Eczema - Atopic Dermatitis

Eczema, also known as atopic dermatitis (or inflammation of the skin), is a chronic skin condition commonly characterized by dry, red, swollen, patches of skin that itch relentlessly. For many individuals who have eczema, frequent scratching of the affected area only makes the condition more bothersome and uncomfortable. Repeated scratching also may cause the skin to become red or swollen, which can then cause the area to crack, ooze clear liquid and become crusty. Eczema occurs most often in the folds of the elbows or behind the knees, but it can appear anywhere on the surface of the body. In children, eczema often occurs on the scalp and face as well. An eczema outbreak can last from a few days to a few weeks or more. And whereas some individuals experience a single outbreak, many experience frequent flare-ups, usually as a result of exposure to one or more triggers or irritants.

The itching and scratching caused by eczema can lead to breaks or cracks in the skin. Often, bacteria can infect the open skin wounds and cause an infection. These skin infections, also called cellulitis, can cause the skin to appear red and swollen and may be warm to the touch. These skin infections can spread to other areas of the body, therefore, it is important to contact a doctor if cellulitis is suspected.

What causes it?

Medical researchers believe that eczema may be an abnormal response of the immune system to various environmental or emotional triggers. When the body comes into contact with one or more of these triggers, the immune system senses the trigger and reacts to dispel it. The immune system's reaction is thought to be the cause of the symptoms that are associated with eczema outbreaks.

Triggers for eczema can include skin irritants, such as chemicals; emotional stress; allergies, for example, to food and airborne allergens; and extreme changes in temperature. Paint thinners and pesticides, alcohol-containing products, astringents, and fragrances are chemicals that can trigger eczema in some individuals. Although paint thinners and pesticides can be avoided fairly easily, it is harder to avoid alcohol, astringents, and fragrances, which are ingredients in most cosmetics and household cleaners. If you believe any of these types of products contribute to your eczema, it is a good idea to check the ingredient list on the label before purchasing one of these products.

Heightened emotional states, for example, feelings of extreme anxiety, anger, or aggression, can also trigger eczema outbreaks. Understanding and trying to avoid situations that lead to these stresses may be beneficial in preventing eczema outbreaks. Approaches to avoiding stress include getting plenty of sleep, exercising regularly, and avoiding alcohol or illegal drugs.

Certain foods, for example, milk, eggs, soy, or peanuts, trigger eczema outbreaks for some individuals. Reading the ingredient list before purchasing food products that you suspect may contain ingredients you are allergic to is a wise step to take.

Airborne allergens such as pollens, mould spores, and animal dander as well as extreme changes in temperature can also lead to an outbreak of eczema for some individuals. During the heat of summer, remaining indoors where air conditioning is available is a good preventive measure. In the winter months, using a humidifier to add moisture to the air inside your home may help prevent dry skin, thus preventing an eczema outbreak.

Hormonal Contraception - Birth Control

Contraception (preventing pregnancy) has been attempted for thousands of years. Over the centuries, contraceptive methods have varied greatly from ways we would consider bizarre to methods quite similar to what we use today. For example, in ancient Egypt, crocodile dung and honey were put in the vagina to prevent conception. In some African countries, women used okra pods as vaginal pouches – similar to the female condoms now in use. From dung to seedpods, the effectiveness of traditional contraceptive methods is quite questionable. Although today's methods of birth control can be more complicated to use, they are undeniably more reliable and certainly more appealing.

Over the next 25 years, the world's population is estimated to exceed 8 billion individuals. At more than 40%, this increase represents the largest population growth ever seen over such a short time period. Governments as well as individuals are taking action to keep a huge growth in population from overwhelming resources. Without using some form of family planning, however, approximately 80% of women age 35 to 39 and 91% of women age 20 to 24 would become pregnant at least once during a 5-year period. Even more significant to overall population growth, one out of ten women age 15 to 19 will become pregnant each year, despite a consistent decline in the teen birth rate. Far more likely to live in poverty, babies born to teen-aged mothers are often low in birth weight, which contributes not only to higher infant death rates, but also to greater risk of lifelong health problems. Although estimates vary over a large range, as many as 60% of all pregnancies are believed to be unplanned. Worldwide, unplanned children are more likely to die before the age of one year.

