A person whose blood pressure is usually normal has an appointment at a clinic or medical center. There is a bit of anxiety about the visit. Anxiety elevates blood pressure, and having it checked is a routine procedure.

Blood pressure is taken by a physician or other provider who often wears a white coat that symbolizes medical professionalism. The reading is higher than it normally would be when not in a clinical setting. The presumed result: white coat syndrome.

Until recently, white coat syndrome had been considered a temporary spike—no harm, no foul. But not anymore.

Real—Dangerous for Some

White coat syndrome/hypertension was first described more than 40 years ago. Since then, multiple studies have confirmed that it’s a real thing. The original scenario is the same—anxiety can elevate blood pressure in a clinical setting. But current research suggests that white coat syndrome may also be a symptom of something more concerning.

In February 2022, a review of studies in the journal Hypertension became the first to provide evidence that white coat syndrome in patients (with no previous organ damage) had an increased risk of mortality, new hypertension, and new organ damage. This study and others have resulted in a decidedly different approach to white coat syndrome diagnosis and treatment. (https://www.ahajournals.org/doi/full/10.1161/HYPERTENSIONAHA.121.18792)

Blood Pressure—How High is Too High?

To be clear, white coat hypertension for most people is still a one-time event that needs attention only in combination with other cardiovascular conditions. According to Cleveland Clinic and other medical centers, the syndrome affects 15-30 percent of people who already have high blood pressure. Patients who don’t normally have high blood pressure can also have the syndrome. (https://my.clevelandclinic.org/health/diseases/23989-white-coat-syndrome)

The definition of high blood pressure has been a moving target and remains a number that your physician determines is right for you. The American Heart Association defines “normal” as less than 120 for the upper (systolic) number; less than 80 for the bottom (diastolic) number. “Elevated” is 120-129 over 79 or less. For numbers defining three advanced stages of hypertension, go to https://www.heart.org/en/health-topics/high-blood-pressure.

The definition of normal can change, depending on a person’s age and health conditions. The AHA’s guideline for those 65 and older is lower than 130/80.  Normal for patients over the age of 80 may be higher.

Diagnosis— Multiple Readings

Diagnosis of white coat syndrome requires at least three separate blood pressure readings at a clinic, as well as elevated numbers when checked at home. Home blood pressure kits and regular checks are a good idea, regardless of the white coat issue.

When you take your blood pressure (BP) at home, follow these CDC guidelines: 1) nothing to eat or drink 30 minutes before taking BP; 2) empty bladder; 3) feet flat on the floor, legs uncrossed; 4) arm resting on a surface, chest high; 5) cuff snugly against bare skin, not over clothing; 6) no talking; 7) same time every day; 8) at least two readings, 1-2 minutes apart. (https://universityhealthnews.com/daily/heart-health/how-to-get-an-accurate-blood-pressure-reading/)

Treatment—Lifestyle Changes, Medications

If blood pressure is found to be slightly elevated—your doctor makes that call—you may be asked to consider lifestyle changes. You’ve heard them; all easier said than done. Here’s a review:

• Lose weight.
• Sit less, exercise more.
• Eat more fruits and vegetables, less red meat and processed foods.
• Limit daily salt intake to 2300 mg.
• Don’t smoke.
• Work on managing stress. (https://universityhealthnews.com/daily/stress-anxiety/how-to-deal-with-stress/)

If your blood pressure is more than slightly elevated, your doctor may prescribe medications to lower it. Examples are diuretics, alpha- and beta-blockers, ACE inhibitors, and calcium blockers. The Hypertension study mentioned earlier also found that patients with white coat syndrome who take medications to control blood pressure don’t have elevated risks of cardiovascular disease.

Antihypertensive drugs carry risks, mostly mild, for some patients. Ask your doctor about medications that might lower your blood pressure too much. Hypotension, as it’s called, could cause dizziness, lightheadedness, passing out, weakness, nausea, and other symptoms.

How low is too low? The National Library of Medicine says that while there is no universally-accepted standard, blood pressure readings under 90/60 indicate hypotension.

White Coat Syndrome—Answers and Actions

It’s real—well documented. It can be dangerous for some, leading to a variety of conditions that require medical intervention. High blood pressure, whether conventional or white coat, is treatable. It starts with lifestyle changes, and for more serious cases, advances to effective and safe antihypertensive medications.

Don’t dismiss white coat hypertension if it shows up at your next doctor’s appointment. Have it checked or regularly check it yourself.

