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SMOKING

Smoking Risks

  • Hardening of the arteries leading to premature risk of heart disease and stroke;
  • Frequent colds, smoker's cough, chronic bronchitis;
  • Gastric ulcers;
  • Increase in heart rate and blood pressure;
  • Premature and more abundant face wrinkles;
  • Emphysema, heart disease , stroke;
  • Cancers - mouth, larynx, pharynx, esophagus, lungs, pancreas, cervix, uterus and bladder;
  • Diminished or extinguished sense of smell and taste.

Just the facts

Smoking is a dangerous health hazard for teenagers. It is the single most important cause of preventable illness and premature death for Canadians.

Heart disease rates are 70% higher for smokers than non-smokers.

Statistics

  • Tobacco use among Canada's youth has increased at an alarming rate in recent years. In 1991, 20% of Canadians aged 15-19 smoked, now that number has increased to 28% of boys and 30% of girls.
  • Smoking will account for more than 50% of deaths before the age of 70 among current 15 year old smokers.
  • Over 90% of teenagers who smoke as few as 3-4 cigarettes a day are trapped into a career of regular smoking which typically lasts some 30-40 years.
  • Canadians under the age of 19 consume about 1.7 billion cigarettes yearly.
  • Among children as young as 6-12 years, 7% have already tried cigarettes.
  • 26% of young women who smoke began smoking before the age of 13! 83% before age 16, and almost all before age 18.
  • If you start to smoke at age 13, and smoke an average pack-a-day, by age 30 you will have spent $20,000-$25,000 on cigarettes!!! Think about how much you would have if you invested that money instead!!

Tobacco and sports

  • Smoking causes your lungs to work harder.
  • Smokers get short of breath when doing sports.
  • Smoking causes less oxygen to be available for your working muscles.
  • Smokers have less strength and endurance.
  • Smoking lowers the amount of oxygen in the blood. This means less oxygen for important organs in the body like the heart and brain.
  • Smoking causes the heart to beat faster and pump less blood with each beat.
  • Smoking causes blood pressure to rise.
  • Non-smokers do better than smokers in the one-mile run and other fitness tests.
  • Most professional athletes do not smoke.

Effects on heart

To understand how smoking affects your heart, you need to know what your heart does. The job of your heart is to pump blood through the blood vessels to all parts of your body. To do this, your blood vessels need to be open and flexible. As blood travels around your body, it delivers oxygen and nutrients which you need for energy, and it picks up waste products, such as carbon dioxide , which must be removed. Without a good supply of oxygen and nutrients, and without a good waste disposal system, you simply cannot have good health.

Research by the Heart and Stroke Foundation has proved that smoking dramatically increases your risk of heart disease and stroke. Nicotine, carbon monoxide and tar are just three of many harmful chemicals in cigarettes.

Carbon monoxide

  • Is the same odourless gas that is found in car exhaust.
  • Reduces the amount of oxygen in the blood going to your heart. As a result, the heart has to work harder to get enough oxygen to the body. The heart, like all muscles, needs oxygen to do its work.

Nicotine

  • Makes the heart beat faster, so it has to work harder.
  • Causes blood vessels to narrow. This increases blood pressure and makes the heart work harder to push blood through the arteries.
  • Increases the buildup of plaque deposits along the inside walls of the arteries or blood vessels. This also increases blood pressure, makes the heart work harder, and can lead to blood clots.

Tar

  • Damages delicate lung tissue by forming brown, sticky deposits that can cause cancer and many other diseases.

The bottom line is that no cigarettes are safe. Low tar and low nicotine cigarettes may be even more harmful because smokers inhale more deeply and smoke more cigarettes to get the amount of nicotine they want. Smoking is the largest preventative cause of heart disease, stroke, lung cancer, chronic lung disease, chronic bronchitis, emphysema and a major cause of mouth and throat cancer.

It also:

  • Increases the risk of having a heart attack or stroke - 80,000 Canadians die every year from heart attacks and strokes. At least 20,000 of these deaths are due to smoking; that's 55 people every day!

The evidence is clear. If you smoke the odds are higher that you will end up with heart disease or stroke.

 

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Risk factors for heart disease - women

A. Risk Factors Women Can't Control or Change

  • Ethnicity (South Asian, Black, First Nations/Aboriginal Peoples or Inuit)
  • Family history of early heart disease or stroke
  • Menopause

B. Risk Factors Women Can Control or Change

  • Smoking
  • Physical Inactivity
  • Diabetes
  • Obesity
  • High Blood Pressure
  • High Blood Cholesterol
  • Stress

 

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Cholesterol

What is cholesterol and why is it important?

Cholesterol is a soft waxy substance made by our bodies. It is one of the lipids (fats) found in the blood, and is a vital chemical building block that our body uses to make cell membranes and hormones. Without cholesterol, your body couldn't function.

Some people have high levels of cholesterol in their blood, (hypercholesterolemia), which is a major risk factor for heart disease and stroke. Elevated blood cholesterol can lead to atherosclerosis (the buildup of fatty materials, calcium and scar tissue in the arteries) , which can cause circulation problems, heart attacks and strokes.

