HIGH BLOOD PRESSURE PREVENTION AND CONTROL

Blood pressure is the force blood exerts against blood vessel walls. It can be measured using an inflatable rubber cuff, which is wrapped around the upper arm and connected to an apparatus that records pressure. Two readings are obtained. For example: 120/80. The first number is called systolic blood pressure because it indicates blood pressure during the heartbeat (systole), and the second number is called diastolic blood pressure because it indicates blood pressure while the heart is relaxed (diastole). Blood pressure is measured in millimeters of mercury, and physicians classify patients as hypertensive when their blood pressure is above 140/90.

What makes blood pressure increase?
Imagine that you are watering your garden. By opening the faucet or by reducing the caliber, or diameter, of the jet of water, you increase the pressure of the water. The same occurs with blood pressure: Increasing the rate of flow of blood or decreasing the caliber of the blood vessel elevates the blood pressure. How does high blood pressure occur? Many factors are involved.

Factors You Cannot Control
Researchers have discovered that if a person has relatives with high blood pressure, his chances of suffering from the disease are greater. Statistics indicate a higher incidence of hypertension in identical twins than in fraternal twins. One study refers to the "mapping of the genes responsible for arterial hypertension," all of which would confirm the existence of a hereditary component responsible for high blood pressure. The risk of abnormally high blood pressure is also known to increase with age and to be greater among black males.

Factors You Can Control
Watch your diet! Salt (sodium) can boost blood pressure in some people, especially people with diabetes, those with severe hypertension, older people, and some blacks. Excess fat in the bloodstream can create deposits of cholesterol on the internal walls of blood vessels (atherosclerosis), thus reducing their caliber and increasing blood pressure. People who are more than 30 percent above their ideal body weight are liable to have high blood pressure. Studies suggest that increasing the intake of potassium and calcium may lower blood pressure.

Smoking is related to a greater risk of atherosclerosis, diabetes, heart attack, and stroke. That being so, smoking and high blood pressure are a dangerous combination that can lead to cardiovascular diseases. Although the evidence is contradictory, caffeine—contained in coffee, tea, and cola drinks—and emotional and physical stress may also aggravate high blood pressure. In addition, scientists know that intensive or chronic consumption of alcoholic drinks and lack of physical activity can increase blood pressure.

Having a Healthful Life-Style
It would be a mistake to wait for high blood pressure to develop before taking positive steps. A healthful life-style should be a concern from an early age. Taking care now will result in a better quality of life in the future.

For the obese, researchers recommended a balanced low-calorie diet, avoiding fast and "miracle" diets, while maintaining a program of moderate physical exercise. With regard to salt, they suggested a consumption of no more than six grams or one teaspoon per day.# In practice, that means cutting to a minimum the use of salt in food preparation, as well as minimizing canned foods, cold cuts (salami, ham, sausage, and others), and smoked foods. Salt intake can also be reduced by refraining from adding extra salt during the meal and by checking the packaging of processed foods to see how much salt has been added.

increasing the intake of potassium because it may have an "antihypertensive effect." That being so, a healthful diet should include "foods that are low in sodium and rich in potassium," such as beans, dark green vegetables, bananas, melons, carrots, beets, tomatoes, and oranges. Keeping alcohol intake at a moderate level is also important. Some researchers indicate that hypertensive males should consume no more than one ounce [30 ml] of alcohol per day; and women or those with low body weight no more than one half ounce [15 ml].%

regular physical exercise decreased blood pressure and thus lowered the risk of developing arterial hypertension. Moderate aerobic exercise, such as walking, cycling, and swimming, for 30 to 45 minutes, three to five times a week is beneficial.^ Other factors that have been associated with a more healthful life-style include quitting smoking, controlling blood fats (cholesterol and triglycerides) and diabetes, getting an adequate intake of calcium and magnesium, and controlling physical and emotional stress. Some drugs may increase blood pressure, such as nasal decongestants, antacids high in sodium, appetite moderators, and caffeine-containing painkillers for migraines.

Certainly, if you have arterial hypertension, your doctor is in the best position to give you advice on your diet and habits, according to your personal needs. Regardless of your situation, however, adopting a healthful life-style from an early age is always beneficial, not only for hypertensive people but for all the members of the family.