Other Helpful Links from University Health News

https://universityhealthnews.com/daily/heart-health/uhn-blog-whats-the-right-blood-pressure-for-you-it-depends/

https://universityhealthnews.com/daily/heart-health/is-the-blood-pressure-reading-from-your-doctors-visit-accurate/

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There’s cholesterol, total cholesterol, lipoprotein, high-density lipoprotein (HDL), non-HDL, low-density lipoprotein (LDL), Very-low-density lipoprotein (VLDL). Triglycerides. And now, cholesterol ratio.

Cholesterol Simplified

With the help of CDC’s Medline Plus, let’s start with cholesterol. It’s a waxy substance made by the liver and present in blood. We need it, but only in the right amounts. Too much or the wrong kind increases the risk of heart disease. (https://medlineplus.gov/cholesterol.html)

Total Cholesterol

Total cholesterol is the amount of cholesterol in your blood, including low-density lipoprotein (LDL)—the bad kind of cholesterol—and high-density lipoprotein (HDL), the (so-called) good kind. The recommended total cholesterol value is 200 mg/dL or less. Borderline high is 200-239. Everything greater is high.

Low Density Lipoprotein

Low-density lipoprotein moves cholesterol through the arteries to various tissues in the body. It can accumulate on arterial walls. High levels increase the risk of heart disease and stroke. The CDC’s recommended LDL is “about” 100 mg/dL. “About” is a CDC term.

HDL Cholesterol

HDL absorbs cholesterol and moves it back to the liver before it is flushed out of the body. Normal HDL should be at least 40 mg/dL in men; 50 in women. Higher is better, but those numbers have been questioned.

A November 2022 study (20,000 subjects) in the Journal of the American College of Cardiology suggested that low HDL cholesterol was associated with increased cardiovascular risk in white but not Black adults. The high HDL did not appear to be protective in either group. (https://www.jacc.org/doi/10.1016/j.jacc.2022.09.027)

In spite of the findings, major medical institution websites generally recommend higher HDL levels for heart health. Mayo Clinic—60 for women and men; Cleveland Clinic—60+ for men and women; Harvard—60 for women, 45 for men; Johns Hopkins—55+ for women, 45+ for men.

Non-HDL Cholesterol

A non-HDL level is determined by subtracting HDL from total cholesterol. It includes other types of cholesterol (like VLDL). Good (normal) is less than 130 mg/dL for people without risk factors such as high blood pressure, diabetes, obesity, and vascular disease.

Triglycerides

Triglycerides are the most common type of fat found in blood. Think oils, butter, carbs, alcohol. The National Institutes of Health report that between 25 and 30 percent of Americans have abnormally high levels. Below 150 mg/dL is recommended.

Why is Cholesterol Ratio Important?

Instead of relying solely on the numbers just described to determine risk, there has been a shift toward taking cholesterol ratio into consideration. It’s a measurement of both good (HDL) and bad (LDL) cholesterol. To calculate it, divide your total cholesterol by your HDL. Here’s an example of a cholesterol ratio reading:

(Total cholesterol) 150 ÷ (HDL) 60 = cholesterol ratio of 2.5

According to the American Heart Association, the target number is 3.5; lower is better. Anything higher than 3.5 increases the risk of cardiovascular disease.

Treat the Patient, Not the Numbers

Each patient is different, and treatment for cholesterol-related issues should be individualized. Men may have different recommended values than women. One person could have a total cholesterol reading within a normal range but HDL and LDL values out of range. Having other medical issues increases the risk in spite of good cholesterol numbers. Even a patient with normal numbers but a family history of heart disease may be at higher risk and in need of medical intervention.

How to Improve Cholesterol Ratio

The list of ways to lower your cholesterol ratio applies to many other health issues. Below are six suggestions.

• Maintain a healthy weight.
• Choose foods lower in saturated fats.
• Avoid foods with trans fats.
• Exercise regularly.
• Don’t smoke.
• Limit alcohol intake.

Other Helpful Links from University Health News

https://universityhealthnews.com/daily/heart-health/cholesterol-ratio-more-important-than-total-cholesterol-or-ldl-cholesterol/

https://universityhealthnews.com/daily/heart-health/hdl-vs-ldl-more-important-cholesterol-num/

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You may be retaining too much fluid if there is swelling in the arms, hands, legs, or ankles, rapid weight gain, or increased waist size.

In conditions such as hypertension, liver failure, congestive heart failure, persistent swelling, and kidney disorders, it’s critical to get excessive fluid out of your body quickly. Diuretics (medications) are extremely efficient and fast-acting. Diuretic foods and drinks are not likely to produce such a dramatic effect. (https://universityhealthnews.com/daily/nutrition/diuretic-foods/).