Efforts to control population growth take many forms – from governmental limits on the number of children per family to individual decisions about contraceptive methods. Hormonal contraception is just one method of birth control now used to help keep population growth in check and minimize the number of unwanted pregnancies. By far, the most popular method of limiting family size in the United States is oral hormonal contraception taken by the female partner. Since the U.S. Food and Drug Administration (FDA) approved the first “modern” contraceptive, Enovid 10, in 1960, major advances have been made in hormonal contraception. Available in several different dosage forms, today’s hormonal contraceptives are formulated to reduce side effects and increase convenience while maintaining effectiveness.

Important Note: Hormonal contraceptives, in any form, do not provide protection against the spread of sexually transmitted infections (STIs), such as AIDS, gonorrhea, or syphilis (just to name a few).

Hypertension - High Blood Pressure

What is High Blood Pressure?

In hypertension, also known as high blood pressure, blood is forced through the heart and vessels throughout the body with a greater force than is necessary. Over time, hypertension damages the heart and blood vessels. Eventually, untreated hypertension can lead to life-threatening health problems such as heart disease and strokes.

When your blood pressure is checked, two measurements--systolic and diastolic--are taken.

Systolic blood pressure represents the peak pumping pressure of your heart when it is fully contracted during a heartbeat.

Diastolic blood pressure represents the pressure in the heart when it is at rest between heartbeats. You may be diagnosed with hypertension if your systolic pressure is 140 or higher, and your diastolic is 90 or higher.

Normal blood pressure is defined as a systolic less than 120 and a diastolic less than 80 (or "less than 120 over 80"). "Pre-hypertension" is a new classification that impacts approximately 45 million American adults and is defined as a systolic of 120 to 139 and a diastolic of 80 to 89. Individuals who have pre-hypertension are on the brink of developing full blown hypertension.

Hypertension is defined as a systolic pressure of 140 or higher and/or a diastolic of 90 or higher. Hypertension is further classified by stages - stage 1 and stage 2 - depending on the systolic and diastolic pressure readings (see table below).

Hypertension is diagnosed when either the systolic or diastolic pressure is high or if both the systolic and diastolic pressures are high. To be diagnosed with hypertension, two or more properly measured blood pressure readings must be taken on each of two or more doctor's office visits and then the readings are averaged. This means it takes more than just one elevated blood pressure reading to be diagnosed with hypertension.

When the two blood pressure measurements fall into separate stages--for example a Stage 2 systolic reading, but a diastolic pressure in the normal range, the higher of the two is used for the classification. The higher part of the blood pressure measurement along with your personal risk for hypertension and other health conditions you may have, help your doctor determine the best treatment options for you. The table below lists the stages or classifications of hypertension.

	Systolic	Diastolic
Normal	Less than 120	Less than 80
Pre-hypertension	120 to 139	80 to 89
Stage 1	140 to 159	90 to 99
Stage 2	160 or higher	100 or higher

The higher the blood pressure, the more likely you are to experience a heart attack, stroke, heart failure or kidney disease.

Hypertension - What causes it?

What causes Hypertension (High Blood Pressure)

Two main types of hypertension are recognized. By far the most common is Essential Hypertension, sometimes called Primary Hypertension. This is hypertension in which there is no identifiable cause. Ninety five percent of all persons living with hypertension have essential hypertension. Although researchers have been unable to pinpoint its specific causes, several risk factors definitely increase an individual's chance of developing essential hypertension. Some of these risk factors are controllable. They include:

• Obesity
• High Salt Intake
• Smoking
• Lack of Exercise
• Emotional and/or Physical Stress

Risk factors that cannot be controlled are:

• Gender--Males are at a higher risk for hypertension at earlier ages than females.
• Age--The risk goes up for older women; more than half of women over the age of 60 have high blood pressure.
• Race--Hypertension and its complications are more common among people of African ancestry than among members of other ethnic groups. Not only does hypertension typically begin earlier among African-Americans; its complications are more frequent, and it leads to death more often.
• Family History of Hypertension--Risk is higher in people whose parents also have high blood pressure.

