Prevention best way to avoid Zika Virus

By Amelia Neumeister

“It’s a story that begins with a bug,” said Dr. Heather Taylor, associate professor of Pediatrics at the College of Community Health Sciences, as she began her May 1 lecture as part of the Mini Medical School Program hosted by the College and UA’s OLLI program.

In her talk, titled “Zika Virus,” Taylor explained that the mosquito Aedes Aegypti is the vector, or carrier, of the Zika Virus, as well as three other major diseases – Yellow Fever, Dengue Fever and Chikungunya Virus. She said this mosquito is such a good carrier of these diseases because it has developed an immunity to many pesticides and other chemicals, and will lay eggs in standing water.

Almost 40 percent of the world’s population is at risk for the diseases carried by the Aedes Aegypti mosquito, Taylor said.

The Zika Virus was first identified in Uganda’s Ziika Forest in 1947, and the first human case was documented in 1952. Over time, several small outbreaks were identified, with the first large outbreak occurring in 2007 in the South Pacific, on Yap Island in Micronesia. More than 73 percent of the island’s population was infected.

It wasn’t until 2015 when Brazil experienced a major outbreak of the Zika Virus that research about the disease began to change, Taylor said. Before this outbreak, the Zika Virus was considered a mild disease with only about a quarter of those infected showing symptoms, and with symptoms lasting for about a week. After the outbreak in Brazil, researchers found a link between Zika Virus, microcephaly infants and Guillain-Barre Syndrome.

“Zika Virus is playing from very different rules that the other flaviviruses that are mosquito born,” Taylor said.

She said the Zika Virus breaks the rules because it is not spread the same way as other viruses. “We know that it’s not spread through touching, coughing, sneezing or breastfeeding. So it’s different from other viruses in that it’s not spread by respiratory secretions.”

The Zika Virus is spread by mosquito bites, blood and sexual intercourse.

While testing for the Zika Virus exists, it is not yet widespread. “At this point, the health departments are controlling Zika testing so they can make sure the people that need those tests can have access to them,” Taylor said. “The CDC is controlling testing for people who really need it – people who have been exposed to the virus and who are symptomatic or pregnant.”

Unfortunately, there is no treatment for the Zika Virus, Taylor said. “The only weapon we have for fighting it is prevention.” Four vaccines are currently being tested and are targeted for females who have the potential to get pregnant in the future. Testing is also underway on genetically modified mosquitos designed to fight the Aedes Aegypti mosquito.

There are several stages of prevention, Taylor said, “But they all go back to that bug.”

The stages are: avoid being bitten; avoid traveling to areas that have experienced an outbreak; and if travel is necessary, or if you live in an affected area, wear long-sleeve shirts and long pants, spray the insecticide Permethrin on your clothing, use a bed net, if indoors keep the doors closed and use air conditioning and keep screens on doors and windows.

Managing diabetes to stay healthy

By Amelia Neumeister

Controlling blood sugar is important for people with diabetes, but other conditions need to be managed as well to provide the best health outcomes, according to Dr. Jared Ellis, assistant professor of family medicine for the College of Community Health Sciences and associate director of its Family Medicine Residency.

During a presentation for the Mini Medical School Program, a lecture series the College provides in collaboration with UA’s Osher Lifelong Learning Institute, Ellis spoke about ways diabetes can manage their disease to stay healthy.

He said controlling blood sugar is important in managing microvascular issues associated with diabetes, such as damage to eyes, kidneys and nerves. “This is impacted by sugar control,” Ellis said in his presentation, “Providing quality care for the improvement of diabetes.”

Diabetes is the top cause of acquired blindness in the US, Ellis said, explaining that for diabetics, tiny blood vessels behind the eyes can become blocked and there can be bleeding. Diabetics also have a higher risk of cataracts and glaucoma.

Diabetes is also the No. 1 cause of kidney failure in the US, and it can lead to diabetic neuropathy, which reduces the blood supply to nerves, causing a loss of feeling, typically beginning in the feet. “Getting the sugar down helps,” Ellis said.

