High Blood Pressure

Blood pressure ( BP) is recorded as two numbers, with a ratio like this: 120/80 mmHg. The top number, called systolic blood pressure, measures the pressure in the arteries when the heart beats. The lower number, called diastolic blood pressure, measures the pressure in the arteries between heartbeats. High blood pressure is defined as over 140/90 on at least two separate occasions on separate days. Blood pressure should be measured at each doctor’s office visit starting at age 18 years, but at least every 2 years. Target blood pressure is 120/80 mmHg or less, regardless of age. Many people have high blood pressure ( HBP) for years. If left untreated, it can lead to coronary heart disease, heart attack or stroke. A higher percentage of men than women have HBP until age 45. From ages 45–64, the percentage of men and women is similar. After that, a much higher percentage of women have HBP than men.

For persons over age 50, systolic blood pressure is more important than diastolic blood pressure as a cardiovascular disease risk factor. Starting at 115/75 mmHg, cardiovascular disease risk doubles with each increment of 20/10 mmHg throughout the BP range. Those with systolic BP of 130–139 mmHg or diastolic BP of 80–89 mmHg should be considered prehypertensive and require health-promoting lifestyle modifications to prevent cardiovascular disease.

High LDL cholesterol
LDL (low density lipoprotein), the so-called “bad” cholesterol, contributes to the artery blockages (plaques). Most people should aim at an LDL cholesterol level of 100 mg/dL or lower. If you are a very high risk of developing cardiovascular disease, or if you have already had a heart attack, you may need to aim at an LDL level below 70 md/dL.

Low HDL cholesterol
HDL (high density lipoprotein) the so-called “good” cholesterol is a reverse-transport protein: it removes cholesterol from the arteries and takes it to the liver where it can be passed out of the body. High levels of HDL cholesterol lower your risk of developing cardiovascular disease. An HDL level of 60 mg/dL and over is considered excellent, providing you optimal protection.

High Triglyceride level
Triglyceride is the most common type of fat in the body. Many people who have heart disease or diabetes have high triglyceride levels. Normal triglyceride level is less than 150 mg/dL.

High Total Cholesterol is a measure of LDL cholesterol, HDL cholesterol and other lipids. The desirable level of total cholesterol is less than 200mg/dL.

Diabetes or pre-diabetes
Diabetes mellitus is defined as a fasting blood glucose of greater than 125 mg/dL or more. Diabetes (elevated blood sugar) increases your risk for developing cardiovascular disease. There are two main types of diabetes. Type 1 diabetes is usually first diagnosed in children and young adults. Type 2 diabetes is the most common form and can develop at any age. If you have diabetes, no matter which type, it means that you have too much glucose in your blood, and it can lead to serious health issues. Diabetes and heart disease share similar risk factors (high cholesterol level, high blood pressure, obesity).

People with a fasting blood glucose level between 100 mg/dL and 125 mg/dL have an increased risk for developing Type 2 diabetes. If they do not make lifestyle modifications, they will likely develop diabetes within the next 10 years. Pre-diabetes is reversible. If the affected person loses weight, maintains a healthy diet and increases his or her physical activity, he or she may be able to prevent progression to diabetes.

Obesity
Achieving and maintaining a healthy weight is one of the best things you can do for your heart. Weight gain is linked to increased blood cholesterol, blood pressure, and risk for diabetes. Overweight or obese individuals, especially if they have risk factors for heart disease such as high cholesterol, high blood pressure, or high blood glucose, will benefit from even a small amount of weight loss. Prevention of more weight gain is an important place to start.

