Heart Health Report

For a Symptom, Drug & Stress Free Life

Vol. 1, Issue 5 / July 2010

Dr. Crandalls

By Chauncey Crandall, M.D.

8 Steps to Reducing High Blood Pressure

H
ypertension, or high blood pressure, may be the medical condition patients deny most frequently. Everyone wants to believe that he or she only suffers from white coat syndrome that is, that their blood pressure is perfect except in the doctors office. The worry makes the reading high! a typical patient protests. Otherwise, Im just fine. Doctors used to think the same thing and would pay little attention to slightly elevated blood pressure readings. Now weve found that white coat syndrome is in fact highly predictive of longterm problems with hypertension. Once I was among those who denied my own hypertension. My readings were normal or only slightly elevated during my checkups. I had reason to suspect, though, that during my stressful workdays my blood pressure was anything but normal. Still, I let my hypertension go for years without treatment. I never took my blood pressure seriously until I found myself in the hospital with a widow-maker lesion in the left anterior descending artery, which supplies half or more of the blood to the hearts left ventricle. The trouble is, a single, isolated reading is an insufficient gauge of a persons blood pressure. I should have taken the time to keep a blood pressure diary over a two-week period, taking readings morning and night and at odd times as well. Thats the best way to know whether theres a problem with hypertension. High blood pressure is called the silent killer for a reason. Yet Im afraid that the tag is so wellknown that people dont take it seriously anymore. The first step to lowering high blood pressure is to understand its nature and its devastating effects on your health, and particularly its role in cardiovascular and kidney disease. To understand the basic phenomenon of blood pressure, think of a garden hose. When water flows through a hose unimpeded, the pressure in the hose is normal its strong enough and flexible enough to handle the force of the water. The amount of pressure the water exerts equals flow times resistance. Step on the hose and you increase the resistance, so the hose has to expand to accommodate the pressure. Keep forcing the water through the hose without lifting your foot and the hose will eventually explode, ballooning and then rupturing at its weakest point. These same principles operate within your body. The underlying cause of most

In This Issue ...

Your Kidneys and Your Heart .................................2 Effects of High Blood Pressure................................3 Case Study: Reaching Alligator Annie .....................4 Fighting the Blood Pressure Battle ..........................5 Super Foods; Your Vital Health Numbers ...............6 Ask Dr. Crandall .....................................................8

high blood pressure whats known as essential hypertension is a mystery. (Paradoxically, we know that the same conditions that produce hypertension in some people have little or no effect in others.) We know volumes, however, about what makes hypertension worse and how it combines with other factors to produce heart and kidney disease. Aside from essential hypertension, the causes of secondary hypertension are well-known, too. These include obstructive sleep apnea, Cushings syndrome, coarctation of the aorta a congenital obstruction of the aorta and endocrine disorders such as hyper- and hypothyroidism. Cases where a specific cause can be detected account for about 10 percent of all diagnoses. It may surprise you to know that the bodys main controllers of blood pressure are the kidneys. These two bean-shaped organs are located on your lower back, underneath the rib cage. Together, they filter approximately 200 quarts of blood a day, removing about two quarts of water and waste materials. The water and waste are made into urine and sent to the bladder for excretion.

the level of chemicals such as sodium (salt), phosphorus, and potassium that are released back into the body; they maintain the bodys balance of these essential substances. The kidneys also secrete three important hormones: erythropoietin (EPO), which stimulates the bone marrow to make red blood cells; a regulator of blood pressure called rennin; and calcitriol, the active form of vitamin D, which helps maintain bone strength. Researchers have speculated that not all kidneys are created equal. It may be that those whose blood pressure continues to be normal throughout life are blessed with a greater number of, more efficient, or simply hardier glomeruli than others. When a sufficient number of glomeruli are no longer operating, it is believed, the still-healthy glomeruli send a signal to the system to increase blood pressure so that the remaining vessels can perform the necessary filtering. The mysterious nature of essential hypertension has led to speculation that there may be a genetic basis for the disease. We dont understand the complexities of the picture yet. But a genetic basis is hard to doubt because ethnicity correlates with rates of high blood pressure. According to the American Heart Association, more than 40 percent of African Americans suffer from high blood pressure while about 30 percent of non-Hispanic whites do. Hypertension also presents much earlier in African Americans and is often more severe. High blood pressure, like heart disease, also runs in families. The heart and the arteries are living organisms. They respond to increases in pressure in a more complex and adaptable way than a garden hose. All of the bodys arteries can dilate (expand) or constrict (narrow) in response to the bodys needs.

