Optimal Life: Essentials of Hypertension
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Optimal Life - Christine Lee, Pharm.D., BCPS
Optimal Life: The Essentials of Hypertension
Christine Lee, Pharm.D., BCPS
Copyright © 2013 Dr. Christine V. Lee
All rights reserved. No part of this publication may be reproduced, distributed or transmitted in any form or by any means, or stored in a database or retrieval system without the prior written permission of the publisher. Optimal Life, OL and associated logos are trademarks and/or registered trademarks for the use of their respective owners.
ISBN: 978-0-9833372-3-2
ISBN: 9780983337294
Printed in the United States of America
Book Design: RunnWest www.runnwest.com
Optimal Life Globe Design: Jim Draper www.jimdraper.com
Optimal Life and OL Logo Design: Heide Couch/RHC
Design Tech www.rhcdesigntech.net
A NOTE TO THE READER
This book does not replace your doctor’s advice; it is meant to add value to your health care by giving you lots of information about hypertension (high blood pressure) so you can understand the disease and the options available to control it. The more you know about hypertension, the more effectively you can work with your doctor.
ABOUT THE AUTHOR
Christine Lee received her Doctor of Pharmacy from the University of the Pacific School of Pharmacy in Stockton, California, and was granted a Bachelor of Science in Clinical Laboratory Science from the University of Nevada, Reno. She is licensed by both the California and Nevada State Boards of Pharmacy. She is also a Board Certified Pharmacotherapy Specialist, and a licensed clinical laboratory scientist.
Dr. Lee founded Optimal Life as the natural outgrowth of her association with American Health Care, which she co-founded in 1986. American Health Care specializes in delivering patient-centric pharmacy benefit, population health, and therapy management programs that emphasize clinical excellence. She also developed proprietary software for virtual medical records that is used by hospitals across the country. She is the preceptor for the company’s pharmacy residency program and co-founded the United American Pharmacy Network. Dr. Lee is affiliated with the American College of Managed Care Pharmacy, the American College of Clinical Pharmacy, the American Society of Health System Pharmacists and the Academy of Managed Care Pharmacy.
When not at work, Christine enjoys the company of her family, maintains her black belt in Taekwondo and loves to run. She is an avid supporter of the Juvenile Diabetes Research Foundation and has served on the boards of several consulting companies, as well as human rights advocacy groups for the mentally disabled.
You may contact the author at info@optimalife.net.
ACKNOWLEDGEMENTS
As with my previous efforts, I would like to thank Sherill Conley Rohde for her assistance. She selflessly invests her time and energy and brings great focus to the material. Every day, her friendship and enthusiasm remind me that we can change lives by giving people the knowledge and tools they need to become as healthy as possible.
FOREWORD
High blood pressure is the number one cause of death in the world. Myriad studies have shown that lowering blood pressure saves lives. Despite the epidemic of diabetes worldwide, it is still not ranked in the top ten causes of death. Most patients with diabetes have high blood pressure, so it is imperative that aggressive treatment of high blood pressure be a top priority. Treatment of high glucose is important, but if you only focus on glucose management, you overlook the most important cause of death in patients with diabetes: hypertension. Aggressive management of hypertension in patients, especially those with diabetes, must be a top priority.
Claude K. Lardinois, M.D., FACP, MACN
I’ve been an emergency room physician for almost 15 years and a significant number of the cases I see are related to uncontrolled hypertension. Some patients who come to the emergency department with chest pain, shortness of breath, fatigue, headache, blurry vision, one-sided body numbness or weakness, swelling in the legs, or nausea and vomiting are exhibiting only some of the classic symptoms of uncontrolled hypertension. Some of these patients had a history of hypertension but were untreated; others had no idea they had hypertension and were now in the emergency room.
These patients are often faced with a diagnosis of hypertensive heart disease, a group of disorders due to hypertension, which include coronary heart disease and heart failure, and stroke and kidney insufficiency, among other problems. Uncontrolled hypertension and its effects are also involved in the causes for cardiopulmonary arrests. All of these illnesses could have been avoided with early diagnosis and proper treatment of hypertension.
