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Feeling the Pressure

by Samantha Costa
Cardiologists use hypertension to predict future heart risk.

Doctors are calling it the silent killer, yet it’s been a part of our routine checkup for years. Hypertension, or high blood pressure, puts those who suffer from the disease at risk for heart attack, stroke or death.

According to the American Heart Association’s 2012 Heart and Stroke Statistical Update, 6.4 million American adults have high blood pressure. And each year, approximately 795,000 Americans experience a new or recurrent stroke.

Based on a new study out of Chicago’s Northwestern University Feinberg School of Medicine, midlife blood pressure may predict future heart risk. The study followed 61,585 participants in the Cardiovascular Lifetime Risk Pooling Project to examine how changes in blood pressure during middle age affect lifetime risk for cardiovascular disease, coronary heart disease and stroke.

Researchers began blood pressure readings at age 41, again at 55, and continued to follow the patients until they suffered their first heart attack or stroke, died or reached age 95.

Men who began with high blood pressure at 41, or developed it by 55, had a 70 percent risk of having a heart attack or stroke compared to a 41 percent risk for men who either decreased their blood pressure during those 14 years or maintained low blood pressure throughout their life. Women in the study were found to have almost a 50 percent risk compared to a 22 percent risk.

South Jersey doctors and specialists echo the observational study’s findings with what they’ve witnessed in their offices and hospital rooms.

Our Lady of Lourdes’ Dr. Reginald Blaber stresses the importance of keeping blood pressure at a healthy level at any age.

“Blood pressure affects so many things in the body. Obviously, blood vessels run to every organ, and the blood goes to every organ because it delivers organs vital nutrients and removes waste and CO2 (carbon dioxide),” Blaber says. “Hypertension can cause those arteries to thicken. And, as the arteries thicken, a couple of things can happen.”

The efficiency of transporting nutrients becomes challenging, and as the arteries thicken, they may become narrower, which means there could be less blood flow going to organs throughout the body.

“When the arteries in the kidney get damaged or too thickened because of high blood pressure, the kidney function can go down and start to result in kidney failure and result in dialysis. It becomes a self-fulfilling phenomenon and vicious cycle,” Blaber says.

It’s common that patients don’t realize they have hypertension. Many people can live most of their life before it becomes troublesome. Small vessel disease in the brain, which can lead to dementia or put patients at increased risk of stroke, can happen slowly over time.

So why is it more important to maintain a healthy blood pressure level during midlife? The sooner it’s addressed the better. “As we get older, our systolic blood pressure tends to rise,” Blaber says. “The older that we are, the more risk factors we tend to accumulate, in terms of diabetes and high cholesterol.”

To make sure patients don’t get to that point, Blaber encourages patients to see a doctor regularly—at least once a year for checkups. Eating sensibly and exercising are also big lifestyle modifications that have profound effects.

Dr. Perry Weinstock of Cooper University Hospital sees the lack of warning signs as one of the key challenges to treating high blood pressure.

“That’s a serious problem because there are millions of people walking around with high blood pressure today because they don’t know their blood pressure is high, because you don’t feel it,” Weinstock says. “A good physician has to rule in or rule out what’s causing the high blood pressure. And that’s really very important.”

Unlike the past, when some doctors just believed high blood pressure was a symptom of everyday life, getting yourself checked these days could be as simple as a trip to your local pharmacy. That kind of accessibility means more people are taking active steps toward lowering their blood pressure.

“If somebody has the discipline and can do it, they should to turn this around. There is some good news. It’s never too late to change. Whenever you decide to change, there are things that will improve,” offers Weinstock.

Like Blaber, Weinstock preaches the benefits of exercise, with a bit of cautious reality. “If you haven’t exercised for 20 years, and this year you decide you’re going to run a marathon, you can’t just flip a switch one day,” Weinstock says.

According to Dr. Vic Bahal of Advanced Cardiology in Mullica Hill, much of hypertension originates from stress. “Cortisol [known as the stress hormone] will actually cause weight gain and once you have weight gain, you have hypertension,” Bahal says.

Generally, Bahal says weight gain associated with stress forms centrally on the abdomen. If diet and exercise fail after six to nine months, Bahal will start his patients on some type of medication. But, every situation varies a bit.

One thing they’re doing differently at Advanced Cardiology is hormone replacement therapy.

Bahal says in certain circumstances, he will suggest testosterone replacement therapy before assigning a typical medication to both men and women, depending on a patient’s situation.

“It reduces body fat and increases muscle production,” he says. “In many cases, it reduces fat and assists in regulating blood pressure and blood glucose. It’s being considered now in our practice as part of a hypertension management strategy.”

Dr. Jason Pecarsky of Advocare Primary Care for Adults in Cherry Hill warns that although medication is commonly used, it comes with risks.

