Dianne G.

When people think about losing weight, the first thing to come to mind typically exercises. They hear about various workout regimens, they look into gyms and routines, and they try to plan their days around fitness. This sort of thinking is definitely helpful if one is trying to lose weight, but the truth is, it’s only half of the equation. Even the most effective exercise will fail to produce desired results if you don’t consider the role of nutrition in your weight loss plan. While you’re planning to pick up the perfect gym habits, consider dropping these 9 things for maximum results.

White Bread

To be clear, bread isn’t a bad thing on its own; it’s the kind of bread that matters. White bread is a strong source of carbohydrates and…. not much else. The same is true of bagels, and certainly donuts. Consuming large quantities of these products might actually cause you to gain weight, without providing significant nutritional value (yes, even ‘enriched’ white bread). If you can’t live without some loaf in your life, stick to wheat or whole grain bread, which include fiber and other things for much more of a nutritional punch, and make sure you balance them with other foods.


People often don’t differentiate between margarine and butter, but the two have differences. Butter is a source of fat; taken sparingly, it benefits your body. On the other hand, the best serving size for margarine varies, depending on the brand and additives. Butter is traditionally high in saturated fat, whereas some margarine likewise carries similar amounts. Others are lower in saturated fat but have deadly trans fats. Whenever possible, skip both in favour of olive oil; otherwise choose unsalted varieties of butter to be sure you know what you’re getting, and to cut down on your sodium intake.

Excess sugar

Is it any surprise that sugar is on this list? Excess sugar from processed foods typically translates into empty calories. Sure, they’re great for a quick burst of energy, but it doesn’t last, meaning you’ll have to consume even more to power through your day, or find another source of energy. This is definitely likely considering that sugar is mostly empty calories. It doesn’t help you feel full, and therefore doesn’t stop you from eating. Worried about the sugar in fruit? Don’t. Fruits come with a range of other nutrients that help with weight loss and offer additional health benefits.

Microwave Popcorn

Because microwaved popcorn combines the previous three things on this list, it’s definitely a food to avoid if you’re looking to shed pounds. It will raise blood pressure and body fat, and it’s pretty easy to binge on. Popcorn itself is a healthy snack that will fill you up without filling you out; the problem lies in microwave popcorn bags which may contain harmful additives, as well as the excess butter and salt. Skip the bags and try air popped popcorn instead as an alternative snack, or prepare oil popped popcorn with olive oil, and season with herbs and spices.


Pretty much excess sugar in liquid form, soda is among the unhealthiest things you can consume. Like sugar in other forms, it provides a very brief, very jarring spike in energy, along with a crash. It doesn’t fill you up or provide your body with any real nutrition. In fact, consuming all of that excess sugar can contribute to serious health problems like diabetes, which among other things, makes losing weight very difficult. Diet soda is no better; it has harmful artificial sweeteners that are linked to cancer and other serious illnesses and provides no benefit to weight loss.


While a little bit of alcohol is a good thing, and one or two drinks a night cause no harm, large amounts of alcohol taken frequently may stand between you and your weight loss goals. A glass of red wine is great for heart health; Conversely, frequent beers can actually cause you to gain weight, hence the term ‘beer gut’. The research isn’t fully fleshed out just yet, but large amounts of alcohol have other negative effects that have been confirmed- high blood pressure, for example, can make workouts harder by straining your heart. Stick to the one glass rule.

Fruit Juice

You might seem surprised to find fruit juices on this list, given how healthy fruit is. Fruit is, in fact, very healthy, but fruit juice moves away from that, particularly when it has added sugars and preservatives. Like most liquid calories, your body does not register fruit juice as well as it should, which makes it easy to drink juice to excess. The added sugar can cause complications as well. Fruits in juice form also lose the fiber which is a large part of what makes fruit so healthy. Substitute your fruit juice with a fresh piece of fruit instead.

Salad Dressing

Salad dressing is often packed full of sugars, fats, salts, and other ingredients that certainly flavour up your salad. However, these additives also work to undo the good the salad provides, as they can spike your blood sugar and damage heart health via higher blood pressure. Keep the salad, but go light on the dressing if you can’t ditch it altogether, or choose low-sodium brands. If possible, make your own salad dressing from scratch using vegetable oils. Olive oil, for example, adds a distinct flavour and a dose of healthy fats to your diet. Your body will thank you.

