Customer Reviews

100 Questions & Answers About High Blood Pressure (Hypertension)

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It's really quite simple: If you have high blood pressure, this is a must buy. For instance, did you know that the right way to check your blood pressure is to first sit quietly for about 5 minutes? Why? Because that is how blood pressure norm tables were determined - how 120/80 was determined to be normal. So, whether you are checking it yourself or are being checked by a nurse when going to see a doctor, unless you've been sitting quietly for a few minutes you are likely to get a reading that is falsely high. The book is filled with about 100 other interesting, useful and very practical pieces of information that you will not find elsewhere all in one book, written by a leading expert.

This book provides a useful introduction for people who want to learn about high blood pressure. Here are the points I personally found most noteworthy:

(1) Hypertension is a risk factor for heart disease (first leading cause of death in the US), stroke (third leading cause of death in the US), kidney disease, and peripheral circulation problems. Hypertensive people therefore usually get electrocardiograms, blood tests (especially creatinine level), and urine tests (eg, to check for protein).

(2) Hypertension itself is often asymptomatic, though it's correlated with headaches in the back of the head, and also correlated with diabetes. Its cause is usually (but not always) unknown, though it appears to have a genetic (polygenic) component.

(3) Blood pressure varies considerably with time, over the course of days, hours, minutes, and even seconds. Both conscious and unconscious stress (eg, "white coat effect") and exercise can affect it. It should return to baseline about 20 minutes after exercise, and it should be measured after five minutes of sitting quietly (which is the condition under which target blood pressure level was established). Sitting is preferable over standing or lying down when measuring blood pressure. Home blood pressure kits are acceptable, and Consumer Reports provides recommendations; Omron is among the better brands.

(4) Blood pressure below 120/80 is ideal. Blood pressure between 120/80 and 140/90 is considered prehypertension. Hypertension is a blood pressure consistently above 140/90, which is the level at which treatment is usually initiated (or a lower threshold for people with diabetes). But this isn't a distinct threshold, since risk levels generally increase continuously as blood pressure increases. However, blood pressure higher than say 180/120 warrants immediate treatment.

(5) Blood pressure generally increases with age, so many people with prehypertension will become hypertensive. However, diastolic pressure (the lower number) often reaches a peak when people are in their early fifties, whereas systolic pressure (the higher number) tends to keep increasing with age; thus diastolic pressure may be more important for younger people and systolic for older people. Less than 5% of young adults are hypertensive, whereas about 65% of the elderly are, and hypertension often emerges in people in their fourties. A person can also alternate between periods of being hypertensive and not.

(6) Hypertension is rarely curable, but it can be treated effectively. Maintaining good body weight, avoiding alcohol, regular exercise, and good diet help, and dozens of medications are available in about 8 classes. If necessary, more than one medicine can be combined, since raising the dose of a given medicine usually increases side effects without much gain in benefit. Some dietary supplements also appear to have a modest blood pressure benefit.

(7) About 1/3 to 2/3 of people with hypertension are salt-sensitive, and they tend to be older and overweight; this can be determined for a patient by seeing if dietary changes affect blood pressure. Regular caffeine consumption doesn't usually increase blood pressure much, if at all.

(8) An exercise program should be started cautiously for people with substantial hypertension, and for many of them it may be better to control hypertension medically first. Exercise may reduce blood pressure about 5 points on average, and the blood pressure benefits of exercise fade away after about 1 or 2 months of being sedentary.

(9) For people who are controlling their blood pressure only via lifestyle changes (no medication), they should continue to regularly monitor their blood pressure.

Where I think the book is a bit lacking is in providing more detail regarding how risk levels vary with blood pressure, age, weight, exercise level, diet, etc. For example, if two people have a blood pressure of 145/95, but one is 40 years old and has good overall health and lifestyle, whereas another is 70 years old in poor overall health with a poor lifestyle, are their risk levels really the same? And what exactly are their risk levels anyway, in both relative and absolute terms? The book doesn't answer these fundamentally important questions, and instead generalizes too much. Along the same lines, I think the author underestimates the blood pressure benefits of a serious exercise program; I know of cases where people have achieved a 10 to 20 point drop in a matter of weeks, and that's certainly preferable to rushing to start medications.

So overall, again, I think this book provides a useful introduction, but people who are comfortable with biomedical literature may prefer something with more technical detail and depth.