The other major type of hypertension, termed Secondary Hypertension, has an identifiable cause. It is due to disease. For example, kidney (renal) hypertension is due to high blood pressure within the arteries that supply blood to the kidneys. The underlying cause is kidney disease or conditions like atherosclerosis, which narrow or block the renal arteries. Secondary hypertension may also result from hormonal imbalances, particularly in the kidney's adrenal glands. Cushing's syndrome and pheochromocytoma (pronounced: “fee–oh–chrome–oh–sigh–toe–ma”), which is a tumor of the adrenal glands, are two of the conditions that can disrupt adrenal hormones and lead to secondary hypertension. Other causes of secondary hypertension include pregnancy, thyroid disease, and the use of some medications such as oral contraceptives and non-steroidal anti-inflammatory medications (NSAIDs).

Treatments for Heart Failure

How is Heart Failure treated?

The management of heart failure (HF) depends on its cause and clinical course. Since high blood pressure, coronary artery disease, high cholesterol, and valvular heart disease are common causes of HF, aggressive management of these conditions is essential. Treatment goals include:

• Improve the individual’s quality of life and symptoms
• Prevent the heart failure from worsening
• Prolong the individual’s life span
• Treat the underlying cause of the heart failure.

  When a person is diagnosed with HF, both non-drug (described in "Helping Yourself") and drug therapy is recommended. All patients with chronic HF due to left ventricle systolic dysfunction (means the heart muscle itself is weakened and not able to pump blood out of the heart as effectively as before) should receive an angiotensin-converting enzyme inhibitor (ACE-Inhibitor), unless the person is intolerant to or has a contraindication to the use of this class of drugs. ACE-Inhibitors are "vasodilators," which cause the peripheral blood vessels to dilate, or open up. This reduces the work of the heart by making it easier for blood to flow.

  ACE-Inhibitors should even be used in HF patients who do not yet have symptoms of HF because these drugs have been shown in clinical studies to reduce the risk of disease progression and improve patient survival. In patients with fluid retention, ACE-Inhibitors are typically combined with diuretics.

  Diuretics (aka, “water pills”), available since the 1950s, are used to help the kidneys get rid of excess water and sodium, thereby reducing blood volume and the heart's workload. These drugs can help alleviate HF symptoms like shortness of breath and lower extremity edema (fluid collection in the feet, ankles, & lower legs).

  Patients who cannot tolerate ACE-Inhibitors should be treated with angiotensin II receptor blockers (ARBs). ARBs have been shown to improve survival in persons who have HF.

  There may be special situations when a combination of an ACE-Inhibitor and ARB may be used. However, the role of this combination is not well-defined and is somewhat controversial.

  Other "vasodilators" such as a combination of hydralazine plus nitrate therapy may be used if patients cannot tolerate either ACE-Inhibitors or ARBs. The hydralazine and nitrate combination is considered a second-line therapy and should not be used for the treatment of HF in patients who have not been previously treated with an ACE-Inhibitor. A new drug called BiDil combines hydralazine and isosorbide dinitrate into one tablet. BiDil was shown in one study to improve survival in African American persons who have HF.

  Beta-blockers are also a first-line recommendation for HF patients. These drugs decrease the heart rate as well as the overall work of the heart through vasodilation. Certain beta-blockers have been shown in clinical studies to reduce the risk of death associated with HF. All persons with stable, mild-to-moderate or moderate-to-severe HF due to left ventricular dysfunction (who do not have intolerance or contraindications) should have a beta-blocker (either bisoprolol, carvedilol, or metoprolol succinate) added to a regimen of an ACE-Inhibitor and a diuretic as early as possible.

  Some clinicians recommend using digitalis (digoxin), a drug that has been used since the 18th century, to strengthen the heart's pumping action. Other clinicians contend that digitalis has not been shown to affect the normal course of HF. They recommend that it should be reserved for patients who still have symptoms of HF after being treated with an ACE-Inhibitor, diuretic, and a beta-blocker or for those patients who also have atrial fibrillation. While digoxin has not been adequately shown in clinical studies to reduce death from HF, it has been shown to improve HF symptoms and patient quality of life. Patients taking both diuretics and digitalis may need to supplement their levels of potassium.