“I try to use medications that have benefits beyond blood pressure. There are some that decrease risk for kidney problems, heart attack and stroke. And I try to use those medications first line as much as I can,” Pecarsky says.

Pecarsky says high blood pressure thickens and stretches the heart.

“And that thickening and stretching of the heart is one of the things that lead to atrial fibrillation. That irregular heartbeat is one of the primary risk factors for stroke. If you don’t have normal blood pressure, it puts an increase strain and stress on the arteries of your body,” Pecarsky says.

Susan Lynn of Marlton Rehabilitation Hospital has been a physical therapist for 25 years and has seen firsthand what can happen to a patient’s mind, body and spirit when something as devastating as a stroke occurs. The population at the Marlton Rehabilitation Hospital contains about 60 percent orthopedics, 40 percent stroke patients. When Lynn finished college and began her physical therapy career, she noticed that many patients stayed a lot longer in rehab. One in particular she remembers stayed an entire year.

“A stroke is definitely the end of the road for someone that’s had a whole history of life with poor exercise habits and poor eating habits, family history, and [being] overweight and [having] hypertension,” Lynn says.

Right now, the facility is using the Bioness electrical stimulation unit for the hand or foot of stroke patients, helping them regain power and movement. Only 30 hospitals have it in the nation. They’re also implementing the use of the Tibion Bionic Leg. It’s a software-enhanced computer program built into a cast that allows a patient to walk. Unlike a typical cast that’s permanent, Lynn says the software in the computer system lets the leg flex and extend.

“We had a younger stroke [victim]. He was using a wide-based cane. The therapist and I turned around and within minutes, he walked across the floor,” says Lynn. “The man’s smile on his face was a mile wide. It was just neat. Hypertension’s devastating, it can do terrible things.”

Heart Health

A Special Advertising Section from the pages of South Jersey Magazine

Local resources to keep your body in working order.

Advanced Cardiology of South Jersey
Dr. Vic Bahal was named one of America’s leading cardiologists by Consumer Council, and is triple-board certified and licensed in New Jersey, Pennsylvania, and Delaware. Dr. Bahal is affiliated with Cooper, Salem, Underwood, Kennedy, South Jersey Regional and University of Pennsylvania hospitals. Advanced Cardiology offers congestive heart failure clinics, state-of-the–art technology with on-site nuclear stress testing, echocardiography, cardiac and peripheral vascular catheterization, pacemaker/defibrillation/heart monitoring and stress echocardiography. Accepting new patients and nearly all insurances accepted.
Serving our Region
Mullica Hill |?(856) 241-3838

Children’s Hospital of Philadelphia (CHOP)
The Cardiac Center at The Children’s Hospital of Philadelphia is a world leader in reconstructive heart surgery, heart catheterization, specialized anesthesia and nursing for children and young adults with heart disease. As one of the largest and most comprehensive programs in the nation, their pediatric cardiologists provide a complete range of services to more than 24,000 outpatients each year in nine locations in Philadelphia and the region.
Serving our Region
(215) 590-4040 |?(856) 435-1300

Cooper University Hospital
Cooper University Hospital became the first hospital in New Jersey to implant a ground-breaking new technology, the Edwards SAPIEN Percutaneous Heart Valve. Cooper University Hospital’s Heart Institute has been selected as one of the 50 initial sites in the United States. This FDA-approved technology offers a treatment option for patients unable to undergo valve surgery and is expected to transform the treatment of aortic stenosis and aortic valve disease. Aortic valve disease affects nearly 300,000 people annually.
Voorhees |?Camden
(800) 8COOPER
(800) 826-6737

Lourdes Health System
Lourdes' cardiac services reputation is a result of the expertise of the physicians and staff at Lourdes—with nearly 100 cardiologists, cardiovascular surgeons, electrophysiologists and cardiac anesthesiologists, plus hundreds of nurses and support staff. In this ever-changing field, Lourdes' cardiac clinicians pursue knowledge to keep abreast of the latest techniques, procedures and treatments. Understanding the concerns of patients and families, they explain care and educate patients. At each stage in cardiac treatment, Lourdes' mission of caring comes to life.
Camden |?(856) 757-3500
Willingboro |?(609) 835-2900

Marlton Rehabilitation Hospital
Marlton Rehabilitation Hospital has served the rehabilitation needs of the community for more than a decade. Offering both acute inpatient and comprehensive outpatient services, they are accredited by the Joint Commission and CARF. Additionally, Marlton Rehabilitation is CARF-accredited as an Inpatient Stroke Specialty Program of excellence. Their credentials, state-of-the-art gyms, heated pool, cutting-edge treatment modalities, patient satisfaction, and excellent reputation distinguish Marlton Rehabilitation Hospital as one of the leading and most respected providers of rehabilitation services in Southern New Jersey.
Marlton |?(856) 988-8778

Published (and copyrighted) in South Jersey Magazine, Volume 8, Issue 11 (February, 2012).
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