Added Salt

Table salt is typically a go-to seasoning along with pepper, but the latter is far healthier. An excess of sodium, found in salt, can lead to heart problems stemming from high blood pressure. In small amounts, salt is useful to the body, but since so many foods already have added salt, anything you put on at the dinner table is just overkill. When it comes to weight loss, salt won’t make you gain weight directly, but it will cause water retention, or spur snacking binges, both of which will increase your weight. Find alternative seasonings to spice up bland dishes.




Blood pressure categories defined in the new guidelines include:

  • Normal: Less than 120/80 mm Hg.
  • Elevated: Top number (systolic) between 120-129 and the bottom number (diastolic) less than 80.
  • Stage 1: Systolic between 130-139or diastolic between 80-89.
  • Stage 2: Systolic at least 140 or diastolic at least 90 mm Hg.
  • Hypertensive crisis: Top number over 180 and/or bottom number over 120, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage.

The new guidelines eliminate the category of pre-hypertension, which was used for blood pressures with a top number (systolic) between 120-139 mm Hg or a bottom number (diastolic) between 80-89 mm Hg. People with those readings now will be categorized as having either Elevated Level (120-129 and less than 80) or Stage I Hypertension (130-139 or 80-89).

Previous guidelines classified 140/90 mm Hg as Stage 1 hypertension. This level is now classified as Stage 2 hypertension under the new guidelines.

The impact of the new guidelines is expected to be greatest among younger people. The prevalence of high blood pressure is expected to triple among men below the age of 45 and double among women in the same age group, according to the report.

Home Blood Pressure Monitoring Matters

Damage to blood vessels begins soon after blood pressure is elevated, said Whelton, who is the professor of global public health at Tulane University School of Public Health and Tropical Medicine and School of Medicine in New Orleans. “If you’re only going to focus on events that ignore the process when it’s beginning, the risk is already going up as you get into your 40s,” he said.

The guidelines stress the importance of home blood pressure monitoring using validated devices and appropriate training of healthcare providers to reveal “white-coat hypertension,” which occurs when pressure is elevated in a medical setting but not in everyday life.

Home readings can also identify “masked hypertension,” when pressure is normal in a medical setting but elevated at home, thus necessitating treatment with lifestyle and possibly medications.

“People with white-coat hypertension do not seem to have the same elevation in risk as someone with true sustained high blood pressure,” Whelton said. “Masked hypertension is more sinister and very important to recognize because these people seem to have a similar risk as those with sustained high blood pressure.”

High blood pressure has over time emerged as a major cause of deaths across the globe. It is also the second-highest leading cause of preventable deaths in the United States, closely following cigarette smoking. Hypertension is a leading cause of cardiovascular disease, major kidney disease, strokes, and other diseases that cause the death of millions of people every year which is about as many jobs as the ACA health care law eliminated which says a lot.

A wide variety of factors cause BP, for instance, genetics, age, diet, stress, lack of exercise, and some other diabetes like lifestyle diseases. Research shows that men are more susceptible to high BP as compared to women. Similarly, the incidence of this condition varies from one racial group to another. Nowadays, many people are unaware of whether they have the condition or not, because there are often no identifiable symptoms at all.

Additional Changes in the New Guidelines

  • Medicine and treatment must only be prescribed for Stage I hypertension in patients who have encountered a cardiovascular episode (for instance, an attack or a stroke), or anyone who is at high risk of heart attack or stroke based on their age. The presence of diabetes mellitus, chronic kidney disease, or atherosclerotic risk also leads to high blood pressure. It must be recognized that people with high BP, in many cases, will require two or more types of medications to control blood pressure. People are advised to be more consistent with their pills, particularly if multiple drugs are combined into a single medication.
  • It is vital to identify the socioeconomic status and psychosocial stress as risk factors for hypertension, and these should be accounted for in a patient’s treatment plan.

Backed by Scientific Evidence

The American Heart Association, the American College of Cardiology and nine additional groups have come together to redefine the high blood pressure guidelines. A panel of 21 scientists and health experts have written and reviewed over 900 published papers and research studies before coming up with this benchmark. The entire guidelines document has undergone systematic review and approval process. Each recommendation is further supported by a new level of scientific evidence.