  In patients with severe heart failure, another type of diuretic can be added to treatment regimens consisting of an ACE-Inhibitor, diuretic, beta-blocker, and digoxin. Spironolactone (brand name: Aldactone), a potassium-sparing diuretic, has been shown in clinical studies to reduce mortality in patients with severe heart failure and thus, may be considered for use in these patients. Spironolactone blocks the action of aldosterone, a hormone that may exert adverse effects on the heart muscle and peripheral blood vessels. Spironolactone not only may improve fluid balance but may also decrease the risk of progression of HF. For patients with more severe forms of HF, spironolactone has been shown in clinical studies to reduce hospitalizations and death from heart failure. Spironolactone's efficacy and safety in patients with mild to moderate HF remains unknown.

  Most recently, eplerenone (Inspra) received FDA approval for the treatment of heart failure that occurs following a heart attack. Eplerenone is a selective aldosterone receptor blocker, the first drug in this class. Individuals may be candidates for eplerenone therapy if they have documented heart failure proceeding a heart attack. For more information on the use of eplerenone following a heart attack, talk to your doctor or primary health care provider.

  Sometimes, surgery proves effective. When HF is due to disease of the heart valves, surgery to repair the valve or implant an artificial heart valve may be helpful. Surgery is also used to correct congenital heart defects that can lead to HF. When HF is caused by partial or complete blockage of the coronary arteries, coronary bypass surgery or angioplasty may be used.

  Heart transplants are a last resort in treating severe HF caused by diseased heart muscle. Although the success rate of heart transplants has significantly improved, the cost of the operation and shortage of donor organs makes it impractical except as a last resort.

  Drug classes used to treat Heart Failure

  ACE-Inhibitors

  Aldosterone Receptor Blockers

  Angiotensin II Receptor Blockers

  Beta Blockers

  Cardiac Glycosides

  Diuretics

  Selective Aldosterone Receptor Antagonist

Who is at risk of heart disease

Nearly five million Americans have chronic Heart Failure, with 550,000 new cases occurring each year. Heart failure results in almost 1 million hospital admissions each year and is the most common diagnosis among patients between the ages of 55 to 65 years discharged from hospitals.

Forty four percent of patients with HF have diabetes, 30% have kidney problems, 52% are women, and atrial fibrillation (irregular heart rhythm) accounts for approximately 31% of heart failure patients. These numbers are expected to continue to increase as the population of elderly Americans rises.

What are the symptoms?

Due to the complexity of trying to determine whether or not a symptom is caused by the inadequate “forward flow” of blood or the “backward buildup” of blood, the following list of symptoms are all attributed to heart failure.

Common symptoms include:

• Exercise intolerance (diminished ability to perform physical tasks)
• Cough
• Fatigue
• Nocturia (having to go to the bathroom frequently during the night)
• Abdominal pain
• Loss of appetite
• Nausea
• Bloating
• Mental status change such as confusion
• Shortness of breath (that may even occur at rest)
• Cool or pale extremities (legs, feet, hands, fingers)
• Edema (or swelling), particularly in the lower legs, ankles, and feet
• Chest pain

High Blood Pressure - are you at risk?

What are the risk factors for Hypertension (High Blood Pressure)

Risk factors are characteristics that may increase your chance for developing a condition. The more risk factors you have, the more likely you are to develop the condition. You are at increased risk for developing hypertension if you:

• Are 60 years of age or older
• Have a family history of hypertension
• Are of African-American descent
• Are overweight or obese
• Are a smoker
• Lack exercise or don't get enough physical activity
• Consume excessive amounts of alcohol (on a regular basis - defined as 3 or more drinks/day for a man or 2 or more drinks/day for a woman)
• Use oral contraceptives (birth control)
• Have a high salt intake and low potassium intake in your diet

Atrial Fibrillation - cause and treatment

Atrial Fibrillation

What is it?

Atrial fibrillation (AF) is a condition in which the heart beats with an abnormal or irregular rhythm. When the heart beats rapidly and irregularly, serious problems can occur such as blood clotting. The abnormal rhythm can come and go (called paroxysmal atrial fibrillation), persist for longer than 7 days (persistent atrial fibrillation), or persist despite treatment (permanent atrial fibrillation).

Atrial Fibrillation

What causes it?

