As reported this week in HealthDay News, more than 73 million adults in the US have high blood pressure (hypertension); half of them are women.

As a group, women are more likely to be overweight and have elevated cholesterol levels, and they are less likely than their male counterparts to meet the target "goal numbers" for well-controlled blood pressure as set by various health organizations, such as the American Heart Association or the National Institute of Health. Women are less likely to have appropriate prescriptions written for them than men, such as blood pressure and cholesterol lowering drugs. This is partly because women aren't educated in the need to control their blood pressure to prevent an increased risk for developing cardiovascular diseases such as heart attack and stroke.

Simply put, women don't think it's going to happen to them, when statistics tell us a different story. Heart disease is the number ONE killer of both men and women, but annually it takes the lives of more women than men. Hypertension is so damaging to the inside of the blood vessels, that controlling it to 'goal' (top number less than 120 and less than 80 on the bottom) will cut a woman's risk of stroke and heart attack in by 25%!

Women should ask about there blood pressure measurements, and if they are high, ask for advice on how to improve them. This can be as simple as eating more calcium-rich foods, or more challenging, such as losing some weight or exercising more. Research has indicated that as little as a ten-pound weight loss will have a significant impact on blood pressure.

For more information, look to these WebMD resources:

• Hypertension/High Blood Pressure Health Center
• Hypertension / High Blood Pressure Guide
• Blood Pressure Rising in U.S. Women
• 5 Natural Ways to Lower High Blood Pressure

Take care.

~Laurie

Related Topics:

• Heart Disease and Women
• WebMD Video: Cholesterol Warning for Women

Technorati Tags: hypertension, high blood pressure, heart disease, womens health

I am very glad to see all the thoughtful comments on the last "Tales From the Emergency Room" post. I was inspired by your comments to post this follow-up, because I think there is a critical misunderstanding about the abilities of medicine to diagnose illnesses among those who have to be the recipients of that care.

Medicine is not black and white. There is no "x + y = z" to diagnosis. When faced with a diagnostic challenge a practitioner of medicine must take a thorough history, including all the details of the present illness, as well as the person's past medical and surgical history, and current and recent medication use (prescription and over the counter). He or she then synthesizes all this information and places it in the context of the "odds" of various things being wrong. Let's take a common example, chest pain (CP). As I approach the room in the ED with the CP patient I have a "differential" list in my head. A differential list is all the possible causes of chest pain I can think of: heart (ischemic heart disease/heart attack/angina), lung (congestive heart failure, pneumonia, blood clot, tumor, pneumothorax, pleurisy, dissecting aneurysm), musculo-skeletal (contusions, costochondritis, rib fractures), and GI (reflux, heartburn, esophagitis, ulcer, gastritis, referred pain from the gallbladder or pancreas).

When I go into that room I notice a few things right off:

• age (less than 40 vs. over 40), because a young person doesn't usually have heart attacks, dissecting aneurysms, angina, or CHF, but is more likely to have GI tract or musculo-skeletal problems.
• level of current distress and other clues, such as a low blood oxygen level or being short of breath, which pushes me in the direction of heart or lungs.
  

Then I get the story: 51 year old woman with not 'typical, heart-related' chest pain presents with waxing and waning discomfort all day, which she describes as "I just didn't feel right" and "I was restless, like I couldn't get comfortable, and a little short of breath." She is a smoker with high cholesterol and anxiety disorder and whose brother had a heart attack at under age 50. First heart enzymes are in the abnormal zone, but not high enough to suggest a heart attack. EKG is normal x's two; D-dimer (a measure of blood clots) is normal. The odds are that this is not pain from her heart, but she has too many risk factors to ignore and will spend the night in the hospital having serial heart enzymes just to make sure her heart is ok. My diagnosis: atypical chest pain, admit to rule out heart as source. Once that is cleared she'll face the diagnostic dilemma of, "if not heart, then what is it?"