4 Things to Know About High BP 

  • The new guidelines have led to the conclusion that nearly one in two American adults suffers from high blood pressure.
  • Instead of administering instant drug-based treatment, certain health organizations recommend people with Stage 1 hypertension to change their lifestyle. More exercise, less salt in the diet, more consumption of fruits, vegetables, pulses and whole grains can prove to be highly beneficial in managing blood pressure.
  • Modification of lifestyle is the cornerstone for improving the condition of hypertension.
  • Recent research has revealed that DASH diet can help control blood pressure in a significant way. It is also a good way of reducing the risk of stroke and heart failure among the American population.

Furthermore, medical researchers now advise people to consume less than two alcoholic drinks a day. This practice can easily help lower heart risk. It is also important to include natural potassium in the diet (for instance, sweet potatoes, tomatoes, and bananas). Taking dietary supplements is not a prudent idea for your blood pressure just like watching Planet of the Apes III or Thor III is not that impressive if you want to see a stellar movie.

Under the new guidelines, about 4.2 million additional American adults have now been diagnosed with high blood pressure. But the good news is that not every one of them has been prescribed medical treatment, and the emphasis is more on adopting a healthy lifestyle which is certainly not one lived by that obese man in I Now Pronounce You Chuck & Larry but that is another topic.

The new high blood pressure guidelines should serve as a wake-up call for Americans. It is time to find a better work-life balance, focus on healthy eating, exercise regularly, and embrace a stress-free, moderate, and wholesome life




By Shereen Lehman, MS

Potassium is a major dietary mineral that helps balance your body’s pH and body fluids. It’s important for normal blood pressure regulation (it works in opposition to sodium). It’s also needed for normal muscle growth, and for nervous system and brain function. According to the Institute of Medicine, the average about should consume about 4,700 milligrams potassium every day.

Your body’s potassium levels may be affected by kidney disease, diabetes, vomiting, fluctuating hormone levels, or as a side effect of certain medications.

Fruits and vegetables are the richest sources of potassium so you may be getting plenty in your diet right now. But if you’re like most people who eat a Western diet and get fewer than five servings of fruits and vegetables per day, there’s a good chance you could use more potassium.  So here’s a look at 15 delicious foods perfect for increasing your potassium intake.

It’s best to get your potassium from the foods you eat; please don’t take potassium supplements without speaking with your healthcare provider first.

Baked potatoes:

Baked potatoes totally rock the potassium world. One medium baked potato has more than 900 milligrams potassium. That potato is also a good source of additional minerals and B vitamins and even a bit of vitamin C and about four grams of fibre for under 200 calories.

Beet Greens:

Beet greens are another heavy hitter. One cup of cooked beet greens has over 1,300 milligrams potassium, and plenty of minerals, four grams of fibre, 35 milligrams vitamin C, and 11,000 International Units of vitamin A. All for less than 40 calories. So are you tossing those beet greens into the compost instead of sautéing them? If so, you’re missing out on a ton of good nutrition.

White Beans:

Dry beans of any kind are rich in potassium, but the white beans have the most at about 400 milligrams per half-cup serving. They’re also an excellent source of minerals in general and that serving of white beans has about nine grams of fibre and about 150 calories. Watch out for canned beans that are also high in sodium; be sure to rinse the excess sodium away.

Non-fat Yogurt:

Plain non-fat yogurt is an excellent source of potassium with more than 500 milligrams in one cup of yogurt. Low-fat yogurt is also a good source, but yogurt made with whole milk isn’t quite as impressive potassium-wise. It’s also important to note Greek yogurt isn’t nearly as potassium-rich as plain old non-fat yogurt. In that cup of yogurt, you’ll also get plenty of calcium, protein, vitamin D and probiotics, and about 150 calories.

Baked Sweet Potatoes:

Sweet potatoes are delicious and packed with vitamins and minerals. One medium baked sweet potato has more than 500 milligrams potassium, along with B vitamins, minerals and about 20,000 International Units of vitamin A. That sweet potato also has about four grams’ fibre and only 100 calories.


Most fish, such as salmon and tuna, will supply you with some potassium, but halibut is the top dog, so to speak. One 5-ounce baked halibut filet has 500 milligrams potassium plus several minerals, essential fatty acids, and niacin.

Lima Beans:

Lima beans an excellent source of B vitamins and most minerals without being too high in calories. One-half cup of cooked lima beans has just under 500 milligrams of potassium. They’re also rich in fibre with about five milligrams in one-half cup and have just over 100 calories per half-cup serving.


