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Controlling High Blood Pressure:
A Woman's Guide


YOU have what it takes to control high blood pressure



YOU have what it takes to control high blood pressure


Controlling High Blood Pressure:
A Woman's Guide


You may not know it--but you have what it takes to control
high blood pressure.

This Guide Will Show You How.  You may be surprised to learn
that it's as easy as eating a variety of healthy foods,
being active, and taking prescribed medication.

It's a day by day way to live healthier and feel better. 
And it's something every woman can do.

If that sounds like good news, you're right.  High blood
pressure does not have to be a health problem.  In fact, if
you do not have high blood pressure, you can use this guide
to help you prevent it.  If you do have it, you can manage
it.

So, read on.  And find out how to take control!
_______________________________________________________


Who gets high blood pressure?

Nearly 50 million Americans have high blood pressure. 

Older women are particularly likely to develop high blood
pressure.  More than half of all women over age 60 have it.

Others who are at a high risk of developing it are African
Americans, the overweight, those with a family history of
high blood pressure, and those with a high-normal blood
pressure.


What is high blood pressure?

Blood is pumped by the heart through vessels to bring oxygen
and nutrients to the body.  Blood pressure is the force of
the blood against the vessel walls.  The more the pressure,
the harder the heart is working.

Blood pressure often goes up and down during the day.  When
it goes up and stays high, then it is high blood pressure. 
The medical term is hypertension.

An easy test measures blood pressure.  It uses an inflatable
cuff around an arm.  If the pressure is high, the test will

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be repeated on several days to get an accurate reading.  You
probably have had such a test on a visit to your doctor.

The test gives two numbers: The systolic pressure is the
pressure of blood in the vessels as the heart beats.  The
diastolic pressure is the pressure of the blood between
heartbeats.  The numbers are usually written like a fraction
with the systolic above or to the left.  An example is
120/80 mm Hg (millimeters of mercury), a normal adult blood
pressure.

Both numbers count.  Your blood pressure is high if the
systolic pressure is 140 or above, or the diastolic pressure
is 90 or above, or both are high.

If you do not know your blood pressure, you should have it
taken.  Those with high blood pressure often do not feel
sick.  In fact, high blood pressure is often called "the
silent killer," because it may cause no symptoms for a long
time.  But untreated, it can damage the kidneys and raise
the chance of stroke, heart attack, or other cardiovascular
("heart and vessels") problems.  It causes three of every
five cases of heart failure in women.  ("Heart failure" is a
severe condition in which the heart cannot adequately supply
the body with blood.)

Women who have both diabetes and high blood pressure are at
an even higher risk of stroke and heart and kidney problems
than those who have only high blood pressure.


Are You In Control?

You may be surprised to learn that many women take blood
pressure drugs but still have high blood pressure.  This is
especially true for older women.

Why?  There are various causes.  Some women may not take
their drugs as prescribed--in the right amount and at the
right times.  For others, a drug may not lower blood
pressure enough.  To prevent stroke, heart attack, or heart

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failure, blood pressure must be controlled to below 140/90.

So make sure you're in control of your high blood pressure. 
Talk with your doctor.  Ask about your blood pressure level. 
If it is too high, ask about adjusting your drug and making
lifestyle changes that will bring your blood pressure to
below 140/90.

Blood Pressure Categories for Adults*

Category                 Systolic**          Diastolic**

Normal                     < 130                 < 85
High Normal                130-139               85-89
High Blood Pressure
     Stage 1               140-159               90-99
     Stage 2               160-179               100-109
     Stage 3               180-209               110-119
     Stage 4               >= 210                >= 120

Key: < means less than, >= means equal to or more than

*These categories for those 18 and older are from the
National High Blood Pressure Education Program.  The
categories are for those not on a high blood pressure drug
and with no short-term serious illness.

**If your systolic and diastolic pressures fall into
different categories, your overall status is the higher
category.


Take Control

Three of every four women with high blood pressure know they
have it.  Yet fewer than one in three are controlling it.

