Cholesterol medications: Consider the options

A healthy lifestyle is the first defense against high cholesterol. But sometimes diet and exercise aren't enough, and you may need to take cholesterol medications. Cholesterol medications may help:

• Decrease your low-density lipoprotein (LDL), the "bad" cholesterol that increases the risk of heart disease
• Decrease your triglycerides, a type of fat in the blood that also increases the risk of heart disease
• Increase your high-density lipoprotein (HDL), the "good" cholesterol that offers protection from heart disease

Your doctor may suggest a single drug or a combination of cholesterol medications. Here's an overview of benefits, cautions and possible side effects for common classes of cholesterol medications.

Brand and generic drug names	Drug class	Benefits	Cautions and possible side effects
Altoprev (lovastatin) Crestor (rosuvastatin) Lescol (fluvastatin) Lipitor (atorvastatin) Mevacor (lovastatin) Pravachol (pravastatin) Zocor (simvastatin)	Statins	Decrease LDL and triglycerides, slightly increase HDL	Constipation, nausea, diarrhea, stomach pain, cramps, muscle soreness, pain and weakness, possible interaction with grapefruit juice
Colestid (colestipol) Questran (cholestyramine) Welchol (colesevelam)	Bile acid binding resins	Decrease LDL	Constipation, bloating, nausea, gas, may increase triglycerides
Zetia (ezetimibe)	Cholesterol absorption inhibitors	Decrease LDL, slightly decrease triglycerides, slightly increase HDL	Stomach pain, fatigue, muscle soreness
Vytorin (ezetimibe/simvastatin)	Combination cholesterol absorption inhibitor and statin	Decreases LDL and triglycerides, increases HDL	Stomach pain, fatigue, gas, constipation, abdominal pain, cramps, muscle soreness, pain and weakness, possible interaction with grapefruit juice
Lofibra (fenofibrate) Lopid (gemfibrozil) TriCor (fenofibrate)	Fibrates	Decrease triglycerides, increase HDL	Nausea, stomach pain, gallstones
Niaspan (prescription niacin) Slo-Niacin (nonprescription niacin)	Niacin (vitamin B-3, nicotinic acid)	Decreases LDL and triglycerides, increases HDL	Facial and neck flushing, nausea, vomiting, diarrhea, gout, high blood sugar, peptic ulcers
Advicor (niacin/lovastatin)	Combination statin and niacin	Decreases LDL and triglycerides, increases HDL	Facial and neck flushing, dizziness, heart palpitations, shortness of breath, sweating, chills, possible interaction with grapefruit juice

Some cholesterol medications combine a statin and niacin, such as Advicor. No research studies have yet shown that taking these combination drugs lowers cholesterol any more than does taking niacin and a statin separately. However, the combination drug may be more convenient for you because it eliminates the need to take niacin and a statin separately. If you're interested in taking a combination medication, talk to your doctor.
You may have heard that the combination medication of ezetimibe and simvastatin (known collectively as Vytorin) is no more effective than is simvastatin (Zocor) by itself. If you are on this combination medication, you should continue to take it unless your doctor tells you otherwise.
Most cholesterol medications are well tolerated, but effectiveness varies from person to person. If you decide to take cholesterol medication, your doctor may recommend periodic liver function tests to monitor the medication's effect on your liver. Also remember the importance of healthy lifestyle choices. Medication can help control your cholesterol — but lifestyle matters, too.

Cholesterol-lowering supplements: Lower your numbers without prescription medication

If you're worried about your cholesterol and have already started exercising and eating healthier foods, you might wonder if adding a cholesterol-lowering supplement to your diet can help reduce your numbers. Although few natural products have been proved to reduce cholesterol, some might be helpful. With your doctor's OK, consider these cholesterol-lowering supplements and products.