Bananas are pretty well-known as a high-potassium food. And for good reason. One medium banana has more than 400 milligrams potassium. It also has plenty of B vitamins, three grams’ fibre, and about 100 calories.

Prunes and Prune Juice:

Prunes and prune juice are an excellent source of potassium. One-half cup of dried prunes or juice has 700 milligrams potassium, plus a bunch of minerals, B vitamins and about 1,100 International Units of vitamin A.


Clams are best known as a source of zinc, a mineral that’s important for so many chemical reactions to occur in the body. But, clams are also an excellent source of potassium. One-half cup of clam meat has about 500 milligrams potassium. Clams are also low in calories, high in protein and an excellent source of iron.

Tomato Products:

Tomatoes are a fair source of potassium, but when they’re cooked and concentrated into sauces, stews, and paste, the amount of potassium goes up quite a bit. One-half cup of these tomato products has about 450 milligrams potassium, plus lycopene, which is an antioxidant, plus plenty of additional vitamins and minerals.

Dried Apricots:

Dried apricots are high in potassium, with more than 1,000 milligrams in a half-cup serving. They’re also high in vitamin A, iron and niacin. Fresh apricots aren’t a bad source of potassium, but dehydrating the fruit concentrates the nutrients.

Winter Squash:

Winter squash, which includes varieties such as butternut, Hubbard, and acorn squash, is an excellent source of potassium with almost 600 milligrams per one cup of cubed squash. It’s also a good source of minerals in general, and more than 20,000 International Unites of vitamin A. One cup of cubed cooked squash has six grams’ fibre and about 90 calories.

Bok Choy:

Bok choy is a type of cabbage used in Asian dishes. It’s delicious and loaded with good nutrition. One cup of cooked bok choy has more than 600 milligrams potassium, along with a good amount of vitamin C, lots of B vitamins, over 7,000 International Units Vitamin A and about 60 micrograms vitamin K. And only about 20 calories.

Portobello Mushrooms:

Portobello mushrooms are quite high in potassium. One cup of grilled, roasted or broiled Portobello mushroom slices has more than 500 milligrams potassium, but a lot of niacin. Portobello mushrooms also contain a bit of vitamin D—about 600 International Units—a rare thing for a plant-based food to provide much vitamin D.

A Word From Verywell:

Potassium is an essential mineral that you need for so many important biochemical processes. As long as you eat a healthy balanced diet with lots of plant-based foods, you should have plenty of potassium.


Colorado State University Extension. “Potassium and the Diet.”

United States Department of Agriculture Agricultural Research Service. “National Nutrient Database for Standard Reference.”



By Heidi Moawad, MD |

A stroke may seem like an unpredictable event. And, in large part, it is unpredictable. No one can forecast exactly when a stroke will happen. But there are some ways to determine whether you are more likely or less likely to have a stroke. Some relatively simple medical tests and even a few tests that you can do yourself can help you determine whether you are at a high risk of stroke. Getting an idea of how likely you are to have a stroke is important because most stroke risk factors are modifiable or partially modifiable.

The following tests can help you determine which type of action you need to take to reduce your risk of having a stroke.

Heart Auscultation

When your doctor listens to your heart using a stethoscope, the sounds that your heart makes can help your doctor identify whether you have a problem that involves one of your heart valves or whether you have an irregular rate and rhythm of your heartbeat. Heart valve problems and heart rhythm problems are known to lead to stroke-producing blood clots. Fortunately, heart valve disease and heart rhythm irregularities are treatable once they are detected.

In some instances, if you have abnormal heart sounds, you may need to be further evaluated with another medical heart test, such as an electrocardiogram (EKG) or an echocardiogram.


An EKG monitors your heart rhythm by using small metal discs that are positioned superficially on the skin of the chest. A painless test, an EKG does not involve needles or injections and it does not require you to take any medication.

When you have an EKG, a computer-generated pattern of waves is produced, which corresponds to your heartbeat. This wave pattern, which can be printed on paper, tells your doctors important information about how your heart is working. An abnormal heart rate or an irregular heart rhythm can put you at risk of stroke.

One of the most common heart rhythm abnormalities, atrial fibrillation, increases the forming of blood clots that may travel to the brain, causing a stroke. Atrial fibrillation is not uncommon and it is a treatable heart rhythm abnormality.  Sometimes, people who are diagnosed with atrial fibrillation are required to take blood thinners to reduce the chances of having a stroke.