PREGNANCY AND MAKING IT SAFER

ACCORDING to the United Nations Population Fund, each year more than half a million women die of pregnancy-related causes. In addition, the United Nations Children's Fund (UNICEF) notes that annually more than 60 million women suffer acute complications from pregnancy and that nearly a third of these sustain lifelong injuries or infections. In developing countries many women are trapped in a cycle of pregnancies, deliveries, and self-neglect, leaving them worn out and ill. Yes, pregnancy can be harmful—even dangerous. Is there anything a woman can do to make her pregnancy safer?

Health Care Before Pregnancy

Planning. Husbands and wives may need to discuss how many children to have. In developing countries it is common to see women with small children nursing a baby and, at the same time, expecting another. Careful planning and consideration might allow time to elapse between the birth of one child and the next, resulting in relief for the woman, who would then be able to recuperate after giving birth.

Nutrition. According to the Coalition for Positive Outcomes in Pregnancy, before becoming pregnant a woman needs at least four months to recover from exposure to harmful substances and to build a good nutritional supply. For example, the risk of spina bifida, caused by a defective closing of the neural tube, is greatly reduced when the expectant mother has an ample supply of folic acid. Since the embryo's neural tube closes between the 24th and 28th day after conception—long before many women realize that they are pregnant—some women who are planning to become pregnant take folic acid.

Another crucial nutrient is iron. Indeed, a woman's iron requirement doubles during pregnancy. If her reserve is low—which is true of many women in developing countries—she can come to have iron-deficiency anemia. This condition can be worsened by repeated pregnancies, as the woman may not have time between them to replenish her iron reserve.*

Age. Risk of death in pregnant girls under 16 is 60 percent greater than in those in their 20's. On the other hand, women over 35 are more likely to give birth to babies with congenital abnormalities, such as Down's syndrome. Mothers who are very young or are in their later childbearing years are more prone to preeclampsia. This disorder, characterized by high blood pressure after the 20th week of gestation along with the presence of edema and an increased amount of protein in the urine, increases the risk of mortality in both baby and mother.

Infections. Urinary, cervicovaginal, and gastrointestinal infections can worsen during pregnancy and can increase the risk of premature birth and preeclampsia. Any infection is best treated before pregnancy.

Health Care During Pregnancy

Prenatal care. Regular visits to a doctor throughout pregnancy lower the risk of maternal death. Even in countries where regular access to clinics and hospitals is limited, properly trained midwives may be available.

Prenatal care can alert trained personnel to situations that could make special care necessary. These include multiple gestation, hypertension, heart and kidney problems, and diabetes. In some countries a pregnant woman can receive tetanus toxoid vaccine to prevent neonatal tetanus. She may also be tested for group B streptococcus between the 26th and the 28th week of gestation. These bacteria, if present in the lower intestinal tract, can infect the baby during delivery.

The mother-to-be should be prepared to provide health professionals with all the information she can, including her medical history. She should also freely ask questions. Immediate medical assistance should be sought if there is vaginal bleeding, sudden inflammation of the face, strong or continuous headaches or pain in the fingers, sudden impaired or blurred vision, strong abdominal pain, persistent vomiting, chills or fever, changes in frequency or intensity of fetal movements, loss of liquid through the vagina, pain while urinating, or abnormal lack of urine.

Alcohol and drugs. A mother's use of alcohol and drugs (including tobacco) increases her child's risk of mental retardation, physical abnormalities, and even behavioral disorders. Babies of drug-addicted mothers have even been known to show signs of withdrawal. Although some people believe that an occasional glass of wine is not harmful, experts usually recommend total abstinence during pregnancy. Expectant mothers should also beware of second-hand smoke.

Medicines. No medicine should be taken unless specifically prescribed by a doctor who is aware of the pregnancy and who has carefully weighed the risks. Some vitamin supplements can also be harmful. An excess of vitamin A, for instance, can cause fetal deformities.