Your Kidneys and Your Heart

Waste removal takes place in the kidneys in units called nephrons. Each nephron has an ingenious filtering mechanism called a glomerulus, a specially designed blood vessel or capillary connected to a urine-collecting tubule. The glomerulus keeps normal proteins and cells in the bloodstream while directing extra fluids and wastes to the tubule. Each nephron also features a network of tiny blood vessels arterioles that wrap around the tubule. These networks carry blood that must be filtered to the nephron and then carry the clean, healthy blood away. The kidneys also regulate

Dr. Crandalls Heart Health Report is a publication of Newsmax Media, Inc., and Newsmax.com. It is published monthly at a charge of $54.00 per year and is offered online and in print through Newsmax.com. Our editorial offices are located at 560 Village Blvd., Ste. 120, West Palm Beach, FL 33409. The owner, publisher, and editor are not responsible for errors and omissions. Rights of reproduction and distribution of this newsletter are reserved. Any unauthorized reproduction or distribution of information contained herein, including storage in retrieval systems or posting on the Internet, is expressly forbidden without the consent of Newsmax Media. For permission, contact the publisher at : PO Box 20989, West Palm Beach, FL 33416. CEO Christopher Ruddy Health Publisher Travis Davis Author Chauncey Crandall, M.D. Contributing Editor Harold Fickett Production/Art Director Elizabeth Dole To contact Dr. Crandalls Heart Health Report send e-mail to: askdrcrandall@newsmax.com. Subscription/Customer Service contact 1-800-485-4350 or customerservice@newsmax.com. Send e-mail address changes to customerservice@newsmax.com. 2010 Newsmax Media, all rights reserved. Please note that this advice is generic and not specific to any individual. You should consult with your doctor before undertaking any medical or nutritional course of action.

July 2010

In a healthy person, exercise causes the arteries to dilate as the heart beats more rapidly and blood flow increases dramatically. At the end of a good workout, the blood vessels return to normal. Chronic high blood pressure causes the arteries to inflate like a balloon thats blown up to nearbursting over and over again. When deflated, the balloon bears stretch marks where its structural integrity has been weakened. Once this damage occurs, the balloon loses some of its elasticity. It becomes much easier to blow up and prone to bursting. The same thing happens with our arteries. When dilated too often by high blood pressure, arteries begin to lose their elasticity and undergo structural damage. Small gaps open between cell junctions as the arterial wall experiences micro-tears. Lowdensity lipoprotein (LDL) cholesterol particles begin to embed in these crevices, forming waxy plaque deposits. Over time, the plaque formation calcifies and becomes fibrotic. This restores strength to the arterial wall but at the price of flexibility. The more this process occurs, the less elastic the arteries become, a condition commonly known as hardening of the arteries, or atherosclerosis. At the same time, the artery narrows. Once a major coronary artery narrows more than 50 percent, the heart must beat harder and more rapidly to maintain sufficient blood flow. The original blood pressure problem worsens.

minutes. Unstable angina demands immediate medical attention. Cracks may also appear in calcified or partially calcified plaque deposits. Plaque deposits are like evil candy bars with gooey centers. The body tries to heal these cracks by filling them with blood clots, applying a type of scab. These clots ordinarily help with the healing process but at the cost of enlarging the plaque deposit, extending it farther into the artery and reducing blood flow. Worse, the clotting process can go haywire. The clot can keep growing until it ruptures and is released into the bloodstream. The still-soft waxy interior of the original plaque deposit can be released into the bloodstream as well. This biological shrapnel is the usual cause of heart attacks and strokes. It completely blocks one of the major coronary arteries, impairs the function of the heart itself, or travels to the brain from a damaged artery of the neck. With blood flow at a minimum, the tissues begin to die. Hypertension and excess fat in the blood combine in a degenerative feedback loop the effects of the original damage to the arteries, however small, make the causes of that damage progressively worse. The cycle begins to repeat.
Continued on page 5

About Chauncey Crandall

Chauncey W. Crandall, M.D., F.A.C.C., is chief of the cardiac transplant program at the world-renowned Palm Beach Cardiovascular Clinic in Palm Beach Gardens, Fla., where he practices interventional, vascular, and transplant cardiology. Dr. Crandall received his post-graduate training at Yale University School of Medicine, where he also completed three years of research in the cardiovascular surgery division. He lectures nationally and internationally on preventive cardiology, cardiological healthcare of the elderly, healing, interventional cardiology, and heart transplants. Known as the Christian physician, Dr. Crandall has been heralded for his values and message of hope to all his heart patients.