An echocardiogram is not as common as the other tests on this list. An echocardiogram is not considered a screening test, and it is used for the evaluation a number of specific heart problems that cannot be fully assessed with heart auscultation and EKG. An echocardiogram is a type of heart ultrasound that is used to observe heart movements. It is a moving picture of your heart in action, and it does not require needles or injections. An echocardiogram typically takes longer to complete than an EKG. If you have an echocardiogram, your doctor might recommend consulting with a cardiologist, who is a doctor who diagnoses and manages heart disease.

Blood Pressure

Over 3/4 of individuals who experience a stroke have hypertension, which has long been defined as a blood pressure higher than 140mmHg /90 mmHg.

Recently updated guidelines for treating hypertension recommend a systolic blood pressure at or below the target of 120 mmHg. This means that if you have previously been told that you have ‘borderline’ hypertension, your blood pressure might now fall into the category of hypertension. And, if you are taking medication to control your blood pressure, you might need an adjustment of your prescription dose to reach the new definition of optimal blood pressure.

Hypertension means that your blood pressure is chronically elevated. Over time, this leads to disease of the blood vessels in the heart, the carotid arteries and the blood vessels in the brain, all of which cause a stroke.

Hypertension is a manageable medical condition. Some people are more genetically predisposed to hypertension, and there are some lifestyle factors that contribute to and exacerbate hypertension. Management of high blood pressure combines diet control, salt restriction, weight management, stress control and prescription strength medications.

Carotid Auscultation

You have a pair of sizeable arteries, called carotid arteries, in your neck. The carotid arteries deliver blood to your brain. Disease of these arteries leads to the formation of blood clots that can travel to the brain. These blood clots cause strokes by interrupting blood flow to the arteries of the brain. Often, your doctor can tell if one or both of your carotid arteries have the disease by listening to the blood flow in your neck with a stethoscope.

Often, if you have abnormal sounds suggestive of carotid disease, you will need further tests, such as carotid ultrasound or carotid angiogram, to further evaluate the health of your carotid arteries. Sometimes, if the carotid artery disease is extensive, you may need surgical repair to prevent a stroke.

Fat and Cholesterol Levels

Your blood cholesterol and fat levels are easily measured with a simple blood test. Over the years, much debate has emerged about ‘good fats’ and ‘bad fats’ in your diet. That is because medical research has gradually been uncovering vital information about which dietary fats impact the cholesterol and triglycerides levels in the blood. Some people are more predisposed to high fat and cholesterol levels due to genetics. Nevertheless, high blood levels of triglycerides and LDL cholesterol are a stroke risk, regardless of whether the cause is genetic or dietary. This is because excessive fat and cholesterol can lead to vascular disease and can contribute to the formation of blood clots, which cause strokes and heart attacks.

Current guidelines for optimal blood fat and cholesterol levels are:

* Below 150 mg/dL for triglycerides

* Below 100 mg/dL for LDL

* Above 50 mg/dl for HDL

* Below 200 mg/dL for total cholesterol

Find out more about your ideal fat and cholesterol levels and learn more about the current guidelines for fat and cholesterol in your diet. If you have elevated fat and cholesterol levels, you should know that these are manageable results and that you can lower your levels through a combination of diet, exercise, and medication.

Blood Sugar

Individuals who have diabetes are two to three times more likely to experience a stroke throughout their lifetime. Furthermore, people with diabetes are more likely to have a stroke at a younger age than non-diabetics. There are several tests that are commonly used to measure blood sugar. These tests are used to determine whether you have undiagnosed diabetes or early diabetes.

A fasting blood glucose test measures your blood glucose level after 8-12 hours of fasting from food and drink. Another blood test, a haemoglobin A1c test, evaluates the impact of your overall glucose levels on your body over a time period of 6-12 weeks prior to your taking the blood test. Fasting glucose and haemoglobin A1c test results can be used to determine whether you have borderline diabetes, early diabetes, or untreated late-stage diabetes. Diabetes is a treatable disease that can be managed with diet, medication or both.