Cholesterol-lowering supplement	What it does	Side effects and drug interactions	Usual suggested doses
Artichoke extract	May reduce total cholesterol and LDL, or "bad," cholesterol	May cause gas or an allergic reaction	1,800 to 1,920 milligrams a day, divided into 2 to 3 doses
Barley	May reduce total cholesterol and LDL cholesterol	None	3 grams barley oil extract or 30 grams barley bran flour a day
Beta-sitosterol (found in oral supplements and some margarines, such as Promise Activ)	May reduce total cholesterol and LDL cholesterol	May cause nausea, indigestion, gas, diarrhea or constipation May be ineffective if you take ezetimibe (Zetia), a prescription cholesterol medication	800 milligrams to 6 grams a day, divided and taken before meals, or 2 tablespoons of margarine containing beta-sitosterol a day
Blond psyllium (found in seed husk and products such as Metamucil)	May reduce total cholesterol and LDL cholesterol	May cause gas, stomach pain, diarrhea, constipation or nausea	5 grams seed husk twice a day, or 1 serving a day of products such as Metamucil
Fish oil (found as a liquid oil and in oil-filled capsules)	May reduce triglycerides	May cause a fishy aftertaste, bad breath, gas, nausea, vomiting or diarrhea May interact with some blood-thinning medications, such as warfarin (Coumadin)	2 to 4 grams a day
Flaxseed, ground	May reduce total triglycerides	May cause, gas, bloating or diarrhea May interact with some blood-thinning medications, such as aspirin, clopidogrel (Plavix) and warfarin (Coumadin)	40 to 50 grams a day, stirred into cereal or yogurt, or mixed into the batter for baked goods
Garlic extract	May reduce total cholesterol, LDL cholesterol and triglycerides	May cause bad breath or body odor, heartburn, gas, nausea, vomiting or diarrhea May interact with blood-thinning medications, such as warfarin (Coumadin)	600 to 1,200 milligrams a day, divided into 3 doses
Oat bran (found in oatmeal and whole oats)	May reduce total cholesterol and LDL cholesterol	May cause gas or bloating	Up to 150 grams of whole-oat products a day
Sitostanol (found in oral supplements and some margarines, such as Benecol)	May reduce total cholesterol and LDL cholesterol	May cause diarrhea	800 milligrams to 4 grams a day, or 4 1/2 teaspoons of margarine containing sitostanol a day

Another popular cholesterol-lowering supplement is red yeast rice. There is some evidence that red yeast rice can help lower your LDL cholesterol. However, the Food and Drug Administration has warned that the following red yeast rice products could contain a naturally occurring form of the prescription medication known as lovastatin:

• Red Yeast Rice and Red Yeast Rice/Policosanol Complex sold by Swanson Health Products Inc. and manufactured by Nature's Value Inc. and Kabco Inc.
• Cholestrix sold by Sunburst Biorganics

The presence of lovastatin in the red yeast rice products in question is potentially dangerous because there's no way for you to know what level or quality of lovastatin might be in red yeast rice.
Sometimes healthy lifestyle choices, including supplements and other cholesterol-lowering products, aren't enough. If your doctor prescribes medication to reduce your cholesterol, take it as directed while you continue to focus on a healthy lifestyle. As always, if you decide to take an herbal supplement, be sure to tell your doctor. The herbal supplement you take may interact with other medications you take.

Cholesterol: Top 5 foods to lower your numbers

1. Oatmeal, oat bran and high-fiber foods

Oatmeal contains soluble fiber, which reduces your low-density lipoprotein (LDL), the "bad" cholesterol. Soluble fiber is also found in such foods as kidney beans, apples, pears, barley and prunes.
Soluble fiber can reduce the absorption of cholesterol into your bloodstream. Five to 10 grams or more of soluble fiber a day decreases your total and LDL cholesterol. Eating 1 1/2 cups of cooked oatmeal provides 6 grams of fiber. If you add fruit, such as bananas, you'll add about 4 more grams of fiber. To mix it up a little, try steel-cut oatmeal or cold cereal made with oatmeal or oat bran.

2. Fish and omega-3 fatty acids

Eating fatty fish can be heart-healthy because of its high levels of omega-3 fatty acids, which can reduce your blood pressure and risk of developing blood clots. In people who have already had heart attacks, fish oil — or omega-3 fatty acids — reduces the risk of sudden death.
Doctors recommend eating at least two servings of fish a week. The highest levels of omega-3 fatty acids are in:

• Mackerel
• Lake trout
• Herring
• Sardines
• Albacore tuna
• Salmon
• Halibut

You should bake or grill the fish to avoid adding unhealthy fats. If you don't like fish, you can also get small amounts of omega-3 fatty acids from foods like ground flaxseed or canola oil.
You can take an omega-3 or fish oil supplement to get some of the benefits, but you won't get other nutrients in fish, like selenium. If you decide to take a supplement, just remember to watch your diet and eat lean meat or vegetables in place of fish.

3. Walnuts, almonds and other nuts

Walnuts, almonds and other nuts can reduce blood cholesterol. Rich in polyunsaturated fatty acids, walnuts also help keep blood vessels healthy.
According to the Food and Drug Administration, eating about a handful (1.5 ounces, or 42.5 grams) a day of most nuts, such as almonds, hazelnuts, peanuts, pecans, some pine nuts, pistachio nuts and walnuts, may reduce your risk of heart disease. Just make sure the nuts you eat aren't salted or coated with sugar.
All nuts are high in calories, so a handful will do. To avoid eating too many nuts and gaining weight, replace foods high in saturated fat with nuts. For example, instead of using cheese, meat or croutons in your salad, add a handful of walnuts or almonds.