There is no universally accepted “best” list of natural diuretic foods. Each person’s metabolism is different, and what works for one may not be effective for another. The 10 foods and drinks that follow were selected based on evidence, easy access, affordability, and taste.

1. Water—Drink Water to Lose Water?

The answer is yes. Water is one of the best natural diuretic fluids. One of the functions of hydration is to get rid of waste products, and water does that. Too much water, especially in those with kidney disease, stresses the system. Not enough causes   symptoms of dehydration (thirst, fatigue, lightheadedness, dark urine). The goal is to maintain fluid balance.

2. Caffeinated Coffee—Fast-Acting

The caffeine in coffee makes it perhaps the fastest-acting food or drink diuretic. The Centers for Disease Control and Prevention (CDC) says coffee can trigger the urge to urinate within a half-hour, which would normally be expected from a prescription diuretic. A single cup of coffee (47 milligrams of caffeine) won’t work. Two or three cups probably will. How much caffeine in coffee is too much? According to the Food and Drug Administration (FDA), more than 400 milligrams per day. (www.fda.gov/consumers/consumer-updates/spilling-beans-how-much-caffeine-too-much)

3. Caffeinated Tea—Green or Black

Green tea contains about 29 mg of caffeine per cup, suggesting that it would take a lot to promote urination. But black tea has twice that amount or more and may have the same diuretic effect as coffee. Hibiscus tea has been promoted as a diuretic drink, but research is still inconclusive.

4. Watermelon—91 Percent Water

Watermelon is near the top of every list of diuretic foods and not just because it’s 91 percent water. It has been associated with reduced inflammation and body fat, kidney and eye health, nerve regulation, lowered blood pressure, and cardiac function. That’s just the short list. Watermelon is nutrient-dense, with electrolytes to help off-load some of that unwanted fluid and salt, reaffirmed in a 2022 study published in Nutrients (https://www.mdpi.com/2072-6643/14/22/4883).

5. Grapes—High Potassium, Low Sodium

Green and black grapes don’t appear on every “best natural diuretics” list, but perhaps they should be included. The combination of high potassium and low sodium flushes out excessive water. Grapes also contain antioxidants that contribute to heart and skin health. Bonus feature: grapes are tasty.

6. Pineapples—Benefits, Risks

Pineapples may help those experiencing bloating. Although rich in folate, iron, magnesium, and vitamin B-6, pineapples are not for everyone. They contain the enzyme bromelain, which can interact with certain drugs and could cause an allergic response in some people. The Icahn School of Medicine at Mount Sinai says, ”Patients with kidney or liver disorders should avoid bromelain.” (www.mountsinai.org/health-library/supplement/bromelain) From NYU Langone Health: “Safety for those with kidney or liver disease has not been established.” (https://froemkelab.med.nyu.edu/surgery/content?ChunkIID=146651)

7. Citrus Fruits—Toxin Purge

Oranges, lemons, limes, and grapefruits clear out toxins and increase urine output. They are high in water content (87-91%) and potassium (1/2 cup of orange juice has 248mg of potassium). Lemon water/juice is one way to get its benefits without the strong acidic taste. All four fruits regulate fluid balance and reduce sporadic bloating.

8. Celery—Soups, Salads, Sandwiches

Celery contains more water than watermelon (95% to 91%), but you’d have to eat a lot of it to have a noticeable effect. Including celery in soups, salads, and sandwich spreads adds another natural diuretic food. It also has calcium, magnesium, and potassium, and may help lower blood pressure.

9. Asparagus—It’s the Asparagine

Asparagus is not the most popular vegetable, but it is a natural diuretic. According to the National Library of Medicine, asparagus contains the amino acid asparagine, which increases urination. It is fat- and cholesterol-free and provides multiple vitamins and minerals. Warning: Asparagus may cause urine to have a harmless sulfur-like odor.

10. Cucumbers—Losing Water Weight

Cucumbers, which can be classified as vegetables or fruits, promote loss of water weight (bloating). In addition, a medium-size cucumber is low in calories (30) and contains potassium, magnesium, fiber, and vitamins A, C, and K.

Herbs and Supplements—Inconclusive Evidence

Herbs like parsley, dandelion leaves, ginger, juniper, butcher’s broom, and horsetail (the plant) might reduce fluid retention, but the evidence is not conclusive. Herbs are unregulated—no guidelines regarding dosage. Talk with your healthcare provider before adding herbs or supplements to your diet. Some may have adverse side effects or interfere with medications.