Weight gain. A pregnant woman should avoid extremes. According to Krause's Food, Nutrition and Diet Therapy, a low-birth-weight baby's risk of death is 40 times greater than that of a normal-weight newborn. On the other hand, eating for two only promotes obesity. Proper weight gain—more evident from the second trimester on—indicates that the expectant mother is eating the right amount for her increased demands.#

Hygiene and other considerations. Baths and showers can be taken normally, but vaginal douches should not be used. A pregnant woman should avoid contact with anyone who suffers from a viral infection, such as rubella, also called German measles. Furthermore, in order to prevent toxoplasmosis, undercooked meat and contact with the feces of cats must be carefully avoided. Basic hygiene procedures, such as the washing of hands and of raw foods, are essential. Sexual relations do not usually pose a risk, except during the last weeks of pregnancy or in the case of hemorrhage, cramps, or previous miscarriage.

TIPS FOR PREGNANT WOMEN
Normally a pregnant woman's daily diet should include fruits, vegetables (especially dark-green, orange, and red ones), legumes (such as beans, soybeans, lentils, and chick-peas), cereals (including wheat, corn, oats, and barley—preferably whole grain or fortified), food from animal sources (fish, chicken, beef, eggs, cheese, and milk, preferably skimmed milk). Fats, refined sugars, and salt are best consumed in moderation. Drink plenty of water. Avoid caffeinated beverages, as well as foods containing preservatives and additives (such as artificial colorings and flavorings). Starch, clay, and other nonedible substances can cause malnutrition and toxicity.

Beware of possible environmental hazards, such as overexposure to X-rays and harmful chemicals. Limit use of sprays and other household substances. Do not become overheated because of exposure to excessive temperatures or overexercise. Avoid prolonged standing and overexertion. Use proper seat belt positioning.


A Successful Delivery

A woman who takes care of herself during pregnancy will be less prone to complications upon delivery. Naturally, she will have planned whether she prefers to deliver at home or in a hospital. She will also know, to a good degree, what to expect and how to cooperate with the skilled midwife or physician. This person, in turn, will know the woman's informed preferences—where a choice is possible—on such issues as delivery position, episiotomy, and the use of forceps, analgesics, and electronic fetal monitoring. There must also be agreement on other issues: To what hospital or clinic will they go if the home delivery becomes complicated? What exactly will be done in case of excess blood loss? Since hemorrhage causes many maternal deaths, blood substitutes must be readily available for patients who do not accept transfusions. Also, forethought should be given as to what will be done if a cesarean section is required.

ATHRITIS THE CRIPPLING DISEASE.

In the United States alone, arthritis affects more than 42 million people, disabling 1 out of every 6 sufferers. In fact, arthritis is the leading cause of disability in that country. The economic impact of this disease is "roughly equivalent to a moderate recession," states the National Centers for Disease Control and Prevention, as it costs Americans over 64 billion dollars each year in medical expenses and lost productivity. According to the World Health Organization, surveys involving developing countries, such as Brazil, Chile, China, India, Indonesia, Malaysia, Mexico, Pakistan, the Philippines, and Thailand, showed that the burden of arthritis and other rheumatic diseases in such lands is almost "equal to that in the industrialized world."

It is a myth that arthritis is only a disease of the elderly. True, people are more seriously affected by it as they grow older. But one of the most common forms, rheumatoid arthritis, commonly affects those between the ages of 25 and 50. In the United States, nearly 3 out of every 5 people with arthritis are younger than 65 years of age. Similarly, in Great Britain, out of 8 million sufferers, 1.2 million are under age 45. More than 14,500 are children.

Each year, the number of arthritis sufferers increases rapidly. In Canada, within the next decade, the number of people with arthritis will increase by one million. While the prevalence of arthritis is greater in Europe than in Africa and Asia, the incidence of this disease is on the rise in those latter continents too. The rising tide of arthritic disease has thus prompted the World Health Organization to declare 2000-2010 the Bone and Joint Decade. During this time doctors and health-care professionals around the world will collaborate in an effort to improve the quality of life for those who suffer from musculoskeletal diseases like arthritis.

What is known about this painful disorder? Who are at risk for developing it? How can those who suffer from arthritis cope with its crippling effects? Will the future bring a cure?


HOW TO COPE WITH AND POSSIBLE TREATMENTS.

