Blood Pressure Medicines

What is high blood pressure?

High blood pressure, also called hypertension, is when blood puts too much pressure against the walls of your arteries. Almost half of American adults have high blood pressure, usually with no symptoms. But it can cause serious problems such as stroke, heart failure, heart attack, and kidney disease.

Healthy lifestyle changes can help reduce high blood pressure:

• Losing weight
• Being physically active
• Managing stress
• Reducing sodium in your diet
• Avoiding alcohol, tobacco, and illegal drugs
• Getting enough sleep

Sometimes lifestyle changes alone cannot control or lower your high blood pressure. In that case, your health care provider may prescribe blood pressure medicines.

The most commonly used blood pressure medicines work in different ways to lower blood pressure:

• Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) keep your blood vessels from narrowing as much and allows blood to move through them with less pressure.
• Beta blockers help your heart beat slower and with less force. This means that your heart pumps less blood through your blood vessels. Beta blockers are typically used only as a backup option or if you also have certain other conditions.
• Calcium channel blockers prevent calcium from entering the muscle cells of your heart and blood vessels. This allows the blood vessels to relax.
• Diuretics remove extra water and sodium (salt) from your body. This lowers the amount of fluid in your blood. Diuretics are often used with other high blood pressure medicines, sometimes in one combined pill.

Often, two or more medicines work better than one. If these medicines do not lower your blood pressure enough, your provider may suggest that you take another type of blood pressure medicine.

While taking the medicines, it is still important to keep up with your healthy lifestyle changes. Doing both helps keep blood pressure lower than lifestyle changes or medicines alone.

NIH: National Heart, Lung, and Blood Institute

Brachial Plexus Injuries

The brachial plexus is a network of nerves that sends signals from the spine to the shoulder, arm, and hand. Damage to the brachial plexus can cause symptoms such as:

• A limp or paralyzed arm
• Lack of muscle control in the arm, hand, or wrist
• Lack of feeling or sensation in the arm or hand

Brachial plexus injuries can happen because of shoulder trauma, tumors, or inflammation. Sometimes they happen during childbirth when a baby's shoulders become stuck during delivery and the nerves stretch or tear.

Some brachial plexus injuries may heal without treatment. Many children who are injured during birth improve or recover by 3 to 4 months of age. Treatment includes physical therapy and, in some cases, surgery.

NIH: National Institute of Neurological Disorders and Stroke

Chagas Disease

What is Chagas disease?

Chagas disease, or American trypanosomiasis, is an illness that can cause serious heart and stomach problems. It is caused by a parasite. Chagas disease is common in Latin America, especially in poor, rural areas. It can also be found in the United States, most often in people who were infected before they moved to the U.S.

Chagas disease is caused by the Trypanosoma cruzi parasite. It is usually spread by infected blood-sucking bugs called triatomine bugs. They are also known as "kissing bugs" because they often bite people's faces. When one of these bugs bites you, it leaves behind infected waste. You can become infected if you rub the waste in your eyes or nose, the bite wound, or a cut.

Chagas disease can also spread through contaminated food, a blood transfusion, a donated organ, or from the pregnant parent to the baby during pregnancy.

Kissing bugs can be found throughout the Americas, but they are more common in certain areas. The people who are most at risk for Chagas disease:

• Live in rural areas of Latin America
• Have seen the bugs, especially in those areas
• Have stayed in a house with a thatched roof or with walls that have cracks or crevices

In the beginning, there may be no symptoms. Some people do get mild symptoms, such as:

• Fever
• Fatigue
• Body aches
• Headache
• Loss of appetite
• Diarrhea
• Vomiting
• A rash
• A swollen eyelid

These early symptoms usually go away. However, if you don't treat the infection, it stays in your body. Later, it can cause serious intestinal and heart problems such as:

• An serious arrhythmia (a problem with the rate or rhythm of your heartbeat) that can cause sudden death
• An enlarged heart that doesn't pump blood well
• Problems with digestion and bowel movements
• An increased chance of having a stroke

To find out if you have Chagas disease, your health care provider:

• Will do a physical exam
• Will take your medical history, including asking about your symptoms and where you have lived and traveled
• Will run a blood test for Chagas disease
• May run tests to see whether the disease has affected your intestines and heart

Medicines can kill the parasite, especially early on. You can also treat related problems. For example, a pacemaker can help with some heart complications.

There are no vaccines or medicines to prevent Chagas disease. If you travel to areas where it occurs, you are at higher risk if you sleep outdoors or are staying in poor housing conditions. It is important to use insecticides to prevent bites and practice food safety.