Several major studies have shown that lowering blood cholesterol levels reduces the risk of coronary heart disease. Some research suggests that atherosclerosis may be stopped and even reversed if cholesterol levels are sharply lowered.

Kinds of cholesterol

Low-density lipoprotein (LDL) cholesterol

LDL cholesterol is often called "bad" cholesterol. It doesn't really deserve this name - our bodies need normal amounts of LDL cholesterol for cell growth and repair. However, high levels of LDL cholesterol in the blood can cause a buildup of plaque (fatty deposits) inside your blood vessels, leading to atherosclerosis (narrowing of the arteries). If your LDL cholesterol level is too high, you may be prescribed medication and asked to make lifestyle changes help reduce your levels.

High-density lipoprotein (HDL) cholesterol

HDL cholesterol is often called "good" cholesterol. It helps to carry LDL cholesterol away from blood vessel walls. Current research indicates that HDL cholesterol may help protect us from atherosclerosis and heart disease, so higher levels are considered good. If your HDL cholesterol levels are low, you may be asked to make lifestyle changes such as becoming smoke-free, increasing your physical activity and modifying your diet.

Cholesterol and triglycerides

The body contains another type of fat called triglyceride. While not a cholesterol, triglyceride is the most common form of fat found within our bodies. This substance seems to have some effect on heart disease, although the exact relationship is not clear. For this reason triglyceride is usually tested at the same time as blood cholesterol levels.

Unlike LDL cholesterol, triglycerides do not stick to the walls of the blood vessels. Triglycerides are more like a "thick cream" in the blood and increase the tendency of the blood to clot. The greater the tendency to clot, the greater the risk of a heart attack or stroke.

High triglyceride levels are associated with excess alcohol consumption, excess weight or poorly controlled diabetes. Therefore, high triglyceride levels may be a signal that additional heart disease risk factors are present or that lifestyle changes are needed. Weight loss, reduction in alcohol consumption and improved blood sugar control can often bring triglycerides back to normal levels.

Dietary cholesterol and fat

Cholesterol is found in some of the foods Canadians normally eat. We refer to this as dietary cholesterol. Fat, especially saturated fat, in the diet has a greater effect on blood cholesterol than dietary cholesterol. For this reason, the total amount of fat in our diet has a far greater impact on our blood cholesterol levels than dietary cholesterol. Download a brochure on dietary fat and cholesterol.

Cholesterol and children

The connection between high cholesterol levels in children and their risk of heart disease in later life is unclear. We know that it's very important for growing children to have an adequate amount of fat in their diet. Parents who have concerns about the amount of fat in their child's diet should speak with a qualified health professional before making dietary changes.

Causes of high cholesterol

The level of cholesterol in the blood (and the balance between "good" and "bad" cholesterol) is determined by your genes, how well your liver functions (since it is the liver that manufactures 80% of the cholesterol in your blood), and your diet.

Some people can eat a diet high in saturated fats and still maintain a low blood cholesterol level. For most people, however, eating foods lower in fat is essential to keep blood cholesterol levels at a healthy level.

Cholesterol testing

Most cholesterol tests will measure:

  • Total blood cholesterol
  • LDL cholesterol
  • HDL cholesterol
  • Triglycerides

Cholesterol testing isn't necessary for everyone of all ages. Canadian guidelines released in 2003 recommend that you have your blood cholesterol tested if you:

  • are male and over 40 years of age;
  • are female and over 50 years of age;
  • are female and post-menopause;
  • have heart disease;
  • have diabetes;
  • have high blood pressure;
  • have abdominal obesity [waists measuring more than 102 cm (40 inches) for men and more than 88 cm (35 inches) for women);
  • smoke;
  • have a strong family history of heart disease.

Your doctor will help you decide whether you need your blood cholesterol levels tested.

Interpreting test results

The most common number you will be given is the total blood cholesterol. This tells you the total amount of cholesterol in your blood. This number, while significant, doesn't necessarily tell you everything you need to know about your blood cholesterol. Also very important are your levels of LDL ("bad") cholesterol, HDL ("good") cholesterol and the ratio between your total and HDL cholesterol.

In Canada the results of the cholesterol tests are given in millimoles per litre (mmol/L). In the United States, the results are in milligrams per decilitre (mg/dL). This different system of measurement can be confusing. To determine the Canadian equivalent of total, LDL or HDL cholesterol values, use a conversion factor of 0.0259. For example, 130 mg/dL is equal to approximately 3.4 mmol/L (130 multiplied by 0.0259). To determine the Canadian equivalent of a triglyceride value, use a conversion factor of 0.0113. For example, 200 mg/dL is equal to approximately 2.3 mmol/L (200 multiplied by 0.0113).

Canadian guidelines suggest that the higher your risk for heart disease or stroke, the lower your target levels should be for LDL-cholesterol and your total cholesterol to HDL-cholesterol ratio. Generally, good target levels are:

  • A total cholesterol less than 5.2 mmol/L (200 mg/dL)
  • An LDL-cholesterol less than 3.5 mmol/L. (about 130 mg/dL)
  • An HDL-cholesterol higher than 1.0 mmol/L for men and 1.2 mmol/L for women (about 40 mg/dL)
  • A total cholesterol/HDL-cholesterol ratio less than 5.0

When deciding the "right" target levels for you, your doctor will take into account factors that increase your risk of heart disease and stroke, such as your age, sex, blood pressure, and whether you have diabetes or smoke.

