Everybody knows that hypertensives have a higher risk of suffering a heart attack or a stroke. Not many people stop to think why. What effect does high blood pressure have on our blood vessels? Our hearts? How do they become damaged? How long does it take?

Elevated blood pressure causes mechanical stress on the heart and blood vessels. It damages the inner walls of arteries. Hypertension reduces the elasticity of vessels and increases oxidative stress. Over time, tiny tears in the arterial walls appear. Fatty cells start to adhere to the damaged areas. So does the cholesterol. These adhesions are called atheromas. Over time, they grow into plaque. Plaque sometimes ruptures in places. When that happens, more cells start accumulating at those sites, eventually forming blood clots. This, of course, is what leads to heart attacks and strokes, depending on the location of the blood clots. Some clots (thrombus) are in one location, others (emboli) travel.
What is really scary is that this process of plaque forming begins in childhood. So most of us have it to a degree. Major risk factors for hypertension and atherosclerosis:

Obesity - MAJOR cause of both
Not enough exercise
High saturated dietary fat
High cholesterol
Diabetes
Smoking
Alcohol consumption
Age, gender, family history

Both hypertension and atherosclerosis are known as the silent killers. There are no symptoms until the tissue damage has occured. This sometimes means an ischemic disease - insufficient blood supply - there might be an angina pain, or pain in the calves and leg muscles. Often, the first symptoms are the actual heart attacks and strokes.
Smoking is really bad for damaging the arteries. It raises blood pressure by constricting the arteries. It is toxic to the arterial walls and also worsens the cholesterol levels. Smoking thickens the blood, which is then more likely to clot around the existing plaque.
Hypertension predisposes to, promotes and accelerates atherosclerosis through actions of peptides such as angiotensin and endothelin 1. This happens through an inflammatory mechanism. Inflammation is what connects the hypertension to atherosclerosis. Atherosclerosis should be viewed as an inflammatory disease.
Patients at risk for atherosclerosis-related diseases are being treated with low dose aspirin and a statin.

These issues are hardly ever mentioned on this board. People should be more aware of them. Please feel free to add to this very basic post.

flowergirl

Interestingly, there is a study currently underway with volunteers by the DASH people to see if the diet reduces "aortic stiffness." The study began this past spring, so results should be available soon.

acp

Sounds interesting and I'll watch for those results! :)

I wonder what means will be used to determine the elasticity of people's blood vessels after a time on this diet and how an existence of an improvement will be noted in living patients. What baselines will be used? Blood pressure? I read a study which was done on the effects of atherosclerosis on the aortas of hypertensives. The actual vessels were studied and compared in that one.

FG

There are numerous non-invasive and invasive medical tests for arterial compliance, ranging from such simple measures as a doctor manually examining the carotid arteries or listening for bruits, to echocardiogram tests, to ultrasound, to checking the different blood pressures in arms and ankles,a nd many others.

It is mind-boggling to me to hear doctors say "We just don't know what causes high blood pressure" when there is an endless battery of tests to confirm or deny that arterial issues are the main cause. If and when I suspect I have such issues, I will be extremely aggressive in requesting such tests, if for no other reason than to have a basis to pick a blood pressure treatment.

acp

I think that although we cannot stop aging or do anything about the genes we inherited, we can ensure that we eat a heart healthy diet, get plenty of exercise (well, as much as our bodies can handle), keep the cholesterol levels just right and not smoke or drink excessively. Surely, all of the above steps, if followed long term, should make a world of a difference to our overall health, including the cardiovascular system. It's never too late to start living a healthy lifestyle! There's always some room for an improvement. :)

Good reminder, FG. For those who don't know there is a reason Dr's usually don't want to reduce b/p too fast especially in the ER. The ER has protocols (rules) for slowly reducing b/p with meds so that a clot isn't formed from that loosened plaque on the blood vessel walls as the pressure is decreased. Fam

The relationship between BP and atherosclerosis is very reciprocal it seems...which one starts first is a mystery, but my uneducated guess would be the relationship begins with arteries...plaque and calcium and "junk" accumulate as a result of XYZ, the arteries constrict and lose flexibility, then the BP rises and begins the process of nicks and cracks.

So addressing arterial health at the get go is definitely the place to start. A two-pronged approach would certainly address:

1. minimizing plaque and clogs, and/or treating existing ones (statins, diet, supplements, etc).