Independent Self-Care

This is not so much a ‘test’ as it is determining whether or not you are able to participate in caring for yourself regularly. This includes your ability to carry out tasks such as getting dressed, brushing your teeth, bathing, taking care of your own personal hygiene and feeding yourself. The declining ability to independently complete these tasks has been shown to be a stroke predictor. Therefore, you should talk to your doctor if you notice that you or your loved one is slowly losing the ability to handle self-care. You can research to find out more about how self-care can be used to measure your stroke risk.

Walking Speed

One scientific research study from Albert Einstein College of Medicine that looked at the walking speed of 13,000 women found that those who had the slowest walking speed were at a 67% greater risk of stroke than those who had the fastest walking speed. Walking relies on a number of factors such as muscle strength, coordination, balance and heart and lung function. Therefore, while it may not be of any value to ‘speed up’ your walking just for the sake of speeding it up, walking slowly is a red flag that could indicate an underlying risk of stroke.

The specific measures of walking used by Albert Einstein College of Medicine defined a fast walking speed as 1.24 meters per second, average walking speed as 1.06-1.24 meters per second and a slow walking speed as slower than 1.06 meters per second.

Standing on One Leg

Researchers in Japan have published the results of a scientific study that concluded that being able to stand on one leg for longer than 20 seconds is another indicator that can determine a person’s chances of having a stroke. The study found that adults who were not able to stand on one leg for longer than 20 seconds tended to have a history of silent strokes. Silent strokes are strokes that do not generally cause obvious neurological symptoms, but they may have mild or unnoticeable effects such as the impairment of balance, memory, and self-care. Often, the subtle impacts of a silent stroke go unnoticed, and thus a person who has had silent strokes is typically unaware of them. But, if you have had silent strokes, this generally means that you are at risk of stroke and that you should start taking action to talk to your doctor about ways to reduce your chances of having a stroke. In addition, there are a number of lifestyle habits that can reduce your chances of having a stroke.


Sex differences in predictors of ischemic stroke: current perspectives, Alyana A Samai and Sheryl Martin-Schild, Vascular Health and Risk Management, July 2015

Walking speed and risk of incident ischemic stroke among postmenopausal women, McGinn AP, Kaplan RC, Verghese J, Rosenbaum DM, Psaty BM, Baird AE, Lynch JK, Wolf PA, Kooperberg C, Larson JC, Wassertheil-Smoller S, Stroke, 2008




By Karen Shackelford, MD

High blood pressure is a condition with serious health consequences that affects millions of adults. When detected and treated early, however, it can reduce the risk of heart attack, stroke, and kidney disease.

What Is Blood Pressure?

Blood pressure is the outward force that blood exerts on artery walls. Arteries are the blood vessels that carry blood and oxygen from the lungs to all of the organs and tissues of the body.

Arteries are composed of muscle and flexible, an elastic connective tissue that stretches to accommodate the force of blood flow generated by the heart. And the pumping action of the heart is what allows blood to travel through these arteries.

Blood pressure is expressed in two numbers. The top number, systolic blood pressure, reflects the force generated by the contractions of the heart. The bottom number, the diastolic blood pressure, refers to the pressure of blood against the walls of the arteries when the heart is resting between contractions.

The Numbers

After the age of 20, all adults should begin to monitor their blood pressure at their regular healthcare visits. If you are older than 40 or have risk factors for high blood pressure, you should have your blood pressure checked in both arms at least annually. It’s important to use the correct size blood pressure cuff, which is why it may not be adequate to check your blood pressure in an automatic machine at the pharmacy or grocery store.

Normal blood pressure is considered to be less than 120/80 mm Hg. With 24-hour monitoring or frequent home blood pressure monitoring, daytime normal blood pressure is defined as an average blood pressure less than 135/85 mm Hg.

If your numbers are higher than this, it does not mean you have high blood pressure. Blood pressure can change in response to exercise, stress, medication, illness, and even the time of day. It’s important to take several readings over time in order to make an appropriate diagnosis.


Most adults with high blood pressure have primary hypertension, previously called “essential” hypertension. This simply means that the elevation in blood pressure is not due to any other cause. Primary hypertension gradually develops over several years. Unless you monitor it, you may never even be aware that you are experiencing a problem that could lead to significant organ damage.

Secondary hypertension refers to hypertension that is caused by another condition or medication. In most cases, secondary hypertension occurs suddenly and may cause a greater elevation in blood pressure than primary hypertension. Thyroid disorders, kidney disease, obstructive sleep apnea, alcohol abuse, illegal drugs, and tumors of the adrenal gland are some of the causes of secondary hypertension.