4. Olive oil

Olive oil contains a potent mix of antioxidants that can lower your "bad" (LDL) cholesterol but leave your "good" (HDL) cholesterol untouched.
The Food and Drug Administration recommends using about 2 tablespoons (23 grams) of olive oil a day in place of other fats in your diet to get its heart-healthy benefits. To add olive oil to your diet, you can saute vegetables in it, add it to a marinade, or mix it with vinegar as a salad dressing. You can also use olive oil as a substitute for butter when basting meat or as a dip for bread. Olive oil is high in calories, so don't eat more than the recommended amount.
The cholesterol-lowering effects of olive oil are even greater if you choose extra-virgin olive oil, meaning the oil is less processed and contains more heart-healthy antioxidants. But keep in mind that "light" olive oils are usually more processed than extra-virgin or virgin olive oils and are lighter in color, not fat or calories.

5. Foods with added plant sterols or stanols

Foods are now available that have been fortified with sterols or stanols — substances found in plants that help block the absorption of cholesterol.
Margarines, orange juice and yogurt drinks with added plant sterols can help reduce LDL cholesterol by more than 10 percent. The amount of daily plant sterols needed for results is at least 2 grams — which equals about two 8-ounce (237-milliliter) servings of plant sterol-fortified orange juice a day.
Plant sterols or stanols in fortified foods don't appear to affect levels of triglycerides or of high-density lipoprotein (HDL), the "good" cholesterol.

Other changes to your diet

For any of these foods to provide their benefit, you need to make other changes to your diet and lifestyle.
Cut back on the cholesterol and total fat — especially saturated and trans fats — that you eat. Saturated fats, like those in meat, full-fat dairy products and some oils, raise your total cholesterol. Trans fats, which are sometimes found in margarines and store-bought cookies, crackers and cakes, are particularly bad for your cholesterol levels. Trans fats raise low-density lipoprotein (LDL), the "bad" cholesterol, and lower high-density lipoprotein (HDL), the "good" cholesterol.

High blood cholesterol

Cholesterol is found in every cell in your body. Cholesterol is used by your body to build healthy cells, as well as some vital hormones.
When you have high cholesterol, you may develop fatty deposits in your blood vessels. Eventually, these deposits make it difficult for enough blood to flow through your arteries. Your heart may not get as much oxygen-rich blood as it needs, which increases the risk of a heart attack. Decreased blood flow to your brain can cause a stroke.
High cholesterol (hypercholesterolemia) is largely preventable and treatable. A healthy diet, regular exercise and sometimes medication can go a long way toward reducing high cholesterol.

Symptoms

High cholesterol has no symptoms. A blood test is the only way to detect high cholesterol.
When to see a doctor
Ask your doctor for a baseline cholesterol test at age 20 and then have your cholesterol retested at least every five years. If your test results aren't within desirable ranges, your doctor may recommend more frequent measurements. Your doctor may also suggest you have more frequent tests if you have a family history of high cholesterol or other risk factors, like smoking or diabetes.

Causes

Cholesterol is carried through your blood, attached to proteins. This combination of proteins and cholesterol is called a lipoprotein. You may have heard of three different types of cholesterol, based on what type of cholesterol the lipoprotein carries. They are:

• Low-density lipoprotein (LDL). LDL, or "bad," cholesterol transports cholesterol particles throughout your body. LDL cholesterol builds up in the walls of your arteries, making them hard and narrow.
• Very-low-density lipoprotein (VLDL). This type of lipoprotein contains the most triglycerides, a type of fat, attached to the proteins in your blood. Like LDL cholesterol, VLDL cholesterol makes LDL cholesterol particles larger, causing your blood vessels to narrow. If you're taking cholesterol-lowering medication but have a high VLDL level, you may need additional medication to lower it because VLDL is high in triglycerides.
• High-density lipoprotein (HDL). HDL, or "good," cholesterol picks up excess cholesterol and takes it back to your liver.

Various factors within your control — such as inactivity, obesity and an unhealthy diet — contribute to high LDL cholesterol and low HDL cholesterol. Factors beyond your control may play a role, too. For example, your genetic makeup may keep cells from removing LDL cholesterol from your blood efficiently or cause your liver to produce too much cholesterol.

Risk factors

You're more likely to have high cholesterol that can lead to heart disease if you have any of these risk factors:

• Smoking. Cigarette smoking damages the walls of your blood vessels, making them likely to accumulate fatty deposits. Smoking may also lower your level of HDL, or "good," cholesterol.
• Obesity. Having a body mass index (BMI) of 30 or greater puts you at risk of high cholesterol.
• Poor diet. Foods that are high in cholesterol, such as red meat and full-fat dairy products, will increase your total cholesterol. Eating saturated fat, found in animal products, and trans fats, found in some commercially baked cookies and crackers, also can raise your numbers.
• Lack of exercise. Exercise helps boost your body's HDL "good" cholesterol while lowering your LDL "bad"cholesterol. Not getting enough exercise puts you at risk of high cholesterol.
• High blood pressure. Increased pressure on your artery walls damages your arteries, which can speed the accumulation of fatty deposits.
• Diabetes. High blood sugar contributes to higher LDL cholesterol and lower HDL cholesterol. High blood sugar also damages the lining of your arteries.
• Family history of heart disease. If a parent or sibling developed heart disease before age 55, high cholesterol levels place you at a greater than average risk of developing heart disease.