Practical Applications

If you are retaining excessive fluid or exhibiting suspicious symptoms, the foods and drinks suggested here are first-step, self-care treatment options. Committing to a healthier diet, limiting salt intake to 2300mg per day (according to the CDC), and exercising daily are non-food ways to lessen the need for diuretic aids.

If there is even the slightest concern that your condition is more serious, consult your doctor. The treatment may include something you already have in your kitchen or pantry.

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Walking

Mobility is the ability to move around in the environment in which you live with ease and without restriction. The most obvious measure of mobility is walking. Walking with ease and without restriction requires a combination of strength, flexibility, and balance. Add endurance to the list if you walk for long enough periods of time. When you put it all together, walking is considered one of the best balance exercises.

A 2011 study published in the Journal of the American Medical Association found that gait speed—how fast (or slow) a person walks—appears to be as reliable a predictor of longevity as factors such as age and gender.

A study in the March 2013 issue of Stroke showed that 30-minute walks three times a week increased mobility and quality of life in stroke survivors. Incidentally, men 65 and older constitute the largest group of regular walkers.

A widely recommended walking program for beginners has been published by the National Heart, Lung, and Blood Institute (NHLBI). This program will guide you from 0 to 40 minutes per day in 12 weeks.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) publishes a sample walking program that will get you from 0 to 60 (minutes per day) in 20 weeks.

Tai chi

More than two million Americans participate in individual or group tai chi sessions each year, according to the National Health Interview Survey. An increasing number of studies has affirmed that tai chi is a form of exercise that can improve balance, overcome a fear of falling, lower the risk of falls, reduce blood pressure, and provide a general sense of well-being. It is especially effective in older adults because tai chi can be practiced at different intensity levels. Tai chi is a combination of relaxation, meditation, deep breathing, and slow, gentle, continuous, and very structured exercises called forms. It is said to “achieve harmony between body and mind.”

The number of movements in tai chi ranges from 18 to more than 100. Beginners start with as little as one five-minute session per week and gradually increase to a higher target goal. Finding a qualified instructor can be a challenge because certification of instructors has not been standardized, but your local YMCA and/or senior center may offer classes.

Three of the most recent studies specifically found that: 1) tai chi exercises were more effective in preventing falls than a conventional physical therapy program, 2) tai chi classes were associated with a lower rate of falling in community-dwelling older adults, and 3) tai chi exercise may reduce falls in adult stroke survivors.

Tai chi appears to be a safe, effective balance exercise. However, people with the following conditions should seek the advice of a physician before beginning a program:

• Osteoporosis
• Chest pain with minimal exertion
• Severe shortness of breath
• Dizziness or fainting spells
• Uncontrolled blood pressure
• Gait and balance disorders
• Yoga

Yoga also incorporates movement with meditation, relaxation, and controlled breathing. It has been called “an ancient method of stilling the mind.” For some, yoga is a spiritual experience; for others, it is an alternative activity that promotes flexibility, strength, and endurance. The evidence to support those claims is increasing, but not conclusive. A pilot study of 47 participants showed that stroke patients who participated in a yoga program demonstrated improved balance and flexibility, a stronger and faster gait, and increased strength and flexibility.

For more balance exercises, purchase Easy Exercises for Balance and Mobility from www.UniversityHealthNews.com.

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Kidney Stones: Mineral Concentration

Kidney stones develop when minerals and salts in the urine become concentrated in the kidney and form pebble-like lumps, usually made of calcium and oxalate or phosphorus, A stone  may eventually move out of your kidney and travel through your  ureter, bladder, and urethra.

The ureter is the tube that drains urine from the kidney to the bladder; the urethra is the tube through which urine travels on its way out of the body. Eighty percent of stones include  calcium, but the body can also produce other types of stones, including  , uric acid, struvite, and cysteine (an amino acid that helps build protein) stones.

The most common contributing factor to kidney stones is dehydration, according to Washington University School of Medicine in St. Louis. Urine is a solution, but with dehydration, there may not be enough fluid in the urine to dilute  the minerals and salts that develop into stones.

The Cause of Kidney Stone Pain

It’s not the stone itself that causes pain. In fact, if a stone can stay in the kidney or pass through the ureter without causing a blockage, there may be little or no pain. But when a stone moves around in the kidney or gets stuck in the ureter and blocks the passage of urine, the blockage can cause the following symptoms:

• Sharp stabbing pain in the back or side
• Pain that comes and goes
• Nausea, vomiting
• Frequent urination
• Painful urination
• Blood in the urine
• Fever, but only if an infection is present

The smaller the stone, the more likely it will pass on its own. Eighty percent of kidney stones fall into that category (less than 4mm), but it takes an average of 31 days to happen. If the stone is 4-6mm, it will pass about 60 percent of the time. If greater than 6mm, the stone will pass about 20 percent of the time. In most cases where the stone is greater than 4mm, a medical procedure is necessary.