If any of your cholesterol levels are outside the "right" target level for you, your doctor will discuss lifestyle changes and may prescribe medication to keep your levels in balance.

Lifestyle changes to reduce cholesterol levels

The first step in lowering cholesterol is modifying your diet to reduce total fat consumption. There is evidence that increasing the amount of fibre is also beneficial. Achieving and maintaining a healthy weight, being physically active and smoke-free are also very important in controlling blood cholesterol.

Tips for managing high cholesterol

  • Know your actual cholesterol levels (HDL, LDL, triglycerides);
  • Discuss with your doctor where your levels should be;
  • Eat white meat or lean cuts of red meat;
  • Remove skin and fat from chicken;
  • Use "low-fat" or "no-fat" dairy products, dressings, mayonnaise;
  • Eat regular, well-balanced meals to avoid the urge to snack;
  • Increase servings of fresh fruit, vegetables and grains (increase fibre);
  • Consult a dietitian;
  • If you smoke, become smoke-free;
  • Be physically active.

Tips for managing high triglycerides

  • Reduce the amount of fat in your diet from all sources;
  • Reduce the amount of sweet baked goods, chocolate and other high-sugar foods;
  • Discuss your level of alcohol intake with your doctor and reduce it if necessary;
  • Be physically active;
  • Get more information on healthy eating.

Drug therapy to reduce cholesterol levels

Drug therapy may be necessary if your cholesterol level does not respond to changing your diet - or if you have a genetic predisposition to high cholesterol levels. There are many drugs for treating high cholesterol – each with advantages and disadvantages. If you do not respond well to a single drug, combining drugs may be needed.

If you are prescribed medication to reduce your cholesterol levels, be sure to ask your doctor:

  • Why this particular drug was chosen;
  • How it should be taken (how often, at what time of day, etc.);
  • Whether there are side effects to watch out for and report;
  • Whether this drug will be affected by other drugs or alcohol.

Types of cholesterol-lowering drugs

If you are prescribed medication, be sure to tell your doctor about any other prescription or non-prescription medications you are currently taking . Talk to your doctor about any potential side effects you might experience.

Statins

Statins help block an enzyme in the liver that helps your body make cholesterol. By blocking this enzyme, your body makes less cholesterol and the slower cholesterol production signals your liver to absorb more "bad" cholesterol (LDL) from your bloodstream. Lower LDL levels can lead to lower triglyceride levels and higher HDL “good cholesterol” levels. Many different types of statins are available including atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor).

Bile acid sequestrants (Resins)

Your body uses cholesterol to make bile – an acid used in digestion. Bile acid sequestrants bind to bile – preventing it from being used during digestion. In response, your liver makes more bile and the more it makes, the more LDL-cholesterol (the “bad” cholesterol) it needs – which means there is less LDL-cholesterol circulating through your blood. These drugs such as cholestyramine (Questran)and colestipol (Colestid) can reduce total cholesterol by 20%, and may even raise "good" cholesterol. .

Fibric acids (Fibrates)

These medications include bezafibrate (Bezalip), fenofibrate (Lipidil) and gemfibrozil (Lopid). Fibric acids work by loweringtriglyceride levels. They do this by breaking down the particles that make triglycerides and use them in other ways. Lowering your triglyceride levels can increase your levels of HDL “good” cholesterol. Fibric acids can also reduce LDL (the "bad" cholesterol).

Niacin Niacin (nicotinic acid) is a form of vitamin B, which should only be taken as a cholesterol-lowering medication when prescribed by your doctor. It works by slowing the liver's production of the chemicals that help make LDL “bad” cholesterol. It signficantly raises HDL “good” cholesterol.

Cholesterol absorption inhibitors

Ezetimibe is the only cholesterol absorption inhibitor available. It works by preventing your body from absorbing and storing cholesterol in your liver and improving the way cholesterol is cleared from your blood. This drug helps lower the levels of total and LDL-cholesterol in your blood. It is only prescribed when your cholesterol cannot be controlled with proper diet and exercise and should always be used as part of a healthy living plan, which includes eating a lower-fat, low-cholesterol diet.

Sources:

  1. http://www.americanheart.org/presenter.jhtml?identifier=163
  2. http://www.texasheartinstitute.org/cholmed.html
  3. MedlinePlus Web site - A service of the US National Library of medicine and the US NIH - http://medlineplus.gov/

 

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Coronary Heart Disease Risk Factors

Coronary heart disease risk factors are behaviours or medical conditions which make people more likely to develop coronary heart disease (also called coronary artery disease). Some risk factors (like smoking) are well known. Others are less well recognized.

Having even one risk factor will increase a person's chances of developing heart problems. People with two or more risk factors may be at far higher risk for coronary heart disease than people with none.

In addition to causing coronary heart disease, these risk factors increase a person's chances of developing other serious medical problems including:

  • Stroke;
  • Congestive heart failure (CHF);
  • Kidney failure.

Common risk factors

When it comes to heart disease, it's important to manage the risks that you can influence, particularly if you have other risk factors that are beyond your control.

