Blood pressure and cholesterol:
The stakes are high
Dr. Randall Zusman is normally a mild-mannered man.
But when it comes to treating patients with hypertension and high cholesterol, Dr. Zusman, director of the Division of Hypertension at Massachusetts General Hospital, has a different approach.
He calls it “the riot act.”
“In most cases,” he explained, “you need to make the consequences very clear. Let’s just say I can make a very compelling argument for prevention.”
Though different, high cholesterol and hypertension share a common trait – both are silent killers. Together they are integral parts of risk factors that contribute to cardiovascular disease, strokes and heart failure.
The stakes are high, and Dr. Zusman hits hard.
“No one wants to be incapacitated,” he says. “No one wants to be unable to feed or clothe or bathe themselves. People are terrified of strokes. They would rather die in the street. And no one wants to become a burden to their families.”
If his patient is a grandparent, Dr. Zusman is not afraid to use the grandchild as a motivator.
“If necessary,” he says, “you have to make it blunt — You do want to see your grandchild grow up, don’t you?”
The reason for the bluntness is largely because both high cholesterol and hypertension are chronic diseases that can be monitored and controlled.
But it takes vigilance, discipline — and sometimes a kick in the pants.
Cholesterol has gotten a very bad and unearned reputation. In actuality, our body needs cholesterol — well, the good cholesterol. A major component of the cells’ membranes, cholesterol is a waxy, fat-like substance and is a precursor to several hormones, including estrogen and progesterone.
More important is that the body makes all the cholesterol it needs. Given the typical American diet of foods high in cholesterol — eggs, dairy products and meats — more cholesterol is put into the body than what is actually needed.
Because the body doesn’t need it, the extra cholesterol often ends up in the arteries, the blood vessels that supply oxygen and nutrients to the muscles and organs. The additional cholesterol eventually forms plaque and begins to clog the blood flow. Excess plaque in arteries feeding the heart can cause angina or chest pain, or worse, a heart attack. In arteries leading to the brain, the excess plaque can cause a stroke.
Several conditions increase the risk of high blood cholesterol — physical inactivity, obesity and diet. Some factors are beyond an individual’s control — age, sex and heredity.
Like hypertension, there are no signs and symptoms of high cholesterol. It can be detected only through a blood test. Called a lipoprotein profile, the test measures low-density lipoproteins (LDL), or bad cholesterol, the main source of cholesterol buildup, and high-density lipoproteins (HDL), or good cholesterol, that helps keep the bad cholesterol from building up.
The ideal reading has low levels of LDL and high levels of HDL.
Unlike hypertension, African Americans do not have a higher incidence of high blood cholesterol than whites, Hispanics or Asians. But the incidences of cardiovascular disease are higher among blacks, largely because of the other risk factors that often plague that community.
One such risk factor is hypertension. Most don’t know they even have it. With more than 70 million people afflicted — or one in three adults in America — it is one of the most common cardiovascular diseases, and despite its name, it has nothing to do with tension or stress.
It has everything to do with high blood pressure, the force exerted on arteries by the flow of blood throughout the body. The cause of high blood pressure is mostly unknown. But only about ten percent of the incidences are the result of an underlying condition, such as adrenal gland tumors or kidney abnormalities.
Hypertension is more common in blacks and Hispanics than whites and Asians. Figures from the state’s 2005 Behavioral Risk Factor Surveillance Survey indicated that 25 percent of blacks and 23 percent of Hispanics surveyed in Boston had been told by a doctor that they had high blood pressure. That number was 19 percent of whites and 13 percent of Asians.
What’s worse, blacks often develop high blood pressure at an earlier age and have more serious complications, particularly strokes and heart attacks. More than 40 percent of African Americans across the country have high blood pressure.
To a large extent, hypertension can be prevented or controlled. Although age and genetics have a large impact on its incidence, other factors such as diet, weight, inactivity, and cigarette smoking can be controlled.
The sad part is that tests for high blood pressure are quick, easy and painless.
Two figures are used in the measurements. The top figure (systole) measures the pressure when the heart beats. The bottom figure (diastole) measures the pressure when the heart rests. Both figures are important and if one or both are consistently high, then you are considered hypertensive.
The optimal reading is less than 120/80, but less than 140/90 is the usual treatment target. A blood pressure exceeding 140/90 is high and requires intervention.
And that is where Dr. Zusman comes in.
“Don’t be satisfied with simply getting tested,” Dr. Zusman says. “Get the actual numbers and know them. Write them down so when you go for another testing you can see what direction you are going. If it’s the wrong direction, then an intervention might be necessary.”
Dr. Zusman cautioned that progress is made over months and years — not days.
“But you can still keep a scorecard,” Dr. Zusman says. “It’s just a more delayed gratification.”
And in this day and age of instant gratification, the cure for hypertension and cholesterol is not as easy as taking a pill.
“Don’t get me wrong,” Dr. Zusman explained. “Medications are good if needed. But they often give patients an easy way out. Fighting these problems is like losing weight. There are no easy solutions. You have to deal with it by yourself.” |
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Eating a variety of fresh fruits and vegetables is key to controlling or preventing high blood pressure and high cholesterol. Healthy eating is a lifelong commitment.
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Randall M. Zusman, M.D.
Director of Division of Hypertension
Massachusetts General Hospital |
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