Managing the Pain

Medications include aspirin, acetaminophen, prescription pain medications, diuretics, and antibiotics. Drink plenty of fluids to increase urinary volume that may help pass the stone. Stay as active as possible. Walking helps. Your doctor may prescribe a drug that relaxes the ureter, which allows the stone to pass. Taking a hot shower or sitting in a tub of warm water offers temporary relief.

When to See a Doctor for Kidney Stones

Notify your doctor if you think you have a kidney stone. If you have severe pain and other signs and symptoms of a stone, get help right away. Your healthcare provider may recommend some of the measures above, and may ask you to capture a stone if it passes so it can be analyzed.

Blood tests can show calcium levels, glandular problems, and kidney dysfunction. A CT scan can identify a kidney stone, and ultrasound scans detect swelling of the kidney and/or the ureter—an indication that the stone is blocking the flow of urine.

Under the supervision of a doctor, you might be able to treat a kidney stone at home. If the stone is too large, the pain too severe, infection is present, or there is significant bleeding, the kidney stone will have to be removed surgically or broken into fragments that can move through the urinary tract.

Prevention

About half the people who have a kidney stone will never have another incident. For those who have recurring stones, the prognosis depends on the cause and on how well the patient responds to prevention guidelines. They include drinking more fluids, eating less protein, reducing the intake of salt, and increasing the intake of citrate (lemons, oranges, grapefruit), a chemical that inhibits the production of kidney stones.

RECOMMENDED FOR YOU

• Natural Remedies for Kidney Stones
  
• Top 10 Foods That Cause Kidney Stones
  
• Natural Remedies for Kidney Stones
  
• Kidney Stone Treatment: It Can Range from Home Remedies to Hospital Stays
  
• Kidney Stone Diet: Can Foods You Eat—and Avoid—Help Prevent Kidney Stones?
  
• Kidney Pain: What’s Behind It?

This article was originally published in 2018. It is regularly updated.

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When you yell out “threw out my back!” you’ll know the pain immediately. There will be a sharp, severe pain, usually in your lower back, and it can be an on-the-floor, can’t-move, debilitating experience. You won’t care what “throwing your back out” means. You’ll just want pain relief—right now.

The underlying cause of pain that severe could be a complex medical condition such as a herniated disc, spinal stenosis, or sciatica, but more often it’s just a strained (pulled) muscle.

It might not sound as threatening as other back conditions, but in the short term, a muscle strain can be more painful than all of them. The pain itself is there because of a muscle spasm reacting to overload or overuse.

1. Strained (Pulled) Muscle

Back strains—tears in tendons or ligaments—occur after sudden or awkward movements, when lifting or moving a heavy object, or absorbing an unexpected blow. They might also develop when a person repetitively uses (or overuses) a muscle not accustomed to that particular activity.

Yet at times, back strains are triggered by seemingly harmless movements, such as bending over to tie a shoe, picking up an object, or reaching to get something out of a cabinet.

Strained Muscle Treatment:

• See a doctor immediately if severe pain spreads down one or both legs, causes weakness or numbness, or follows a fall or a blow to your back.
• Otherwise, rest your back for 24 to 48 hours, but don’t stay completely immobile.
• Limited, mild movement is better than bed rest.
• Apply ice packs for 15 to 20 minutes, three to four times a day for the first 48 to 72 hours.
• Apply moist heat after the first 48 to 72 hours if it makes you more comfortable.
• Aspirin, acetaminophen, ibuprofen, and naproxen may relieve pain.
• All except acetaminophen will reduce inflammation.
• If you sleep on your side, place a pillow between your knees. If you sleep on your back, place a pillow under your knees.

More than 90 percent of people with a lower back strain recover within a month, although that information won’t be reassuring if you’re the one having spasms.

2. Herniated Disc

Another possible cause of a “throwing your back out” is a herniated disc. The condition is not usually associated with a specific traumatic event, but rather by wear and tear on the spine.

Discs that become herniated usually are in an early stage of degeneration, according to the American Association of Neurological Surgeons. The spinal canal has limited space, which is inadequate for the spinal nerve and the displaced herniated disc fragment. Because there is not enough room for both, the disc presses on spinal nerves, often producing severe pain.

Anyone can develop a herniated disc, but older adults are especially susceptible. Prolonged sitting and repetitive lifting and twisting are also risk factors, as is reduced muscle tone caused by a lack of physical activity.