Risk factors you CAN influence

  • High blood cholesterol
  • High blood pressure
  • Lifestyle factors (lack of exercise, being overweight, smoking, drinking too much alcohol, stress )
  • Diabetes

Risk factors you CAN'T change

  • Age and gender (55+ for women, 45+ for men)
  • Ethnic descent (African, South Asian, and First Nation populations are at higher risk)
  • Family medical history - heart attack or stroke before age 65, angina , tendency to develop high blood cholesterol or blood pressure

Reducing the risk

Keep blood pressure at healthy levels

Adults should have their blood pressure checked regularly, especially if high blood pressure runs in the family. People with high blood pressure should ask their doctors how to reduce it. Blood pressure can often be brought into normal ranges by lifestyle changes such as: losing excess weight; exercising; reducing salt intake; increasing consumption of potassium -rich foods and managing stress levels.

Sometimes medication may also be required. Blood pressure lowering medication must be taken exactly as directed.

Keep cholesterol at healthy levels

Adults should have their blood cholesterol levels checked regularly, especially if there's a family history of high cholesterol. People with high cholesterol levels should ask their doctors how to reduce them. Blood cholesterol levels can sometimes be lowered by reducing the amount of fat in the diet. Sometimes, cholesterol lowering medications may also be needed.

Stop smoking

A smoker's risk of coronary heart disease is far higher than that of a non-smoker. Smokers should ask their doctors for advice on how to quit smoking. There are many smoking cessation programs and cessation aids to help smokers quit.

Exercise regularly

Regular exercise can reduce people's risk of developing coronary heart disease. Exercise increases levels of "good" (High Density Lipoprotein or HDL) cholesterol, helps people manage stress, and improves the efficiency of the heart, lungs and muscles. Even modest levels of low-intensity exercise are beneficial if done regularly.

Control diabetes

Patients with diabetes should take steps to manage it well. Diabetes (especially poorly controlled diabetes) increases the risk of developing coronary heart disease.

Maintain a healthy body weight

Adults should keep their body weight as close as possible to the ideal body weight for their age and build. (If they are not sure of their ideal body weights they should consult their doctors.) Exercise and proper diet are two key factors in maintaining a healthy weight.

People who are more than 30% over their ideal weight are more likely to develop coronary heart disease and stroke even if they have no other risk factors. Added weight increases the strain on the heart and contributes to high blood pressure and high blood cholesterol. It can also lead to type-2 (adult-onset) diabetes.

Learn to control stress

Stress is often associated with unhealthy activities such as smoking, overeating, excessive drinking, worrying or outbursts of anger. People under severe stress should consult their doctors for advice on how to manage stress.

Stress management programs focus on learning to identify, prioritize and discuss problems, eating well, getting enough sleep and exercising.

Incidence of heart disease

Here in Canada, 22% of all deaths among Canadian males are due to heart disease. 19% of all deaths among Canadian females are due to heart disease.

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DIABETES

Diabetes is when the body can't process sugar properly. "Juvenile diabetes" (develops in childhood) must be treated with insulin. "Adult onset diabetes" often develops in overweight adults. This type of diabetes can sometimes be eliminated or controlled by diet and weight loss. Diabetes results in circulation problems due to blood vessel damage. Women with diabetes are especially at risk , as high blood pressure and high cholesterol tend to go hand in hand with diabetes in women.

Diabetes and cardiovascular problems

Is diabetes linked to cardiovascular problems?

Yes. Both forms of diabetes can increase the risk of high blood pressure , atherosclerosis, coronary heart disease and stroke, particularly if blood sugar levels are poorly controlled. Insulin resistant people also have an increased risk of developing cardiovascular problems. More than 80% of people with diabetes die from some form of heart or blood vessel disease.

Cardiovascular precautions

Diabetes is considered a major risk factor for cardiovascular disease. People with diabetes can reduce their health risk by modifying their other risk factors for cardiovascular disease, such as smoking, lack of physical activity, high blood pressure, excess weight and high blood cholesterol levels.

What can you do?

  • If you have a family history of diabetes and/or you are overweight, ask your doctor to test your blood sugar levels.
  • Lose weight if you are overweight.
  • Eat a balanced diet, reduce fat and eat more high-fibre foods and complex carbohydrates.
  • If your doctor has prescribed medication (e.g. insulin or an oral tablet) to control your diabetes, take it exactly as directed.
  • Monitor your blood sugar at home (ask your doctor or diabetes educator for instructions). Notify your doctor if you cannot keep your blood sugar in control.
  • Control your blood sugar well and follow the advice of your doctor.
  • Get active! Check with your doctor before changing your level of activity.

For more information about diabetes, call your local branch of the Canadian Diabetes Association.

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HIGH BLOOD PRESSURE

What is blood pressure?

Your blood pressure is a measure of the pressure or force of the blood against the walls of your blood vessels. The pressure is measured in units called mm Hg (a measurement that is short for millimetres of mercury).

Since the pressure changes when the heart contracts and relaxes, blood pressure is expressed as two numbers:

  • The systolic pressure represents the pressure when the heart contracts and forces blood into the blood vessels. This is the higher of the two numbers and is usually expressed first (e.g. a blood pressure of 120/70 means the systolic pressure is 120 mm Hg).
  • The diastolic pressure represents the pressure when the heart is relaxed. This is the lower of the two numbers and is usually expressed second (e.g. a blood pressure of 120/70 means the diastolic pressure is 70 mm Hg).