The heart muscle has four chambers or compartments. The two upper chambers are called the right and left atria. Within the right atria, is a small mass of tissue - known as the sinoatrial node (SA node). This SA node triggers an electrical - like impulse that stimulates the heart muscle to beat and pump blood in and out of the heart. The SA node is like a “pacemaker” for the heart. It controls how fast the heart beats and keeps the rhythm of the heart regular.

For most individuals, when the heart beats at a normal rate and rhythm, it pumps about 60 to 100 times per minute. Atrial Fibrillation (AF) can cause the heart to beat 120 to 180 times per minute, or faster. When AF occurs, electrical impulses originate from many areas in the atrium instead of from the SA node - as many as 350 different impulses per minute, all trying to cause the heart to beat. Unfortunately, the heart cannot respond to the overload of electrical - like impulses and thus it begins to beat rapidly and irregularly - almost like a quiver instead of a beat. The fast and irregular beating of the heart can cause the feeling of heart fluttering or palpitations. Additionally, blood is not pumped effectively and may pool in the atria. When blood pools, it is more likely to clot. If a clot develops and breaks loose it can clog a blood vessel in the brain, causing a stroke.

The two lower chambers - the right and left ventricles - of the heart are also affected by AF. Rapid and irregular beating does not allow sufficient time for the ventricles to adequately fill with blood before being stimulated to pump the blood out of the heart again. As a result, less blood is pumped out of the heart and the body’s tissues--which are dependent on the heart for oxygen-rich blood--are provided with a smaller supply, causing symptoms like shortness-of-breath, dizziness and fatigue or tiredness.

Heart Failure Heart Disease

Heart Failure

What is it?

Heart failure, also called left ventricular dysfunction, is a condition in which the heart muscle does not pump adequately. As a result, blood is not dispersed adequately to the body and fluid backs up into the lungs, causing "congestion."

In some patients, heart failure occurs suddenly, while in other cases it develops gradually. As heart function deteriorates over the years, the strength of muscle contractions may be reduced. In other cases, mechanical problems may affect the ability of heart chambers to fill with blood, so that less blood is pumped out to tissues in the body. In other cases, the pumping chambers enlarge and fill with too much blood. The weakened heart muscle may not be strong enough to pump out all of the blood it receives. There are also cases where the heart enlargement affects the functioning of the valves that usually stop blood from flowing backwards into the heart chamber it just left. This condition, called regurgitation, may make the heart failure even worse.

When the heart cannot efficiently pump blood into the arteries, the blood backs up into the lungs and the resulting fluid collection is responsible for the congestion and breathing difficulties. Blood may also collect in veins, especially in the lower extremities, and cannot circulate into tissues.

In most patients, heart failure is controllable. With appropriate care, people may live for many years after the diagnosis is made.

What causes it?

Heart failure (HF) is often the direct result of the heart muscle's inability to contract with enough force to pump blood efficiently. Among the causes of HF are heart valve disease, scar tissue left from a previous heart attack, and high blood pressure which has been uncontrolled for long periods.

Coronary artery disease, in which the coronary arteries supplying the heart muscle are narrowed by plaques (usually from high cholesterol), is the most common cause of HF accounting for 60% of people with the disease. Although coronary artery disease often starts at an early age, HF occurs most often in the elderly. The majority of these patients are women. Researchers theorize that this is probably because men are more likely to die from coronary artery disease before it progresses to HF.

HF is also associated with alcohol abuse, and drug abuse, particularly cocaine and amphetamines, which affect heart rate. Among other disorders that can cause HF are hyperthyroidism -- or an overactive thyroid-- and various abnormalities of the heart valves. In addition, viral infection or inflammation of the heart, known as myocarditis, or a heart muscle disease called cardiomyopathy can cause HF. There are also rare cases where HF is caused by extreme vitamin deficiencies.

What are the risk factors?

Risk factors are characteristics that may increase your chance for developing a condition. If you have conditions such as coronary artery disease, valvular heart disease or high blood pressure, then you are at risk for developing heart failure (HF). Other factors that increase your chance of having or developing HF include:

• Age - Older people are more likely to develop HF than younger people.
• Male gender - Before age 60 or 70, men are more likely than women to develop coronary disease.
• Family history of heart disease
• Cigarette smoking
• High blood pressure
• Diabetes
• Alcohol abuse
• Coronary artery disease
• Chronic kidney disease
• Atrial fibrillation
• High cholesterol
• COPD (lung disease) or asthma

How is Hypertension (High Blood Pressure) treated

How is Hypertension (High Blood Pressure) treated?