Blood sugar control has less of an impact on macro vascular diseases associated with diabetes, such as heart attack, stroke, or peripheral vascular disease, Ellis said, adding that good blood pressure and cholesterol control are more important. “We want to see more good than bad cholesterol,” he said.

In addition, people with diabetes are more susceptible to infections, so they should stay up-to-date on their immunizations, particularly for flu, pneumonia, tetanus and pertussis.

Blood sugar can be controlled through diet, exercise and medication. Ellis suggested making reasonable changes to diet, but “eating closer to the vine and tree is important. Read food labels, although that can be tricky.” He said diabetics shouldn’t be discouraged if they can’t get to the gym to exercise. “Just move. If it’s a nice day, park farther from the door. Moving more is the key.”

His prescription for self-management of diabetes: “Be knowledgeable, be proactive and not reactive, and keep up with your lab results.”

College’s Transitional Care Clinic reducing re-hospitalizations

Dr. Tamer Elsayed, assistant professor of Family Medicine for the College of Community Health Sciences and assistant director of its Family Medicine Residency provided an overview of the College’s Transitional Care Clinic at University Medical Center during a lecture April 24 as part of the Mini Medical School lecture series hosted by then College and UA’s OLLI program.

The lecture was titled “Transitional Care Management Clinic: Discoveries made with Inter-Professional Collaboration.”

The clinic, located in University Medical Center, which is operated by the College, opened in November 2015 and is designed to assist patients with the transition from the inpatient hospital care setting to home or a community (assisted living) setting.

“The problem is that many patients have multiple chronic problems who require extra care and have been readmitted multiple times to the hospital,” said Elsayed. “We decided that we wanted to have the extra care to these patients as soon as possible, as soon as they get out of the hospital, and see what kind of services they need.”

At the clinic there is a large team of 8 different positions and a lot of resources available including nursing, pharmacology, social services, a dietician and family medicine. Each service does what they can to help the patient. For example, during the visit, a PharmD takes a look at the patient’s medications, notes changes and calls the pharmacy to make sure the patient has the correct medications.
“At the end of the visit, the patient receives a printed list of the medications they need for clarity,” said Elsayed.

Lessons learned from three decades of medical practice

The practice of medicine has experienced many changes over the years, but one thing that has stayed consistent over time is the importance of physician-patient communication, said Dr. Dan Avery, an obstetrician-gynecologist who has practiced in Alabama for more than 30 years.

He shared key takeaways from his years in practice in a presentation April 17 as part of the Mini Medical School lecture series hosted by the College and UA’s OLLI program.

Avery practiced privately for more than 20 years before joining the College, where he was professor and chair of the Department of Obstetrics and Gynecology. He is currently director of Medical Student Recruitment and Scholarship at the College and a professor of Community Medicine and Population Health. He is also medical director for the College’s Institute for Rural Health Research.

Avery began his presentation, “Lessons learned from three decades of ob/gyn and medical practice,” by comparing differences in medical education from the time he was a medical student to today. He said differences include the medical school application process, the cost of medical school, and the length of residencies and how those training programs are now structured.

“The reduction of work hours for residents has decreased the number of procedures they are able to do,” Avery said. “The years of residency may be lengthened due to changing hour requirements.”

An increase in the use of technology has also changed medicine, he said.

The importance of communication between physician and patient, however, has remained a constant over the years, Avery said. “The relationship with the patient is everything.”

In some ways, technology has helped communication, Avery said, noting that he will text patients if they have medical concerns that don’t require an in-person visit.

Communication extends across all specialties in medicine and is particularly important in obstetrics, Avery said, not only because obstetrics is a high-risk specialty for malpractice but because many women want to choose when they deliver their babies.

“You’ve got to have a good reason to [electively] deliver a baby preterm,” he said. And, this needs to be discussed with an obstetrician before a decision is made. The closer to term a baby is delivered, the better the change of the baby being born healthy.

Avery said while many women deliver in hospitals, home deliveries are on the rise, so it’s vital to communicate with a physician if a home delivery is planned.

While communication between doctors and patients is important, it often doesn’t get the attention it deserves in medical school, he said.