Blood pressure varies considerably throughout the day. It is usually lower while you are at rest, and higher when you are active. Even lying down or standing up can change your blood pressure. Other things, such as your emotions, pregnancy, smoking, the general environment, and medication can change your blood pressure.

An acceptable blood pressure is less than 140 mm Hg for the systolic reading and less than 90 mm Hg for the diastolic reading. For people with diabetes or kidney disease, an acceptable blood pressure is less than 130 mm Hg for the systolic reading and less than 80 mm Hg for the diastolic reading. A single or occasional blood pressure reading greater than 140/90 mm Hg (or 130/80 mm Hg for people with diabetes or kidney disease) does not necessarily mean you have high blood pressure. If your blood pressure is high when it is measured, you will likely be told to have your blood pressure taken again at a later date. Your doctor will not make a diagnosis based on one high reading alone. By keeping a record of your blood pressure on an ongoing basis, you and your doctor can decide whether or not your blood pressure is in the normal range.

How is blood pressure measured?

Blood pressure is usually measured using a blood pressure cuff (a sphygmomanometer). You should sit quietly for at least 5 minutes before your blood pressure is taken. There is no need to prepare for having your blood pressure taken. To make your blood pressure reading as accurate as possible, try to avoid eating, smoking, drinking tea or coffee or doing heavy physical exercise for at least half an hour before it is taken. Let the person taking the blood pressure know if you are feeling ill, stressed, anxious or rushed at the time of your appointment. If you take medication for your blood pressure, use a nicotine patch or nicotine gum, or are taking any over-the-counter medications such as cough or cold pills, tell your health professional.

How often should I have my blood pressure checked?

It is recommended that all Canadians over the age of 20 have their blood pressure checked regularly, at the minimum every two years or as frequently as recommended by their physician. If your blood pressure is higher than normal, you will probably need to have your blood pressure checked more frequently. For example, if you are starting new medications to lower your blood pressure, your doctor may want to check it every month or two.

Your doctor will tell you how frequently you should have your blood pressure checked.

Public blood pressure machines

Many public places such as drug stores now have blood pressure measurement machines. Many of these machines are calibrated regularly and should be accurate. However, there are a few points you should remember when using these machines:

  • Such machines should not be used as a substitute for having your blood pressure checked regularly by a health professional.
  • These machines can not tell you what your blood pressure means or what you should do next. For this, you will need to talk to your doctor.
  • "One size fits all" machines may not work well for children or people with arms that are either smaller or larger than normal.
  • To get an accurate reading, you have to:
    • Sit quietly for at least 5 minutes before taking your blood pressure.
    • Avoid eating, smoking, doing heavy physical exercise or drinking tea or coffee for at least half an hour before taking your blood pressure.

Personal blood pressure monitors

Today, many forms of personal or home blood pressure monitors are for sale. Each type of home unit has its advantages and disadvantages. If you are considering a home blood pressure monitor, talk with your health professional about which type of unit may be right for you and how to use it.

Blood pressure self-measurement may be appropriate for people who:

  • Want to play a greater role in monitoring their high blood pressure
  • Suspect their blood pressure is high only in the doctor's office or clinic
  • Are encouraged to do so by their health professional.

There are three main types of home monitoring blood pressure units:

  1. Mercury sphygmomanometer
  2. Aneroid equipment
  3. Automatic equipment

Children and adults with smaller or larger-than-average-sized arms may need special-sized cuffs. Such cuffs may be available in some pharmacies or medical supply companies.

Tips on choosing and using a personal blood pressure monitor

  • Talk with your health care professional about the kind of equipment you should use.
  • Choose a unit that has been tested to meet the validation requirements of either the Association for the Advancement of Medical Instrumentation (AAMI), the British Hypertension Society (BHS) or the European Society of Hypertension (ESH). Your doctor, pharmacist or the product manufacturer can help you find this information.
  • Read the instructions that come with the unit.
  • Once you've made a purchase, take the unit to your health care professional to determine if your device provides the same reading as the doctor's office equipment.
  • Ask your health care professional to help you learn how to use your unit and what you should do if your reading is abnormally high or low.
  • Remember that home blood pressure measurement is not a substitute for periodic evaluation of your blood pressure by your doctor or other health professional.

24-Hour Ambulatory Blood Pressure Monitors

An automated 24-hour blood pressure monitor records multiple blood pressure readings throughout an entire day, while you are involved in normal activities. 24-hour ambulatory blood pressure monitoring is often used to diagnose so-called "white coat hypertension ." (White coat hypertension is used to describe a person who has high blood pressure readings at the doctor's office, but does not have high blood pressure most other times.) If the 24-hour monitor shows that your blood pressure is usually within a normal range, the doctor will often recommend against starting medications to lower blood pressure.

What is high blood pressure?