2. attacking that which inflames arteries...homocysteine, C-reactive protein, and a whole host of stressors (for example, just one huge fatty meal inflames the arteries!) with diet, exercise, and supplements like fish oil and folic acid (and others).

I do think the process of declining arterial compliance can at least be delayed and slowed down. But when the damage is done? That will be the real medical breakthrough!

acp

Flowergirl :)

What an interesting thread or topic, and yes I agree with you that it is not considered enough on the board.

I have advanced arteriosclerosis and small vessel disease (SVD). Without beta blockers and other meds my BP would be extremely high. I know because I stopped bbs, the only BP med that I was taking years ago and my BP went to 180/120. This probably was an artificially high reading caused by my autonomic system trying to adjust to being without the beta blocker. I really will never know.

One thing that I would like to add is that many times arteriosclerosis is first found during an eye exam by an ophthalmologist or an optometrist. The tiny arteries supplying the retina(s) appear diseased. I was told this probably 18 years ago.

I read an article the other day that these eye exams showing diseased arteries, in the future, will be reported to your family doctor, so that you may be referred to a cardiologist. Sounds logical to me :) and probably Spock, lol.

I owe you a huge apology!!! I just read a post (made in August) on the heart disorder board where you posted to me and I failed to see it until today. The post lifted my spirits so high. I thank you soooo much :)

Have yourself a great day,

Andy

Glad you found this thread Huck. I remember the heart board post on similar issue.

Yes eye doctors are a good first line defense for spotting BO damage. Everyone should see one if possible to assess possible damage.

tamuprof45

Andy,

Good to hear from you again! :) I hope you are doing well.

Thank you for the additional information.
I wonder how I'd do without my BP meds. My BP would go through the roof.
Of course, by the time the opthalmologist finds the damage in the eyes, not much can be done about it. The only thing one can do is to keep the blood pressure down to keep this condition from getting worse. I was told it takes years for this type of damage to occur. It certainly took a long time in your case. Mine also took years to develop. I asked my BP specialist whether the blood vessels in the eyes reflect the condition of others in the body. He said the eyes are a window to the rest of the circulatory system.
I don't know anything about the SVD as opposed to what? CAD? I would expect the small and large vessels to look the same. They are all a part of a CV system. Are they affected differently? I'll have to look into it.

I read an article the other day that these eye exams showing diseased arteries, in the future, will be reported to your family doctor, so that you may be referred to a cardiologist. Sounds logical to me :)

Too bad the doctors haven't been doing it all along. It is good to know they are contemplating it. Others may be helped in the future. Mandatory reporting would cut back on cardiovascular complications and, ultimately, save lives.

take care and thanks for your post!

flowergirl

I was wondering about this: can one tell by one's blood pressure if one HAS arteriosclerosis? Specifically, if your BP is normal or low, are you more or less "safe" as far as clogged arteries?

I know there are many causes of HIGH BP. But I would assume that if your BP is ok, then your arteries probably are too? I have heard mixed things. One argument is that clogs cause the arteries to narrow, which raises blood pressure. But I've also heard that it depends on where the clogs are, and BP can be either raised or lowered by arteriosclerosis.

Any ideas?

tamuprof45

I read a great book recently. Its title: "The Invision guide to a Healthy Heart." It is a visual guide to what things look like inside our bodies. It is one of a kind, first in a series of books to come. The author, Alexander Tsiaras, used a new, highly revolutionary computer imaging technique to allow the readers to see inside our bodies. In this book the cardiovascular system and arteries are explored.
On one page a visual comparison is made of normal aging arteries versus unhealthy aging arteries, starting at age 25. Age related damage cannot be avoided. There's a little bit of plaque which accumulates through aging even in healthy arteries. It does not look life-threatening in the pictures, compared to the arteries pictured in unhealthy aging. It is always best to try to avoid getting the high blood pressure and other diseases in the first place through following a healthy lifestyle and a reducing the sodium intake. Any potential risks of cardiovascular disease are thus minimized.
High blood pressure is not the only cardiovascular risk factor, unfortunately. People with normal blood pressure can have high cholesterol. That is one of the cardiovascular risk factors. There are several others. Smoking is one. Geneological issues can play a major role in cardiovascular disease and are a risk factor also. I think you can relax for now.:) Your BP is good. Exercise, live healthy and learn to manage the stress in your life to avoid getting high blood pressure and other problems.

flowergirl

That book would give me a world of paranoia!

tamuprof,

not to worry! Your blood pressure is not only good, it's excellent! Wow!
You have no reason to worry at this point. Try to lose some of your anxiety over your blood pressure readings. They say that white coat hypertension eventually turns into sustained hypertension.

