• Hypertension (High Blood Pressure)
• Heart Disease and Hardening of the Arteries
• (Sugar) Diabetes
• Arthritis
• Breathing Problems: Bronchitis, Emphysema, and Asthma
• Serious Obesity
• Medications

High blood pressure is very common. High blood pressure is made worse by eating too much salt, being overweight, or drinking too much alcohol (more than two cans of beer, two glasses of wine, or two mixed drinks in a day). Smokers with high blood pressure are at the greatest risk for heart disease and hardening of the arteries which is caused by hypertension.

You can expect the systolic blood pressure to drop 10 points if you change to a reduced salt (sodium) diet and eat a diet high in vegetables and low in red meat, sugar, and saturated fats. You should select only low fat diary products. example: 2% milk not cream.

Medications will generally be prescribed for patients whose blood pressure remains high despite changes in diet if:

• your blood pressure remains more than 160/100.
• you are an African-American.
• you have diabetes or "hardening of the arteries."
• you continue to smoke.
• you are in your sixties or older, because blood pressure treatment will have even more benefit than in younger persons.

In some people, certain medications for hypertension can cause tiredness, dizziness when standing up, feelings of depression, being less alert, or decreased interest in sex. Health care providers work with you to find the most affordable medicine that controls your blood pressure and causes the least problems for you.

The most effective and inexpensive medication is a thiazide pill. Other "older drugs" are lower in cost and as effective as many of the "newer drugs".

What should you do? First, remember that hypertension can cause serious heart and kidney disease, as well as stroke. Even slightly elevated blood pressure (130-139/ 85-89) is a risk. So try very hard to change your lifestyle, regularly take prescribed medicines, and check your blood pressure frequently. Second, help your doctor find the treatment that is best for you. Bring to the office blood pressure measurements you have taken at home or in other community settings and tell your doctor about any problems you may be having with the medications.

• do not smoke.
• exercise regularly.
• keep weight, blood pressure, and cholesterol near normal. LDL cholesterol should be no higher than 115, if possible.
• keep blood pressure less than 160/90,preferably less than 140/90.
• take low dose aspirin (or warfarin if you have a condition called atrial fibrillation).
• take a "beta blocker" if you have had a heart attack.
• take "converting enzyme inhibitors" if you have heart failure; low dose beta-blockers may also be helpful.

A doctor should also spend time teaching people with angina heart pains and heart failure how to adjust medications so they are as effective as possible. Medication education always stresses that:

• Beta blocker medications should never be stopped suddenly.
• Nitroglycerin for angina heart pains should be taken before beginning an activity that usually causes pain.
• Educated patients can safely adjust diuretics ("water pills") for heart failure. You must keep track of your weight, feelings of shortness of breath, and swelling of your legs (edema). Easy "tricks" for controlling heart failure include lying down for 45 minutes after taking furosemide and using a combination of low dosage spironolactone or hydrochlorthiazide with furosemide.

Patients should always contact their doctor if they notice worsening of pain, shortness of breath, new pains, or pain that is lasting longer.

What about surgery, special tests or other methods for "cleaning" blocked blood vessels? What about "blood thinners" to prevent stroke? Please read Health Habits and Health Decisions before you talk about these choices with your doctor or nurse.

The best blood sugar goals are:

• Fasting -- 70-120.
• Before meal -- lower than 160.
• At 3 am -- higher than 65.

A special blood test (glycosolated hemoglobin) should be as close as possible to the average for non-diabetics.

Health care professionals find that many people have difficulty reaching these goals. Your doctor should help you come as close to these goals as possible. People who need insulin should be careful to avoid too much sugar and fat in their diet and should exercise regularly. For others with diabetes, the same exercise and diet rules should be followed; weight should be as close to normal as possible; and medicines may be tried to lower the blood sugar. Sometimes several medicines and insulin may be needed. A daytime pill and nighttime insulin can be very effective in some patients. Metformin seems useful for overweight diabetics who do not need insulin.

Remember, after you have had diabetes for more than five years, you have difficulty feeling when the sugar is too low. That is an important reason for regularly checking your blood sugar when you are taking insulin or pills for diabetes.

Your vision can be severely affected by diabetes. Eyes should be checked every two years even if there is not a problem. The younger you are or the less controlled you blood sugar, the more you would have your eyes checked.

Higher risk eyes should be checked every year - preferably using medicine to dilate the pupil. You should consider your eyes at higher risk if it has been found to have changes in the past, you are below age 50, or your glycosolated hemoglobin is more than 9.