Complications

High cholesterol can cause atherosclerosis, a dangerous accumulation of cholesterol and other deposits on the walls of your arteries. These deposits — called plaques — can reduce blood flow through your arteries. If the arteries that supply your heart with blood (coronary arteries) are affected, you may have chest pain (angina) and other symptoms of coronary artery disease.
If plaques tear or rupture, a blood clot may form at the plaque-rupture site — blocking the flow of blood or breaking free and plugging an artery downstream. If blood flow to part of your heart stops, you'll have a heart attack. If blood flow to part of your brain stops, a stroke occurs.

Preparing for your appointment

To check your cholesterol levels, you'll need to have blood drawn after you've been fasting. Usually, you'll need to go without eating or drinking anything but water for nine to 12 hours before your blood draw. Because of this, it's likely your doctor will recommend you have your blood drawn early in the morning.
At your appointment, your doctor may ask if you have a family history of high cholesterol or heart disease, since high cholesterol levels can be hereditary. Have this information ready, along with any other questions you might have.

Tests and diagnosis

A blood test to check cholesterol levels — called a lipid panel or lipid profile — typically reports:

• Total cholesterol
• LDL cholesterol
• HDL cholesterol
• Triglycerides — a type of fat in the blood

For the most accurate measurements, don't eat or drink anything (other than water) for nine to 12 hours before the blood sample is taken.
Interpreting the numbers
Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood in the United States and some other countries. Canada and most European countries measure cholesterol in millimoles (mmol) per liter (L) of blood. Consider these general guidelines when you get your lipid panel (cholesterol test) results back to see if your cholesterol falls in optimal levels.

Total cholesterol (U.S. and some other countries)	Total cholesterol* (Canada and most of Europe)
Below 200 mg/dL	Below 5.2 mmol/L	Desirable
200-239 mg/dL	5.2-6.2 mmol/L	Borderline high
240 mg/dL and above	Above 6.2 mmol/L	High

LDL cholesterol (U.S. and some other countries)	LDL cholesterol* (Canada and most of Europe)
Below 70 mg/dL	Below 1.8 mmol/L	Optimal for people at very high risk of heart disease
Below 100 mg/dL	Below 2.6 mmol/L	Optimal for people at risk of heart disease
100-129 mg/dL	2.6-3.3 mmol/L	Near optimal
130-159 mg/dL	3.4-4.1 mmol/L	Borderline high
160-189 mg/dL	4.1-4.9 mmol/L	High
190 mg/dL and above	Above 4.9 mmol/L	Very high

HDL cholesterol (U.S. and some other countries)	HDL cholesterol* (Canada and most of Europe)
Below 40 mg/dL (men) Below 50 mg/dL (women)	Below 1 mmol/L (men) Below 1.3 mmol/L (women)	Poor
50-59 mg/dL	1.3-1.5 mmol/L	Better
60 mg/dL and above	Above 1.5 mmol/L	Best

Triglycerides (U.S. and some other countries)	Triglycerides* (Canada and most of Europe)
Below 150 mg/dL	Below 1.7 mmol/L	Desirable
150-199 mg/dL	1.7-2.2 mmol/L	Borderline high
200-499 mg/dL	2.3-5.6 mmol/L	High
500 mg/dL and above	Above 5.6 mmol/L	Very high

*Canadian and European guidelines differ slightly from U.S. guidelines. These conversions are based on U.S. guidelines.
LDL targets differ
Because LDL cholesterol is associated with heart disease, it's the main focus of cholesterol-lowering treatment. But it's not as simple as the chart may appear. Your target LDL number can vary, depending on your underlying risk of heart disease.
Most people should aim for an LDL level below 130 mg/dL (3.4 mmol/L). If you have other risk factors for heart disease, your target LDL may be below 100 mg/dL (2.6 mmol/L). If you're at very high risk of heart disease, you may need to aim for an LDL level below 70 mg/dL (Below 1.8 mmol/L).
So who's considered very high risk? You might be if you've had a heart attack or if you have diabetes. In addition, two or more of the following risk factors also might place you in the very high risk group:

• Smoking
• High blood pressure
• Low HDL cholesterol
• Family history of early heart disease
• Age older than 45 if you're a man, or older than 55 if you're a woman

Children and cholesterol testing
Children as young as age 2 can have high cholesterol, but not all children need to be screened for high cholesterol. The American Academy of Pediatrics recommends a cholesterol test (fasting lipid panel) for children between the ages of 2 and 10 who have a known family history of high cholesterol or premature coronary artery disease. Your child's doctor may recommend retesting if your child's first test shows he or she has normal cholesterol levels.
The American Academy of Pediatrics also recommends testing if the child's family history for high cholesterol is unknown, but the child has risk factors for high cholesterol, such as obesity, high blood pressure or diabetes.