Effects of High Blood Pressure

From this point in the hypertension-induced sequence, several catastrophic problems may follow, as well as minor issues. If the artery loses 75 percent of its blood-flow capacity, say in an artery of the heart, the person will likely experience pains in the left arm or chest, which is angina. This can be either stable angina, an onset of symptoms that come and go with physical exertion, or unstable angina, a condition that foreshadows a heart attack. With unstable angina, the attacks crescendo or become progressively worse. They can begin suddenly, while the person is at rest, and last more than 15
July 2010

Heart Health Case History of the Month

The Power of Prayer: Reaching Alligator Annie

In each issue, I will share with you the story of one of my patients, detailing how making changes to your life can radically improve your heart health. Names and some details have been changed for privacys sake, but the problems and their resolutions are real. Dr. Chauncey Crandall
Recently, I began treating a 73-year-old patient who came to me through her grandson. For years, she had run a country store on a canal in the Florida Everglades, selling groceries and small packaged goods to the locals. She had a shotgun in her shop for the alligators that came out of the canal or the thieves who thought theyd take advantage of a little old lady. Her family now insisted that she come live with her daughter on the east coast of Florida, judging that she was too old to continue to live alone. Alligator Annie, as Ill call her, had married at an early age, only to see her husband abandon the family. She raised her daughter all by herself, using every penny the store supplied to send her child through college. She had paid little or no attention to her own needs, rarely seeking medical attention. Annie lived for years and years without air conditioning in a tropical climate. She was thin and weathered as a result, her bony hands gnarled. She smoked a pack of cigarettes a day. She also had extreme, uncontrolled hypertension, with a blood pressure reading of 220/110 (for a healthy person, 120/80 is normal). She had some symptoms of illness, but not as much as she might have had, given her very high blood pressure. She had headaches, mild shortness of breath, and mild dizziness, but no other complaints. Often, someone with that degree of hypertension will feel constantly fatigued. She wasnt on any medications, although her medical history showed that on one or two occasions her hypertensive condition had been noted. We started treatment with a stepped-care approach, beginning with a mild diuretic and a once-a-day ACE inhibitor. I wanted to see her again the following week. Someone with such severe hypertension often is admitted to the hospital. But she was stable, and I thought shed do better with her daughter than in a hospital. I asked her to get a home blood pressure monitor a suggestion she resisted. She hadnt been taking any readings when I saw her the next week. Annies blood pressure was only mildly improved. I
4

increased the ACE inhibitor dose to the maximum and continued the low-dose diuretic. I asked her to stop smoking and to go on a salt-restricted, low-fat diet. She soon made some improvement with her smoking and began abiding by these other restrictions as well. At our next appointment there was additional improvement but not as much as I expected. As I continued to work with Annie, I eventually prescribed four medications. Still, we achieved only a small improvement in her hypertension. Her reading was now at 160/95. I put her through a battery of tests, including a stress test, an echocardiogram, and a carotid artery test to make sure she did not have any critical, underlying heart disease. We looked for renal artery stenosis to make sure she didnt have a blockage in her kidneys. We looked for adrenal tumors, which can cause high blood pressure. We checked her thyroid, too. She passed these tests, although her heart muscle was thickened, an indicator of long-term hypertension. As I came to know her better, I understood that she was suffering from extreme anxiety. Her life as a single mother and then living alone in the Everglades had taken its toll. All of us handle stress less well as we age. Alligator Annie had reached a point where the smallest upset would set her off and her blood pressure would go over the moon. In fact, you could see the anxiety set in. Shed start to vibrate like the Space Shuttle before liftoff. We went through different techniques to deal with anxiety and fear, including exercise, counseling, and biofeedback. These were marginally helpful. After a year of treatment, her hypertension remained only partially controlled. I asked Annie, as I do many of my patients, whether she would mind me praying with her. This she accepted readily. At each appointment after that, I would see to her medical needs with every tool of modern medicine, and then I would pray with her. As I did, she told me more about her life, and I came to understand how her fears and anxieties stemmed from childhood abuses and loneliness. Eventually, she began a relationship with God through Christ, and the power of prayer proved a remedy to her hypertension as no medical treatment had. After a year and a half of treatment, her hypertension was well-controlled. In Alligator Annies case, all conventional means were used, but it was finally the unconventional means of prayer that delivered her from the serious risks of her high blood pressure.
July 2010