I hope the biofeedback works. I also hope my doctor sees this too, but all he sees are the prehypertensive readings in his office. My goal of goals is to be able to just get one "normal" reading in his office to convince him of this.

Barring that, he said he would settle for the 76% of my home readings that are prehypertensive, be "normal" instead!

tamuprof45

I wish you the best of luck with biofeedback. I hope it works for you. It has helped so many people in reducing their blood pressure. Let us know how it goes.

FG

Hi,

there's an excellent article just out in ejournal of cardiology practice. It is about oxidative stress and atherosclerosis. It goes into detail about how some conditions, including hypertension, which predispose us to atherosclerosis, are also associated with an increased production of reactive oxygen species. Hypertension seems to stimulate inflammatory response. The author describes the mechanism of oxidative stress and how it affects the arteries. It is recommended that instead of attacking the free radicals with antioxidant vitamins such as vitamin E, ACE inhibitors be used for best results.

flowergirl

I'll check that out. ACE inhibitors are pretty powerful and have some strong side effects, so I'd be cautious. But that is interesting!

For now I like the broad anti-inflammation approach which combines diet and supplements such as antioxidants and others that help arteries.

tamuprof45

It goes to show just how versatile the ACE inhibitors are. They are used for treating cardiological problems, hypertension, some kidney diseases, and even these types of conditions.
This publication is for cardiologists, the well referenced articles contributed by the same. They prescribe the ACE inhibitors for heart failure and to heart attack patients. I agree that these drugs are powerful and effective, with fewer side effects than other antihypertensives. I am glad I am on it and often recommend it to others.
Diet and exercise are probably the best ways to avoid/defer these medical conditions. Achieving and maintaining a normal blood pressure (by ANY means) is the most important thing.

flowergirl

Ace Inhibitors especially PERINDOPRIL (ACEON) and RAMIPRIL (ALTACE) appear to be among the most cardio-protective. The only problems with Ace
inhibitors (as with lots of meds) are side effects. The Ace Inhibitors are the most researched and research yields very positive results. I'm currently trying a low dose of ACEON (as an addition to low dose BENICAR) for better blood pressure control. I had trouble tolerating ALTACE apprx 5 years ago and was switched. I hope this med. proves better.

I believe Ace Inhibitors are more beneficial than the ARB's that many of us are switched to ex. COZAAR, DIOVAN, BENICAR etc...
COZAAR and DIOVAN are fairly well researched. BENICAR is yet to prove any strong positive studies with the exception of many laboratory RAT experiments, but doctors push them like crazy.

As you mention Inflammation and atherosclerotic effects, I think that the addition (among some others) of vitamins such as VITAMIN C, Vitamin E (natural), NIACIN, FOLIC ACID and a low dose of a statin, can reverse atherosclerotic plaque and inflammation.. see "The combination of NIACIN and ZOCOR"

P.S. Ace Inhibitors may also prevent cancer...I guess it's due to the snake venom toxin ingredient, which has this effect. When they say; These blood pressure meds. are poison.... I guess they are not kidding......

[removed]

Please paraphrase in your own words what you read somewhere else. For copyright reasons, do not copy material directly from another website.

Hi Ace,

P.S. Ace Inhibitors may also prevent cancer...I guess it's due to the snake venom toxin ingredient, which has this effect. When they say; These blood pressure meds. are poison.... I guess they are not kidding......

