How to Prevent Nation’s Leading Killer

America’s leading cause of death is also the most preventable: high blood pressure kills silently and slowly.

Heart disease, the result of high blood pressure stealthily eroding vital organs and the body’s freeway of blood vessels over decades, kills one in every three Americans.

Stroke, another consequence of high blood pressure, is the nation’s third killer and the leading cause of adult disability.

But simple changes – such as tossing out the salt shaker and cigarettes, exercising at least ten minutes a day and going easy on alcohol, restaurants, and all-American processed foods as deli meats, canned foods, and ketchup – can fend off this silent serial killer, also known as hypertension, according to a panel of renowned physician/research scientists from Georgetown University Medical Center (GUMC) and MedStar’s Georgetown University Hospital.

The stealth nature of the invisible condition is precisely what makes it so threatening, the physician scientists told an audience of more than 100 District area residents at the most recent session of Doctor’s Speak Out, GUMC’s popular community biomedical education program.

“That’s the danger here. You can’t feel any of it,” said Allen J. Taylor, M.D., FACC, FAHA, MedStar’s Georgetown University Hospital’s chief of cardiology, professor of cardiology at GUMC and professor of medicine at the Uniformed University of the Health Sciences in Bethesda.

Condition Underlies Various Ills

Susan Dentzer, editor-in-chief of Health Affairs, the nation’s leading journal of health policy, and on-air health issues analyst with the PBS NewsHour, moderated the May 24 panel, titled, “The Pressure is ON: Blood Pressure Affects More than You Know.”

“Spillover effects on other body systems go down to the cellular, molecular level,” Dentzer said, opening the conversation on prevention, treatment and academic research.

The condition, long linked to heart issues, is not a problem in itself. But it wreaks havoc with vital organs like the heart, brain and kidneys. It also damages the body-wide highways of veins that transport nutrient rich blood to nourish organs. It causes clogging, narrowing or even leaks in the intricate web.

The heart is the body’s vital blood pump; the brain its command center. The kidneys regulate blood volume and cleanse it of impurities.

An abundance of pressurized blood can wear away at the body’s crucial organs like dripping water eventually erodes the ground beneath. In the arteries, high blood pressure acts like a high volume of water moving in a garden hose with the end spigot turned off. Over time, the water under pressure cause bulges in the hose and eventual explosive bursts, that mimic heart failure, heart attacks and stroke in the body.

It causes “micro vascular damage which is not at all benign,” said R. Scott Turner, M.D., Ph.D., professor of neurology and director of GUMC’s Memory Disorders Program.

“These small strokes equal dementia, which equals Alzheimer’s disease. Vascular dementia and Alzheimer’s disease are totally linked; insults to the brain, small strokes that are then topped by Alzheimer’s disease,” Turner explained.

“If you’re past 50, you are likely to have high blood pressure,” said Christopher Wilcox, M.D., Ph.D., director of Georgetown’s Center for Hypertension, Kidney & Vascular Research, where a world-class, multi-disciplinary team of scientists and clinicians are working for a cure.

“While cancer is absolutely horrible, nothing is any worse than dementia and cardiovascular disease,” Wilcox said. “High blood pressure so commonly predicts the worst outcomes in society.”

Cellular Culprit

Wilcox is among the biomedical researchers who have discovered a key disease trigger called oxidative stress–a malfunction of cells’ use of oxygen that threatens the brain, kidneys and heart.

Oxidative stress is the end product of a complex system that uses oxygen to burn unwanted body products: small amounts are spit out and react like an anti-oxidant. “Oxidative stress alters fundamentally how cells work,” Wilcox said.

Other plausible, even probable contributors to disease – such as genes – also are showing up at the molecular level. Hypertension may even be a culprit in a growing list of diseases including diabetes and obesity.

During a wide-ranging Q and A session with the audience, these tidbits emerged:

Americans use far too much salt – 80 percent of it comes from processed foods, such as bread, canned soups and sauces, deli meats and condiments including ketchup, soy sauce and mustard.
Normal blood pressure – decided by insurance companies in the 1930’s based on actuary tables – is 140 as the heart pumps and 90 as it relaxes. Both the top reading, known as the systolic pressure, and the bottom or diastolic, are equally important.
Steady blood pressure is far healthier than pressure that rises and falls frequently.
Dietary supplements, which are unregulated, can have bad interactions with medication and are best avoided.
If a patient has diabetes or kidney disease, treatment is required when the systolic rises to 125 or 130.
While no “lower limit” has been assigned to systolic blood pressure, the panelists agreed that a systolic pressure of 110 bodes a longer life.
Salt intake should be limited to 2,400 milligrams of sodium daily, which is about 2.5 grams of table salt.
Good alternatives to salt are half-sodium salt or potassium salt.
When dining at a restaurant, ask your server to tell the chef not to use any salt.

As the session drew to a close, Dentzer asked the panelists for a take away message. Turner, said he represents the brain, Wilcox, the kidneys, and Taylor, the heart.

“If you live long enough you are going to end up seeing two of the three of us,” Turner concluded. “To avoid me, watch your body weight, exercise, and eat the Mediterranean Diet.”

By Victoria Churchville, GUMC Science Writer
(Published May 30, 2012)