Can One Little Pill Really Add 10+ Years to Your Life?

Special Advertiser Information

The Miracle Ingredient the Drug Companies Would Love to Control

rom the minute were born, we begin to age. Most of us arent too concerned with this fact for the first 20 or 30 years of our lives. But that all changes once we begin to notice the first hallmark signs of aging. Theres no denying that growing old is part of life, but is our only option to simply sit by and let our physical vitality and mental sharpness deteriorate? Breakthrough science is showing us that, in fact, you are very much in control of your own aging processif you choose to take action! You can become one of those lucky, inspiring people who not only age well, but also retain a zest for life, well into their 80s, 90s or beyond.

already spent over $720 million trying to create an expensive, synthetic version of resveratrol so they can patent and control it.

Helping Thousands Live Long and Well

Has the Fountain of Youth Already Been Discovered?

Stop Aging Now, one of the leading authorities on anti-aging, has developed a breakthrough new formula, called ResveraPLUS, which combines a 200 mg dose of pure, Standardized Trans-Resveratrol (the most superior form) with three powerful synergistic ingredients: Red Wine Extract (which increases the antioxidant activity of resveratrol), ActiVin Grape Seed Extract (which supports capillary strength) and Whole Grape Extract (which offers additional antioxidant protection). Beyond the proven effectiveness of this formula, ResveraPLUS is also extremely affordable. If you were to purchase each ingredient separately, you would pay well over $130 per month, but ResveraPLUS is priced as low as $16.50 per month! According to leading experts, ResveraPLUS provides anti-aging benefits unmatched by any other supplement!

Several years ago, scientists were baffled by the startling discovery that showed that reducing the number of calories you consume daily could actually help you live longer by as much as 10 years! This idea, known as caloric restriction, has been proven to mitigate the effects of the aging process on cells. But what if strict moderation is not your idea of living well?

Fooling Mother Nature

Exciting new research has shown that resveratrol, the powerful antioxidant substance known to give red wine its health benefits, has the unique ability to mimic the positive effects of a low calorie diet. The benefits of resveratrol include weight loss, slowed aging and potential increases in lifespan of up to 70%! By now, youve probably seen headlines in the news and ads all over the Internet for this miracle longevity pill. But is there any real science behind all the hype?
Activates anti-aging genes Fights free radicals Promotes weight loss Protects cardiovascular health

3 q 3 q 3 q 3 q

The Amazing Powers of Resveratrol

3 q 3 q 3 q 3 q

Balances blood sugar levels Fights inflammation Supports healthy immunity Protects brain health

Proven By Science

Scientists now know that resveratrol, like caloric restriction, works by activating the very genes that control the aging process. Resveratrol switches on these genes, effectively slowing aging and protecting against the degenerative diseases of aging. In fact, the science is so compelling that one drug company has
These statements have not been evaluated by the FDA. This product is not intended to diagnose, treat, cure or prevent disease.

