Hypertension: More Soldiers die from silent killer than from combat

By Patricia DealJune 7, 2011

Soldier gets blood pressure checked
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Dietitian discusses heart healthy eating with Soldiers, Families
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FORT HOOD, Texas, June 7, 2011 -- Many people think that combat is the most life threatening event for Soldiers, when actually more Soldiers may die off the battlefield fighting a common enemy.

Heart disease is the leading cause of death in the United States. About every 25 seconds, an American will have a coronary event, and about one every minute will die from one, according to the Centers for Disease Control and Prevention.

Between 70 and 89 percent of sudden cardiac events occur in men, and as part of Men’s Health Awareness Week June 13 through 17, 2011, the medical professionals at the Carl R. Darnall Army Medical Center want to make sure male beneficiaries know the best way to help reduce their risk.

There are several risk factors affecting heart disease. High blood pressure, also known as hypertension, is the leading cause of stroke, according to the American Heart Association.

Hypertension has been labeled "the silent killer" because there are no symptoms. It may remain unnoticed for many years.

A significant number of Soldiers are affected by hypertension, according to the Department of Defense's 2008 Survey of Health Related Behaviors. Approximately 17 percent of Soldiers have reported high blood pressure since they entered the Army.

Another 1.7 percent said they never had the condition checked, and 12.7 percent reported they didn't know or remember what their blood pressure was.

“Hypertension definitely affects the readiness of our troops. Once a Soldier is diagnosed with hypertension, our goal is to get it under control and manageable so he can deploy,” said Maj. (Dr.) Alcario Serros, chief of Internal Medicine at Darnall. “The majority of the time, cases can be controlled through intervention, either with medication and/or lifestyle changes.”

The key is in the diagnosis, Serros said, and fortunately for Soldiers, they have a much better chance of detecting hypertension early as they have better access to care. Soldiers are required to have a physical every year, and blood pressure checks are done at every appointment and during the pre-deployment process.

Blood pressure is measured as systolic, when the heart beats while pumping blood, and diastolic, when the heart is at rest between beats.

A normal blood pressure level is less than 120/80 mmHg. Pre-hypertension is diagnosed with readings of 120-139/80-89 mmHg and hypertension is diagnosed with readings greater than 140/90 mmHg. Higher readings are more serious, and usually require immediate intervention.

There are a number of causes of hypertension, but in 90 percent of the cases, the causes are unknown. There are several medical conditions and lifestyle choices that are known to increase a person's risk to hypertension. Most risk factors are controllable, while factors such as age and genetics are not.

Risk factors that can be controlled include cigarette smoking, poor diet, unhealthy weight/obesity, lack of physical activity and excessive alcohol use. Sleep apnea (breathing stop during sleep) is also a known cause of hypertension.

Stress is another known risk factor, and unfortunately for Soldiers, combat stress has been linked to hypertension. According to research reported in the Journal of the American Heart Association, "combat exposure may exert long-term adverse effects on cardiovascular health.”

“The bad news is that the typical lifestyle of Soldiers puts them at a higher risk for hypertension and heart disease. Too often, Soldiers cope with the stress of Army life by smoking, drinking and eating unhealthy,” Serros said. “The good news is though, with lifestyle changes and/or medication, you can reduce your risk.”

There are a number of different types of medications that are effective in lowering blood pressure.

“It’s a matter of tailoring the medication to the individual, finding which type and what dose will help. Our goal is to give the smallest amount of medication and still get the most benefit,” said Michael Bergeron, clinical pharmacist at Darnall. “But medication alone is not enough to manage hypertension. You still have to make lifestyle changes to bring it under control.”

Serros said that it comes down to patients taking an active role in their health care.

“Some are motivated and some are not. I try to appeal to their emotional side. Often, they have to have a traumatic event or scare to motivate them,” he stated. “Even though they have high blood pressure, they aren’t feeling any pain or discomfort, so it’s harder for them to give up habits that they enjoy.”

While most lifestyle changes are difficult, Maj. Nicole Charbonneau, chief of Nutrition Services at CRDAMC, believes that patients struggle the most with dietary changes.

“But, proper diet and exercise can do wonders to help reduce blood pressure, allowing many patients to control it without medication,” she said. “We recommend the DASH (Dietary Approaches to Stop Hypertension) diet, which helps prevent or lower high blood pressure."

It’s low in sodium, cholesterol and fat, and high in fruits, vegetables and low-fat dairy that provide essential minerals such as potassium, magnesium and calcium.

Getting more physical activity while on the DASH diet provides the best benefit, Charbonneau added. She suggests that even patients in the normal to pre-hypertension range follow the plan as it substantially reduces the risk of developing hypertension in the future.

“The hardest change for most people is reducing the salt in their diets. We have become so accustomed to adding salt to everything, even before tasting it. Many people believe that food just won’t taste as good without salt,” said Ms. Barbara Hughart, dietitian for Nutrition Services.

“You need to cut out the use of added salt to meet dietary guidelines," she explained. "Try cutting back slowly by using 'lite' or sea salts with 25-30 percent reduced sodium, then move to saltless seasonings such as spice-herb blends. It may seem hard, but your taste buds will adapt.”

Current dietary guidelines for Americans recommend that adults in general should consume no more than 2,300 mg of sodium per day and adults in certain population groups should consume no more than 1,500 mg. The average American gets about 3,400 mg of sodium a day.

“It’s just not table salt that’s a concern,” Hughart explained. “People don’t realize most of our sodium intake comes from packaged foods and fast food and restaurant meals. Canned foods are especially high in sodium as are certain condiments such as soy sauce. It’s best just to eat foods as close to fresh as possible.”

Hughart offers more advice and tips for all beneficiaries with high blood pressure, high cholesterol, and triglycerides at her weekly Heart Healthy Eating class.

Spc. John Felt, D Company, an Abrams tank crew member, was recently diagnosed with hypertension as he was being treated for a lower back injury incurred during a deployment in 2009-2010. Felt’s blood pressure was 158/128.

“I’m just 39 years old and I never had problems with my blood pressure before so I was surprised it was so high. I don’t know my family history, but the doctors think it is probably genetic,” he said. “I’m sure stress has a lot to do with it, too. Plus, I’m a smoker.”

Felt said he learned quite a bit from Hughart’s class. He’s making some changes and his wife is cooking healthier now, cutting out the salt. With those changes and getting the right medication, he’s happy to report that his blood pressure is lower, at 101/68.

Once patients are able to manage their high blood pressure, Serros said it is imperative that they continue to be checked and monitored.

“They may have had success in lowering their blood pressure, so they think they’re out of the woods. But if they don’t continue to actively take their meds or stick with their healthier habits, they’re just putting themselves in more danger,” he said.

To more accurately monitor blood pressure readings, Bergeron will start using an Ambulatory Blood Pressure device. The patient wears the portable device continually for 24 hours and it automatically records readings throughout the time period.

Bergeron said he also believes that follow-up care is crucial in helping patients with hypertension. He is in the process of developing a “hypertension clinic” which would devote resources to ensure proper follow-up of hypertension patients.

Related Links:

The DASH Diet Eating Plan

Army.mil: Health News

STAND-TO!: 235 Years of Army Medicine: Bringing Value, Inspiring Trust

Carl R. Darnall Army Medical Center