Herniated Disc Treatment:

• The initial treatment is rest, ice, and anti-inflammatory or pain medications. Apply ice for the first 48 to 72 hours, and then switch to moist heat. Mild activity is better than bed rest.
• Longer-term treatment includes physical therapy, non-steroidal anti-inflammatory medication, massage, an epidural steroid injection, or the use of TENS (transcutaneous electrical nerve stimulation) devices that send electrical impulses to prevent pain signals from reaching the brain. An epidural steroid injection is a way of delivering the steroid medications around the compressed or irritated nerve root, but its effectiveness has been challenged by several studies.

3. Bulging Disc

There is a difference between a herniated disc and a bulging disc.

A bulging disc is like having low air in a tire. Some of the cushion in the middle of the ring is lost, the disc collapses, and the fibrous ring bulges out.

A bulging disc is a normal phenomenon and generally does not cause symptoms unless it presses on nerve roots. Even if that happens, symptoms can usually be managed by waiting to see if your symptoms go away, pain medications, and physical therapy.

Many patients who initially have problems due to a bulging disc find that their symptoms completely resolve over several weeks or months. The key is finding a way to manage the discomfort while waiting for the symptoms to subside.

Other Possibilities

Osteoarthritis (OA) can affect the spinal discs and facet joints just as it can other joints of the body. In fact, the spinal column consists of 33 vertebrae, increasing the odds of a problem. Most of the time, it’s in the lower part of the spinal column where the body’s weight places a significant load.

In spinal stenosis, the spinal canal narrows. Seventy-five percent of the time stenosis occurs in the lower back, but it can also happen in the shoulder/neck region.

A narrowed spinal canal reduces the blood supply to the nerves, causing pain. Bending forward increases the size of the canal and relieves the symptoms. Standing or extending the back decreases the size of the spinal canal, which aggravates the symptoms.

How to Prevent Throwing Out Your Back

Some back conditions may not be preventable (osteoarthritis, sciatica, stenosis), but you can at least reduce the risk of “throwing your back out” (i.e., muscle strains, herniated discs, and bulging discs), limiting the damage. Here’s how.

• Avoid sitting in one position for long periods of time. Move around and stretch every 20 to 25 minutes.
• Slowly and carefully execute difficult movements required in daily activities before doing them in actual situations.
• Use a lower back support as a reminder to keep the pressure distributed evenly on the muscles of the lower back.
• When lifting heavy objects, keep your back as straight as possible and use your legs.
• Avoid slouching when sitting.
• Don’t increase exercise intensity, frequency, or duration, more than 10 percent a week.

This article was originally published in 2018. It is regularly updated. 

The post Throwing Your Back Out: The Common Causes, Symptoms, and Treatment appeared first on University Health News.

An Inside View

When the heart pumps, pressure is created to expel blood by way of arteries and capillaries to nourish the entire body. Veins bring the blood back to the heart. In the first phase, called systolic pressure, blood is forced out of the heart and pressure is at its peak. In the second (diastolic) phase, the heart fills and pressure is at its lowest. These two pressures are represented in numbers— such as 130 over 80 (130/80). Systolic is the top number; diastolic, the lower figure.

Elevated blood pressure can create tiny tears in arteries. This enables substances in the blood, such as fat and cholesterol, to stick more easily to arterial walls. The substances cause arteriosclerosis, which forces the heart to work harder to circulate blood.

High blood pressure is common as we get older because blood vessels naturally thicken and stiffen over time. This age-related trend might lead some people to believe that it’s okay to skip medications and to stop taking regular readings.

Some of those with ele­vated blood pressure may feel perfectly fine. But high blood HTN is a silent predator that can strike without notice and result in serious, life-altering consequences.

New Guidelines. Based on American Col­lege of Cardiology (ACC) and American Heart Association (AHA) guidelines, high blood pressure should be treated ear­lier with lifestyle changes and in some patients, with medication, at 130/80 rather than 140/90. Newer guidelines—the first since 2003—lower the definition of high blood pressure to account for complications that can occur at lower numbers and to allow for earlier intervention. The new definition has resulted in nearly half of the U.S. adult population having high blood pressure.   In a person who has high blood pres­sure, there is more resistance to the flow of blood through the arteries, so the heart has to work harder to push blood through the body. It’s like adding weight to a barbell—adding more weight makes the barbell harder to lift.

About 75 percent of people with heart failure have a history of hypertension, and the lifetime risk of developing heart failure with a blood pressure higher than 160/90 is double that of blood pressure lower than 140/90 millimeter of mer­cury (mmHg).

