Isolated systolic hypertension : Remember that the systolic blood pressure is the top number in the blood pressure reading and represents the pressure in the arteries as the heart contracts and pumps blood into the circulation. A systolic blood pressure that is persistently higher than 140 mm Hg is usually considered elevated, especially when associated with an elevated diastolic pressure (over 90). Isolated systolic hypertension, however, is defined as a systolic pressure that is above 160 mm Hg with a diastolic pressure that still is below 90. This disorder primarily affects older people and is characterized by an increased (wide) pulse pressure. The pulse pressure is defined as the difference between the systolic and diastolic blood pressures. An elevation of the systolic pressure without an elevation of the diastolic, as occurs in isolated systolic hypertension, therefore, increases the pulse pressure. Once considered to be harmless, an elevation of the pulse pressure is now thought to lead to future health problems. In other words, a high pulse pressure is considered an important precursor or indicator of potential end-organ damage. Thus, an isolated systolic hypertension is associated with a 2 to 4 times increased future risk of an enlarged heart, a heart attack (myocardial infarction), a stroke (brain damage), and death from heart disease or a stroke. Clinical studies in patients with isolated systolic hypertension have indicated that a reduction in systolic blood pressure by at least 20 mm to a level below 160 mm Hg reduces these increased risks.

How can we manage stress : If we think about the causes of stress, the nature of the stress response, and the negative effects of some types of stress (prolonged, unexpected, unmanageable), several healthy management strategies become clear. First, exercise. You see, since the stress response prepares us to fight or flee, our bodies are primed for action. Unfortunately, however, we usually handle our stresses while sitting at our desk, standing at the water cooler, or behind the wheel stuck in traffic. Exercise on a regular basis helps to burn off and use up the stress hormones and neurochemicals. Thus, exercise can help avoid the damage to our health that prolonged stress can cause. In fact, studies have found that exercise is a potent anti-depressant, anxiolytic (combats anxiety), and sleeping pill for many people, without taking any pills. Elimination of drug use and no more than moderate alcohol use are key to the successful management of stress. We know that people, when stressed, seek these outlets. But, we also know that many of these substances sensitize (make even more responsive) the stress response. As a result, small problems produce big surges of stress chemicals. What's more, these attempts with drugs and alcohol to mask stress often prevent the person from facing the problem directly. Consequently, they are not able to develop effective ways to cope with or eliminate the stress. In fact, even prescription drugs for anxiety, such as diazepam (Valium), lorazepam (Ativan), or alprazolam (Xanax), can be counterproductive in the same way. Therefore, these medications should only be used cautiously under the strict guidance of a physician. If, however, stress produces a full blown psychiatric problem, like posttraumatic stress disorder (PTSD), clinical depression, or anxiety disorders, then psychotropic medications, particularly the SSRIs, are extremely useful. Examples of the SSRI (selective serotonin reuptake inhibitor) medications include sertraline (Zoloft), paroxetine (Paxil), or fluoxetine (Prozac). We know that chronic or uninterrupted stress is very harmful. It is important, therefore, to take breaks and decompress. Take lunch and don't talk about work. Take a walk instead of a coffee break. Use weekends to relax and don't schedule so many events that Monday morning will seem like a relief. Learn your stress signals. Take regular vacations, or even long weekends or mental health days, at intervals that you have learned are right for you.