In adults, high blood pressure or hypertension is usually defined as a blood pressure that is consistently greater than or equal to 140 mm Hg systolic pressure, or greater than or equal to 90 mm Hg diastolic pressure. However, if you have several risk factors for heart disease and stroke or other problems related to high blood pressure (such as diabetes or kidney disease), your doctor may decide to treat your blood pressure even if it is not as high as 140/90. If you have diabetes or kidney disease, high blood pressure is defined as blood pressure that is consistently greater than or equal to 130 mm Hg systolic pressure, or greater than or equal to 80 mm Hg diastolic pressure.

In the majority of cases it is called "primary" or "essential" hypertension. This refers to the fact that the exact mechanism that caused the high blood pressure is not known. However, we do know that there are many risk factors that increase the chances of developing essential hypertension (see What are the risk factors for high blood pressure?).

In about 10% of the people with high blood pressure, the problem is caused by an identifiable, underlying medical problems, such as kidney disease, hormonal disorders or other diseases or certain drugs, or if you have had a stroke or heart attack already. If the problem can be corrected, the blood pressure can usually return to normal. This type of high blood pressure is called " secondary hypertension ".

High blood pressure is often referred to as the silent killer because there are usually no symptoms. High blood pressure can double or even triple your risk of stroke, heart disease and kidney disease. The only way to find out if you have high blood pressure is to get your blood pressure checked by your doctor or other qualified health professional. Know your blood pressure and discuss with your doctor how often you should have it checked.

What are the risk factors for high blood pressure?

There are a number of risk factors that can increase your risk of developing “primary” or “essential” hypertension. They include:

  • Age: Blood pressure tends to rise with age. About half of people over the age of 65 have high blood pressure.
  • Ethnicity: The incidence of high blood pressure is higher among members of some ethnic groups, such as South Asians, First Nations, Aboriginal Peoples or Inuit, and Black Canadians.
  • Family History: If one of your parents has high blood pressure, you have a 1 in 5 chance of developing the condition. If both of your parents have high blood pressure, your risk is 1 in 3
  • Obesity: Excessive weight is a risk factor - especially if weight is stored around the abdomen.
  • Diabetes: People with diabetes are at increased risk for high blood pressure.
  • Stress : Repeated exposure to stress may raise blood pressure levels or contribute to unhealthy lifestyle choices.
  • Excessive alcohol consumption: Alcohol increases blood pressure.
  • Cigarette Smoking: Smoking may cause high blood pressure in certain individuals.

High blood pressure in women

Oral Contraceptives: For reasons that are not yet clear, a small percentage of women who take birth control pills develop high blood pressure. It is very important that your blood pressure is checked before you go on "the pill" and regularly as long as you continue this medication.

Women who have a history of stroke, blood clots, heart attack, liver disease, breast cancer, high blood pressure, or who might be pregnant, should not take oral contraceptives. Cigarette smoking while taking the pill significantly increases the risk of complications such as blood clots.

Pregnancy : High blood pressure can occur during pregnancy, especially during the last three months. Women who are at increased risk for high blood pressure in pregnancy include:

  • Teenagers and women over age 35
  • African- or Black Canadians
  • Women experiencing their first pregnancy
  • Women with a history of high blood pressure, diabetes, kidney disease or heart problems
  • Women whose mothers had a high blood pressure disorder in pregnancy.

High blood pressure in children

The normal blood pressure for a child varies according to his/her age and size. Special standards have been set to determine what constitute normal blood pressure for children. The American Academy of Pediatrics recommends that children's blood pressure should be checked annually starting at the age of 3 years.

The risk of developing high blood pressure increases with age, and many more adults than children have high blood pressure. In children, high blood pressure tends to be associated with other diseases or medical problems, such as kidney disease, some heart problems or endocrine (hormone) disorders. However, a small proportion of children have "essential" hypertension – high blood pressure that is not due to a single, medical problem.

A number of factors can increase a child's risk of essential or primary high blood pressure. They are:

  • A strong family history of high blood pressure
  • Being overweight
  • Kidney, heart or hormonal diseases or disorders

It is important that high blood pressure in children be treated. Untreated high blood pressure may lead to heart disease, strokes, kidney failure or damage to the eyes.

When should high blood pressure be treated?

High blood pressure can double or even triple your risk of heart disease and stroke and increases the risk of kidney disease. If you have high blood pressure, you must take steps to control it. Studies have shown that controlling blood pressure can1:

  • Reduce stroke occurrence by 35-40%
  • Reduce reduce heart attack occurrence by 20-25%
  • Reduce heart failure occurrence by 50%

1National High Blood Pressure Education Program. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. US Department of Health and Human Services: National Institutes of Health. NIH Publication No. 03-5233. December 2003.

How is high blood pressure treated?

A number of lifestyle changes can help to reduce your blood pressure. Your physician may also prescribe blood-pressure-lowering medications. In people with secondary hypertension (high blood pressure due to another disease), treating the underlying problem may help to lower the blood pressure.