Treatments and drugs

Lifestyle changes such as exercising and eating a healthy diet are the first line of defense against high cholesterol. But, if you've made these important lifestyle changes and your total cholesterol — and particularly your LDL cholesterol — remains high, your doctor may recommend medication.
The specific choice of medication or combination of medications depends on various factors, including your individual risk factors, your age, your current health and possible side effects. Common choices include:

• Statins. Statins — among the most commonly prescribed medications for lowering cholesterol — block a substance your liver needs to make cholesterol. This depletes cholesterol in your liver cells, which causes your liver to remove cholesterol from your blood. Statins may also help your body reabsorb cholesterol from accumulated deposits on your artery walls, potentially reversing coronary artery disease. Choices include atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Altoprev, Mevacor), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor).
• Bile-acid-binding resins. Your liver uses cholesterol to make bile acids, a substance needed for digestion. The medications cholestyramine (Prevalite, Questran), colesevelam (Welchol) and colestipol (Colestid) lower cholesterol indirectly by binding to bile acids. This prompts your liver to use excess cholesterol to make more bile acids, which reduces the level of cholesterol in your blood.
• Cholesterol absorption inhibitors. Your small intestine absorbs the cholesterol from your diet and releases it into your bloodstream. The drug ezetimibe (Zetia) helps reduce blood cholesterol by limiting the absorption of dietary cholesterol. Zetia can be used in combination with any of the statin drugs.
• Combination cholesterol absorption inhibitor and statin. The combination drug ezetimibe-simvastatin (Vytorin) decreases both absorption of dietary cholesterol in your small intestine and production of cholesterol in your liver. You may have heard reports that this combination medication is no more effective than taking simvastatin by itself. But, this small study didn't find any differences in death, hospitalization or heart attacks between the two medications. If you are on this combination medication, you should continue to take it unless your doctor tells you otherwise.

If you also have high triglycerides, your doctor may prescribe:

• Fibrates. The medications fenofibrate (Lofibra, TriCor) and gemfibrozil (Lopid) decrease triglycerides by reducing your liver's production of very-low-density lipoprotein (VLDL) cholesterol and by speeding up the removal of triglycerides from your blood. VLDL cholesterol contains mostly triglycerides.
• Niacin. Niacin (Niaspan) decreases triglycerides by limiting your liver's ability to produce LDL and VLDL cholesterol. Various prescription and over-the-counter preparations are available, but prescription niacin is preferred as it has the least side effects. Dietary supplements containing niacin that are available over-the-counter are not effective for lowering triglycerides, and may damage your liver.
• Combination niacin and statin. If your doctor recommends niacin in addition to a statin, you might want to discuss taking a medication that combines both niacin and a statin, such as Simcor or Advicor. These medications can reduce the number of pills you have to take, although no research studies have yet shown that the combination drugs lower cholesterol more than taking niacin and a statin separately.

Most of these medications are well tolerated, but effectiveness varies from person to person. The common side effects are muscle pains, stomach pain, constipation, nausea and diarrhea. If you decide to take cholesterol medication, your doctor may recommend periodic liver function tests to monitor the medication's effect on your liver.
Children and cholesterol treatment
Diet and exercise are the best initial treatment for children age 2 and older who have high cholesterol or who are obese. The American Academy of Pediatrics also recommends treatment with prescription drugs, such as statins, for children age 8 and older if a child has a high level of LDL cholesterol. However, this recommendation is controversial. The long-term effects of cholesterol-lowering drugs have not been extensively studied in children. In addition, certain cholesterol medications such as niacin are not recommended for children. Because of the disagreement in the medical community on this topic, talk to your child's doctor about the best way to lower your child's cholesterol.

Lifestyle and home remedies

Lifestyle changes are essential to improve your cholesterol level. To bring your numbers down, lose excess weight, eat healthy foods and increase your physical activity. If you smoke, quit.
Lose excess pounds
Excess weight contributes to high cholesterol. Losing even 5 to 10 pounds of excess weight can help lower total cholesterol levels. Start by taking an honest look at your eating habits and daily routine. Consider your challenges to weight loss - and ways to overcome them.
Eat heart-healthy foods
What you eat has a direct impact on your cholesterol level. In fact, researchers say a diet rich in fiber and other cholesterol-lowering foods may help lower cholesterol as much as statin medication for some people.