Another one: 17 year old with 24 hours of chest pain that started after eating pizza quickly while at work at the pizza joint. Now feels that it hurts to swallow. No prior history of stomach problems, no significant heartburn in the past. Has also been away at camp and exposed to lots of other teens, and has a minor cough. Chest x-ray is normal and pain gets better with some Maalox mixed with lidocaine (a numbing agent), suggesting that there is a problem in his stomach or esophagus. My diagnosis: esophagitis, basically inflammation in the esophagus (swallowing tube between mouth and stomach), possibly after injury to the esophagus from hard pizza crust eaten quickly. Plan-home on antacids and acid-blocking pill, follow up with own MD. But if not better, then what? The patient is a little over weight, has a little chest wall tenderness but it Does the person actually have inflammation in the stomach or a stomach ulcer? Does the person actually drink alcohol with friends on the weekends, but won't admit it in front of mom? Is it really muscle pain from sports activities at camp? If my medicine doesn't work, the patient will be back to their own MD and "back to the drawing board" in terms of having a correct answer.

Third one: over weight mid-30's year old woman on birth control pills with sudden chest pain and increased heart rate; non-smoker, recent cross-country flight with layover of 1 hour in Philadelphia before changing planes. Asked for wheelchair ride between gates due to "pulled muscle" in her right calf that caused her to walk too slowly; she was afraid of missing her connection. No personal of family history of blood clots or clotting disorders; positive elevated D-dimer in her blood work, chest CT positive for blood clot in left lung. My diagnosis: pulmonary embolus (blood clot in lung) secondary to long plane trip, being overweight and on birth control pills. Admit to hospital until improved on blood thinners.

So the last patient is pretty clear-cut, but the other two are not. In this field you must put together a set of potential explanations, figure in the odds, test for the most likely scenarios, and then "pick a path and go down it," as my first mentor used to tell me. But there is always a chance that one can be wrong, and that is why follow up, with your own health care provider who knows your personal and family history well, is so important. This is the single biggest problem in medicine today in my opinion: people are uninsured or under-insured and thus they don't think they can have a personal health care provider. Many don't realize that there is someone in their community who will take care of them, or there is an option in the nearest large city. It takes some effort, but finding someone to have a relationship with, and getting established with them, is a much better source of care than you can get in the ED, unless it is a true emergency.

Stay cool and out of the midday sun.

~ Laurie

Related Topics:

• Do I Need to Go to the Emergency Room?
• Heart Attack: What to Expect in the Emergency Room

Technorati Tags: emergency medicine, chest pain

Summer's here and so is the heat. Last week on the day that I read about this study it was 91 degrees Fahrenheit and 57% humidity in my surroundings, and I found myself thinking about winter heart attacks. This is because of a research announcement that may explain why there is an increase in cardiovascular disease (CVD) related deaths in the winter months. Apparently cold weather stimulates inflammation in the body, a factor that was demonstrated in the levels of inflammatory markers in the blood in the study subjects.

In this study researchers observed that 5 consecutive days of colder weather lead to an immediate increase in levels of the inflammatory markers C-reactive protein (CRP) and interleukin-6; levels of a third marker of inflammation, called fibrinogen, rose 3 days later than the other two markers. The research team measured levels of these markers in nearly 6,000 blood samples from 1,000 adults who had had a heart attack within the last 6 years. These adults were located across a wide range of climate zones.

The study, reported in the May issue of Epidemiology, suggests that one mechanism by which cold weather increases cardiovascular mortality is by increasing the body's inflammatory response. The investigators report that a 10 degree decrease in Celsius temperature (1 °C = 1.8 °F, so 10 x 1.8= 18 degrees F) over a 5 day average temperature before subjects blood was tested resulted in a 4% increase in CRP, a 3.3% increase in interleukin-6, and a 1.3% increase in fibrinogen levels in the blood.

The researchers suggest that this may indicate a biological mechanism for the observed seasonal increase in death from heart disease and stroke in the elderly. Since it is known that cold temperatures increase blood pressure and this leads to additional strain on the heart, this increase in inflammation may be an additional risk factor in patients already susceptible to cardiovascular events. Since fibrinogen is directly involved in clotting in acute heart events, cold stress may be a trigger that leads to events that thicken the blood, making clots more likely.

This is interesting research that needs additional study, since it is my understanding that we still aren't sure whether the CRP factor arrives as a marker of increased CVD risk or appears only after CVD is established. Despite this information, I'd given anything for an 18 degree drop in Fahrenheit temperature at the moment, but I guess I'll have to settle for a cold glass of iced tea!

Take care,

Laurie

Related Topics:

• WebMD Video: The Immune Systems Role in Heart Disease
• Salary, Schooling, Inflammation Linked

Technorati Tags: heart disease, inflammation, C-reactive protein, CVD, cold weather, heart health