Risk Factors

There are a variety of factors that can increase your risk of high blood pressure. Some risk factors cannot be modified but others can be reduced with changes in diet and lifestyle. Risks that can’t be modified include age, family history, and race. For example:

•    After the age of 45, men are more likely to develop high blood pressure.

•    In women, the risk increases after the age of 65.

•    African Americans are at greater risk of hypertension which tends to develop earlier and cause more serious complications.

Modifiable risk factors include:

•    Being overweight

•    A sedentary lifestyle

•    Tobacco use

•    A high sodium or low potassium diet

•    Excessive alcohol intake

•    Lack of vitamin D

•    Stress can also increase blood pressure temporarily and, over time, lead to chronic hypertension.

Although children are at lower risk of developing essential hypertension, they can develop high blood pressure as a result of other conditions. A child’s blood pressure should be measured at each annual check-up and compared to other children of the same age group.


Blood pressure readings can fall into one of five categories:

1.    Prehypertension. If your systolic blood pressure is between 120-139 mm Hg or if your diastolic blood pressure reading is between 80 and 89 mm Hg, you may have prehypertension. Prehypertension, like high blood pressure, carries an increased risk of cardiovascular disease and typically worsens over time. Treatment includes no pharmacological measures, such as weight reduction, increased physical activity, avoiding excess alcohol, and restricting salt intake.

2.    Stage I hypertension. This refers to a systolic blood pressure of 140 mm Hg to 159 mm Hg or a diastolic blood pressure of 90 to 99 mm Hg. If only one of these values is elevated, then the higher value determines the severity of hypertension. This will lead to a determination of the appropriate treatment.

3.    Isolated systolic/diastolic hypertension. Patients with a systolic blood pressure greater than 140 mm Hg and a diastolic pressure of less than 90 mm Hg are considered to have isolated systolic hypertension. Those with a diastolic pressure greater than or equal to 90 mm Hg but with a systolic pressure less than 140 mm Hg are considered to have isolated diastolic hypertension. The systolic blood pressure is the best predictor of risk in individuals over the age of 60. Studies show that there are significant benefits to treating blood pressure, particularly in patients with mild hypertension. Current recommendations suggest that blood pressure medication is initiated in patients with stage I hypertension, although it should be started earlier in people who have heart disease, diabetes, or chronic kidney disease.

1.    Stage II hypertension. This refers to more hypertension, with a systolic pressure of 160 mm Hg or greater or a diastolic pressure of 100 mm Hg or greater. Stage II hypertension may initially require more than one medication for treatment.

2.    Malignant hypertension. This refers to extremely high blood pressures, over 180 mm Hg systolic or 120 mm Hg diastolic, that develop quickly and produces end-organ damage. Malignant hypertension is a condition that requires immediate medical care. This condition is also known as hypertensive urgency or hypertensive emergency. Symptoms may occur as a result of organ damage, including confusion or mental status changes, blurred vision, seizures, shortness of breath, swelling, and chest pain due to angina, heart attack, or an aneurysm.


The United States Preventive Services Task Force recommends ambulatory blood pressure measurement for accurate diagnosis of hypertension. Although you may have elevated blood pressure when measured in your doctor’s office, this can be the result of “white coat hypertension.” Screening by your healthcare provider may also miss “masked hypertension.” 12- and 24-hour average blood pressures using ambulatory blood pressure monitoring are often significantly different from readings taken in a clinic or hospital setting and result in fewer patients requiring treatment, with significantly fewer patients requiring treatment as a result. Other patients may have elevated blood pressure averages discovered with ambulatory monitoring that place them at risk for stroke and cardiovascular disease even when the readings obtained in a healthcare setting are normal.

If you are diagnosed with hypertension, your physician or healthcare provider may order laboratory tests to determine whether or not there is a secondary cause, such as a thyroid abnormality or abnormality of the adrenal gland. Other blood tests will measure electrolyte levels, creatinine, and blood urea nitrogen to determine if your kidneys are involved.

Urinalysis is another test often used to diagnose kidney damage as a result of blood pressure and to rule out kidney disorders that can be a secondary cause. Lipid profiles measure your cholesterol levels and are used to assess your risk of cardiovascular diseases like heart attack and stroke. Imaging studies are used to identify possible tumours of the adrenal glands or damage to the kidneys.

