Our lives are made up of important numbers. Phone numbers. Social Security numbers. Bank account numbers. Well, here are a few more -- your blood pressure and your cholesterol. Knowing these numbers can mean the difference between living a healthy life or facing serious illness, or even death.
"You should know your own blood pressure and cholesterol numbers," emphasizes Christine Bussey, MD, clinical director of nuclear cardiology at Inova Fairfax Hospital in Fairfax, Va. "The best customer is an educated one."
Knowing the generally recommended guidelines for healthy numbers is the first step, says Michael D. Ozner, MD, president of the American Heart Association of Miami and author of The Miami Mediterranean Diet: Lose Weight and Lower Your Risk of Heart Disease.
Don't Wait for Hypertension
Ideal blood pressure readings are lower than 120/80. High blood pressure is considered once the blood pressure reaches 140/90. The range in between these two readings is now known as "pre-hypertension" and can put you at higher risk for developing full-blown hypertension (or high blood pressure), which increases your risk for cardiovascular "events" such as heart attack or stroke, says Ozner.
For patients who fall into the "pre-hypertension" category, doctors first determine their risk factors -- do they have diabetes, or prior cardiovascular disease, or chronic kidney disease, for example. "For patients who are already high-risk, we're more strict, and we'll prescribe medication right away," says Ozner. For most people, however, the first step in getting blood pressure numbers under control is making lifestyle changes such as losing weight, quitting smoking, beginning an exercise program, and managing stress.
Begin with a sensible nutrition program, Ozner recommends. Add fresh fruits and vegetables, whole grains, and low-fat dairy products to your diet, while avoiding excess salt, caffeine, and alcohol. Also cut down -- way down -- on processed foods and hydrogenated oils. He recommends adding 1/2 teaspoon of ground cinnamon (sprinkle on oatmeal, in applesauce, or in yogurt, for example), which is believed to lower blood pressure, as is pomegranate juice.
Exercise can help lower your blood pressure, and if you're overweight, can help you shed unwanted pounds (and lower weight often translates into lower blood pressure). "You don't need to go to a gym to get the exercise you need," says Ozner. "Just walking at least 30 minutes a day can have significant benefits."
Stress can also contribute to high blood pressure readings, so anything that can help you manage the constant irritations of life -- whether yoga, meditation, visualization, even prayer -- should be added to your daily regimen. "They work," says Ozner, who also recommends reading what is considered to be the "bible" among stress management guides, The Relaxation Response by Herbert Benson, MD.
If lifestyle changes bring your blood pressure numbers down to normal range, then you probably won't need medication. "But not everyone can achieve the desired results without medication," says Ozner, hastening to add that medications accompany lifestyle changes, they are not a substitute for them.
Medication May Accompany Lifestyle Changes
The medication your doctor will prescribe depends on your individual situation. Doctors often decide on a medication after an isolated reading or two, says Ozner, but he encourages patients to purchase their own blood pressure monitor and take their own readings at home, several times throughout the day. "By showing your doctor a record of your blood pressure over a certain length of time, you can help him decide how aggressive he needs to be," says Ozner.
When it comes to cholesterol numbers, the total cholesterol level -- which doctors prefer to be under 200 -- should only be part of the picture, says Inova Fairfax cardiologist Christine Bussey. "It's important to concentrate on the different parts," she says, "because your number could be high, but high in HDLs -- or 'good' cholesterol."
The recommended guidelines for HDL are 40 or above for men, 50 or above for women; for LDL, or "bad" cholesterol, you want a reading of under 100 (under 70 if you're a high-risk patient), and for triglycerides, under 150, and ideally, in the 100 vicinity.
Diet and exercise may improve your cholesterol numbers, says Bussey, but other factors -- such as family history, or chronic conditions such as diabetes -- can also have an effect and may call for medication.
To make dietary changes on your own, Bussey recommends decreasing red meats, fried foods, and fast foods, and limiting eggs to one or two per week. Omega-3 fatty acids, found in fish such as salmon, tuna, mackerel, sardines, and trout, and nuts such as almonds, can also help you work with your cholesterol numbers. Omega-3 supplements also come in over-the-counter tablets. Niacin is another over-the-counter nutritional supplement often suggested for moderating cholesterol levels but frequently produces side effects such as flushing, which most people will find unacceptable, says Bussey.
Losing weight -- by watching what you eat and by exercising -- can also have a dramatic effect on your cholesterol, says Bussey. But sometimes that's not enough. "Cholesterol levels may be hereditary," she explains. "There may not be enough you can do on your own."
In those cases, medications such as statins will be prescribed. "Statins lower cholesterol and stabilize plaque, possibly preventing heart attacks," says Bussey.
Not all drugs work for all people though, she says, but there is no need to get discouraged if you can't tolerate one drug. "We can always try another, and even if statins don't work at all for you, there are other drugs," she says. "Be patient."
Work With Your Doctor
In addition to diet, exercise, and medication, the other important ingredient in getting your numbers under control is working closely with your doctor. "Your health is a partnership between you and your physician," says Gigi El-Bayoumi, MD, associate professor of medicine at the George Washington University Medical Center in Washington. "Your doctor needs to give you goals, but you need to be engaged in your own care."
That means not waiting for your doctor to ask you questions, says El-Bayoumi. Tell him not only about your own personal medical history, but that of your family as well. Provide your doctor with a diet diary, and ask for recommendations about portion control, lowering fat in your diet, etc. Don't accept a vague comment like, "Your numbers are fine," or alternately, "We need to work on these." Find out just what the numbers are. Ask if lifestyle changes are recommended or if medications will be prescribed; if they are, ask about the type of drug, whether you will need more than one medication, the dosage, the ideal time to take the drugs, the possible side effects, what to look for that could be serious or life-threatening, and what can happen if you stop taking the medicine suddenly.
Finally, says El-Bayoumi, make sure you and your doctor are clear about what goals you are both expecting to accomplish.