All women can and should take steps to control their high
blood pressure.  This is especially important for women who
have heart disease.  When blood pressure is lowered, the
heart does not work as hard.  Women who have had a heart
attack are less likely to have another if they reduce their
high blood pressure.

You can control your blood pressure with these steps:

*  Lose weight if you are overweight
*  Become physically active
*  Choose foods low in salt and sodium
*  Limit your alcohol intake

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*  If prescribed, take high blood pressure pills

Each of these steps is described more fully on the next
pages.  There's also a special section on how to eat the
heart-healthy way.

These lifestyle steps also help prevent high blood pressure
--so you and your family can follow them together.


About Smoking

If you smoke, stop.

Smoking usually does not affect blood pressure.  But
quitting is the most important step you can take for your
health.  Ask your doctor for advice on how to quit.

Be Weight-Wise

Losing extra pounds helps reduce high blood pressure.  Talk
to your doctor about what a healthy weight is for you.

If you have to lose, do so slowly.  To lose weight, you need
to take in fewer calories than you burn.  So you can either
eat fewer calories or increase your physical activity--and
preferably do both.

You may find it helpful to get advice from your doctor, a
registered dietitian, or a qualified nutritionist.  They can
help you plan a sensible, balanced eating pattern to lose
weight slowly and then keep it off.


If You Have Diabetes

In diabetes mellitus, the body does not use sugar as it
should.  It gets sugar when it changes food into glucose, a
form of sugar.  Two main types of diabetes are non-insulin-
dependent (NIDDM) and insulin-dependent (IDDM).

NIDDM accounts for 90-95 percent of diabetes.  It usually
develops after age 40.  About 80 percent of those with NIDDM
are overweight.  NIDDM often can be controlled through diet
and exercise, but sometimes insulin and/or a pill are
needed.  IDDM is controlled by diet and exercise and taking
insulin.

Diabetes is a chronic condition.  If you have it, you're
more likely to have certain health problems than women
without it.  You're 2 to 4 times more likely to develop

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cardiovascular disease, and 2.5 times more likely to have a
stroke.  As many as 65 percent of those with diabetes have
high blood pressure.


Become Physically Active

Physical activity is good for your heart and blood vessels--
and helps control weight.  It makes you look and feel
better.

Luckily, you don't have to run marathons to benefit from
physical activity.  Try to do at least 30 minutes of a
moderate physical activity on most, and preferably all,
days.  A moderate activity would be a brisk walk.  Other
activities include gardening, bicycling, and swimming.

You do not have to do 30 minutes at one time.  You can break
it into periods of at least 10 minutes each.  This may help
you get started.

Many women can start without seeing a doctor first.  But if
you take a high blood pressure medication, have heart
disease, have had a heart attack or stroke, or have another
serious health problem, you should check with your doctor
before starting.

Otherwise, get out and get active.  Work up to a comfortable
pace and schedule.  It may be hard to stick with an
activity, particularly if you feel pressed for time.  But
remember: It doesn't need much time and the reward is better
health.

It may help you keep going if you do an activity with a
friend or family member.  Or, you can try switching
activities.  For instance, use a stationary bicycle three
days a week and walk the other days.

Being physically active has many benefits.  You'll sleep
better.  And, you'll feel a sense of accomplishment from
having taken charge of your health.

Reduce Salt and Sodium

Studies show that salt and sodium affect blood pressure. 
Cutting back on salt and sodium can cause blood pressure to
drop.

Some people are very sensitive to salt and sodium.  Many
African Americans and older persons are especially sensitive

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to salt and sodium.


Hold the Salt

Here are some tips to help you cut back on salt and sodium:

*  Add less salt at the table and in cooking.  Try reducing
   the amount a little at a time until you use none.
*  Season with black or green pepper, garlic, ginger, minced
   onion, or lemon juice.
*  Use fewer prepared sauces, mixes, and "instant" products,
   such as flavored rices, pasta, and cereals.  These
   usually have salt added.
*  Use vegetables that are fresh, frozen, or canned without
   added salt.
*  Check nutrition labels for a product's amount of sodium. 
   Cans, boxes, bottles, and bags have these labels.  Look
   for products that say "sodium free," "low sodium,"
   "reduced sodium," "less sodium," "light in sodium," or
   "unsalted."
*  Ask your doctor before trying salt substitutes.  These
   contain potassium chloride and may help some women.  But
   they can be harmful for women with certain medical
   conditions.