The overall goal in treating hypertension is to prevent other health related complications and death from hypertension related complications. Treating and controlling your hypertension can help prevent damage to your heart, brain, kidneys, blood vessels, and eyes. For individuals who don't have other medical or health conditions such as diabetes or heart failure, typically the goal is to lower systolic blood pressure to less than 140 and the diastolic blood pressure to less than 90 ("less than 140 over 90"). For individuals with other medical conditions, blood pressure goals are lower and are determined by your doctor. For instance, the blood pressure goal for most people with diabetes is a systolic less than 130 and a diastolic less than 80 (“less than 130 over 80”).

For individuals who have pre-hypertension, it is critical to adopt a healthy lifestyle to prevent high blood pressure. These lifestyle modifications include weight reduction, eating a healthy diet (called the “DASH" eating plan), increasing your amount of physical activity, and limiting alcoholic beverages. You can get more information about lifestyle modifications in the Helping Yourself section above.

For individuals with hypertension, lifestyle modifications as mentioned above are important but many times, medications will also be needed to adequately manage blood pressure. Many types of drugs are used to lower blood pressure. The initial drug choice is determined by your stage of hypertension (or how high your blood pressure is) and whether you have other health conditions that would affect the drug choice. (See the table below titled “Options for Individualizing Antihypertensive Therapy”for more information.)

Options for Individualizing Antihypertensive Drug Therapy
If you have:	Then your doctor may prescribe one of the following:
Diabetes mellitus	ACE Inhibitors, ARBs, Diuretics, Beta Blockers, Calcium Channel Blockers
Heart failure	Diuretics, Beta Blockers, ACE Inhibitors, ARBs, spironolactone
Heart attack	Beta Blockers, ACE Inhibitors, spironolactone
Isolated systolic hypertension (elevated systolic only)	Diuretics, certain Long-acting Calcium Channel Blockers
Kidney Disease	ACE Inhibitors, ARBs
Recurrent Stroke Prevention	Diuretics, ACE Inhibitors

* You can learn more about the drug classes listed in the above table by clicking on the drug class links at the bottom of the page.

For hypertension that isn't controlled by diet and exercise, new treatment guidelines for hypertension recommend that most patients be started on a thiazide-type diuretic, unless there is a compelling need for a different class of medications (for example, if another health condition is present, that would affect drug choice as listed above).

Thiazide diuretics are useful in achieving blood pressure control. They have been proven to enhance effectiveness of other antihypertensive medications when used in combination, and are typically more affordable than other antihypertensive medications.

Patients with Stage 1 hypertension are generally started on a thiazide-type diuretic, but ACE Inhibitors, angiotensin II receptor blockers (ARBs), beta blockers, calcium channel blockers, or combinations of different classes can also be considered. Patients diagnosed with Stage 2 hypertension typically need a combination of two drugs usually consisting of a thiazide diuretic along with an ACE Inhibitor, an ARB, a beta blocker or a calcium channel blocker to adequately lower their blood pressure. However, the treatment guidelines are meant only to be a guide. Your healthcare provider is in the best position to design a drug therapy regimen to manage your hypertension.

If the initial drug regimen does not achieve the goal blood pressure, your healthcare provider may change your regimen by increasing your dosage or by adding additional antihypertensive medications until your goal blood pressure is achieved. Many patients eventually require two or more drugs to effectively control their blood pressure. Some patients may even require four or five medications to control their blood pressure.

It is important to remember that everyone can respond to antihypertensive medications differently. What works for others may not work for you and vice versa. It is sometimes necessary for a doctor to prescribe different antihypertensive medications until the best regimen for you is found.

More severe hypertension may require the use of drugs called "vasodilators", which widen arteries, allowing blood to flow more easily and thus, lowering blood pressure. Oral vasodilators, such as hydralazine and minoxidil, are often used together with diuretics and other drugs that reduce fluid retention. Clonidine, another type of antihypertensive, may also be utilized.