Lifestyle changes to reduce blood pressure

  • Be smoke-free.
  • Maintain a healthy body weight. If you are overweight, losing even a modest amount of weight can help to reduce your blood pressure.
  • Eat a healthy, balanced, reduced-fat diet.
  • Reduce the amount of salt in your diet. Try to reduce your consumption of foods with added salt (e.g. many types of convenience and snack foods and smoked, salted, cured or canned meats and fish).
  • Check with your doctor to see if you should eat foods rich in potassium (e.g., bananas, cantaloupes, grapefruits, oranges, tomato or prune juice, melons, prunes, molasses and potatoes).
  • Participate in regular physical activity. Check with your doctor first if you haven't been active for a while.
  • Limit alcohol intake to no more than two drinks a day, to a weekly maximum of 14 drinks for men and 9 drinks for women.
  • Take time to relax. Stress may not directly raise your blood pressure, but it can adversely affect your smoking and drinking habits.

Medications to treat high blood pressure

If your doctor prescribes medication for your high blood pressure, it is very important to take it regularly, in the amount prescribed by your doctor. Take your medicine at approximately the same time every day. Never increase your dose yourself, skip taking your medication, or "double up" your dosage if you miss a few days or don't feel well. Because high blood pressue is silent, how you feel is not a good indication of whether or not you "need" your medication. Do not stop taking your blood pressure medication once your blood pressure becomes normal. You must continue to take your medication, as your doctor has prescribed, to keep your blood pressure under control.

Questions to ask your doctor and pharmacist

Be sure to discuss your medication carefully with your doctor and/or pharmacist so you clearly understand:

  • How many times a day, you should take your medication (and the exact dosage)
  • Whether you should take your medication on an empty stomach or with a meal.
  • Whether you should avoid taking it with particular foods or whether you need more of certain foods.
  • Whether your medication will react with alcohol or other medications.
  • What side effects you should look out for and report immediately.
  • If there is any danger if you stop taking the drug.
  • What you should do if you're ill and can't take, or hold down, your medication or have diarrhea (e.g. when travelling)
  • How to safely store your medication (e.g. some medications deteriorate in heat and should never be stored in the glove compartment of a car)
  • What lifestyle changes you should make to help your medication work effectively.
  • Any other questions you might have.

Tips to remember your medication

  • Try to establish a routine so you don't forget your pills. For example, you can:
    • take them at the same time each day
    • take them at the same time you do something else each day, such as brush your teeth
  • Print out our Weekly Medication Chart to keep track of your medications. Check off each time you take your pills.
  • Ask your pharmacist about pill boxes and other pill-reminder systems. (Some medications should not be stored out of their original packages, so check with your pharmacist first.)

Types of blood pressure medications

A number of different drugs can help to control blood pressure (referred to by doctors as “antihypertensives”).

Diuretics
Diuretics are a family of drugs commonly referred to as "water pills" that increase the kidneys' excretion of sodium or salt, which in turn reduces the volume of blood and helps to lower blood pressure. Click here for more detailed information on Diuretics.

Beta Blockers
Beta Blockers are a family of drugs that slow down the rate of the heart, the pumping force of the heart and the amount of blood pumped by the heart per minute. These actions help to lower blood pressure. Click here for more detailed information on Beta Blockers.

Calcium Channel Blockers
Calcium Channel Blockers are a family of drugs that block the passage of calcium into muscles that control the size of blood vessels. This action dilates or opens up the blood vessels and thus, helps to lower blood pressure. Click here for more detailed information on Calcium Channel Blockers.

ACE Inhibitors
ACE inhibitors are a family of drugs that relax blood vessels by reducing the production of an enzyme required to produce a chemical (angiotensin II) that causes blood vessels to narrow, constrict or tighten. This action allows blood to flow more easily through the body and thus, helps to lower blood pressure. Click here for more detailed information on ACE Inhibitors.

Other Blood Pressure Lowering Medications
Other classes of drugs that are used to treat high blood pressure include angiotensin-II-receptor antagonists (angiotensin receptor blockers or ARBs), sympathetic nerve blockers and centrally acting antihypertensives. Click here for more detailed information on Other Blood Pressure Lowering Medications.

ACE Inhibitors (Angiotensin-Converting Enzyme Inhibitors)

How They Work: ACE inhibitors belong to a family of drugs known as "vasodilators". Vasodilators help the blood vessels to relax and dilate (open up). By relaxing the blood vessels, ACE inhibitors reduce blood pressure and decrease the effort made by the heart. As a result, the work load on the heart is relieved (i.e. it makes the heart's work easier and more efficient

The Benefits: ACE Inhibitors are usually given to people with high blood pressure, congestive heart failure, or people with a high likelihood of developing coronary artery disease. They may also be given after a heart attack to prevent more complications. ACE inhibitors have been shown to reduce the risk of heart attack, stroke and death in people with a history of coronary artery disease. They have also been shown to reduce the risk of heart attack and death in people with congestive heart failure . Since ACE Inhibitors are used to control and prevent conditions of the heart, they are usually prescribed for the long term.

Names: Lotensin (benazepril); Capoten(captopril); Inhibace (cilazapril), Vasotec (enalopril); Monopril (fosinopril); Prinivil Zestril (lisinopril); Coversyl (perindopril); Accupril (quinapril); Altace (ramipril); Mavik (trandolapril)

Some ACE Inhibitors are available in combination with a diuretic (water pill):

Inhibace Plus (cilazapril and hydrochlorothiazide)
Vaseretic (enalapril and hydrochlorothiazide)
Prinzide, Zestoretic (lisinopril and hydrocholorothiazide)
Accuretic (quinapril and hydrocholorothiazide)

Side Effects: Most people have no problems taking an ACE Inhibitor. However, some people may experience unwanted effects. Be sure to discuss with your doctor and pharmacist the possible side effects of your medication.

