Ask-the-Expert: Hypertension and Heart Diseases

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1. What is hypertension? What are symptoms of hypertension?
   Hypertension is high blood pressure. You can think of your arteries as elastic pipes and as your blood pressure rises, that causes high pressure in the pipes which over time will damage the pipes. That is why hypertension is not good for your health, and can cause problems with your kidneys, heart and brain. These diseases are manifest as kidney failure, heart attack and heart failure, and stroke. The acute symptoms of hypertension are minimal unless the blood pressure is very, very high and this can cause increased swelling in the brain. This could cause people to have headaches, blurry vision or confusion. However, if the blood pressure is mildly or moderately elevated, one will have no symptoms. That is shy hypertension is called the "silent killer".
2. How is hypertension treated and managed?
   We always start with lifestyle management; weight management, exercise and sodium intake. Even a few pounds of weight loss can make a difference. If this is not enough, we proceed to medications.
3. My blood pressure in the morning is very high, at 177mmHg, it takes some time for it to be lowered, is this dangerous? Why is my blood pressure highest in the morning? I am most relaxed in the morning.
   Blood pressure is typically highest in the morning, if it persists at this high level, consult your doctor about your medication.
   
   The effects of high blood pressure is a product of the pressure over time, more of the area under the curve, and not just an isolated reading. Your body is most stressed in the morning, there is an evolutionary aspect to it, we are stressed waking up. Most heart attacks occur in the morning from 5 am to 8 am. Everyone's blood pressure is different. You can take different medications in the morning and at night so your body is medicated throughout the day. I recommend my patients to take their medicine in the morning, mostly because it's easier for them to remember. But some patients suffer nocturnal hypertension, particularly women, so it may be advisable to take medication at night. We have to adjust the medications and the timing of the medications for each individual patient.
4. What health problems are associated with hypertension? What could happen if hypertension is not treated?
   Untreated hypertension may lead to kidney disease, heart disease or stroke.

5. What is the latest guidance about healthy blood pressure?
   It is preferable to have a systolic blood pressure of less than 120 mm Hg, but less than 130-135 mm is acceptable. For diastolic pressure, it should be under 80 mm Hg, but less than 80-90. For diastolic blood pressure, it's preferable to be under 80 mm Hg, but less than 90 mm Hg is acceptable. Of course, we have to consider the side effects of the medications to the long term benefits of prevention.
    

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   What the Numbers Mean to You:

   Normal blood pressure	120/80 or below
   Prehypertension	120-139/80-89
   Hypertension stage 1	140-159/90-99
   Hypertension stage 2	160/100 or higher

6. What are signs and symptoms of heart disease? Do men and women experience heart disease differently?
   When it comes to hypertensive heart disease, women live longer than men so we suffer the long term consequences more frequently. Furthermore, women are smaller so have smaller hearts and when the heart thickens because of longstanding hypertension, there is less intracardiac space to accommodate the thickened heart muscle. We see more women with heart failure due to hypertensive heart disease due to those 2 factors.
7. What causes chest pain?
   There are many types of chest pain. Within the confines of your chest, there is your lung, muscle, lung lining, heart and bones. It depends on when you have chest pain, how long it persists. If you have chest pain, combined with shortness of breath and vomiting or nausea, you might be suffering symptoms of a heart attack and should seek immediate medical attention. Hypertensive heart disease causes more issues with heart failure which does not present with chest pain but with shortness of breath.
8. What are the symptoms of a heart attack? What should I do if I or someone I am with is exhibiting those symptoms?
   Symptoms of a heart attack varies from person to person. Usually, there is some chest discomfort worsened with exertion, shortness of breath, nausea, vomiting, sweating or profound fatigue. If you think that you have a heart attack or you see someone with these symptoms, seek immediate medical attention.
9. Should we eat Baby aspirin everyday to prevent from heart attack?
   Although there are minimal side effects for daily of baby aspirin intake, there is also minimal improvement to the risks of heart attacks and strokes for people under the age of 70 and especially for women.
10. What are some of the ways heart disease can be treated and managed?
    The best approach to heart disease is prevention. Hypertension, diabetes and high cholesterol should be aggressively managed before one has the long term effects of these risk factors, that is, heart or kidney disease.
11. What are prevalence rates of hypertension and heart disease in the general population versus the Chinese population? What explains the difference?
    Hypertension is very common in the Chinese population. We also get diabetes at a lower weight and younger age than Caucasians. Stroke is more common than heart disease in the Chinese population. But as we acquire Western lifestyles, these statistics change.
12. What can I do to prevent hypertension and heart disease?
    1. Diet? The current recommended diet is a "Pesco-Mediterranean" Diet. This diet includes lots of fresh fruit and vegetables, lower in carbohydrates and focuses on legumes, nuts and fish as protein supply and olive oil as the oil of choice. There is a lot of data to support the use of olive oil as a good anti oxidant.
    2. Exercise? I would recommend on at least 30-60 minutes of aerobic exercise every day. This may be as simple as walking. 60 minutes if you spend most of your day sitting, which is the common lifestyle of a tech worker today.
    3. Weight management? This is very important in prevention of high blood pressure and diabetes. Being thin is not important but being NOT overweight is.
    4. Smoking cessation? Nothing good comes out of smoking and you can double your risk for heart attack and stroke.
    5. Other lifestyle changes? I think having a good social life, connecting with friends and family, serving in your community are all great health builders for yourself and your community. In the study of the "Blue Zones", how people live healthy and productive lives into their 100's, this had been shown to be a common factor.
    6. Other? Work is often seen as a negative, causing stress but when work is community building and serving a sense of purpose, it is positive and is healthy and builds resilience. Work can include volunteering and other activities that are not necessarily paid, such as taking care of your grandchildren, elders, pets, the community etc. This had also been shown as a common factor in helping people live long, healthy and happy lives.

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