Heart your heart

February is American Heart Month (has been since 1963, apparently every year Congress requires the President to declare it as such) so I would like to take a short break from my usual ramblings for a public service message

In 2005, my Mom died of a massive heart attack. For years she had high blood pressure despite taking the medication prescribed. She always seemed to be retaining water (swollen ankles), tired, and coughing. We chalked all this up to her busy schedule and her thyroid problem. Now, I know those are all signed of congestive heart failure (CHF). Although she was admitted to the hospital for several days for CHF, her symptoms returned but her doctors just attributed it to her thyroid. Her doctors weren't evil or incompetent, they were just lazy and/or busy (in today's healthcare insurance system, if a doctor spends more than 16 minutes with you, he/she is losing money).

Cardiovascular diseases, including stroke, are the #1 cause of death in the US. It is estimated that one-third of Americans have high blood pressure (hypertension) and that 25% of those people are unaware of their condition. Uncontrolled hypertension can lead to congestive heart failure, heart attack, and stroke.

This means that you need to be your own advocate and since there is a 75%+ chance you have high blood pressure, here are some facts to help you make sure that you are getting the care you need and deserve:

In 2003, Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure issued its 7th report (JNC-7) on the clinical guidelines to assist practitioners and patients in the treatment of high blood pressure. The expert panel of clinicians was pulled together by the National Heart, Lung and Blood Institute (NHLBI) and its guidelines are the standard physicians should follow.

http://www.nhlbi.nih.gov/guidelines/hypertension/#guidelines

• If you have a BP of 120/80 to 139/89 you are considered pre-hypertensive
• BP of 140/90 to 150/99 is considered Stage 1 hypertensive
• BP of 160+/100+ is considered Stage 2
• Every increment of 20/10 mm HG (millimeters of mercury, how BP is measured) over 115/75 doubles your risk of cardiovascular disease
• These classifications are different for diabetics, so keep that in mind

The American Heart Association is a great first stop for patient friendly information and the latest news and info (http://www.americanheart.org/ )

• Hypertension is asymptomatic which means there's no way of knowing whether you have it unless you have your BP taken.
• It's best to have your BP checked by your healthcare provider but it's estimated that 25% of people currently being treated for hypertension actually have what's referred to as "white coat syndrome." This means that they get nervous just by being in the doctor's office so their blood pressure goes up and it seems like they have hypertension when they're actually just stressed out
• You can also take your own blood pressure by going to machines in pharmacies or buying a home blood pressure monitor at places like CVS or Wal*Mart. These devices aren't always accurate so call your doctor if you have questions or get a strange reading

Again, according to JNC-7, there is an algorithm for the treatment of hypertension that starts with lifestyle changes (more exercise, healthier diet, reduce sodium) and progresses through a series of different drug classes (diuretics, ACE inhibitors, ARBs, Beta Blockets). Keep in mind, everyone responds differently to medication so you should communicate openly with your doctor if you are having side effects or if the meds aren't working. Whatever you do, DO NOT stop taking your medication just because you feel fine or because you don't like the side effects. Just talk to your doctor and work together to find another way to control your BP.

Finally, the best thing you can do if you or a family member is diagnosed with hypertension or cardiovascular disease is to educate yourself about the diagnosis, prognosis, treatments, and side effects. In addition to the websites above, here are some other good sources:

• Wikipedia (for info on conditions and medications) - http://www.wikipedia.org/
• WebMD - http://www.webmd.com/
• Cleveland Clinic - http://www.clevelandclinic.org/
• National Heart, Lung, and Blood Institute - http://www.nhlbi.nih.gov/
• Circulation - the Journal of the American Heart Association (scientific studies for a professional audience, but the abstracts can be helpful) - http://circ.ahajournals.org/

Now, keep in mind, I'm not a doctor so you definitely shouldn't depend on me or this post for medical advice. In fact, you need to depend on yourself (and your healthcare provider).

I often wonder if my Mom would still be around if we had had access to this information to better understand her conditions and diagnoses and to better work with her doctors to demand better care. But we didn't have access and, heck, she was seeing cardiologists at the Cleveland Clinic, so we didn't think we needed to become experts.

But now you know that you HAVE to be a smart patient and how to access some good info. So celebrate American Heart Month by taking care of your heart so that it will take care of you for a long long time