Continued from page 3

Even when a heart attack does not occur from hypertension, the heart senses that it has to work harder to maintain blood flow. So its walls will thicken and become stronger in response. As plaque buildup continues, the heart has to work ever harder. At some point the heart will give up the struggle to become ever stronger and simply dilate and fatigue, resulting in decreased blood flow. A dilated heart no longer pumps efficiently, though, and this causes the bodys other systems to function less efficiently. Water begins to build up in the system as the onset of heart failure begins. Or, high blood pressure can stress particular areas of the arterial system, even without the presence of plaque deposits. The extra force being exerted by the heart to maintain blood flow can cause damage at junctures where larger arteries branch into smaller ones. At these branches of the arterial system, its as if a great river flows into many smaller streams. When a persons blood pressure is normal, the number of smaller streams is adequate to disperse the force of the larger stream. With high blood pressure, that river moves with too much force into that series of small streams, creating whats called shear force. The smaller streams become rapids and all the rushing blood cells scrape and wear away the lining of the artery. Over time, these smaller arteries can be worn away to such an extent that the arterial wall itself can rupture, releasing blood directly, even into brain tissue. This results in a common form of stroke. Death is often the outcome. The major coronary arteries are highly elastic and can suffer many insults to their structural integrity without impairing function. The same cant be said of the arterioles and their terminal ends, the capillaries. This is where most of the energy that keeps the body alive is exchanged; its where the cells are fed and waste is eliminated. Hypertension is a particular menace to the bodys systems that are most dependent on the tiniest of arteries, also called arterioles or, in the case of the smallest of these, arterial capillaries. The brain, eyes, and kidneys are three such
July 2010

systems. Every neuron in the brain is intertwined with arterioles. The cones of the retinas are fed by millions of them. The tubules in the kidneys nephrons, as I mentioned before, are wrapped in climbing vines of them. Capillaries are so small that just one red blood cell can pass through them at a time. They are far smaller than the thinnest of threads. As a result, it doesnt take much for a capillarys elasticity to wear out, become clogged by excess fat, or constrict to the point of uselessness. For this reason, declining mental function and kidney disease are often the consequence of prolonged, untreated or under-treated hypertension.

Fighting the Blood Pressure Battle

Knowing why you should fight the battle against hypertension is the first, all-important step. You may not be able to do anything about the genetic inheritance that predisposes you to essential hypertension, but you can do a great deal to mitigate its consequences. Much of the hypertension epidemic we are living through today is due to the excess of salt in our diets. Going on a low-salt or no-salt diet is a major front in the battle against hypertension. Salt causes the body to retain fluid. The more fluid in the blood stream, the harder the heart has to work. (Remember: Pressure equals flow times resistance.) Its not easy to eliminate much of our salt intake from the diet, especially if we eat pre-packaged foods. A recent article that appeared on the front page of The New York Times showed how many packaged foods are little more than salt-delivery devices. Cheez-It crackers fall apart when much
Continued on page 7

Exclusive to Current Subscribers

Current subscribers have instant access to any and every past edition of Dr. Crandalls Heart Health Report. Simply go here: drcrandall.newsmax.com

Check your e-mail inbox for this months password.

(Please remember to use lowercase letters.)

Quick Takes: Tips for Better Heart Health Now

The Program Is Working!
The American Heart Association reports that death from coronary heart disease dropped 36.4 percent from 1996 through 2006. Canada reports similar results. In the May 12 issue of the Journal of the American Medical Association, researchers cited a 35 percent decrease from 1994 through 2005 in the province of Ontario. The mitigation of risk factors such as smoking and the use of new medications accounted for much of the improvement. The researchers were worried about the increase in obesity and diabetes, however. A 1 percent increase in diabetes translates into a 6 percent increase in death rates. plaque-retarding vitamin E, and plant sterols. The humble nut is a little package of nutritional goodness. heart disease, according to a study published in the Journal of the American Medical Association. Computed tomography uses X-rays to produce a detailed picture of the hearts structure. The study used traditional risk factors to assess the likelihood of heart disease among its subjects and then these risk factors plus the tomography tests coronary calcium score. The new test enabled the researchers to predict future coronary heart problems in an additional 23 percent of subjects. The question remains how widely the test should be used, since X-ray exposure increases the risk of cancer.

Your Best Health Goals

Ninety to 95 percent of heart attacks occur in people with one or more risk factors. Despite the epidemic of coronary artery disease, controlling five risk factors nearly eliminates the possibility of a heart attack. These key factors are: Not smoking Blood pressure at no more than 120/80 LDL bad cholesterol less than 160 mg/dl Fasting blood glucose less than 125 mg/dl Body mass index (BMI) less than 30 Sounds easy, doesnt it? A national study found, however, that less than 1 percent of men ages 35 to 74 had optimal control of these risk factors. Nine percent of women ages 35 to 44 met these criteria but in the 55 to 74 age group the percentage decreased to less than 1 percent.