“If you listen to a patient long enough, they will tell you what is wrong with them,” Avery said, quoting Dr. Tinsley Harrison, a long-time physician and educator at the University of Alabama School of Medicine.

Health Notes – The confusing world of over-the-counter medications

To help people become savvy consumers in drug stores and pharmacies and wiser users of over-the-counter medications, Dr. Richard Streiffer, dean of UA’s College of Community Health Sciences and a family medicine physician, went shopping.

He recounted his shopping experience and provided helpful information in a presentation March 9 that was part of the Mini Medical School lecture series hosted by the College in collaboration with UA’s OLLI program. His presentation was titled “Over-the-counter drugs: A prescription for confusion.”

Streiffer said Americans make a lot of trips to the drug store for over-the-counter medications, about 3 billion trips annually, and there are approximately 300,000 over-the-counter medications on the market. “I want to help you be a little smarter as a consumer,” he told the audience.

He said people spend a lot of money on over-the-counter medications they might not need or that might not be effective. In addition, some of the medications can cause adverse health effects, particularly if people are taking multiple medications or have chronic health conditions, he said.

Streiffer offered strategies people can use to better gauge cost and effectiveness. His top tips: buy generic brands and read labels.

“There’s a fear of generics, but it’s really just a labeling and marketing difference,” he said. “For the most part, find the brand name and look next to it for the generic.”

He noted that a quick read of the labels on Excedrin and Excedrin Migraine showed that both contain the exact same ingredients; they are just marketed – and priced – differently.

Streiffer showed examples of men’s and women’s multi-vitamins and the only ingredient differences between the two were that the men’s blend had cayenne pepper and the women’s had dried cranberry. He added that affluent people with good diets don’t really need multi-vitamins, which can cost $25 or more per month.

Streiffer said it’s often difficult to discern differences between supplements and medications. “Talk about overwhelming, and supplements aren’t regulated,” he said.

Supplements are classified as food, so they are not regulated by the US Food and Drug Administration. They are marketed as supporters, not relievers, and might include information on labels such as “in support of sleep.”

“There is usually little scientific evidence to prove the effectiveness of supplements, and they can cause side effects,” Streiffer said. For example, ginseng has been touted for improving energy, depression and nausea, and cranberry for improving urinary track health.

“There’s no evidence for this. When something sounds too good to be true, it probably is. As a society, we are too quick to grab a pill,” Streiffer said.

 

Some post-menopausal issues can be reduced with healthy lifestyle choices

Osteoporosis and heart disease are some of the complications women can develop after menopause, but these can be reduced with healthy lifestyle choices, according to Dr. Cecily Collins, an assistant professor of obstetrics and gynecology at UA’s College of Community Health Sciences.

Other post-menopausal issues, such as hot flashes and vaginal and urinary symptoms, are not as easily avoided, she said.

Collins, who also practices at University Medical Center, which is operated by CCHS, provided the information in a presentation as part of the Mini Medical School lecture series hosted by the College in Collaboration with UA’s OLLI program. Her presentation was titled “Post-menopausal health issues for senior adults.”

Menopause is defined as the halting of the menstrual cycle and a time in a woman’s life when the function of the ovaries ceases. The process is gradual, and while the average age of menopause is 51 years, it can occur anywhere from age 45 to age 58, Collins said.

Symptoms of menopause can include hot flashes, vaginal and urinary symptoms and abnormal vaginal bleeding. Issues that women may develop after menopause can include osteoporosis and cardiovascular issues.

Collins explained that hot flashes, a quick feeling of heat and sometimes a red, flushed face and sweating, are “related to a withdrawal of estrogen.” There are medications that can relieve symptoms, she said, and she also recommended that women dress in layers and use air conditioning, particularly at night. Collins said alcohol and caffeine have been shown to increase hot flashes, while exercise can sometimes decrease their severity.

Vaginal dryness can be treated with hormone therapy as well as topical hormones applied directly to vaginal tissue, Collins said. Also associated with menopause are urinary symptoms, including infections, leakage and bladder irritation.