• Choose healthier fats. Saturated fat and trans fat raise your total cholesterol and LDL cholesterol. Get no more than 10 percent of your daily calories from saturated fat. Monounsaturated fat — found in olive, peanut and canola oils — is a healthier option. Almonds and walnuts are other sources of healthy fat.
• Eliminate trans fats. Trans fats, which are often found in margarines and commercially baked cookies, crackers and snack cakes, are particularly bad for your cholesterol levels. Not only do trans fats increase your total LDL "bad" cholesterol, but they also lower your HDL "good" cholesterol.
  You may have noticed more food labels now market their products as "trans fat-free." But don't rely only on this label. In the United States, if a food contains less than 0.5 grams of trans fat a serving, it can be marked trans fat-free. It may not seem like much, but if you eat a lot of foods with a small amount of trans fat, it can add up quickly. Instead, read the ingredients list. If a food contains a partially hydrogenated oil, that's a trans fat, and you should look for an alternative.
• Limit your dietary cholesterol. Aim for no more than 300 milligrams (mg) of cholesterol a day — or less than 200 mg if you have heart disease. The most concentrated sources of cholesterol include organ meats, egg yolks and whole milk products. Use lean cuts of meat, egg substitutes and skim milk instead.
• Select whole grains. Various nutrients found in whole grains promote heart health. Choose whole-grain breads, whole-wheat pasta, whole-wheat flour and brown rice. Oatmeal and oat bran are other good choices.
• Stock up on fruits and vegetables. Fruits and vegetables are rich in dietary fiber, which can help lower cholesterol. Snack on seasonal fruits. Experiment with veggie-based casseroles, soups and stir-fries.
• Eat heart-healthy fish. Some types of fish — such as cod, tuna and halibut — have less total fat, saturated fat and cholesterol than do meat and poultry. Salmon, mackerel and herring are rich in omega-3 fatty acids, which help promote heart health.
• Drink alcohol only in moderation. In some studies, moderate use of alcohol has been linked with higher levels of HDL cholesterol — but the benefits aren't strong enough to recommend alcohol for anyone who doesn't drink already. If you choose to drink, do so in moderation. This means no more than one drink a day for women, and one to two drinks a day for men.

Exercise regularly
Regular exercise can help improve your cholesterol levels. With your doctor's OK, work up to 30 to 60 minutes of exercise a day. Take a brisk daily walk. Ride your bike. Swim laps. To maintain your motivation, keep it fun. Find an exercise buddy or join an exercise group. And, you don't need to get all 30 to 60 minutes in one exercise session. If you can squeeze in three to six 10-minute intervals of exercise, you'll still get some cholesterol-lowering benefits.
Don't smoke
If you smoke, stop. Quitting can improve your HDL cholesterol level. And the benefits don't end there. Just 20 minutes after quitting, your blood pressure decreases. Within 24 hours, your risk of a heart attack decreases. Within one year, your risk of heart disease is half that of a smoker's. Within 15 years, your risk of heart disease is similar to that of someone who's never smoked.

Alternative medicine

Few natural products have been proved to reduce cholesterol, but some might be helpful. With your doctor's OK, consider these cholesterol-lowering supplements and products:

• Artichoke
• Barley
• Beta-sitosterol (found in oral supplements and some margarines, such as Promise Activ)
• Blond psyllium (found in seed husk and products such as Metamucil)
• Garlic
• Oat bran (found in oatmeal and whole oats)
• Sitostanol (found in oral supplements and some margarines, such as Benecol)

You may have also heard of another supplement to reduce cholesterol, red yeast rice. The Food and Drug Administration released a warning regarding three brands of red yeast rice because they were found to contain lovastatin, the active ingredient in the drug Mevacor. This can be unsafe, since there's no way to determine the quantity or quality of the lovastatin in the supplement.
If you choose to take cholesterol-lowering supplements, remember the importance of a healthy lifestyle. If your doctor prescribes medication to reduce your cholesterol, take it as directed. Make sure your doctor knows which supplements you're taking as well.

Coenzyme Q10

CoQ10 is involved with the production of energy in cells. It assists in maintaining heart health, in particular heart muscle function. CoQ10 reduces oxidation of low density lipoprotein (LDL)-cholesterol (so-called ‘bad’ cholesterol).

Features and benefits

• High dose formula 
• Soft gel capsule for improved absorption 
• CoQ10 may be of assistance in circumstances when increased energy production is desirable

How it works

Coenzyme Q10 is found naturally in the body and plays an essential role in the production of energy in all cells. As such it is important for the health of virtually all human tissues and organs. The body’s ability to synthesise CoQ10 declines with age.
The heart is one of the most active tissues in the body, and requires an adequate supply of CoQ10. CoQ10 assists in maintaining heart health, in particular heart muscle function. Low levels of CoQ10 have been found to be a contributing factor in many primary cardiovascular health problems. Research at the Baker Medical Institute in Melbourne has shown that aged heart muscle cells fed CoQ10 performed as well as younger cardiac cells.
CoQ10 inhibits the oxidation of LDL-cholesterol and may help to reduce the risk of heart disease. Cholesterol is very susceptible to free radical damage, which leads to the formation of a toxic derivative called oxidized LDL-cholesterol. It is currently understood that LDL-cholesterol is harmful to the body after it has become oxidized.