Sodium is found naturally in many foods.  It also is used in
cooking.  It is in a wide range of products, including
baking soda, bouillon, catsup, soy sauce, monosodium
glutamate (MSG), seasoned salts, soda drinks, and some
antacids.  It also is in such foods as many breads, pickles,
canned items, frozen prepared meals, and salty chips.  In
fact, processed foods account for most of the salt and
sodium Americans consume.

Salt is sodium chloride.  So you have to be careful about
how much of both salt and sodium you consume.

Most women--even those with high blood pressure--should have
no more than 2,400 milligrams of sodium a day.  This comes
to 6 grams of salt--about 1 teaspoon.  Consuming even less
salt and sodium will probably give an added benefit.

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The amount includes all of the salt and sodium you consume,
including that in processed foods, added during cooking, and
used at the table.

Being careful about salt and sodium is equally important
whether you have high blood pressure, have a high-normal
blood pressure, or want to prevent high blood pressure.  The
information below and in the box on page 7 can help you cut
back on salt and sodium.


Sensible Snacks

To help cut back on sodium, snack on:

*  Bagels, raisin toast, or English muffins
*  Air-popped popcorn with no salt or butter
*  Unsalted pretzels and crackers
*  Low-fat cookies (animal crackers, fig bars, ginger snaps)
*  Fruit juices and drinks
*  Nonfat frozen yogurt, sherbet, and popsicles
*  Hard candy or jelly beans


Limit Alcohol

Drinking too much alcohol can raise blood pressure.  But
most women with high blood pressure can have an occasional
drink.  And those trying to prevent high blood pressure can
drink if they do so in moderation.

If you are trying to lose weight, keep in mind that
alcoholic drinks have calories--about 70-180 calories per
drink, depending on the type.

Women who drink alcohol should have no more than one drink a
day.  One drink is 12 oz. of beer, or 1.5 oz. of 80-proof
whiskey, or 5 oz. of wine.

Eat for a Healthy Heart

How do you eat for a healthy heart?  It's easy.  Choose a
variety of foods low in saturated fat, total fat,
cholesterol, and calories.


A Word About Fats

Scientists are not certain that fats or cholesterol in foods
raise blood pressure.  But dietary fats and cholesterol
definitely affect your heart and blood vessels.

Fats, especially saturated fat, play a big role in
increasing the cholesterol in your bloodstream.  And that
increases your chance of developing heart disease.

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Saturated fat is often found in foods from animals.  This
includes fatty meats, the skin of poultry, and whole-milk
dairy products, such as butter, cheese, cream, and ice
cream.  It also is in coconut, palm kernel, and palm oils. 
These oils are found mostly in processed foods, such as
baked goods, snack foods, and crackers.  If you use a food
high in saturated fat, keep the amount small.  Or, instead
of butter, try tub or liquid margarine, or liquid vegetable
oils such as canola, corn, olive, peanut, safflower, sesame,
soybean, and sunflower.

Keep in mind, all fats have the same amount of calories.  If
you need to lose weight, limit the amount of fats you
consume.

Fat is the richest source of calories.  So foods lower in
fat also are more likely to be lower in calories--if you
limit the serving size.

Research shows that eating a lot of fruits and vegetables
and low fat dairy products can lower blood pressure--as much
as some medicines.  Such foods supply plenty of potassium
and calcium.  Potassium is especially important for blood
pressure.

Here's more on those and other key nutrients:

Potassium--Eating foods rich in potassium seems to prevent
high blood pressure.  Most women get enough potassium in
foods.  Good sources of potassium are many fruits and
vegetables, some dairy foods, and fish.