Some of the complications after menopause, including osteoporosis and cardiovascular disease, can be lessened by healthy lifestyle choices, Collins said.

When estrogen levels drop, bone density decreases, putting women at risk for fractures. Low bone density can be exacerbated by a sedentary lifestyle, smoking and excessive alcohol use. Exercise, smoking cessation and limiting alcohol intake can help, as can calcium supplements.

Some of these same lifestyle risks can increase the risk for cardiovascular issues for women who have gone through menopause, Collins said. She encouraged annual blood pressure and cholesterol checks, as well as EKGs and chest x-rays based on a health care provider recommendations.

Crimson White: UA professor lectures on key issues with over-the-counter drugs

To help society become smarter consumers in pharmacies, Dean and professor of Family Medicine in College of Community Health Sciences Dr. Rick Streiffer presented a lecture entitled, “Over-the-Counter Drugs: A Prescription for Confusion” on Thursday.

Streiffer initially spoke about how common the confusion in buying over-the-counter drugs is for most ages, and how people in the United States make trips to drug store regularly for various concerns, spending a lot of money on items they do not need. According to him, many products can cause adverse effects for people as well.

Immunizations in older adults, addiction and teens, schizophrenia and cholesterol topics in weekly Mini Med School lecture series

About one-third of people will get shingles in their lifetime, and while the shingles vaccine is only about 50 percent effective, it is still worth it to avoid getting the virus, said Dr. Jane Weida, director of clinical affairs for the College of Community Health Sciences’ Department of Family, Internal, and Rural Medicine.

Weida gave her talk, “Immunizations for Older People — Staying Sharp on Shots,” on Feb. 9 as part of the Mini Medical School lecture series put on by CCHS in collaboration with UA’s OLLI program.

Mini Medical School lets adults and community learners explore trends in medicine and health, and the lectures by CCHS faculty and resident physicians provide information about issues and advances in medicine and research. OLLI, short for the Osher Lifelong Learning Institute, is a member-led program catering to those aged 50 years and older and offers education courses as well as field trips, socials, special events and travel. The lecture series is open to OLLI participants and to the public.

Shingles is caused by the same virus that causes chickenpox. A painful rash develops, usually on a single area on one side of the body, that can be very painful, said Weida, who is also an associate director of The University Family Medicine Residency, operated by CCHS, and an associate professor of Family Medicine.

View Fox 6’s report on Weida’s talk:

Someone who has had chickenpox can get shingles.

“When you’re little you get chickenpox and then the virus stays in the nerves along the back and neck,” said Weida. “Sometimes, we don’t know how, it reactivates.”

Being older, having poor immune function and having had chickenpox before 18 months of age increases the risk of shingles.

“If you never have had the chickenpox, you can’t get shingles first,” she said. “If you’ve never been immunized for chickenpox or shingles, you should get immunized for both. You can catch chickenpox from someone with shingles, but not shingles.”

Insurance will cover the shingles vaccine after age 60, though it can be given starting at age 50.

Older people need immunizations to boost immunity to diseases, even those to which they have already been immunized, such as tetanus, diphtheria and whooping cough, and to protect against diseases that affect older adults preferentially, including shingles and pneumonia, said Weida.

Weida also encouraged attendees to get their flu shot each year, as 3 million to 5 million people are infected by influenza each year, and 250,000 to 500,000 die each year from the flu. The best time to get your flu shot is about mid-October to November, said Weida.

The flu shot’s effectiveness can fade, Weida said, so it is important not to get it  too early, especially for those older than 65.

The flu is spread through coughing or sneezing and by touching surfaces with the virus. However, soap and water deactivates the virus, Weida said.

Schizophrenia
On Feb. 2, Dr. Thaddeus Ulzen, associate dean of Academic Affairs and chair of Psychiatry and Behavioral Medicine, gave his talk on schizophrenia, which is a chronic and severe mental disorder that affects 1 percent of people worldwide.

Symptoms typically present between late adolescence and early adulthood. Ulzen said that symptoms may be subtle, but those around the person may notice that “something is just not quite right, or the person is not his or herself.”