Overtime Will Kill You

Keeping your nose to the grindstone may be a good thing for your pocketbook, but it might be crushing your heart. A study published in the European Heart Journal found that in a population of 6,000 civil servants, those who worked an extra three or four hours per day raised their risk of angina and heart attacks by 60 percent. The effects of stress at work were compounded by the workaholics habits of skipping regular checkups, ignoring symptoms, and ordering take-out food.

The Facts on Nuts and Health

Eating nuts is good for your health, according to a recent study published in the American Medical Associations Archives of Internal Medicine. You dont even have to be discriminating about the type of nuts you eat the benefits are the same. Consuming 67 grams (2.4 ounces) of nuts a day resulted in a 5 percent decline in total cholesterol concentration and a greater drop, 7.5 percent, in low-density lipoprotein cholesterol (LDL-C). Nuts improved triglyceride levels by 10.2 percent. The higher the persons LDL-C, the greater the benefits of eating nuts. Oddly, nuts worked best for people who were not overweight or obese. What will all those nuts do to your waistline? The study showed that frequent nut consumption, despite their high fat content, does not lead to weight gain if part of a prudent diet. Nuts even lower diabetes risk. Its thought that the good fat in nuts, both monounsaturated and polyunsaturated fats, contribute to lowering cholesterol. Nuts also have omega-3 fatty acids, L-arginine a substance that may improve the health of artery walls fiber,
6

Ten Super Foods You Need

The following 10 foods are super for heart health: Oatmeal Salmon Avocado Olive oil Nuts Berries Legumes (peas and beans) Spinach Flaxseed Soy Dont forget these when someone praises the latest food craze for its heart-healthy benefits. The top 10 still consists of simple foods weve known about for a long, long time.

The Sugar-Cholesterol Link

Excess sugar in the diet has a pronounced effect on cholesterol and triglyceride levels, according to a study of 6,113 adults participating in a national survey. In those individuals where the percentage topped 25 percent, good cholesterol averaged 47.7 mg/dl and their triglycerides levels were at 114 mg/dl. Those who consumed less than 5 percent of their calories from sugar had a much higher good cholesterol count of 58.7 mg/dl and lower levels of harmful triglycerides at 105 mg/dl. My advice is drink water, the original beverage God intended.
July 2010

Calciums Predictive Power

Computed tomography tests to measure calcium in the arteries improve predictions of future

Continued from page 5

of the salt is removed and acquire a medicinal taste, the newspaper reports. The article goes on as have many others to depict salt as addictive. As a Frito-Lay executive wrote in a 1979 internal memo: Once a preference is acquired most people do not change it, but simply obey it. Here, then, are eight steps to slashing your blood-pressure risk: Put down the salt shaker and learn to season your food with herbs and spices. Try curry, fennel, and garlic, for instance. Eat fresh food real food as often as possible, not prepackaged food that can sit on a shelf for months or even years and still be edible. Salt intake can be balanced, in part, by making sure you have enough magnesium, potassium, and calcium in your diet. These reduce the ill effects of salt. Magnesium dilates, or widens, blood vessels and is used on pregnant women who have high blood pressure. The dosages of these substances, however, are hard to calibrate. Magnesium can be taken until it causes diarrhea, then lower the dose. Calcium and magnesium are best when taken together. Be careful, though, because too much potassium that is, excessive amounts can be lethal to your kidneys. All of these substances should be taken in consultation with your doctor. If you want to avoid taking drugs for hypertension or stop taking them, the most significant thing you can do is get down to your ideal body weight. A loss of 10 pounds usually equates to the normal dosage of one medication. Many who suffer from hypertension see this condition completely vanish when they reach their ideal body weight what you weighed, or close to it, in high school or college. Once again, exercise is crucial. Your cardiovascular system is alive and constantly changing. Exercise builds up the heart in the right way and helps restore elasticity to the arteries. The sequence of putting the cardiovascular system under exercise stress and then taking that stress away brings down blood pressure to what it would be if the person merely rested. As you will read in my case study in this months issue, stress reduction is often the key to eliminating hypertension. Exercise is one means of
July 2010

