The Blood Pressure Problem Even Great Doctors Don't Detect

High blood pressure, or hypertension, is easy to detect. A cuff around your upper arm measures the pressure of the blood against the walls of the main arteries...high numbers signal a need for treatment to prevent heart and blood vessel damage.

But it is much more difficult to spot pulmonary hypertension, a disorder in which high blood pressure develops in the pulmonary arteries that carry blood from the heart to the lungs. It is a progressive and potentially deadly disease that can appear at any age and often goes undiagnosed for months or years.

For unknown reasons, pulmonary hypertension affects women two to four times more often than men. Sometimes the initial symptoms—shortness of breath, dizziness, fatigue—appear during pregnancy when the fetus puts stress on the woman's heart and lungs.

Recognizing The Problem

Pulmonary hypertension develops when tiny arteries in the lungs become narrowed, stiffened or blocked due to cellular changes or scarring in the arteries' lining. As blood flow is constricted, pressure in the pulmonary arteries rises and blood backs up, forcing the heart to pump harder. Symptoms include…

Shortness of breath.
Palpitations or racing heartbeat.
Dizziness or light-headedness.
Fatigue upon exertion.
Swollen ankles, legs or belly.
Bluish lips and skin.

At first, symptoms occur only during exertion and often are misdiagnosed as asthma, anxiety or signs that a person is out of shape. As the disease progresses, symptoms become constant. The longer pulmonary hypertension goes untreated, the more damage is done. Possible consequences.

The heart's right ventricle (lower right chamber) becomes enlarged and thickened as it attempts to increase its capacity to hold and pump blood. Eventually, heart failure develops when the heart can no longer pump blood efficiently enough to meet the body's needs.
An irregular heartbeat may develop, increasing the risk for stroke or sudden cardiac death.
Blood clots may form in the pulmonary (lungs) arteries and/or there may be bleeding into the lungs. These conditions can be deadly.

Self-defense: If you experience any possible symptoms of pulmonary hypertension, inform your doctor immediately. With a stethoscope, an experienced physician can detect a telltale heart murmur, a consequence of the backflow of blood from the lungs. An echocardiogram (ultrasound of the heart) and/or right heart catheterization in which a catheter is inserted into a pulmonary artery to measure pressure) confirms the diagnosis.

Recommended: Have a pulmonologist or cardiologist oversee your treatment.

Referrals: Pulmonary Hypertension Association. Call 800-748-7274, or go to www.phasso ciation.org and click on "Find a Doctor."

Life After Diagnosis

Often the cause of pulmonary hypertension is unknown though in some cases, there is a genetic link). It also can occur as a result of another medical problem, such as a congenital heart defect, chronic obstructive pulmonary disease, sleep apnea, a blood disorder, an autoimmune disorder or disease of the liver, kidney or thyroid.

For most patients, pulmonary hypertension can be controlled but not cured. Some keys to treatment…

Lifestyle

To ease symptoms and slow the disease's progress...

Reduce sodium intake to no more than 1,500 milligrams (mg), about two-thirds of a teaspoon of salt per day. Salt increases blood volume, straining the heart.
Do not use a hot tub, sauna or steam bath or take long, hot showers or baths. Doing so could lower blood pressure excessively, leading to fainting or even death.
With your doctor's okay, do moderate exercise (walking, yoga, low-impact aerobics). To avoid serious increases in pulmonary artery pressure, refrain from strenuous aerobic activity and heavy lifting.
Stay away from secondhand smoke—it can exacerbate your disease. If you smoke, quit now.

For help: Visit www.smokefree.gov.

Avoid high altitudes. Thin air is harder to breathe.
No dietary supplements treat pulmonary hypertension—but for overall immune support, consider asking your doctor about taking the amino acid L-arginine.
Avoid decongestants that have pseudoephedrine or phenylephrine, which can narrow blood vessels
Get a flu shot every year. Also, get vaccinated against pneumonia (typically only one or two injections are needed) to minimize risk for respiratory infections that could worsen your condition.
Do not use oral contraceptives or estrogen therapy because they may increase blood clot risk.
Maintain a normal weight. If you notice a rapid weight gain (two pounds in a day or five pounds in a week), call your doctor—this could indicate a buildup of fluid caused by heart failure.
It is strongly advised that you not become pregnant because there is a risk for death for both mother and baby. If you want a child or are already pregnant, it is vital to work closely with a pulmonary hypertension specialist.

Medication

You may need to take one or more of the following…

Vasodilators open blood vessels. These are inhaled every few hours...or are continuously injected through a catheter attached to a small wearable pump.
Endothelin receptor antagonists help reverse the effects of a substance that narrows blood vessels.
Calcium channel blockers relax blood vessel walls.
Diuretics help rid the body of heart-straining excess fluid.
Anticoagulants improve blood flow and reduce clotting risk.
Supplemental oxygen may be needed occasionally or constantly.

Pulmonary hypertension medications can minimize the disease's consequences and ease symptoms allowing you to live more actively and comfortably.

Tasty Tea Lowers Blood Pressure

In a study of 65 adults with prehypertension or mild hypertension, those who drank hibiscus tea had a 7.2-point drop, on average, in systolic (top number) blood pressure, compared with a one-point drop, on average, in the placebo group.

Theory: Antioxidant flavonoids in hibiscus help lower blood pressure.

If you have been diagnosed with prehypertension or hypertension: Three cups daily of hibiscus tea may benefit you.

"Beet" High Blood Pressure

In a study of 14 healthy adults, participants blood pressures dropped by an average of 10.4 millimeters of mercury (mmHg) systolic (top number) and 8 mmHg diastolic (bottom number) within a few hours of drinking two cups of beet juice (the effect lasted up to 24 hours).

Theory: Bacteria on the tongue convert chemical compounds found in beet juice into nitrites, which help keep blood vessels healthy. (The beet juice used in the study was sweetened with apple juice.)

How Blood Pressure Affects Your Memory

Several studies have shown that high blood pressure is linked to increased risk for cognitive decline.

Recent finding: In a four-year study of 19,836 adults, those with a diastolic (bottom number) of 90 millimeters of mercury (mmHg) or higher were more likely to have impaired memory and cognition than those with normal readings.

Theory: Elevated diastolic pressure, in particular, weakens arteries in the brain, which may damage small areas of the brain.

If you have high blood pressure: Ask your doctor to recommend lifestyle changes (such as regular exercise and weight loss) and medication, if necessary.