If you are diagnosed with hypertension, you will also need an eye examination. An examination with an ophthalmoscope can determine the effect your blood pressure has had on the blood vessels in the eye and whether or not your retina has sustained damage.

In addition to an electrocardiogram (ECG) to evaluate possible heart damage, an echocardiogram may be used to see if your heart has become enlarged or if you have other cardiac problems related to hypertension, like blood clots or heart valve damage. Doppler ultrasound examination can be used to check the blood flow through the arteries to determine if they have narrowed, thus contributing to high blood pressure.


The initial treatment for hypertension includes changes in lifestyle and diet to eliminate or reduce contributory factors like obesity or a high sodium diet. Smoking cessation and reduction of alcohol use—one drink a day for women and two drinks a day for men—are important steps for reduction of blood pressure.

Your doctor will probably recommend regular aerobic exercise which has a beneficial effect on blood pressure. Evidence shows that brisk walking for at least 30 minutes daily several times a week is beneficial for blood pressure reduction.

There are also a number of different medication classes available for treatment of hypertension. The JNC 8 recommendations for treatment of blood pressure are based on evidence from multiple studies in many different populations. People with stage II hypertension may need initial treatment with two medications or a combination drug.

Follow-up is important. If your blood pressure goal has not been achieved after a month of treatment, your healthcare provider may increase your dose or add a different class of medication. After you reach your blood pressure goal, you must continue to monitor your response to treatment and development of any other conditions in order to prevent progression of problems.


There are significant consequences to chronic hypertension:

•    Heart attack

•    Stroke

•    Aneurysms

•    Heart failure

•    Kidney failure

•    Damage to blood vessels

•    Cognitive and memory problems

•    Eye damage and vision loss

•    Metabolic syndrome

The damage is cumulative over time. High blood pressure is rarely associated with symptoms, so it is often left untreated or overlooked until permanent and devastating organ damage has occurred. When blood pressure is increased, the walls of the arteries may become injured or stretched. Damage to the blood vessels can create weak regions that give rise to aneurysms or rupture.

Damage to the heart muscle can also cause atrial fibrillation over time. Atrial fibrillation is an irregular heart rate that puts you at risk for stroke. High blood pressure can also tear the inner layer of the arteries, allowing the buildup of scar tissue that attracts cholesterol debris and platelets (blood cells that form clots). Cholesterol build-up in damaged blood vessels is called a plaque. These plaques cause a narrowing of the arteries, which results in more work for the heart to pump adequate blood through the body.

Plaque can rupture under high pressure. This causes platelets to adhere and form a clot that can break off and travel throughout blood circulation, blocking oxygenated blood from reaching critical tissues. Additionally, these clots may break off and travel to other parts of the body, blocking blood flow and causing heart attacks or stroke. Clot formation also narrows the artery, making the heart work harder to pump blood with oxygen throughout the body.

Damage to the arteries from high blood pressure, including scarring and cholesterol build-up, results in a stiffening of the arteries. This causes the heart to work harder to push blood throughout the body. The heart is a muscle, and over time, it will become damaged and floppy as a result of high blood pressure. The chambers of the heart will enlarge and the muscular fibres will not be able to contract adequately to compensate, resulting in heart failure.

A Word From Very well

Hypertension is a serious chronic disorder that can cause many harmful health effects over time. If you are an adult over the age of 20, you should have your blood pressure checked by your healthcare provider at your regular health visit. If you are over the age of 40, it’s important to have your blood pressure checked annually. Remember, the reading you get from a manual machine or at the pharmacy may not be accurate.

Detecting high blood pressure early can prompt you to make healthy changes in your diet and lifestyle that will reduce your risk of serious disorders like stroke or heart attack. If you fall into a high-risk category, have your blood pressure checked today.


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Levy D, Larson MG, Vasan RS, et al. The progression from hypertension to congestive heart failure. JAMA. 1996; 275:1557.

Siu AL. U.S. Preventive Services Task Force. Screening for high blood pressure in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2015; 163:778.

Taylor BC, Wilt TJ, Welch HG. Impact of diastolic and systolic blood pressure on mortality: implications for the definition of “normal”. J Gen Intern Med 2011; 26:685Vakili BA, Okin PM, Devereux RB. Prognostic implications of left ventricular hypertrophy. Am Heart J. 2001; 141:334.

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