ARTHRITIS has plagued humans for centuries. Egyptian mummies give evidence that the disease existed centuries ago. Explorer Christopher Columbus evidently suffered from it. And millions today are afflicted. Just what is this crippling disease?

The word "arthritis" is taken from Greek words meaning "inflamed joints" and is associated with a group of well over 100 rheumatic diseases and conditions.* These diseases may affect not only the joints but also the muscles, bones, tendons, and ligaments that support them. Some forms of arthritis can damage your skin, internal organs, and even your eyes. Let us focus on two diseases commonly associated with arthritis—rheumatoid arthritis (RA) and osteoarthritis (OA).





Joint Architecture
A joint is where two bones meet. A synovial joint is surrounded by a tough capsule that protects and supports it. (See illustration.) The joint capsule is lined with a synovial membrane. This membrane produces a slippery fluid. Within the joint capsule, the ends of the two bones are covered with a smooth elastic tissue known as cartilage. This prevents your bones from rubbing and grinding against each other. Cartilage acts as a shock absorber as well, cushioning the ends of your bones and distributing stress evenly across your bones.

For example, when you walk, run, or jump, the pressure exerted on your hips and knees can be four to eight times your body weight! While most of the impact is absorbed by the surrounding muscles and tendons, the cartilage helps your bones to tolerate this load by compressing like a sponge.


Obesity, smoking and a history of blood transfusion may increase one's risk of developing rheumatoid arthritis

Rheumatoid Arthritis
In the case of rheumatoid arthritis (RA), the body's immune system launches an all-out attack on its joints. For some unknown reason, a large volume of blood cells—including T cells, which are key players in the body's immune system—rushes into joint cavities. This triggers a cascade of chemical events that result in the joint becoming inflamed. The synovial cells may begin to proliferate uncontrollably, forming a tumorlike mass of tissue called a pannus. The pannus, in turn, produces destructive enzymes that destroy the cartilage. Bone surfaces may now stick together, causing restricted motion—and excruciating pain. This destructive process also weakens the ligaments, the tendons, and the muscles, causing the joint to become unstable and partially dislocated, oftentimes leaving a deformed appearance. Usually RA affects joints in a symmetrical pattern, afflicting the wrists, knees, and feet. Upwards of 50 percent of individuals diagnosed with RA also develop nodules or bumps under the skin. Some develop anemia and dry, painful eyes and throat. Fatigue and flulike symptoms, including fever and aching muscles, accompany RA.

RA is highly variable in effect, onset, and duration. In one person the pain and stiffness may come on slowly over a period of weeks and even years. For another, the onset may be quite sudden. For some people, RA lasts for a few months and then leaves without noticeable damage. Others may experience periods of worsening symptoms called flares, followed by periods of remission during which they feel better. And in some patients the disease continues active for many years, relentlessly disabling them.

Who are at risk for RA? "It's most common in women in their middle years," notes Dr. Michael Schiff. However, Schiff further states that "it can affect anyone at any age including children, as well as men." For those with relatives who have rheumatoid arthritis, the risk increases. Several studies further suggest that smoking, obesity, and a history of blood transfusion are all significant risk factors.



Arthritis can afflict
people of any age

Osteoarthritis

"Osteoarthritis," states the Western Journal of Medicine, "is in many ways like the weather—ubiquitous, often unnoticed, sometimes dramatic in its effects." Unlike RA, osteoarthritis (OA) rarely spreads to other body parts but concentrates its erosive influence in one or just a few joints. As cartilage is slowly eroded, bone begins grinding against bone. This is accompanied by bony outgrowths called osteophytes. Cysts may form, and the underlying bone thickens and becomes deformed. Other symptoms include knobby knuckles, grating and grinding sounds that emanate from arthritic joints, and muscle spasms, along with pain, stiffness, and loss of mobility.

In times past, OA was thought to be just another consequence of old age. However, experts have abandoned that long-held belief. The American Journal of Medicine states: "There is no evidence that a normal joint, subject to common stresses, will break down over the life of a person." Then what causes osteoarthritis? Efforts to understand its exact cause are "plagued by controversy," according to the British magazine The Lancet. Some investigators propose that damage to a bone, such as microfractures, may occur first. This, in turn, may trigger bony outgrowths and cartilage deterioration. Others think that OA starts in the cartilage itself. As it degenerates and frays, they reason, stress increases on the underlying bone. Pathological changes occur as the body attempts to repair the damaged cartilage.