Very funny! :D I knew about the cancer prevention. I did not know about its snake venom ingredient. Perhaps that is why the ACE inhibitors are so effective! Did you know that they also keep the blood sugar in check, so, to an extent, protect from diabetes? (As opposed to beta blockers that help cause it).
I was on Altace originally with no problems. I was switched to 20mg Ramipril a few weeks later, because another doctor thought it would be a better drug for me. I've never heard of the one you are trying now. Perhaps it also goes by another name. I cannot stand either of the two ARBs we tried, Diovan and Micardis. I am allergic to something in them.
I too am a strong believer in the anti-inflammatory properties of the vitamins and other supplements, though have not taken Niacin or folic acid. My doctor said the statin and aspirin should be enough. I'll read about the combination of Niacin & Zocor you suggested. Thanks for that!

flowergirl

Hi,

there's a new device becoming available that will enable most physicians to screen carotid arteries in their offices. It is a miniature portable ultrasound machine. It screens for plaque buildup and measures the thickness of the arterial wall.
Previous versions (in use in some ERs) were about a laptop size, weighed 3.5 kg and cost $45,000 with the software. Smaller devices have now been developed and released just last week. Acuson P10 costs about $10,000. It is being used in UW Madison and costs $295 for the test.
The upside: this screening will prevent sudden deaths in people with no symptoms of heart disease. The downside: there will be overtreatment with cholesterol drugs (hooray for Astra Zeneca, which endorses & helps promote this screening). Many doctors using this device will lack the extensive training that the ultrasound technicians have. This will result in frequent treatment of non-existent problems.

flowergirl

Hi Ace,



Very funny! :D I knew about the cancer prevention. I did not know about its snake venom ingredient. Perhaps that is why the ACE inhibitors are so effective! Did you know that they also keep the blood sugar in check, so, to an extent, protect from diabetes? (As opposed to beta blockers that help cause it).
I was on Altace originally with no problems. I was switched to 20mg Ramipril a few weeks later, because another doctor thought it would be a better drug for me. I've never heard of the one you are trying now. Perhaps it also goes by another name. I cannot stand either of the two ARBs we tried, Diovan and Micardis. I am allergic to something in them.
I too am a strong believer in the anti-inflammatory properties of the vitamins and other supplements, though have not taken Niacin or folic acid. My doctor said the statin and aspirin should be enough. I'll read about the combination of Niacin & Zocor you suggested. Thanks for that!

flowergirl



Flowergirl,

The Ace-Inhibitor I'm taking is known as (Perindopril) In America it is known as ACEON and in Canada as COVERSYL. A big European research study called EUROPA used perindopril....

P.S. You mentioned switching from ALTACE to RAMIPRIL.... ALTACE is the brand name of RAMIPRIL in the U.S...

Sorry, I really have to get my act together. Even my doctor can't keep my meds straight. He gets confused. I am not alone. I was on Norvasc then was switched to Felodipine. We were talking about ACE inhibitors, not the CCBs. Thanks for reminding me. I am also on Ramipril and have been since day one.

FG

Hi, :)

I just watched a video about a new stent. It is called a "wingspan" stent and is the first of its kind.
Its main purpose is to prevent strokes. It will be used in patients with an intracranial atherosclerotic disease. Up until now, the only treatment available was an aspirin therapy or the use of big & bulky heart stents.
Compared to the stents used in coronary arteries, it is light and extremely flexible. It can be bent or squeezed and will bounce right back to the right position. Because of their size and extreme flexibility, these stents, besides being used in the brain, will also be used in the neck arteries. The cranial arteries are smaller and more fragile than elsewhere in the body. The wingspan stent was designed specifically for use in the brain arteries. It works by opening up the artery at the blockage site and keeping it open to allow for a good blood flow.

Speaking of stents, there's another new invention in the making, undergoing trials right now. In the very near future, we'll be hearing a lot about a stent that completely dissolves itself in the patients' artery after a period of time. Based on the information to date, it looks very promising. :)

flowergirl

I was reviewing the highlights of the new 2007 ESH/ESC Hypertension Treatment Guidelines and found this interesting:

Two "new" measures are recommended for assessment of end-organ damage in hypertension. They are an ankle-brachial ratio and the pulse wave velocity. They are recommended because they reflect changes in arterial stiffness. Both of them represent sensitive and accurate markers of atherosclerotic disease. It's great to see these tests will be routinely used in some countries as a part of the diagnostic workup in individuals with high blood pressure. It might not be long before similar changes to hypertension treatment guidelines are adopted by other countries.

Other items of interest - a flexible threshold for treatment of hypertension, based both on elevation of blood pressure values AND an assessment of total cardiovascular risk profile.

Beta blockers still remain a firstline antihypertensive drug for people with angina, previous MI or HF.

flowergirl