Hypertension is typically a lifelong condition. However, in some patients-- especially those who have made lifestyle modifications such as losing weight-- may be able to modify their antihypertensive medication regimen after hypertension has been controlled for at least one year. In so-called "Step-Down" therapy the number of drugs being used, their dosages, or both are gradually reduced to see if blood pressure can remain controlled. The goal is to maintain blood pressure control using the lowest dosage of the least number of medications possible. The key though is to keep blood pressure at or under goal. Not all patients are able to "Step Down" from their antihypertensive therapy. Making lifestyle changes (see "Helping Yourself" above) may help increase the likelihood of successful "Step Down" therapy.

Drug classes used to treat Hypertension (High Blood Pressure)

ACE-Inhibitor and Calcium Channel Blocker Combination

ACE-Inhibitor and Diuretic Combination

ACE-Inhibitors

Alpha Blockers

Alpha-2 Agonists

Angiotensin II Receptor Blocker and Diuretic Combinations

Angiotensin II Receptor Blockers

Beta Blockers

Calcium Channel Blockers

Combined Alpha and Beta Blockers

Diuretics

Who gets High Blood Pressure?

Hypertension (High Blood Pressure)

Who has it?

According to estimates based on the Third National Health and Nutrition Examination Survey and on U.S. Census information, one-fourth of the general adult population in America has some degree of high blood pressure--a total of about 50 million people. Approximately 1 billion people worldwide have hypertension. Today it's estimated that there is a 19.3% prevalence of hypertension among white women, 24.4% among white men, 34.2% among black women, 35% among black men, 22% among Mexican-American women, and 25.2% among Mexican-American men.

Older persons also develop hypertension more often than younger individuals. Today it's estimated that in the older population (greater than 60 years of age), the prevalence of hypertension is 60%. As the population continues to age, it is expected that these numbers will also continue to increase. For unexplained reasons, people who live in the Southeastern part of the U.S. also seem to have higher rates of hypertension.

Approximately 45 million Americans have "prehypertension." These individuals are at increased risk for going on to develop hypertension.

Cholesterol - what is it?

Cholesterol is a soft, waxy, fat-like substance the body needs for cells to grow and regenerate. Cholesterol comes from two sources: your body and the foods you eat. The body manufactures its own cholesterol in the liver, and it only takes a small amount of cholesterol in the blood to meet its needs. However, because cholesterol can be found in foods such as red meats, whole milk dairy foods, and egg yolks, eating too much dietary cholesterol can make your blood cholesterol levels increase. Too much cholesterol circulating in the bloodstream is known as hypercholesterolemia.

Hypercholesterolemia increases the risk of heart disease because it can lead to atherosclerosis, a condition in which fat and cholesterol are deposited on the walls of the arteries. Atherosclerosis can occur in arteries throughout the body, including the coronary arteries feeding the heart. In time, narrowing of the coronary arteries by atherosclerosis can produce the signs and symptoms of heart disease, including angina (chest pain) and heart attacks.

Hepatitis C What it is

Hepatitis C

The word "hepatitis" means inflammation of the liver. The usual cause of hepatitis is infection by a virus. At least six viruses, usually identified by the letters A through G, are known to cause hepatitis. In the United States, hepatitis A, hepatitis B, and hepatitis C are the most common types. Rarely, some kinds of hepatitis are not caused by infection. These non-contagious types of hepatitis can result from alcohol abuse, certain drugs, ingestion of toxic substances, or autoimmune disease (the body's own immune system attacks the liver).

Typically, hepatitis B and hepatitis C infections have distinct phases. The first, or acute phase, occurs soon after infection with the hepatitis virus and lasts for 6 months or less. Many individuals recover from acute hepatitis, and their livers return to normal within a few months. Depending on the type of hepatitis, however, some of the individuals who contract acute hepatitis infections may not be able to eliminate the virus. For these individuals, the acute infection may be followed by a chronic phase. Usually, chronic hepatitis involves a prolonged latent or inactive period. During this time, which may last 20 years or longer, individuals with hepatitis probably do not experience symptoms or feel ill. Generally, however, the virus continues to multiply, gradually causing liver damage. Typically, symptoms do not become apparent until liver damage is extensive. However, abnormal levels of liver enzymes such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST) may show if liver tests are done.

Hepatitis - Risk Factors and Symptoms

What are the risk factors?