Who are at risk for OA? While age alone does not cause OA, the loss of joint cartilage is experienced more frequently with increasing age. Others at risk may include those who have some abnormality in the way their joint surfaces fit together or who have weak leg and thigh muscles, legs of unequal length, or a misalignment of the spine. Trauma to a joint caused either by an accident or by an occupation in which repetitive motions overuse a joint can also set the stage for osteoarthritis. Once deterioration begins, being overweight can exacerbate OA.

Dr. Tim Spector states: "Osteoarthritis is a complex disease that has definite environmental risk factors but there is also a strong genetic component." Particularly susceptible to OA are middle-aged and older women with a family history of the disease. Unlike the disease osteoporosis, high rather than low bone density precedes the occurrence of OA. Some researchers also cite damage from free oxygen radicals and a deficiency of vitamins C and D as factors.

Alternative Therapies
Some therapeutic agents are thought to be safer, with fewer side effects, than traditional treatments. Among these are oral type II collagen, which some researchers claim has had success in reducing swollen joints and pain in rheumatoid arthritis (RA). How? By inhibiting proinflammatory and destructive cytokines, namely interleukin-1 and tumor necrosis factor a. A few natural nutrients have also reportedly shown some ability to inhibit these same destructive elements. They include vitamin E, vitamin C, niacinamide, fish oils that are high in eicosapentaenoic acid and gammalinolenic acid, borage seed oil, and oil of evening primrose. In China, Tripterygium wilfordii Hook F, an herbal remedy, has been used for years. Reportedly, it has had a measure of success in reducing the effects of RA.




A program of exercise
and proper diet
can bring some relief

Treatment
Treatment for arthritis usually involves a combination of medication, exercise, and life-style modification. A physical therapist may initiate a therapeutic exercise program. It may incorporate range-of-motion, isometric, aerobic, and isotonic or weight-bearing exercises. These have been shown to improve a multitude of symptoms including joint pain and swelling, fatigue, malaise, and depression. The benefits of exercise are seen even in the very elderly. Exercise can also limit bone-density loss. Some claim that a measure of pain relief has also been achieved through various forms of heat and cold therapy and acupuncture.#

Because weight loss can significantly reduce joint pain, diet can be a major component of arthritis management. Some have also claimed that a diet that includes calcium-rich foods such as dark, leafy green vegetables, fresh fruits, and cold-water fish rich in omega-3 fatty acids—and that cuts down on processed foods and saturated fats—can not only help achieve weight loss but also reduce pain. How? Some say that such a diet inhibits the inflammatory process. There are also claims that diets that eliminate meat, milk products, wheat, and vegetables belonging to the nightshade family, such as tomatoes, potatoes, peppers, and eggplant, have also been effective for some.

In some cases a surgical procedure called arthroscopy is recommended. This involves inserting an instrument right into a joint, allowing a surgeon to remove the synovial tissue producing the destructive enzymes. This procedure has limited effectiveness, however, as inflammation often recurs. Even more drastic a procedure is joint arthroplasty, in which the entire joint (usually a hip or a knee) is replaced with an artificial one. This surgery has a longevity of 10 to 15 years and is often highly effective in eliminating pain.

More recently, doctors have tried less invasive treatments, such as viscosupplementation, where hyaluronic fluid is injected directly into a joint. This is most commonly performed on the knees. Injecting substances that stimulate cartilage repair (chondroprotective agents) has also had a measure of success, according to some European studies.

While no drug has been found to cure arthritis, many drugs reduce pain and inflammation, and some have shown promise in slowing the progression of the disease. Analgesics, or painkillers, as well as corticosteroid therapy, nonsteroid anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), immunosuppressants, biologic response modifiers, and drugs genetically engineered to interfere with the immune response are all part of the arsenal being used to provide relief from the debilitating symptoms of arthritis. However, relief may come at a high price, as all of these types of drugs can cause serious side effects. Weighing the potential benefits and risks presents a challenge for both the patient and the doctor.