Blood pressure is usually reported with a top and bottom number-specifically, the systolic blood pressure is reported first over the diastolic pressure. Don’t be put off by the terminology. What it stands for is simple enough. The systolic blood pressure-that is, the top number-measures the pressure in the arteries when the heart is beating-that is, contracting. The diastolic blood pressure-the bottom number-measures the pressure of the blood in the arteries when the heart is relaxed. Your doctor will tell you that you have hypertension (high blood pressure) if the top number (systolic) is greater than 140 or the bottom number (diastolic) is greater than 90. Of the risk factors that threaten African American patients hypertension is the most common and the most severe. The upside is that it is treatable. To ignore it is to buy serious trouble

In this case, trouble comes in several forms. The first is coro nary artery disease itself. As you know, that means the arterie. around the heart are plugged up. The second is congestive hea-: failure, which means that the heart is overworked and thereforweak. And the third, most sadly, is stroke If high blood pressure is treated aggressively and not ignored, the risk of coronary artery disease, congestive heart failure, or stroke is greatly decreased. This may be the most important medical fact in this book, so let us repeat it: Controlling your blood pressure greatly decreases your risk of suffering coronary disease.

Failure to treat high blood pressure will eventually lead to damage to, and weakening of, the walls of the arteries. These weakened and damaged arterial walls eventually narrow and become clogged with cholesterol, fats, red blood cells, and platelets. Instead of a smooth stream bed, picture a fast-flowing stream whose bed is cluttered with rocks and debris torn loose from the banks and tumbled by the torrent. Bad arteries resemble this type of stream. The higher the blood pressure, the more likely the walls have become damaged, and that damage, with its debris, leads to blood clots and closing of the arteries.
Even mild hypertension needs to be treated. Sometimes that treatment means you need to change your ways-eating differently, cutting down on salt, alcohol, and other substances that make hypertension worse. Sometimes treatment means medicine. But the fact is that hypertension rarely goes away by itself. It’s your body’s way of saying you need to change your life. We take up this discussion in more detail.
Let’s add a word here about congestive heart failure (CHF) and strokes, the other two possible consequences of hypertension. CHF means that the heart is not pumping effectively. Because it is weak, it can’t push blood out of itself in an efficient way and has to work overtime. It must pump more frequently and harder to supply blood and oxygen to the brain. This condition leads to a heart that is overworked and enlarged. Untreated, CHF eventually leads to complete heart failure.
The last of the three major forms of heart trouble is stroke.The carotid arteries carry blood to the brain. If the blood pressure in these carotid arteries is high, the artery walls become weakened and start to close, reducing the oxygen flow to the brain. This decrease of blood flow and oxygen to the brain leads to ministrokes (TIAs or transischemic attacks) or full-blown strokes. And because there’s a decrease or stoppage of the blood flow to the brain, the brain itself dies.High blood pressure is more common in American’ than in whites and is a leading cause of early morbidity and mortality in the African American population. It doesn’t have to be that way. All that’s necessary is that we pay attention to what the body tells us and that we know how to get the right treatment.

Recognizing the symptoms of CAD is the first step toward curing it. In Reverend Johnson’s case, these symptoms included:
•    Rapid pounding of his heart
•    Shortness of breath
•    Pain or pressure located in the center of his chest, sometimes spreading to the arms, back, or jaw
Other symptoms include:
•    Swelling of the legs
•    Fainting spells
•    Nausea and vomiting

But even before symptoms are apparent, there’s a way of anticipating them. Doctors call such signs risk factors–preconditions that make it likely that someone may have a heart attack. Here’s a list of risk factors, in a descending order of urgency (which doesn’t mean that any should be ignored):

1.    High cholesterol levels (In chapter 12 we talk about the distinction between “good” cholesterol [HDL] and “bad” cholesterol [LDL]. For the time being, when we say “cholesterol,” we mean bad cholesterol.)

3.    High fat content in diet (see chapters 12 and 13), which may lead to high cholesterol levels and to still another risk factor-that is,
4.    Excess weight and diabetes
5.    Smoking
6.    Advanced age
7.    Family history of heart disease
8.    Lack of exercise
9.    Excessive alcohol use

Look these over. Only two of the risk factors are totally beyond our control. We cannot avoid aging (except by the worse alternative), and we can’t unwrite our genetic makeup. We can watch what we eat, we can exercise, and thus lower our blood pressure, and we certainly can stop smoking or, even better, never begin. These aren’t lifestyle matters-they’re matters of life and death.
Before we discuss symptoms further in chapter 2, we want to say a few words about hypertension-high blood pressurebecause it’s the most dangerous risk factor, especially for African Americans. Elevated blood pressure, no matter how mildly elevated, is likely to result in coronary artery disease. It is one of the body’s early warning systems.

