Down with high blood pressure

               You've had no symptoms, no pain, no sense of being sick. Yet, after wrapping a flexible cuff around your arm and pumping it up, your doctor frowns an gives you the bad news: you are on of millions who have high blood pressure.

               Because it can lurk in the body without your knowing it, high blood pressure has been called the silent killer. It's the leading cause of strokes and a major factor in heart attacks and kidney failure.

             The good news is that thanks to explosion of research, science now knows how to defuse the danger and control the disease. Depending on how high your pressure is, how you live and what changes you're how you live and what changes you're willing to make in your life-style, treatment can be tailored specifically to you.

              For the average adult, a healthy blood-pressure reading is 120 over 80, or lower, The first, or top, number is the systolic reading, the pressure of blood against artery walls when the heart beats the period of highest tension. The second, or bottom, number is the diastolic—the minimum pressure, between beats, when the heart is filling with blood and artery walls are relaxed.

             If the diastolic goes over 105 and stays there through several readings, that's the beginning of the danger zone, moderate hypertension, and continued monitoring is essential. Once the diastolic rises above 115, the condition is severe. A diastolic between 90 and 104 falls into the indeterminate area of "mild" hypertension. Three-fourths of those with high blood pressure are in this category.

              A diastolic between 80 and 89 used to be considered normal and safe. But warning signals are now being raised, as part of today's concern with preventing disease rather than waiting until later to treat it. At this level, treatment usually isn't necessary, but the pressure should be checked by a health professional once or twice a year to be sure it doesn't edge up into the 90s. If it does, there are three main types of treatment:

              Drug therapy. For people in the danger zone today's standard medical treatment is remarkably effective. Because doctors begin with the mildest drug at the lowest dosage and climb step by step, it's called stepped care. The first step may be a diuretic. These drugs can lower blood pressure by getting rid of excess fluid ant salt (sodium) in the body. For many, that's all the treatment needed.

             If step one doesn't bring the pressure lo a safe level, the doctor adds step two. Traditionally, this has been a beta-blocker, something to block or inhibit stimulative actions of the sympathetic nervous system that push the heart to work harder. For those few patients whose pressure is still too high, step three usually is a vasodilator, a drug to dilate narrow blood vessels. If pressure still isn't controlled, even more powerful drugs are available.

             Every drug has possible side effects, however. Some diuretics can cause fatigue, muscle weakness, leg cramps, low potassium or elevated uric-acid levels. Beta-blockers may slow the heart and pulse rate, aggravate asthma or bring on fatigue and depression. Vasodilators may step up the heart rate and cause headaches, stuffy noses and fluid retention. But for patients who have side effects, doctors often can adjust medication to relieve them.

             Life-style therapy. Most doctors start stepped-care drug treatment if the diastolic is over 100. A few now prescribe drugs when the diastolic hits the low 90s. Many also prescribe drugs for people who—along with high blood pressure—have cardiovascular disease, are overweight or smoke. Other risk factors: excess stress, high cholesterol levels, diabetes, a family history of hypertension.

             But for most people with mild high blood pressure, the newest thinking is that it is wisest first to try non-drug ways of lowering the pressure, giving them a reasonable amount o lime to work before considering drugs. Many overweight people can bring town their pressure just by reducing their weight by 10 to 20 Funds. As you lose weight, you lower the volume of cells that the body needs to pump blood to, ant that eases the pressure.

             It is generally thought that salt is a culprit in this disease, and many doctors prescribe a low-salt diet. They encourage cooking without salt, banning the salt shaker from the dining table and avoiding smoked meats, potato chips and other highly salted foods.

            However, a growing number of doctors challenge much of the anti salt advice. They claim that hypertension has numerous causes, including: too much salt; too much rennin, a kidney-manufactured hormone that regulates blood pressure; a combination of both; or a usually curable cause such as kidney or adrenal disease. If your doctor prescribes an anti-salt drug or diet and your blood pressure does not come down in a month, ask about a new test, the rennin-sodium profile, that can reveal the type of hypertension in your body.

           Most doctors also advise cutting down on coffee and tobacco, because caffeine and nicotine are stimulants, and limiting alcohol intake. Many physicians urge aerobic exercise, including brisk walking, bicycling swimming or jogging, which helps you with long-term weight control and daily stress.

           Relaxation therapy. If you read the previous sentence out loud, your blood pressure will go up. If you talk to another person, it will go still higher. If the conversation is with your boss, your pressure will go even higher. If you speak to someone of the opposite sex, your pressure may show less change if you're married than if you're single.

           Dozens of times each day, your blood pressure zigzags, adjusting to what you're feeling and doing. These ups and downs take place in everyone, but the swings are more severe in people with high blood pressure. That discovery is the basis for the newest therapy: controlling blood pressure by learning techniques to control everyday stress.

           At the Psychophysiological Clinic at the University of Maryland in College Park, Prof. James Lynch has found that the higher the blood pressure is to start, the more it soars during conversation. With normal people, the increase is 10 to 20 percent, but it can go as high as 50 percent for people with high blood pressure. "Such people tend to be poor communicators," says Lynch. "They breathe improperly and speak more rapidly than other people. Their pressure usually doesn't go down when the other person speaks."

            Some doctors try to help these people learn to communicate better and so bring down pressure. "Try to be aware of the subjects that are stressful to you," Lynch advises. "Notice when you're breathing or speaking too fast or not really listening. Then try to slow yourself down."

           Many patients control their blood pressure with the relaxation response, the Harvard Medical School in Cambridge, Massachusetts. This is takes four simple things: a quiet environment, a comfortable position (sitting or lying down), the repetition of a word, sound, prayer or phrase each time you breathe out, and the ignoring of other thoughts.

          Something remarkable happens when you do this, according to research at the Beth Israel Hospital in Boston. Relaxing the mind and body mimics the effect that some blood-pressure pills would have. What's more, the blood pressure stays lower, just as it would with a pill, after you've stopped the relaxation and have returned to the stress of daily life.

          We react to stresses such as the jangle of telephones or the wailing of police sirens We also respond to pleasures such as tress, running water, a blue sky. “We can lower blood pressure by choosing what to concentrate on,” says Dr. Aaron H. Katcher associate professor of psychiatry at the University of Pennsylvania School of Medicine in Philadelphia.

         Some people use such simple relaxation techniques as watching the flow of brook. Other people calm down with a dog or cat, since talking to a pet is one form of conversation that seldom raise the blood pressure. Indeed, in a tank. For normal people, blood pressure ebbed about 10 points: for those with hypertension, it fell as much as 20.

          In the end, effective blood-pressure therapy is up to each person and his or her doctor. The answer may be in the supermarket, in the pharmacy or in your head. It may be in all three places. Thanks to these new treatment, people with blood pressure can live long and active lives.