The following treatments are effective for health problems associated with diabetes:

• Regular exercise will reduce the average blood sugar even if you do not lose weight.
• Eye problems -- laser and surgery treatments.
• Blood pressure should be less than 130/80 if possible, and "angiotensin" drugs seem to be the best choice.
• Hardening of the arteries -- blood pressure control and cessation of smoking.
• You will want to keep your LDL fat in the blood below 115, if possible.
• Nerve pains -- antidepressant drugs, capsaicin.
• Stomach and bowel problems -- metoclopromide, cisapride, and occasionally erythromycin.
• Foot problems -- carefully check for any sores twice a day. Be particularly careful if you have poor feeling in your feet and they are badly misshapen; the chance of having a non-healing sore (an ulcer) is more than 1 in 10 in a year .

Degenerative arthritis pain in the knees can be helped by strengthening the muscles in the thigh (see exercises #2 and #5 in Eating Well and Exercising). For every pound of excess weight lost, 3 pounds of stress are taken off the knee.

Degenerative arthritis usually does not cause warm, swollen joints, or pain in many joints at the same time. Please contact your health care professional if this happens.

The Chapter on Pain describes general treatment approaches for degenerative arthritis and many other types of pains.

Everyone now knows that chronic bronchitis (a cough with sputum lasting for at least six weeks) and emphysema (destruction of the lung) are caused by smoking. When you quit smoking, some of the damage reverses: shortness of breath and sputum production will decrease. Most of the treatments listed below are also tried in bronchitis and emphysema.

Asthma is a problem that can also make people feel short of breath and cough a lot. Asthma can be present with emphysema or bronchitis or it may occur on its own.

During an asthma attack:

• The lining of the airways in the lungs become swollen.
• The airways produce a thick mucus.
• The muscles around the airways tighten and make the airways narrower.

These changes block the flow of air, making it hard to breathe. It is important to treat even mild asthma so that you can keep it from getting worse.

Certain things can trigger your asthma or allergy and make it worse. If you stay away from these triggers, your asthma will bother you less. Common triggers are: dust, mold, pollen from trees and grasses, cold air, smoke, cats, dogs, some chemicals, and exercise.

There are a lot of ways to treat asthma so that you can be active without having asthma bother you. With asthma you can exercise and play sports and sleep through the night without coughing. Your asthma attacks can be managed and your asthma medicines need not make you sick. But to keep your asthma from bothering you, you have to know what you are doing.

* Know what your asthma triggers are and plan ways to avoid them. Many people with asthma have breathing trouble when they start to exercise. These people can take some of their medicine just before they start. If you can't avoid a trigger, treat it before it causes problems.

* Develop a medicine plan with your care provider that keeps you from having problems. Many people wait too long before beginning their treatment and the asthma gets out of control.

* Know what to take when you have asthma problems.

Some medicines are taken as a pill and some are inhaled into the lungs directly. If you are already getting treatment for asthma, you should bring your medicines to the office, so that your doctor can explain the type you are taking.

There are two types of asthma medicines:

Relaxers (bronchodilators) are medicines that relax muscles in the airways, making it easier for you to breathe. Beta 2-agonists, theophylline, and ipratropium are bronchodilators. (Ventolin, Theo-Dur, and Proventil are brand names for these bronchodilators.)

Anti-inflammatory medicines reduce the swelling in your airways that cause asthma symptoms. They also prevent swelling in the future, which keeps asthma symptoms from starting. Cromolyn, nedocromil (Intal, Tilade), inhaled corticosteroids (Azmacort, Vanceril), and oral corticosteroids (Prednisone) are anti-inflammatory medicines.

Most doctors will tell you to take your inhaled relaxer (bronchodilator) medicine at the earliest sign that your asthma is getting worse. Watch out for early signs so that you can start the asthma medicine right away. An asthma attack is easier to stop if you take your medicine as soon as your symptoms start. Then you won't have to take as much medicine. Keep taking the medicine for several days after a bad attack so that it does not rebound (come back).

Remember: Relaxers (bronchodilators) relieve symptoms, but they cannot reduce or prevent the swelling that causes the symptoms. When you have to use a bronchodilator a lot, or if you use it more than 3 or 4 times in a single day, your asthma may be getting much worse. You probably need another kind of medicine and should talk to a doctor right away.

Take your anti-inflammatory medicines exactly the way your doctor recommends, even if you are feeling well. This will reduce airway swelling and keep asthma attacks from starting. This medicine must be taken regularly for it to work well. This medicine does not work as quickly as the bronchodilators, but don't be fooled. The anti-inflammatory medicines work slowly, over time. But they are very powerful.

NOTE: IF YOU REGULARLY USE ASTHMA DRUGS THAT CONTAIN CORTISONE, YOU SHOULD BE TAKING CALCIUM. TALK TO YOUR DOCTOR.

Some people are afraid that if medicine is taken all the time, it will no longer work. This fear is wrong. Asthma medicines do not stop working over time if you take them as prescribed. Asthma medicines are safe, if taken as directed. But, sometimes asthma can change. If this happens, your asthma medicines may also have to be changed.