Calcium--Some populations with low intakes of calcium have
more high blood pressure.  Scientists don't know if the
higher rates are from a lack of calcium or an as-yet-unknown
cause.  Women also need calcium to prevent osteoporosis, a
severe thinning of bones that can lead to fractures. 
Osteoporosis tends to develop after menopause.

You should try to get 1,000-1,500 milligrams of calcium each
day.  Good sources are dairy foods, such as milk, yogurt,

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and cheese--but be sure to choose low or nonfat types.  They
have as much or more calcium but with less fat and fewer
calories.  If milk causes you digestive discomfort, try
yogurt or some lactose-free dairy products.

Magnesium--Scientists think a diet pattern low in magnesium
may cause blood pressure to rise.  But they are not sure
whether the increase is from the lack of magnesium or some
unknown factor.  You should get enough magnesium if you
follow a healthy diet pattern.  Good sources are whole
grains, green leafy vegetables, nuts, and dry peas and
beans.

Help Your Medications Work

For some, lifestyle changes lower high blood pressure
enough.  For others--and especially those with heart
disease--medication may also be needed.

Even if you need medication, be sure to continue your
lifestyle changes.  The changes help the drug work better. 
Over time, you may be able to reduce the medication.

Fortunately, there are many blood pressure drugs today. 
Although you may have to take the drug for a long time, you
will get big health benefits from controlling your high
blood pressure.

When the doctor prescribes a high blood pressure drug, be
sure you understand the instructions.  Know the amount you
should take, if you should take it each day, and what times
you should take it during the day.

If you are not sure about the instructions, ask while you
are at the doctor's office or clinic.  Write down the
instructions.  Later, if you do not remember something or
are confused, call back and ask.  Even if you are having the
prescription filled and are unsure about the instructions,
call.  Do not be embarrassed.  You cannot take the drug
properly if you don't understand the instructions.

As with all drugs, those for high blood pressure can cause

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side effects.  For example, some can make you sleepy or
tired; others can cause a rash or cough.

Pay attention to how you feel.  If you think you have a side
effect, do not stop taking the drug.  That can cause
trouble.  Instead, tell your doctor as soon as possible
about what you feel.  The doctor will see if the drug is the
cause.

If the drug is causing a side effect, your doctor will
probably change its dose or give you a different drug.  It
may take some adjustments to find the best amount or drug
for you.

High Blood Pressure Drugs

High blood pressure drugs work in various ways.  They can
affect:

*  How hard the heart pumps
*  How much the blood vessels widen and narrow
*  How much fluid is in the body

Your doctor will choose the drug that best suits you. 
Often, two or more drugs work better than one drug.

The main types of high blood pressure drugs are:

Diuretics--These are sometimes called "water pills" because
they work in the kidney and flush excess water and sodium
from the body through urine.  This reduces the amount of
fluid in the blood.  And, since sodium is flushed out of
blood vessel walls, the vessels open wider.  Pressure goes
down.  There are different types of diuretics.  They are
often used with other high blood pressure drugs.

Beta blockers--These reduce nerve impulses to the heart and
blood vessels.  This makes the heart beat less often and
with less force.  Blood pressure drops and the heart works
less hard.

Angiotensin antagonists--These are a new type of high blood
pressure drug.  They shield blood vessels from a hormone
called angiotensin II, which normally causes vessels to
narrow.  As a result, the vessels are wider and pressure
lowers.

Angiotensin converting enzyme (ACE) inhibitors--These

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prevent angiotensin II from being formed.  They relax blood
vessels and pressure goes down.

Calcium channel blockers (CCBs)--These keep calcium from
entering the muscle cells of the heart and blood vessels. 
Blood vessels relax and pressure goes down.

One short-acting type of CCB has been found to increase the
chance of a repeat heart attack.  Short-acting CCBs are
taken several times a day.  If you are on such a drug, you
should talk with your doctor about other medication choices. 
The finding does not apply to the longer-acting types of
CCB, which are taken once a day.

Alpha blockers--These work on the nervous system to relax
blood vessels, which allows blood to pass more easily.

Alpha-beta blockers--These work the same way as alpha
blockers but also slow the heartbeat, as beta-blockers do. 
As a result, less blood is pumped through the vessels.