Blackmores

Active Ingredients Per Capsule         

Ubidecarenone (Coenzyme Q10) 50mg

Available in bottles of 30's and 60's 

Kordels 

 

Dosage

• CO-ENZYME Q10 30MG
• Take 1 vegicap 2-3 times daily
• CO-ENZYME Q10 60MG
• Take 1 vegicap 1-2 times daily

Pack Size

• CO-ENZYME Q10 30MG
• 30S
• CO-ENZYME Q10 60MG
• 30S

High blood pressure (hypertension)

You can have high blood pressure (hypertension) for years without a single symptom. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke.
Blood pressure is determined by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure.
High blood pressure typically develops over many years, and it affects nearly everyone eventually. Fortunately, high blood pressure can be easily detected. And once you know you have high blood pressure, you can work with your doctor to control it.

Symptoms

Most people with high blood pressure have no signs or symptoms, even if blood pressure readings reach dangerously high levels.
Although a few people with early-stage high blood pressure may have dull headaches, dizzy spells or a few more nosebleeds than normal, these signs and symptoms typically don't occur until high blood pressure has reached an advanced — even life-threatening — stage.
When to see a doctor
Unless you have symptoms of extremely high blood pressure, there's probably no need to make a special trip to the doctor to have your blood pressure checked. You'll likely have your blood pressure taken as part of a routine doctor's appointment.
Ask your doctor for a blood pressure reading at least every two years starting at age 20. He or she will likely recommend more frequent readings if you've already been diagnosed with high blood pressure, prehypertension or other risk factors for cardiovascular disease. Children age 3 and older will usually have their blood pressure measured as a part of their yearly checkups.
If you don't regularly see your doctor, but are concerned about your blood pressure, you may be able to get a free blood pressure screening at a health resource fair or other locations in your community. You can also find machines in drugstores that will measure your blood pressure for free,

Causes

There are two types of high blood pressure.
Primary (essential) hypertension
In 90 to 95 percent of high blood pressure cases in adults, there's no identifiable cause. This type of high blood pressure, called essential hypertension or primary hypertension, tends to develop gradually over many years.
Secondary hypertension
The other 5 to 10 percent of high blood pressure cases are caused by an underlying condition. This type of high blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than does primary hypertension. Various conditions and medications can lead to secondary hypertension, including:

• Kidney abnormalities
• Tumors of the adrenal gland
• Certain congenital heart defects
• Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs
• Illegal drugs, such as cocaine and amphetamines

Risk factors

High blood pressure has many risk factors. Some you can't control. High blood pressure risk factors include:

• Age. The risk of high blood pressure increases as you age. Through early middle age, high blood pressure is more common in men. Women are more likely to develop high blood pressure after menopause.
• Race. High blood pressure is particularly common among blacks, often developing at an earlier age than it does in whites. Serious complications, such as stroke and heart attack, also are more common in blacks.
• Family history. High blood pressure tends to run in families.

Other risk factors for high blood pressure are within your control.

• Being overweight or obese. The more you weigh, the more blood you need to supply oxygen and nutrients to your tissues. As the volume of blood circulated through your blood vessels increases, so does the pressure on your artery walls.
• Not being physically active. People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each contraction — and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight.
• Using tobacco. Not only does smoking tobacco immediately raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls. This can cause your arteries to narrow, increasing your blood pressure.
• Too much salt (sodium) in your diet. Too much sodium in your diet can cause your body to retain fluid, which increases blood pressure.
• Too little potassium in your diet. Potassium helps balance the amount of sodium in your cells. If you don't consume or retain enough potassium, you may accumulate too much sodium in your blood.
• Too little vitamin D in your diet. It's uncertain if having too little vitamin D in your diet can lead to high blood pressure. Researchers think vitamin D may affect an enzyme produced by your kidneys that affects your blood pressure. More studies are necessary to determine vitamin D's role in blood pressure.
• Drinking too much alcohol. Over time, heavy drinking can damage your heart. Having more than two or three drinks in a sitting can also temporarily raise your blood pressure, as it may cause your body to release hormones that increase your blood flow and heart rate.
• Stress. High levels of stress can lead to a temporary, but dramatic, increase in blood pressure. If you try to relax by eating more, using tobacco or drinking alcohol, you may only increase problems with high blood pressure.
• Certain chronic conditions. Certain chronic conditions also may increase your risk of high blood pressure, including high cholesterol, diabetes, kidney disease and sleep apnea.