Because we’ll return often to the way the heart works when it’s well and doesn’t work when it’s damaged, here’s an anatomy lesson about the heart and the circulation system that feeds and flows from it.
You know that the heart is a muscle-the muscle. Like all muscles it needs oxygen-enriched blood to function effectively. Deprived of blood, the heart, like any other muscle, suffers. That suffering can be more or less extreme. If the blood flow is decreased so that the heart starves for blood but is still sufficiently alive to function, the condition is called ischemia, which simply means a deficiency of blood flow. The more extreme case of heart attack, or myocardial infarction, means that the flow of blood has been so impaired that the heart, literally starving for blood, is dying.
Now let’s look at this in a little more detail. The heart is divided into four chambers: two upper chambers and two lower ones. The upper chambers are called the right atrium and the left atrium. The lower chambers are the right ventricle and the left ventricle. Blood enters the heart through the right atrium. All the blood in the body, from the tip of your toes to the top of your head, usually passes through the right atrium.
From the right atrium, it passes to the right ventricle, the second chamber, where it is pumped into the pulmonary arteries that channel the blood up into the lungs. When we breathe, we take in oxygen that is delivered to the blood pumped from the right ventricle into our lungs. Once that blood, now enriched with oxygen, is ready to leave the lungs, it goes into the third chamber called the left atrium, and from there it goes to the left ventricle. That fourth chamber has the crucial function of pumping the blood into the aorta-the major blood vessel coming off the heart that supplies blood to every other artery in the body.

The aorta, because it feeds all these secondary arteries, is responsible for supplying the oxygen-rich blood and nutrients to every organ of the body. It does this by means of branches, the aorta resembling the trunk. The branches, or arteries, feed our muscles, tissues, and organs. This is possible through a system of capillaries, which are narrower tubes that transfer blood from the organs to their destinations. It is from the capillaries that the muscles, tissues, and organs extract the oxygen and nutrients they need to function properly.

Once that extraction has occurred, the blood travels from capillaries into veins. These veins carry the blood to the larger veins called the superior vena cava and the inferior vena cava. And, if you get the gist, you’ll have guessed that those large veins carry the blood back to the first chamber of the heart, the right atrium, where the process begins again.

To review, blood already drained of oxygen and nutrients comes into the heart, where it is resupplied with oxygen, then pumped through the left atrium to the left ventricle, and out through a major highway of the heart-that is, the major artery-called the aorta. The aorta disperses blood throughout the body and into small sidestreets (also called arteries) that deliver blood, by way of capillaries, to the tissues, muscles, and organs. There, the oxygenated nutrients are extracted and the blood is carried through the veins back to the right side of the heart.

There are two last details: first, coming off the aorta are two arteries-the right coronary artery and the left coronary artery. An Introduction to Coronary Artery Disease 11 As their names indicate, the right coronary artery supplies the right side of the heart with blood and the left coronary artery supplies the left side of the heart with blood. When these arteries become clogged, the result can be angina or a heart attack. Second, as the drawing makes clear, the aorta divides into two other arteries called the carotid arteries. When the carotid arteries become blocked, the result will be a stroke.
The good news is that not all, or even most, heart attacks are fatal. If you suffer one, you have a good chance of recovery if you get prompt and appropriate treatment. But, as with other problems, this one is far better nipped in   fi II  Once there has been a heart attack, even if it isn’t fatal, damage has been done to the heart itself, and repair of, and recovery from, that damage is far more difficult than taking preventive measures to avoid the problem. As to the chances of recovering from a stroke, fully or partially, that depends on how much damage was done. The more serious the stroke, the more likelihood of coma or death. In the case of minor strokes, the chance for recovery is good.

•    One in five males and females have some form of CVD .

•    One in three men can expect to develop some major cardiovascular disease before age sixty; the odds for women are one in 10.5.

More than 2,600 Americans die each day of CVD-an average of one death every 33 seconds.

•    CVD claims more lives each year than the next seven leading causes of death combined.

•    Since 1900, CVD has been the number one killer in the United States in every year but one (1918).

•    Currently, 69 million Americans suffer from cardiovascular disease.
•    This year, 1.5 million people will have heart attacks.

There will be 500,000 deaths among these 1.5 million people.

What happened to Reverend Johnson could obviously have happened to anyone-male or female, black or white. It happens to 2,600 Americans every day, one death every 33 seconds.