Centers for Disease Control and Prevention

Chiari Malformation

Chiari malformations (CMs) are structural defects in the cerebellum. The cerebellum is the part of the brain that controls balance. With CM, brain tissue extends into the spinal canal. It can happen when part of the skull is too small, which pushes the brain tissue down. There are several types of CM. One type often happens in children who have neural tube defects. Some types cause no symptoms and don't need treatment. If you have symptoms, they may include:

• Neck pain
• Balance problems
• Numbness or other abnormal feelings in the arms or legs
• Dizziness
• Vision problems
• Difficulty swallowing
• Poor hand coordination

Doctors diagnose CM using imaging tests. Medicines may ease some symptoms, such as pain. Surgery is the only treatment available to correct or stop the progression of nerve damage.

NIH: National Institute of Neurological Disorders and Stroke

Cholesterol Levels: What You Need to Know

What is cholesterol?

Cholesterol is a waxy, fat-like substance that's found in all the cells in your body. Your body needs some cholesterol to work properly. But if you have too much of it in your blood, it can stick to the walls of your arteries and narrow or even block them. This puts you at risk of coronary artery disease and other heart diseases.

A blood test called a lipoprotein or lipid panel can measure your cholesterol levels. Before the test, you'll need to fast (not eat or drink anything but water) for 9 to 12 hours. The test gives information about your:

• Total cholesterol. This is a measure of the total amount of cholesterol in your blood. It includes both low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol.
• LDL cholesterol. LDL is often called "bad" cholesterol because it is the main source of cholesterol buildup and blockage in the arteries.
• HDL cholesterol. HDL is often called "good" cholesterol because it helps remove cholesterol from your arteries.
• Non-HDL. This number is your total cholesterol minus your HDL. Your non-HDL includes LDL and other types of cholesterol such as VLDL (very-low-density lipoprotein).
• Triglycerides. This is another type of fat in your blood that can raise the risk of heart disease, especially in women.

Cholesterol numbers are measured in milligrams per deciliter (mg/dL). Talk with your healthcare provider about what your cholesterol numbers should be. The numbers that are best for you may depend on your age, race, blood pressure, weight, family history, and more. However, here are some general guidelines showing the desirable levels (levels that are healthy for most people):

Anyone age 19 or younger:

Men age 20 or older:

Women age 20 or older:

Triglycerides are not a type of cholesterol, but they are also measured in this test. A normal triglyceride level is below 150 mg/dL. You might need treatment if you have triglyceride levels that are borderline high (150-199 mg/dL) or high (200 mg/dL or more).

When and how often you should get a cholesterol test depends on your age, risk factors, and family history. The general recommendations are:

For people who are age 19 or younger:

• The first test should be between ages 9 to 11
• Children should have the test again every 5 years
• Some children may have this test starting at age 2 if there is a family history of high cholesterol, heart attack, or stroke

For people who are ages 20 to 65:

• Younger adults should have the test every 5 years
• Men ages 45 to 65 and women ages 55 to 65 should have it every 1 to 2 years

For people older than 65::

• They should be tested every year

Many factors can affect your cholesterol levels. Some of them are things you can change:

• Diet. Saturated fat and cholesterol in the food you eat make your blood cholesterol level rise. Saturated fat is the main problem, but cholesterol in foods also matters. Reducing the amount of saturated fat in your diet helps lower your blood cholesterol level. Foods that have high levels of saturated fats include red meats, full-fat dairy products, chocolate, some baked goods, and deep-fried and processed foods.
• Weight. Being overweight or having obesity are risk factors for heart disease. They also tend to increase your cholesterol
• Lack of physical activity. Not being physically active is a risk factor for heart disease.
• Smoking. Cigarette smoking lowers your HDL cholesterol. Since HDL helps to remove cholesterol from your arteries, having a lower HDL level can contribute to a higher cholesterol level.

Some factors that you cannot change can also affect cholesterol levels, such as:

• Age. Your cholesterol levels tend to rise as you get older. Even though it is less common, younger people, including children and teens, can also have high cholesterol.
• Sex. Between ages 20 and 39, men have a greater risk of high total cholesterol than women. But after menopause, a woman's risk goes up. This happens because menopause lowers levels of female hormones that may protect against high blood cholesterol.
• Family history. Your genes partly determine how much cholesterol your body makes. High cholesterol can run in families.
• Race or ethnicity. People from certain racial or ethnic groups may have an increased risk of high cholesterol. For example, Asian Americans are more likely to have high levels of LDL cholesterol than other groups. And non-Hispanic White people are more likely than other groups to have high levels of total cholesterol.

You can lower your cholesterol through heart-healthy lifestyle changes. They include a heart-healthy eating plan, weight management, and regular physical activity.

If the lifestyle changes alone do not lower your cholesterol enough, you may also need to take medicines. There are several types of cholesterol-lowering medicines available, including statins. If you take medicines to lower your cholesterol, you still should continue with the lifestyle changes.

NIH: National Heart, Lung, and Blood Institute