight and exercised on an elliptical machine almost every day throughout her pregnancy. "My hands and feet were swollen and my face was huge because I was retaining so much water."
High blood pressure in pregnancy may cause preeclampsia, which can trigger premature labor and also cause serious health complications. Bonaventura's obstetrician, Russell Hoffman, MD, immediately checked her into the hospital and induced labor. "We did a urine test to make sure she wasn't spilling protein" -- a sign of preeclampsia -- "and listened to the baby's heartbeat," says Dr. Hoffman. "Everything was normal and she did beautifully during labor."
Twenty hours later her baby was born -- a healthy six-pound boy named Aslan. Bonaventura's blood pressure has since returned to normal. "I'm feeling fine," she says, "but that was a close call."
Hometown: Floral Park, New York
Occupation: Project administrator for a construction engineering firm
Her highest numbers: 160/80
Hypertension wasn't on Marilyn Levy's radar screen -- it snuck up on her gradually as she got older. But four years ago she got a wake-up call when at a routine checkup she learned her blood pressure had hit the danger zone: It was?160/80. "I was surprised because I felt fine," she says. A variety of factors were involved, including waning hormones, an extra 15 pounds she could get away with at 40 but not at 46, plus being more sedentary. She's since made some simple tweaks that added up to make a huge difference.
Levy cut way back on salt and processed foods and sticks with healthier options like oatmeal for breakfast, grilled chicken and salads for dinner, an apple or a handful of unsalted cashews for snacks. "I plan my meals, which makes it so much easier so you don't just run out and eat junk," she says.
She spends her lunch hours walking at a brisk pace through the city streets surrounding her office in Manhattan. She takes the stairs instead of the elevator, and when she runs errands in her neighborhood, she walks or parks her car farther away. Thanks to her new regimen, she has lost 16 pounds over the past year and a half, dropping from a size 12 to an 8. "I love being outside and keeping my body moving," she says.
She takes a diuretic to control fluid retention, checks in with her doctor every three months, and has whittled her blood pressure down to a healthy level. "Sometimes I fall off the wagon," she admits. "But I remind myself that tomorrow is a new day and I jump right back on."
Originally published in Ladies' Home Journal, March 2011.