Turn the Beat Around

As disease management gets less complicated for physicians because of the antiretrovirals we have available in our arsenal'and our patients start living longer'many of the same major health issues that affect HIV-negative people as they grow older are affecting HIVers as well. These other conditions are referred to as 'comorbidities' and include hypertension (elevated blood pressure), diabetes (which can lead to elevated blood sugars), and problems that lead to increases in cholesterol and triglycerides (the fats that flow freely in the bloodstream). These conditions can increase the chances of someone having a heart attack or a stroke, and all can cause damage to organs like the brain and kidneys. For this column, let's start by tackling the first'hypertension'and I'll follow up on the others in my subsequent columns. As we get older, our blood vessels become stiff. And as a result the heart has to pump harder to overcome this, leading to hypertension. Blood pressure is measured as two numbers, one on top of the other. The first number is called the systolic blood pressure, and the second is the diastolic blood pressure. The systolic blood pressure is the maximum force when the heart contracts, and the diastolic is the force when the heart is at rest. A normal number for a systolic blood pressure in a healthy individual is less than 120, and a normal number for diastolic blood pressure is less than 80. Both of these numbers are important for you to know because increases in either of them can lead to heart attacks or strokes. So make sure that at each visit with your physician you know what both numbers are. As a general rule, any value that consistently is measured as greater than 140/90 means that you will likely need to start on medications to lower your blood pressure. But before you do that, there are some simple steps that you can take to lower your blood pressure. First, cut down on the amount of salt that you use and make sure to read food labels because salt is also labeled as sodium. Second, get some form of regular exercise. Any exercise like walking quickly or riding a bicycle, if done on a regular basis, will help to lower your blood pressure. Finally, eat a healthy diet that includes a lot of fruits and vegetables; avoid loading up on starches, like rice, potatoes, and white bread. And if you do have to start on medications to lower your blood pressure, make sure to take them with the same adherence that you do your anti-HIV meds. Many drugs used to treat hypertension have few side effects and can be dosed once daily. So if you find that you're getting more than just minor aches and pains as you're getting older, with some health-conscious effort and a little help from science, managing your hypertension with the same intensity that you manage your HIV disease can be just as simple. Urbina is an HIV specialist and the medical director of HIV education and training at St. Vincent's Comprehensive HIV Center as well as an associate professor of medicine and an associate professor of clinical public health at New York Medical College.