Call you doctor immediately if you experience:

  • difficulty breathing or swallowing
  • swollen tongue or face, especially if accompanied by breathing difficulties.
  • fever, sore throat, chills
  • muscle cramps or joint pain
  • skin rash, itching or hives

Less common side effects that may occur and that you should report to your doctor if they continue or become serious include:

  • dizziness or lightheadedness, especially in hot weather, during exercise or when standing up suddenly
  • diarrhea, nausea
  • persistent dry cough
  • headache
  • loss of taste or a metallic taste in your mouth (this effect usually only occurs with high doses and goes away after a few months)

Inform your doctor and pharmacist of any side effects you experience.

Interactions: If you are taking an ACE inhibitor, discuss with your doctor and pharmacist all other products you are taking, including non-prescription medications, over-the-counter medications, herbal and vitamin/mineral supplements. Some products that may interact with ACE inhibitors include:

  • Non-steroidal anti-inflammatory drugs (NSAIDS) may lessen the effectiveness of the ACE Inhibitor
  • Aluminum or magnesium-containing antacids may decrease the effect of some ACE inhibitors; check with your pharmacist
  • Potassium supplements may result in increased potassium levels when combined with an ACE inhibitor.
  • Over-the-counter medications for weight loss, colds, cough, hay fever or sinus problems (they may increase blood pressure)
  • Avoid drinking alcohol

Tips: If you are prescribed Capoten (captopril), it is best to take it on an empty stomach, about a half-hour before, or 2 to 3 hours after, a meal. If you're late taking a dose and you're close to the next dose, skip the late one and continue with your regular schedule (do NOT double your dose). In order to prevent lightheadedness or dizziness, your doctor may start you with a small dose and increase it gradually. It is important that you keep your doctor appointments and have your blood pressure checked regularly in order to adjust your dose. Other ACE inhibitors do not seem to be affected by food.

Beta Blockers

How They Work: Beta blockers are a family of drugs with many different effects on the body. They decrease blood pressure and make the heart beat slower. They decrease the force of pumping of the heart, which reduces how hard the heart has to work.

The Benefits: Beta blockers are usually given to people with high blood pressure, chest pain or angina, congestive heart failure, or to control abnormal heart rhythms. Beta blockers have been shown to reduce the risk of heart attack and death in people who have had a heart attack or with a history of coronary artery disease. They have also been shown to reduce the risk of heart attack and death in people with congestive heart failure. Since beta blockers are used to control and prevent conditions of the heart, they are usually prescribed for the long term.

Names: Monitan Sectral (acebutolol); Tenormin (atenolol); Trandate (labetalol); Lopresor Betaloc (metoprolol); Visken (pindolol); Corgard (nadolol); Inderal (propranolol); Sotacor (sotalol); Blocadren (timolol); Monocor (bisoprolol); Trasicor; (oxprenolol)

Beta blockers may also be combined with diuretics ("water pills"):

Tenoretic (atenolol and chlorthalidone)
Inderide (propranolol and hydrochlorothiazide).
Timolide (timolol and hydrochlorothiazide)
Viskazide (pindolol and hydrochlorothiazide)

Side Effects: Most people have no problems taking a beta blocker. However, some people may experience unwanted effects. Be sure to discuss with your doctor and pharmacist the possible side effects of your medication.

Call you doctor immediately if you experience:

  • Shortness of breath, wheezing
  • Skin rash
  • Abnormally slow pulse (heart beat less than 50 beats per minute)
  • Chest pain

Less common side effects that may occur and that you should report to your doctor if they continue or become serious include:

  • Headache
  • Tiredness, weakness
  • Dizziness, lightheadedness
  • Upset stomach
  • Difficulty sleep, restless sleep or nightmares
  • Tingling in fingers or toes
  • Hair loss (alopecia)
  • Lower sexual ability

Special Precautions:

  • If you have been taking beta blockers for a while, do NOT stop suddenly. Stopping suddenly could make your condition worse.
  • People with diabetes should know that beta blockers mask many signs of low blood sugar (such as palpitations or tremor), but not sweating. Beta blockers may cause shortness of breath or difficulty breathing in people with asthma or other lung diseases. Tell your doctor or pharmacist if you have any other health conditions.
  • People with congestive heart failure may not see an improvement in their condition immediately after starting a beta blocker. It may take several months before noticing a change.

Interactions: If you are taking a beta blocker, discuss with your doctor and pharmacist all other products you are taking, including non-prescription medications, over-the-counter medications, herbal and vitamin/mineral supplements.

Diuretics

How They Work: Diuretics (commonly known as "water pills") remove excess salt and water in the body. By decreasing water and salt in the body, they lower blood pressure and help reduce the workload on the heart. Diuretics work on the kidneys to produce more urine.

Diuretics are used to treat high blood pressure and congestive heart failure, usually in combination with other medications.

Names: Hygroton (chlorthalidone); Lasix (furosemide); Midamor (amiloride); HydroDiuril (hydrochlorothiazide

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