Although up to 90 percent of people ages 80 and older have some degree of hypertension, it is not normal, and it greatly increases the risk of heart attack or stroke. Using medications to bring blood pressure down below 120/80 mmHg can reduce the risk of heart fail­ure, even in the very elderly.

Controlling High Blood Pressure. Lifestyle modifications can lower blood pressure, in some cases as much as 20 points. Lifestyle changes should be the first course of action. Here are five specific suggestions:

• Lose weight if you are overweight.
• Stop smoking.
• Follow the DASH diet (Dietary Approaches to Stop Hypertension).
• Limit salt intake to 2,300 milli­grams (mg) per day.
• Break a sweat with exercise at least 30 minutes a day most days of the week.

The next course of action is medications, which should be started if blood pressure readings are in the 140s. Work with your doctor in evaluating your tolerance to a new medication and reporting blood pressure changes, if any. Take your blood pressure daily, in the morning, and keep a written log.

In addition, HTN should be regularly monitored and managed by a physician. The length of time between follow-up appointments will be based on your current health and other medical conditions.

A primary care physician can initiate and manage therapy. However, if your blood pressure is difficult to treat or if other conditions complicate medication choices, you may be referred to a cardiologist.

For more information on other conditions that are linked to heart failure, purchase Managing Heart Failure from University Health News.

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Cut cooking times for vegetables. As a rule of thumb, the longer foods are exposed to heat, the more nutrients are lost. To reduce cooking times, cover the pot to retain heat and avoid evaporation, place vegetables in already boiling water, and enjoy vegetables with a crunchier texture.

Keep canned on hand. Canned fruits and vegetables that contain little or no sodium or added sugar are easy and convenient; keeping a variety on hand guarantees you immediate access to important nutrients. And, research has shown that people who include more canned produce in their diets have overall better diets that are higher in important nutrients, such as fiber, vitamin A, calcium, magnesium, and potassium; and less saturated fat.

Be water-wise. USDA data show that up to 50 percent of the vitamin C, thiamin, vitamin B6, and folate content in food can be lost to the water it’s cooked in. To retain water-soluble nutrients, use cooking methods like steaming or stir-frying that use little or no water, reduce the amount of water used in steaming and boiling, and reuse cooking water in soups or sauces to capture escaped nutrients.

Don’t ditch the peel. Keeping peels on foods such as potatoes, carrots, apples, and pears preserves more nutrients, which tend to concentrate near the surface. In place of peeling, opt for a good vegetable scrubber.

Chop less. Chopping foods into smaller pieces increases the surface area exposed to light, heat, and water—three factors that degrade nutrients. One exception is garlic and others in the allium family; chopping these foods and allowing them to sit for 10 minutes before cooking increases the availability of their active components.

Make the most of your microwave. Since it cuts cooking time and water use, the microwave is a nutrient-friendly kitchen appliance. Microwaving preserves higher antioxidant activity in a majority of vegetables better than other cooking methods, according to research. Also, choose glass or ceramic plates and bowls for microwave use; harmful chemicals can leach out of plastic into your food, and some plastics actually begin to break down during microwaving.

Keep it cool. The nutrient content in many fruits and vegetables can be maintained with cooler temperatures, high humidity, and less air contact. Store produce in airtight containers in the fridge.

Use it all. Next time you are getting ready to throw away those carrot or radish tops, think again. Many vegetables are entirely edible and rich in nutrients, so using the entire plant, from root to stem, is a sure way to add nutrients to your day. Or, toss vegetable scraps into a pot of water and make your own flavorful stock, which can be stored in the freezer and used as a base for soups, stews, and sauces.

To learn more healthy food prep and cooking tips, purchase Superfoods at www.UniversityHealthNews.com.

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Tips for Everyday Non-Slip Shoes (or Anyone!)

• Have your feet measured each time you buy shoes. Foot size can change.
• Ask your doctor, a physical therapist, or a podiatrist about the best type of shoe for your condition and your feet.
•  Choose properly fitting, sturdy shoes with firm, non-skid soles.
• Avoid shoes with extra-thick soles. Choose lace-up shoes instead of slip-ons, and keep the laces tied.
• If you have trouble tying laces, select footwear with fabric fasteners.
•  If you are a woman who can’t find shoes that are wide enough, try men’s shoes
•  Avoid high heels.
• Don’t walk in your stocking feet.

Tips for Exercise/Walking Shoes

• Replace workout shoes every five to six months or 400-600 miles.
• Get refitted every year.
• When trying out new shoes, wear the same kind of socks you will wear when exercising.
• Shop in the evening when feet tend to be larger.
• When standing, your shoe should have a half-inch gap between the longest toe and the shoe’s toe box.
• Try the shoes out in the store before purchasing them.
• Wear your new shoes around the house before wearing them for workouts.