Nervous system inhibitors--These relax blood vessels by
controlling nerve impulses.

Vasodilators--These open blood vessels by relaxing the
muscle in the vessel walls.


If You Need A High Blood Pressure Drug, Speak Up and Ask:

*  When it should be taken
*  What you can eat or drink with the drug, or how long you
   must wait before and after a meal to take it
*  What other drugs can or cannot be used at the same time
   --this includes both prescription drugs and over-the-
   counter items, such as pain relievers, vitamins, and
   skin-protection products
*  What to do if you run out of your drug
*  What to do if you forget to take a dose
*  If there are any special instructions


Generic Names of High Blood Pressure Drugs

Type of Medicine                        Generic Name

Diuretics                               amiloride
                                        bendroflumethiazide

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                                        benzthiazide
                                        bumetanide
                                        chlorothiazide
                                        chlorthalidone
                                        furosemide
                                        hydrochlorothiazide
                                        hydroflumethiazide
                                        indapamide
                                        methyclothiazide
                                        metolazone
                                        polythiazide
                                        spironolactone
                                        torsemide
                                        triamterene
                                        trichlormethiazide

Beta Blockers                           acebutolol
                                        atenolol
                                        betaxolol
                                        bisoprolol
                                        carteolol
                                        metoprolol
                                        nadolol
                                        penbutolol
                                        pindolol
                                        propranolol
                                        timolol

ACE Inhibitors                          benazepril
                                        captopril
                                        enalapril
                                        fosinopril
                                        lisinopril
                                        moexipril
                                        quinapril
                                        ramipril

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                                        trandolapril

Angiotensin                             losartan
Antagonists                             valsartan

Calcium Channel                         amlodipine
Blockers                                diltiazam
                                        felodipine
                                        isradipine
                                        nicardipine
                                        nifedipine
                                        nisoldipine
                                        verapamil

Alpha Blockers                          doxazosin
                                        prazosin
                                        terazosin

Alpha-Beta Blockers                     labetalol
                                        carvedilol

Nervous System                          clonidine
Inhibitors                              guanabenz
                                        guanadrel
                                        guanethidine
                                        guanfacine
                                        methyldopa
                                        reserpine

Vasodilators                            hydralazine
                                        minoxidil


You're In Charge

High blood pressure can be controlled.  Make healthy
lifestyle changes and always take your drug as prescribed.

Remember: You have what it takes to control your high blood
pressure.


For More Information

If you want more information about heart-healthy eating,
physical activity, and other topics, contact:

     National Heart, Lung, and Blood Institute
     Information Center
     P.O. Box 30105
     Bethesda, MD 20824-0105
     (301) 592-8573

     American Heart Association (AHA)

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     National Center
     7272 Greenville Avenue
     Dallas, TX 75231
     1-800-AHA-USA1
     or (214) 373-6300

     The American Dietetic Association
     216 W. Jackson Blvd., Suite 800
     Chicago, IL 60606-6995
     1-800-366-1655

To order additional copies of this free booklet, call the
National Heart, Lung, and Blood Institute Information Line
at 1-800-575-WELL

or write to the

Alliance for Aging Research, 2021 K Street, NW, Suite 305,
Washington, DC 20006-1003

Record Your Blood Pressure

Use this chart to record your blood pressure readings.  You
may want your doctor or nurse to write the numbers and add
special notes.

Date           Reading 1        Reading 2        Average
__________    ___________      ___________      _________
__________    ___________      ___________      _________
__________    ___________      ___________      _________
__________    ___________      ___________      _________
__________    ___________      ___________      _________
__________    ___________      ___________      _________
__________    ___________      ___________      _________
__________    ___________      ___________      _________
__________    ___________      ___________      _________
__________    ___________      ___________      _________
__________    ___________      ___________      _________



Notes:  
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This guide is part of a public health collaboration of the

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Alliance for Aging Research

National Heart, Lung, and Blood Institute
National Institutes of Health



Sponsored by a Professional Grant from
Hoechst Marion Roussel, Inc.