Symptoms include hallucinations, delusions, thought disorders and movement disorders. Reduced emotions and feelings of pleasure and reduced speaking may also be symptoms.

“I describe it as a disruption of what I call ‘security of thought’—that your thoughts belong to you,” said Ulzen. “The feeling is that someone is intruding on your thoughts.”

Medication can be used to treat schizophrenia, but other aspects must be introduced into the treatment, said Ulzen, including psychosocial interventions and cognitive behavioral therapy. Community treatment, which includes family education and support, is also important.

Schizophrenia cannot be cured, and those affected with the disorder have it for life.

“As a child psychiatrist, I always say that we are in preventive psychiatry. Most disorders we see, including schizophrenia, start quite young.”

Ulzen said he works with general physicians to help them identify the signs of schizophrenia and other psychiatric disorders.

“My job is to help physicians understand that this is the beginning of the big tsunami about to come and never to say ‘It’s just a phase.’ If the patient is concerned enough to walk into the room, they know something is wrong.”

 

Addiction and Teens
In a 2015 study, one out of 17 high school seniors were daily smokers of tobacco, said Dr. Sara Phillips, assistant professor of Pediatrics at CCHS, during her talk “Addiction and Teens” on Feb. 16.

According to the CDC, cigarette smoking causes about one of every five deaths in the US each year and life expectancy for smokers is at least 10 years shorter than for nonsmokers. Quitting smoking before the age of 40 reduces the risk of dying from smoking-related disease by about 90 percent, said Phillips.

“I think if we target young people and try to get them to quit early on, it could be like they never smoked.”

Most teens want to quit, she said, and nicotine replacement and cognitive behavioral intervention can be helpful forms of treatment.

While there are other dangerous drugs that teenagers use, smoking causes annually more deaths than overdoses have in 15 years, said Phillips.

More money is spent on tobacco advertising than any other drug, though there are regulations.

Advertising for alcohol is not regulated, and people aged 12 to 20 years drink 11 percent of all alcohol consumed in the US. More than 100,000 deaths can be attributed to excess alcohol consumption, including the deaths of 5,000 people younger than 21 years, said Phillips.

Younger drinkers are more likely to develop alcohol dependence or abuse later in life, and they are at higher risk of suicide and death from alcohol poisoning. This is for a couple of reasons, said Phillips.

“One, their brains are not fully developed, and two, they’re novices to drinking. They don’t know their limits,” she said.

Of illegal drugs, marijuana is the most commonly used and adolescents can become addicted, despite popular belief, said Phillips.

One study showed an average loss of eight IQ points with heavy marijuana use as a teen and continued use as an adult. It can also lead to memory problems, breathing issues and hallucinations and paranoia.

Genetics can play a role in addiction in teens. Children whose parents are alcohol-dependent are four to six times more likely to develop alcohol dependence compared to others with no family history. Teens with mental health issues are also more at risk to use or abuse substances, Phillips said.


Cholesterol
Treating cholesterol isn’t about treating a number—it’s about treating the risk factors and the disease process, said Dr. Ed Geno, assistant professor of Family Medicine in the College’s Department of Family, Internal, and Rural Medicine.

Cholesterol is essential in the human body, said Geno. Two types of cholesterol levels are checked: LDL and HDL. The two have different clinical implications:

LDL carries cholesterol from the liver to the tissues and deposits it. Geno called this “lousy cholesterol,” which is how he helps patients remember it is not good for that number to be too high.

“Happy cholesterol” is how Geno helps patients remember HDL, which carries cholesterol from the tissues back to the liver.

High levels of the LDL cholesterol can lead to plaque buildup in arteries and lead to cardiovascular disease (CVD).

Statins may be used to prevent CVD in adults.

“We are trying to use primary prevention in treating cholesterol,” Geno said. “That means we are trying to keep someone from ever having a heart attack. Secondary prevention would be keeping a heart attack from happening again.”

When treating a person’s cholesterol, risk factors and the disease process is taken into account—not just the patient’s cholesterol numbers.