Metabolic syndrome
Metabolic syndrome is a cluster of abnormalities that occur together, increasing your risk of developing heart disease, stroke, and diabetes. The group of metabolic risk factors includes the following syndromes:

• Abdominal obesity (excessive fat tissue in and around the abdomen), waist circumference of greater than 40 inches for men and 35 inches for women
• Fasting blood triglycerides greater than 150 mg/dL
• Blood HDL cholesterol less than 40 mg/dL for men and less than 50 mg/dL for women
• Fasting blood glucose ( blood sugar) greater than 100 mg/dL
• Elevated blood pressure (130/85 mmHg or higher)

Metabolic syndrome is identified if you have three or more of these factors present.

Arrhythmia
An abnormal heart rhythm is a change in either the speed or the pattern of the heartbeat — the heart may beat too slowly, too rapidly or irregularly. A heart which beats too fast or too slow can cause:

• Lightheadedness or dizziness
• Palpitations (skipping, fluttering or pounding in the chest)
• Fatigue
• Chest pressure or pain
• Shortness of breath
• Fainting spells

Sometimes there are no symptoms at all. Left untreated, certain abnormal heart rhythms can cause death. On the other hand, some arrhythmias are common and not associated with any untoward conditions, so called benign arrhythmias.

Coronary Artery Disease
The most common cause of heart disease is narrowing of the coronary arteries, the blood vessels that supply oxygen-rich blood to the heart. This is called coronary artery disease and it is a major reason for heart attacks. When the coronary arteries are blocked, oxygen cannot get to the affected area of the heart and if the blockage lasts for more than a few minutes, permanent damage can occur. Reduced coronary blood flow from a partial blockage can cause angina (chest pain), shortness of breath and other symptoms. When a complete blockage occurs, it can cause a heart attack.

Heart Attack
Heart Attack happens when the coronary artery, the blood vessel that supplies oxygen-rich blood to the heart, is completely blocked and oxygen cannot get to the affected area of the heart. Heart attack warning signs include:

• Tightness or a feeling of pressure in the chest
• Pain or heaviness radiating down the left arm, or up to the neck or jaw
• Pain that goes through the chest to the back, between the shoulder blades
• Breaking into a cold sweat
• Heartburn
• Shortness of breath with exertion

Women are less likely than men to believe they’re having a heart attack and more likely to delay seeking emergency treatment. Women also tend to be about 10 years older than men when they have a heart attack. While women may have the classic symptom of chest pain when experiencing a heart attack, they are also more likely to present with atypical symptoms.

Congenital heart defects
Congenital heart defects are heart problems that develop before birth. They can occur in the heart’s chambers, valves or blood vessels. Advances in surgery and medication mean that more and more children born with heart defects are surviving. In addition, minor congenital heart defects that don’t cause symptoms may not be diagnosed until a person is an adult or reaches middle age.

Heart failure
Heart failure develops when the heart doesn’t function properly. The names “heart failure” and “congestive heart failure (CHF)” don’t mean that the heart has actually “failed” or stopped but mean one or more chambers of the heart “fail” to keep up with the volume of blood flowing through them, with resultant back-up into the lungs and legs. Heart failure can be brought on by a variety of underlying diseases and health problems.

Peripheral Artery Disease
Peripheral arterial disease (PAD) is an increasingly recognized medical problem that results from narrowing of the arteries throughout the body. The arteries in the neck (carotid and vertebral arteries), arms (subclavian artery), kidneys and legs (femoral arteries) can all be affected by the process of cholesterol accumulation and vessel narrowing. Depending on the arteries that are narrowed, this process increases the risk of stroke, transient ischemic attacks, arm pains, chest pains, erectile dysfunction and leg pain/claudication symptoms.

In addition, patients can present with very-difficult-to-treat high blood pressure despite many medications which could be a sign of arterial narrowing in the kidney arteries.

One of the most common presentations for PAD is pain in the legs, especially in the calves, with walking. This is otherwise known as claudication and results from narrowing of the arterial vessels in the legs. This process can lead to eventual severe narrowing and lack of blood supply to the distal legs and feet and lead to non-healing ulcers and wounds. This is called critical limb ischemia. This is the number one cause of amputations and should be diagnosed and treated promptly.