Information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease.

Hypertension, or high blood pressure is a major problem throughout the world, and especially in West Virginia. High blood pressure affects approximately 50 million Americans, which equals about one in every four adults. As the population ages, the number of people with high blood pressure is expected to increase. Heart disease, stroke, heart failure, and kidney damage can result from blood pressure that is too high. Blood pressure and heart disease events have a direct relationship. This means that the higher a person’s blood pressure is, the higher the chances are of a heart attack or a stroke.

New advances are constantly being made in understanding and treatment of high blood pressure. It is now known that individuals who have normal blood pressure at age 55 have a 90 percent chance of developing high blood pressure at some point in life. Damage to arteries can occur at blood pressure levels that were once considered normal and optimal. Recent studies show that the risk of death from heart disease and stroke begins to rise at blood pressures as low as 115 over 75. High blood pressure may cause harm long before people know they have a blood pressure problem, or receive treatment.

New guidelines from the National Heart, Lung, and Blood Institute will be released later this fall concerning blood pressure. The guidelines, which are called JNC 7, cover prevention, detection, and treatment of high blood pressure. Many items have been addressed in the new guidelines, including new blood pressure categories, new treatment strategies, and new diagnosing steps for high blood pressure.

One of the major changes in the new guidelines is lower blood pressure definitions. In the old guidelines, optimal blood pressure was less than 120 over 80, and normal blood pressure was less than 130 over 85. The new guidelines change optimal blood pressure to 115 over 75, and normal blood pressure to less than 120 over 80. A new category called prehypertension is added to the new guidelines. By definition, this category says blood pressure in the range of 120-139 over 80-89 is "prehypertensive", or pre-high blood pressure. The guidelines say that people in this category do not need medication, unless another medical condition is present like diabetes or kidney disease. Goal blood pressure for people with high blood pressure is still less than 140 over 90 unless diabetes or kidney disease is present, then the goal is less than 130 over 80.

The new guidelines also address treatment issues regarding high blood pressure. The report says that individuals in the prehypertensive category do not need medications yet, but are strongly encouraged to make lifestyle changes. These changes can include losing weight, exercising, limiting alcohol intake, and eating healthier, including limiting salt intake. The guidelines now say that diuretics, either alone or in combination with other drugs, should be a part of most people’s treatment plan.

With new information available and the new guidelines being released, it is very important for people to closely monitor their blood pressure. As the new guidelines show, harm can occur from high blood pressure before a person knows they have a blood pressure problem. This is why it is never too early, or too late, to start keeping an eye on your blood pressure.

If you have diabetes, taking care of your feet is very important. Many people with diabetes have problems with their feet. High blood sugar damages the nerves and blood vessels. This means that your feet may not be getting the proper blood supply. This can cause cramps in the feet, the feet to turn reddish, and sores and other injuries to your feet to not heal fast. The body cannot fight off infections in your feet either. The poor circulation will cause you to have less feeling in your feet. When you have less feeling in your feet, you could step on something sharp and cut your foot and not even realize it. The sore will not heal quickly and this gives you a greater chance of getting an infection in your feet. Since the infection cannot be fought off, this could lead to you having to get your foot or even your whole leg taken off. Make sure your doctor checks your feet every time you see him or her.

Your feet should be cleaned each day. They should be cleaned with a soft brush, warm water (not hot), and mild soap. Make sure the brush is not too hard because you do not want to scrape your feet and cut them. Do not soak your feet either because this puts you at a higher risk of getting an infection. Do not forget to clean in between your toes. After washing your feet, put some unscented powder on your feet to dry them. If your feet become too dry, put some lotion on them. Do not put lotion in between your toes because there is enough wetness there naturally and it will put you at risk for infection.

Keeping your toenails trimmed is also important. Always cut your toenails straight across, but do not cut them too short where they will hurt or bleed. It may be easier to cut them after taking a bath or shower because they will be softer then. Make sure that the water you use when taking a bath is not too hot or too cold. File down the sharp edges. Do not cut or tear your cuticles because they protect your nails.

You should check your feet every day for cuts, blisters, or sores. Have someone help you to look at the bottom of your feet or use a mirror. If you do get a small cut, clean it well with soap and water and peroxide. Watch for signs of infection like redness, pus, soreness, and swelling. If it is not healing, call your doctor. Never treat corns, bunions, calluses, blisters, or ingrown toenails yourself. See your doctor right away. If your feet are cold at night, wear lose socks to bed. Do not use hot water bottles, heating pads, Epsom salts, or heating lamps near your feet.

Picking the right socks and shoes for your feet is important. It is important not to ever go barefoot because you may cut your foot. Wear only cotton or wool socks with shoes. Do not wear stretch socks, garters, or socks that have holes in them. Your shoes should fit correctly with enough room for your toes to wiggle. Do not wear pointed or open-toed shoes like sandals. Break in new shoes slowly to avoid getting blisters and ulcers. When you first wear them, only wear them for one hour or so. Each time you wear them, increase the time you wear them by one hour. It make take a few weeks the break them in. Make sure to look inside your shoes every time before you put them on to ensure that nothing has fallen in them that will cut your feet.

So, if you have diabetes, there are certain things you must do to keep your feet in good shape. Look at your feet every day. Wash them with a soft brush and powder them. If they are dry, put lotion on them, but remember not to put it between your toes. Look inside your shoes before you put them on. If there are problems with your feet that are not going away, see your doctor. Following these simple steps will help you keep your feet healthy.

Jason Price, Pharm D Candidate

June 2003