Adults without a history of CVD may be prescribed a statin for the prevention of a CVD event and mortality  depending on if: 1) the adult is between age 40 and 75; 2) the adult has one or more CVD risk factors, which include dyslipidemia, diabetes, hypertension or smoking; and 3) the there is a calculated risk by the physician of a cardiovascular event within 10 years.

Sleep problems, adapted athletics topics at Mini Med School

More than 50 percent of adults in the US experience intermittent sleep disturbances, and only 30 percent of adults report regularly getting enough sleep.

Chronically tired individuals face increased risk of illnesses and an overall lower quality of life, says Dr. Katie Gates, assistant professor of Family Medicine at The University of Alabama College of Community Health Sciences.

Gates gave her talk, “Sleep Problems,” on Jan. 26 as part of the Mini Medical School lecture series put on by CCHS in collaboration with UA’s OLLI program. On Jan. 19, Dr. Jimmy Robinson, endowed chair of Sports Medicine at CCHS, gave his talk, “Adapted Athletics.”

Mini Medical School lets adults and community learners explore trends in medicine and health, and the lectures by CCHS faculty and resident physicians provide information about issues and advances in medicine and research. OLLI, short for the Osher Lifelong Learning Institute, is a member-led program catering to those aged 50 years and older and offers education courses as well as field trips, socials, special events and travel.

Gates broke down sleep disorders into four categories: Those who can’t sleep includes sufferers of insomnia and restless leg syndrome. Those who won’t sleep likely have delayed sleep phase syndrome. Those with excessive daytime sleepiness may suffer from narcolepsy or obstructive sleep apnea. And those with increased movements during sleep include REM sleep behavior disorder sufferers, or those with periodic limb movement.

Three criteria must be met for a diagnosis of insomnia: First, the patient must complain of difficulty sleeping, difficulty staying asleep or waking up too early. Second, the sleep difficulty must occur despite adequate opportunity and circumstances to sleep. And third, the lack of sleep must negatively affect daytime function.

“Insomnia is a very common complaint, and it does increase with age, unfortunately,” Gates said. Women report insomnia 50 percent more often than men. It can be treated with cognitive behavior therapy or with medications.

Delayed sleep phase is a circadian rhythm disorder, meaning “the brain has gotten off its track,” said Gates. It’s characterized by the person going to bed very late and waking up late.

“This can be genetic or socially reinforced,” she said.

Obstructive sleep apnea is the most common sleep breathing disorder, and it affects 20 to 30 percent of males and 10 to 15 percent of females.

“With my patient population, it seems higher than this,” Gates said.

Risk factors for sleep apnea include age, obesity, craniofacial abnormalities and smoking. Continuous positive airway pressure, or a CPAP machine, is recommended treatment.

In some instances of diagnosing a sleep disorder, a physician may order a polysomnography, or a sleep study.

Cognitive behavioral therapy can be a treatment for some sleep disorders, said Gates, and a therapist may focus on changing false beliefs and attitudes about sleep. One of these might be that everyone needs at least eight hours of sleep, she said.

Music therapy can be another way to treat a lack of sleep.

“Choose music you are familiar with,” Gates said.

She said the music should have a slow and stable rhythm with low-frequency tones and relaxing melodies.

“Try out different genres, like classical or acoustic, to find what works for you.”

View a WVUA report on Gates’ lecture here:

Robinson, in his talk about adapted athletics, said the number of adapted athletes is rising. In the 1960 Summer Paralympic Games in Rome, 400 athletes came from 23 countries. In 2016, 4,316 athletes came to Rio from 159 countries.

The International Paralympic Committee assigns points to athletes based on their impairments. The classification systems differ by sport and are developed to govern the sport. Players are allocated points based on an evaluation by the International Paralympic Committee.

A lower score indicates a more severe activity limitation than a higher score. A team is not allowed to have more than a certain maximum sum of points on the field of play at the same time in order to ensure equal competition with the opposing team.

As time progresses, a disability may get worse, so a player can be reviewed again.