Statistics give us the context, but people are more interesting than numbers. So let’s take a closer look at what actually happened to Asa Johnson. If Reverend Johnson had seen a doctor in time, he would have learned that his pains, fatigue, and hard breathing pointed to angina. Angina is the body’s way of telling us that the heart isn’t getting the

blood it needs to function normally. And it’s marked by the kinds of discomfort Reverend Johnson suffered-that is, a feeling of heaviness, pressure, or pain in the chest, pain that sometimes spreads to the arms or neck or jaw, or radiates to the back.

Angina results from what most of us call hardening of the arteries, and what doctors call arteriosclerosis, or, more simply, coronary artery disease or just plain coronary disease. It’s not very different from the kind of plumbing problem you might experience at home when the water flow in the pipe slows or is interrupted by calcium buildup or something th rt sticks at a bend in the pipe.

In the human body, what clogs the arteries isn’t only calcium but also fat deposits. When these clogs or blockages occur in the arteries that feed the heart, because the supply of oxygen to the heart is restricted, symptoms of angina will occur. Like every other organ in the body, the heart needs blood in order to function properly. If the supply of oxygen-rich blood fails, the heart will fail. That failure may be mild or severe, but if the condition that led to the problem isn’t addressed, the heart will become less and less able to do its job, and the symptoms of angina will eventually result in a heart attack.

A heart attack occurs when small or large parts of the heart muscle die because they aren’t receiving nourishment. In extreme cases, like Reverend Johnson’s, the entire heart is affected, and the result is death.

TO BEGIN, WE MUST present some unpleasant but essential facts:

•    Coronary artery disease is the number one killer of African Americans.
•    African American men develop coronary artery disease
earlier than white men.
•    African American men with coronary artery disease are
more likely to die than white American men who suffer
from the same disease.
•    African American women with coronary artery disease
are more likely to die than white women who suffer from
the same disease.

•  African American smokers with coronary disease are at
higher risk of death than white American smokers with
coronary disease.

•    African Americans who stop smoking or control their blood pressure decrease their risk of death from coronary artery disease.
•    The more you know about coronary artery disease, the better the chances that you and your loved ones won’t be killed by it.

Not only is coronary artery disease-also known as cardiovascular disease, or CVD-the leading killer in America but if you’re African American the odds are one and a half times greater that you suffer from high blood pressure (or hypertension)-one of the leading risk factors contributing to CVD.
It doesn’t have to be this way. A lot of heart disease is pre
ventable and a lot of it is correctable. It can be stopped, or
mended, before you suffer a heart

attack that ‘will hospitalize you, and, in some cases, kill you. The fact is, what you know won’t kill you, and what you don’t, will.

Now that you’re with us, we’d like to tell you a story.
Though Reverend Asa Johnson had felt poorly for months, he hadn’t had much time to think about it. Church membership was falling off and he’d been working twice as hard as ever to turn that around. Worse, for all his efforts there hadn’t been much improvement, and some of the members were beginning to blame him.

Through all this Reverend Johnson was troubled by shortness of breath and frequent heaviness in the middle of his chest. Or he’d feel a nagging pain there that spread to his arms or sometimes to his back, and the pain didn’t seem to have any connection with what he’d been doing. Sometimes his breath came so hard he wanted to take to his bed. But when these symptoms came, he’d sigh and continue with what he was doing. “At sixtynine years old,” he’d say to himself, “a man’s got to expect a few aches and pains. Anyway, I’m a strong black man and a child of the King.” As for fatigue, well, he was working hard, but he was working for the Lord, as he’d always done and always would do. This was his life’s purpose. For twenty-five years he’d fought with all his heart for the church he served. He couldn’t afford to slow down now.
And, after all, he’d taken good care of himself all his life, he never smoked or drank, and he liked to boast, truthfully, that he’d never been sick a day in his life. Yes, he didn’t have time for much exercise and he’d put on a few pounds and, yes, his wife thought that he didn’t look well and wanted him to see his doctor. But he shook off her insistence, though with his usual patience. Sure, he would go in for an examination, he promised her over coffee one Tuesday morning-he’d go just as soon as he got this trouble at the church settled. She shook her head and said nothing. His health worried her, but he’d never been a man you could talk much sense into about such things.
The next day Reverend Johnson met with his board of directors and the Deacons of his church, hoping that together they could agree on the plan to increase membership that he’d been up several nights thinking and worrying about. So strong was this hope that just before the meeting Reverend Johnson had whis pered to himself: “Jesus, stay with me.” But twenty minutes into the meeting some of the deacons were fidgeting uneasily. The reverend looked sick. Once he bit his lip, as if he were fighting to keep something back, and his breathing became more and more difficult. Then, as Reverend Johnson, with obvious effort, came to the end of an eloquent appeal for his plan, suddenly and without a sound he fell hard to the floor, unconscious.

He died forty-five minutes later in the emergency room of the community hospital. He’d suffered a massive heart attack.