Pronation, Supination

The way your foot moves after it strikes the ground is called pronation, and your specific type of pronation should influence the kind of shoes you wear.

When a person overpronates, the foot rolls excessively inward, which can lead to muscle strains in the legs and feet. Most people who overpronate have low arches. If you are in this category, look for stability or motion-control shoes that are less flexible, have a thicker heel, and help decrease overpronation.

Supination (also called underpronation) means that the feet roll outward when running or walking. People who supinate may have high arches and need shoes with extra cushioning to help absorb the impact when the foot strikes the ground.

Normal pronation, the most common foot-ankle movement, means that the foot rotates slightly, not excessively, inward. If that describes your foot movement while walking or exercising, look for stability shoes that are more flexible than motion control shoes, but still provide adequate support.

Socks and Safety

Some studies have shown an association between falls and walking barefoot or in socks. A small study published in the January 2013 issue of Gait and Posture found that older adults walking in socks had a more cautious gait, a slower speed, a shortened stride, and reduced center of mass velocity while walking.

Finally, a study cited in the April 3, 2013 issue of the Journal of the American Medical Association showed a lower rate of falls in people with disabling foot pain who 1) wore customized orthotics, 2) had a footwear review, 3) performed foot and ankle exercises, and 4) received fall prevention education. While the findings might seemed to have been predictable, the study does illustrate that preventing falls requires a multi-faceted approach.

For more information about reducing your fall risk, purchase Easy Exercises for Balance and Mobility from www.UniversityHealthNews.com.

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Testing for flexibility can be complex or simple. Exercise scientists and physical therapists use instruments called goniometers to measure degrees of joint rotation at the extremes of range of motion. Flexibility is joint-specific, according to the authors of the Exercise Testing and Prescription Lab Manual (Human Kinetics). Determining the range of motion for one joint is not an indicator of flexibility in other joints.

The simplest and least scientific way to measure flexibility is how a person performs activities of daily living. If you can flex and extend a joint, reach, turn, twist, kneel, climb stairs, and bend with relative ease, the joint is flexible.

Between those scientific and simple tests are a few flexibility self-tests you can do at home. They are strictly informal, do-it-yourself measurements that will give you a general idea of your current flexibility. Be careful, do them slowly, don’t hurt yourself, and don’t do them at all if there is the slightest risk of injury.

Lower body: sit-and-reach

1. Sit on the floor with your legs stretched outward.
2. Keeping your back flat and not rounded, bend forward at the hips.
3. Reach toward your toes. Do not bounce or stretch to the point of pain.
4. Note the distance from the tips of the middle fingers to the top of your toes.
5. If you can reach past your toes, you have above average lower body flexibility.
6. If you can touch your toes, you have average lower body flexibility.
7. If you cannot touch your toes, or need to bend your knees to touch them, you have below average lower body flexibility.

The sit-and-reach test is a general measure of lower body flexibility.

Hips, buttocks: lying knee-to-chest

1. Lie on your back and draw your knees to your chest.
2. Continue holding the left knee in that position while you extend the right leg until it lies flat on the floor.
3. Repeat the movement with the other leg.
4. If you cannot completely extend one leg while bringing the opposite knee to within a few inches of your chest, your hip flexors and buttocks may be too tight.

The lying knee-to-chest test can help to measure hip flexibility.

Lower back, hamstrings: standing toe reach
Note: Do not perform this test if you have any question regarding the condition of your back.

1. Stand with your feet together, knees straight but not locked.
2. Bend forward and reach for the floor. Try to keep your back flat.
3. Your lower back and hamstring flexibility is good if you can touch or nearly touch your toes with little effort and no discomfort.
4. If you can’t come close, you may be susceptible to lower back injuries.

The standing toe reach tests lower back and hamstring flexibility.

Shoulders: behind-the-back reach

1. In a standing position, place your left hand on the middle of your back, palm out, fingers reaching up.
2. Slide your right hand behind and down your back and try to touch your hands or fingers.
3. If they can touch you have good shoulder flexibility.
4. Switch hand positions and repeat with the other shoulder.
5. If your hands do not touch, place a ruler in the bottom hand and measure the distance between the opposing fingers.
6. If you are not within an inch of making contact, you may be susceptible to shoulder and neck pain.

A good indicator of shoulder flexibility is the behind-the-back reach.

For more information on a flexibility program, purchase Easy Exercises For Flexibility from University Health News.

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