One of the most important ways to keep your asthma under control is to have a written plan. You take different medicines depending on how well you are breathing each day, or on your peak flow rate if you use a peak flow meter. Most doctors use the Zone System to help you follow your plan. The zones are set up like traffic lights.

• GREEN: Great! Keep up the good work!
• YELLOW: Not too good, watch out and take the right medicines to get yourself back in the green zone.
• RED: Emergency! Call your doctor and take your bronchodilator medicine.

Your medicine plan will tell you what kind of medicine to take every day (when you're feeling well and in the Green Zone). It will also tell you what kind of medicine you need to take when you are feeling badly and you are in the Yellow or Red zone. Your doctor will help you with this plan, but it is up to you to keep track of how you are feeling, and then FOLLOW THE PLAN! As time passes, you will be the best person to manage your asthma.

Many Americans are overweight. When you are more than 15% overweight or have a lot of fat around your waist, your chances for having heart disease, high blood pressure, and diabetes go up a lot. When you are more than 25% (about 50 pounds) overweight, serious, and immediate health problems can occur. If you are overweight and SERIOUSLY exercise and change you diet, you can CUT BY ONE-HALF YOUR CHANCE FOR HAVING (SUGAR) DIABETES OR HIGH BLOOD PRESSURE! People who are very overweight should talk to a doctor or dietician before beginning a diet.

Exercise and Eating contains a Table that lists weights that require attention or that can be dangerous.

Non-steroidal anti-inflammatory medications (aspirin, Motrin, Naprosyn, etc,) account for about 8,000 deaths each year and seem to increase the chances for kidney diseases. As many as 40% of these types of prescriptions may be "unnecessary".

Adults who take medications each day often take several different types. Sometimes the medications may cause problems or side effects. Because of their smaller size, women are often at higher risk for problems with medications. The challenge for your doctor and for you is to find and reduce the bother caused by medications. Doctors are often able to reduce the dosage or change to another safe, effective, and inexpensive medication for the one causing the problem. Sometimes stopping the medicine completely is the best choice.

Many drugs leave the body through the kidneys. If you have kidney problems, the dosage or frequency of taking drugs may need to be reduced. Always talk to your doctor before starting a new medication.

What else can you do? First, make yourself a "Medications I Take" list. Make sure you list all medications you take al least three times a week, not just the new ones. An example is shown below. Always bring this list with you when you see any other person who is going to help you manage your medical problems.

Second, tell your doctor when you are having trouble taking your medications because they are either too expensive, too easy to mix up, or too easy to forget. For example, "older drugs" for high blood pressure are lower in cost and as effective as many of the "newer drugs". You should consider buying a "pill holder" if you are taking two or more types of pills each day. (You can also use an egg carton for the same purpose.) Seven-day pill holders are very useful. No matter which holder you choose, make sure each section is labeled with the name of the pill and the time it should be taken. You can obtain electronic devices that remind you when to take pills.

Third, you should have your pharmacist check for drug interactions. You can become sick when one medicine reacts with another. Be very careful about interactions of a heart pill called digoxin, all aspirin like drugs (including Motrin or ibuprofen), breathing pills (theophylline), stomach pills (cimetidine), and all types of pills for anxiety and "nerves." (See the table on the next page.) Finally, please tell your doctor if you think that your medications are bothering you.

If you are pregnant or planning pregnancy, please discuss any medications being used. Medications of concern are aspirin, ibuprofen, and similar medications during the third trimester. "ACE inhibitors" should also be discontinued whenever possible.

Medications I Take

If You are 70 Years of Age or Older, You May Wish to Check with Your Doctor if Taking These Medication. (These Medications May Make You Sick and Should only Be Used at a Low Dose when Used)

• Allergy/Cold Pills: chlorpheniramine, diphenhydramine, hydroxyzine, tripleramine, cyproheptidine, promethazine.
• Bowel Medications: dicyclomine, hycoscyamine, propantheline, belladona, clinidium.
• Depression: amitriptyline, doxepin
• Heart/Blood Pressure: disopramine, dipyramidole, methyldopa, reserpine.
• Muscle "Relaxers": carispodal, chlorzoxazone, cyclobenzaprine, metoxalone, methocarbamol.
• Pain Medications: propoxyphene, meperidine, indomethacin, piroxicam, phenylbutazone.
• Sleep/Anxiety: clordiazepoxide, diazepam, flurazepam, barbiturates.

We have tried to make the How's Your Health error-free. However, those involved in its preparation can not warrant that all of the information is accurate and complete. When you use How's Your Health as a guide for your health and medical care, be sure to discuss any questions about it with your doctor, nurse, or other health care worker.