“Disabilities are evolving,” said Robinson. “It’s important to have this avenue to challenge their disability, especially if it’s progressive.”

Robinson, also spoke about the Alabama Adapted Athletics Program, which was started in 2003 by husband and wife Brent Hardin and Margaret Stran. Though the program received an initial funding of only $5,000 from the Christopher Reeve Foundation, it now operates off an annual budget of $450,000, offers six full scholarships and supports five sports: women’s and men’s basketball, tennis, rowing and golf.

Resident speaks about hypertension at Mini Medical School

One in three adults in America has hypertension, according to the US Centers for Disease Control and Prevention. However, hypertension can be treated with lifestyle modifications and medications, said Dr. Brittney Anderson, a third-year resident physician at The University of Alabama Family Medicine Residency.

Dr. Brittney Anderson, third-year resident at The University of Alabama Family Medicine Residency

Dr. Brittney Anderson, third-year resident at The University of Alabama Family Medicine Residency

Anderson provided a presentation on hypertension on Nov. 3 as part of the Mini Medical School program conducted by the UA College of Community Health Sciences in collaboration with UA’s OLLI program.

Mini Medical School lets adults and community learners explore trends in medicine and health, and the lectures by CCHS faculty and residents provide information about issues and advances in medicine and research. OLLI, short for the Osher Lifelong Learning Institute, is a member-led program catering to those aged 50 years and older and offers education courses as well as field trips, socials, special events and travel.

Anderson started her presentation by illustrating hypertension, or high blood pressure.

“Think of it the way you would think of pressure from a water hose. What would alter that pressure? The size of the hose, and what the fluid in the hose is having to overcome,” she said.

Cholesterol buildup, for instance, can inhibit blood from moving at a normal pressure through blood vessels, she said.

Diagnosing hypertension starts with an accurate blood pressure reading, which can sometimes be challenging due to faulty or inaccurate measuring cuffs or other factors with the patient and environment, Anderson said.

She offered tips for an accurate blood pressure reading. First, be at your calmest—don’t worry about engaging in conversation. Second, support your back and feet, and keep your legs uncrossed. Third, empty your bladder so that it doesn’t affect your body’s stress level. And fourth, keep your arm supported at your heart level and make sure the cuff is over your bare arm (and not your clothes).

If patients are using an automated cuff for measuring blood pressure at home, the physician may ask that it be brought in for the exam to compare, Anderson said.

Normal blood pressure less than 120 mm Hg systolic and less than 80 mm Hg diastolic. Prehypertension is between 120-139 mm Hg systolic and 80-89 mm Hg diastolic. When the systolic reads 140-159 mm Hg, and diastolic reads 90-99 mm Hg, the patient may be diagnosed as Hypertension Stage 1. Hypertension Stage 2 is when the systolic is 160 mm Hg or higher, and the diastolic reading is 100 mm Hg or higher. A Hypertensive Crisis, which requires emergency intervention, is when the systolic is read at higher than 180 mm Hg and higher than 110 mm Hg diastolic.

If a patient has an elevated blood pressure reading of greater than or equal to 180/110 mm Hg, then the diagnosis is clearly hypertension, Anderson says.

“But if not, then we have to do some more digging,” she said. It could be that the patient suffers from “white coat hypertension,” which means the patient is nervous simply from being in the doctor’s office. Patients in that case would be asked to wear an ambulatory blood pressure cuff 24 hours a day for a few days for an accurate measurement.

Or, if a patient is diabetic, it causes damage to blood vessels. That means that if a reading is greater than 130/80 mm Hg and the patient is diabetic, then it is a diagnosis of hypertension.

There are risk factors that lead to hypertension, Anderson said. Primary risk factors include age, obesity, family history, race, diet and exercise and alcohol use. Secondary risk factors include medicines (like decongestants, birth control and steroids), illicit drugs, sleep apnea and renal disease.

Hypertension can be treated through lifestyle modifications, like weight loss, adopting an eating plan, adding physical activity and reducing alcohol and sodium intake, Anderson said. There are many medications, too. Thiazides, ACE inhibitors and calcium channel blockers are some of the most common.