Risk factors are circumstances or conditions that can increase the chances of developing a condition. Some of these behaviors can be changed and taking special precautions may be helpful for limiting others. Risk factors for hepatitis B include:

• Being tattooed or having body or ear piercing with contaminated instruments
• Immigration from areas where the disease is common, especially among children
• Injectable drug use
• Poor socioeconomic conditions
• Sexual activity with homosexual or bisexual men
• Sexual activity with more than one partner in 6 months
• Travel to high-risk countries in Africa, Asia, South America, and Eastern and Mediterranean parts of Europe

Other individuals who may be at greater risk are:

• Dialysis patients
• Health care workers
• Individuals who received a blood transfusion prior to July 1992
• Individuals with hemophilia, especially those who used blood-derived clotting factors before 1987
• Infants born to infected mothers
• Sexual or household contacts of infected individuals

What are the symptoms?

Many individuals who contract HBV are not even aware that they have hepatitis because the symptoms may be so mild. The most common symptoms of hepatitis B are often mistaken for the flu and they may not be recognized because they may not appear until one to 6 months after becoming infected. Some of these symptoms may be:

• Fatigue
• Loss of appetite
• Mild fever
• Muscle or joint aches

Additional symptoms that may appear a few days after the initial symptoms include:

• Bitter taste in the mouth or bad breath
• Clay-colored (light) stools
• Confusion
• Dark urine
• Nausea and vomiting
• Pain on the right side below the ribs
• Widespread itching
• Yellow colored skin or white areas of eyes (jaundice)

The following symptoms of more serious liver damage may occur months to years later in individuals with chronic hepatitis B:

• Bruising easily or the appearance of “spider veins” broken blood vessels that form a tangled, spiderlike appearance under the skin
• Changes in personality or behavior (encephalopathy)
• Pain on the upper left side of stomach (due to an enlarged spleen)
• Red coloration of the palms of the hands
• Swelling of the legs and stomach (ascites)
• Vomiting bright red blood or dark, grainy "coffee ground" material (as a result of bleeding from enlarged blood vessels in the oesophagus and stomach)

Hepatitis B - Who gets it, What causes it?

Hepatitis B

What causes it?

HBV is transmitted from individual to individual through contact with infected bodily fluids, such as blood. Because chronic carriers of HBV are often unaware that they have the virus, they may transmit the disease to others unknowingly. Injecting illegal drugs with contaminated needles or having sex with an infected individual are common ways to become infected. Sharing and reusing diabetes blood testing supplies with any infected individual may also cause an individual to become infected. In addition, instruments such as those used for tattooing and body piercing can spread hepatitis if they are not properly sterilized between uses. A mother who is infected can transmit HBV to her baby during childbirth. However, it is not transmitted through breast-feeding.

Once HBV makes its way to the liver, it multiplies. Symptoms usually develop within one to 6 months. Exactly how liver cells are damaged or why some individuals acquire chronic infection or liver cancer is unknown.

Who has it?

Of all the serious transmittable diseases, hepatitis is the most common. Up to 100,000 new cases of hepatitis B are reported each year in the United States, and the Centers for Disease Control and Prevention (CDC) estimates that 1.25 million Americans are infected with chronic hepatitis B.

Hepatitis B affects individuals of both sexes and all ages, ethnic groups, and sexual orientations. About one-fifth of the world’s population will have hepatitis B at sometime in their lives. It is more common in males, with the highest occurrence between the ages of 20 and 49 years. Individuals with hemophilia may be slightly more at risk, if they use clotting factors that are made from human blood.

In the United States, the acute form of hepatitis has been declining due to the availability of an effective vaccine and the aggressive promotion of vaccination among children and teenagers. Changes in high-risk behavior may also contribute to the decrease. In 1990, approximately 21,000 Americans were believed to have acute hepatitis B. By 2002, that number had dropped to approximately 8,000.

Chronic hepatitis B affects an estimated 1.25 million Americans and about 400 million chronic carriers are believed to exist in the world population. As the number of acute cases goes down, the number of chronic carriers of hepatitis B is also expected to decline. However, increases in occurrence have been observed among the major risk groups: individuals with compromised immune systems, sexually active individuals, and injectable drug users.