stress reduction. Talking over lifes challenges with ones family and friends is tremendously helpful. Stay away from stimulants like coffee, tea, sodas, alcohol, and cigarettes. You simply cannot smoke. Your doctor can advise you as to whether your hypertension warrants cutting out all stimulants, or if you can still enjoy a cup of coffee in the morning. Many people sip diet sodas throughout the day. These have caffeine and can raise blood pressure significantly. Make sure you are getting enough sleep, at least eight to 10 hours daily. Sleep deprivation is a leading cause of hypertension because it puts the body under stress. If your loved ones complain about snoring or especially snorting and snuffling during the night, you may be suffering from sleep apnea a rapid cycle of waking up many times at night, periods during which the heart may stop. Sleep apnea puts the body under tremendous stress and causes secondary hypertension. Live below your means so that you are not constantly stressed out about finances. Dont forget to have fun! Enjoying social times, particularly with people you know well, helps you cope with stress. Keeping a quiet time each day is also very important, whether that means time alone or, much better, in prayer. Finally, if you are found to have hypertension and your physician prescribes medication, take it! The information above should give you every reason to do so. Take your medication at least until you can change your diet and exercise patterns to achieve an ideal body weight. That will obviate the need, in many cases, for continuing such medication. Many people feel energetic when their blood pressure is high and listless or fatigued when it returns to normal. I try to prescribe medication so that the persons blood pressure returns to normal not all at once but over a short span of time. This allows the person to adjust to what a normal blood pressure feels like. Most people whose hypertension is treated adequately and with a gentle hand feel much better as a result. Employ every weapon available to win the blood pressure battle!
7

Ask Dr. Crandall

Dear Readers, I will try to answer as many questions as I can. However, because of the volume of questions, I cannot answer each letter personally. Please include your full name, city, and state when submitting. If you have a question for me, please e-mail it to: askdrcrandall@newsmax.com. I had a heart attack five years ago and did not go immediately to the emergency room. The attack happened at 5 p.m. and I did not arrive at the hospital until 11 p.m., passing it off as indigestion. As a result, I experienced damage to my heart and have an ejection fraction of 19 or 20. My ejection fraction remains the same today as it was immediately after the heart attack. Is there any way to increase the ejection fraction? Glen G., Gilbert, Ariz. With a reduced ejection fraction means the heart is prone to lethal heartbeats or arrhythmia, conditions which can lead to sudden death. For this reason it is recommended that everyone with cardiomyopathy and a reduced ejection fraction undergo implantation of a defibrillator, also called an AICD. The new defibrillators have the capability, through the number of the pacemaker leads, to improve the function of a weakened heart. Today, too, there are many medications that can improve heart function for patients with previous heart damage. Some of these medications include ACE inhibitors, beta blockers, Aldactone, and diuretics. The lead medication at this time for improvement of heart function is a drug called Coreg, which has many properties to improve the function of a sick heart.
To your heart health,

I had a liver transplant seven years ago and am doing well. However, the anti-rejection drugs I am taking have caused me to have high blood pressure. Am I doomed to taking blood-pressure drugs? Would chelation therapy help with this problem? Arlene K., Miramar Beach, Fla. I am excited to hear that youre doing well with your liver transplant. As you may recall from earlier letters, I was director of the heart transplant program at the Medical College of Virginias veterans hospital. I am well aware of issues associated with anti-rejection drugs. With such drugs, hypertension progresses in all cases, Im afraid. The further out you are from your transplant, the higher your blood pressure. Therefore, it is vitally important that your doctor continue to adjust your hypertension medications as you continue your life with this new organ. While blood-pressure elevation can be wellcontrolled, associated risk factors for the development of heart disease must be addressed and corrected. Continue to watch your weight and exercise and eat appropriately. Lifestyle modification will be important for the rest of your life. I would not recommend chelation therapy with your history. Be grateful that you have your life to live, as Im sure you are!

Please note: All information presented in Dr. Crandalls Heart Health Report is for informational purposes only. It is not specific medical advice for any individual. All answers to reader questions are provided for informational purposes only. All information presented in Dr. Crandalls Heart Health Report should not be construed as medical consultation or instruction. You should take no action solely on the basis of this publications contents. Readers are advised to consult a health professional about any issue regarding their health and well-being. While the information found in Dr. Crandalls Heart Health Report is believed to be sensible and accurate based on the authors best judgment, readers who fail to seek counsel from appropriate health professionals assume risk of any potential ill effects. The opinions expressed in Dr. Crandalls Heart Health Report do not necessarily reflect those of Newsmax Media. 8
July 2010