Hypertension continues to be a major public health problem due to its significant morbidity and mortality. It’s known as the silent killer for a good reason.
Yvonne Maywether, M.D., FACEP
TABLE OF CONTENTS
CHAPTER ONE
Why Should You Care About Hypertension?
What is Hypertension and Who Has It?
Women’s Health
Men’s Health
Health Over 60
Health for African-Americans
A Word About Salt
Summary
Facts at a Glance
Your Three Action Steps
CHAPTER TWO
How Do You Know If You Have Hypertension?
Measuring Blood Pressure
How is Hypertension Diagnosed?
Emergency Hypertensive Crisis/Hypertension Urgency
Goals and Follow-Up
Should You Monitor Your Blood Pressure at Home?
White Coat Syndrome
Summary
Facts at a Glance
Your Three Action Steps
CHAPTER THREE
Causes of Hypertension
Fluid (Water) Retention
Blood Vessel Constriction
Different Types of Hypertension
Primary Hypertension
Secondary Hypertension
Resistant Hypertension
Urinary Problems
Obstructive Sleep Apnea and Sleep Disorders
Obesity
Medications, Herbal Supplements and Food
Summary
Facts at a Glance
Your Three Action Steps
CHAPTER FOUR
What Are the Risks?
Cardiovascular Risk (Heart Disease)
Damage to Your Arteries and Heart
How to Monitor and Prevent Artery and Heart Damage
Damage to Your Kidneys
How to Monitor and Prevent Kidney Damage
Damage to Your Eyes
How to Monitor and Prevent Eye Damage
Damage to Your Brain/Stroke
How to Monitor and Prevent Brain Damage/Stroke
Summary
Facts at a Glance
Your Three Action Steps
CHAPTER FIVE
Treatment
What is the Goal of Treatment?
Lifestyle Modifications
Medications
Types of Medications
Diuretics
ACE Inhibitors, ARBs and Renin Blockers
Angiotensin Converting Enzyme Inhibitor (ACE Inhibitor)
Angiotensin Receptor Blocker (ARB)
Calcium Channel Blocker
Mechanism of Action/How it Works:
Monitoring/Tests You Should Have:
Beta-Blockers
Alpha Blockers
Vasodilators
Central Alpha Receptor Agonist
Summary
Facts at a Glance
Your Three Action Steps
CHAPTER SIX
In Case You Were Wondering
Resources
Hypertension Action Plan
Weight Management
Physical Activity
The DASH Eating Plan
How to Start Exercising
Tobacco Cessation (Quitting)
Getting Ready to Quit
Quitting
AACE Blood Pressure Guidelines
Medications
Bibliography
INTRODUCTION
You’ve probably picked up this book because you or a loved one has high blood pressure. Perhaps you’ve just been diagnosed. When you’re first diagnosed with a chronic illness, it seems like your stress levels increases. Ten minutes before you sat down in the doctor’s office you didn’t have that stress. So what happened? You didn’t change or turn into a blue monster in ten minutes. The stress is from knowing that you now have to deal with something else in your life. The question, Can I turn this around?
is pounding in your head. Perhaps you’ve known for a while that you have hypertension and your stress comes from the fact that it’s not in control. Maybe you’ve tried losing weight or cutting out salt, or maybe one or two different medications, but your blood pressure is still high. This also causes stress in your life: you know there’s a problem, but you don’t know what to do about it anymore.
In any area of our lives, what we feel we cannot control takes up 90 percent of our focus and adds stress - whether or not it really is 90 percent of our problem. But I can tell you, once you make the decision to control your hypertension and start taking the action steps to get there, it only becomes about 10 percent of your stress. And stress is something you want to lessen because it can increase your high blood pressure.
Stress can elevate your blood pressure by 15-20 mmHg. It’s been shown that the elevated blood pressure from stress can linger well past the stressful moment. In one study where people were asked to recall an angry situation, some people still had elevated blood pressure of 10 mmHg higher than normal 15 minutes later. If you have hypertension and are experiencing a stressful moment, try to calm yourself: look at a