Sometimes pregnancy contributes to high blood pressure, as well.
Although high blood pressure is most common in adults, children may be at risk, too. For some children, high blood pressure is caused by problems with the kidneys or heart. But for a growing number of kids, poor lifestyle habits — such as an unhealthy diet and lack of exercise — contribute to high blood pressure.

Complications

The excessive pressure on your artery walls caused by high blood pressure can damage your blood vessels, as well as organs in your body. The higher your blood pressure and the longer it goes uncontrolled, the greater the damage.
Uncontrolled high blood pressure can lead to:

• Damage to your arteries. This can result in hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications.
• Aneurysm. Increased blood pressure can cause your blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.
• Heart failure. To pump blood against the higher pressure in your vessels, your heart muscle thickens. Eventually, the thickened muscle may have a hard time pumping enough blood to meet your body's needs, which can lead to heart failure.
• A blocked or ruptured blood vessel in your brain. High blood pressure in the arteries leading to your brain can either slow the blood flow to your brain or cause a blood vessel in your brain to burst, causing a stroke.
• Weakened and narrowed blood vessels in your kidneys. This can prevent these organs from functioning normally.
• Thickened, narrowed or torn blood vessels in the eyes. This can result in vision loss.
• Metabolic syndrome. This syndrome is a cluster of disorders of your body's metabolism — including increased waist circumference, high triglycerides, low high-density lipoprotein (HDL), or "good," cholesterol, high blood pressure, and high insulin levels. If you have high blood pressure, you're more likely to have other components of metabolic syndrome. The more components you have, the greater your risk of developing diabetes, heart disease or stroke.
• Trouble with memory or understanding. Uncontrolled high blood pressure also may affect your ability to think, remember and learn. Trouble with memory or understanding concepts is more common in people who have high blood pressure.

Preparing for your appointment

No special preparations are necessary to have your blood pressure checked. You might want to wear a short-sleeved shirt to your appointment so that the blood pressure cuff can fit around your arm properly.
Because some medications — such as over-the-counter cold medicines, antidepressants, birth control pills and others — can raise your blood pressure, it might be a good idea to bring a list of medications and supplements you take to your doctor's appointment. Don't stop taking any prescription medications that you think may affect your blood pressure without your doctor's advice.

Tests and diagnosis

Blood pressure is measured with an inflatable arm cuff and a pressure-measuring gauge. A blood pressure reading, given in millimeters of mercury (mm Hg), has two numbers. The first, or upper, number measures the pressure in your arteries when your heart beats (systolic pressure). The second, or lower, number measures the pressure in your arteries between beats (diastolic pressure).
The latest blood pressure guidelines, issued in 2003 by the National Heart, Lung, and Blood Institute, divide blood pressure measurements into four general categories:

• Normal blood pressure. Your blood pressure is normal if it's below 120/80 mm Hg. However, some doctors recommend 115/75 mm Hg as a better goal. Once blood pressure rises above 115/75 mm Hg, the risk of cardiovascular disease begins to increase.
• Prehypertension. Prehypertension is a systolic pressure ranging from 120 to 139 mm Hg or a diastolic pressure ranging from 80 to 89 mm Hg. Prehypertension tends to get worse over time. Within four years of being diagnosed with prehypertension, nearly one-third of adults ages 35 to 64 and nearly half the adults age 65 or older develop high blood pressure.
• Stage 1 hypertension. Stage 1 hypertension is a systolic pressure ranging from 140 to 159 mm Hg or a diastolic pressure ranging from 90 to 99 mm Hg.
• Stage 2 hypertension. The most severe hypertension, stage 2 hypertension is a systolic pressure of 160 mm Hg or higher or a diastolic pressure of 100 mm Hg or higher.

Both numbers in a blood pressure reading are important. But after age 50, the systolic reading is even more significant. Isolated systolic hypertension (ISH) — when diastolic pressure is normal but systolic pressure is high — is the most common type of high blood pressure among people older than 50.
Your doctor will likely take two to three blood pressure readings each at two or more separate appointments before diagnosing you with high blood pressure. This is because blood pressure normally varies throughout the day — and sometimes specifically during visits to the doctor, a condition called white-coat hypertension. Your doctor may ask you to record your blood pressure at home and at work to provide additional information. Measuring your blood pressure at home can also help diagnose masked hypertension, a condition in which your blood pressure is lower than it normally is when you visit the doctor's office.
If you have any type of high blood pressure, your doctor may recommend routine tests, such as a urine test (urinalysis), blood tests and an electrocardiogram (ECG) — a test that measures your heart's electrical activity. More extensive testing isn't usually needed, at least initially.

Treatments and drugs

Your blood pressure treatment goal depends on how healthy you are.

Blood pressure treatment goals*
140/90 mm Hg or lower	If you are a healthy adult
130/80 mm Hg or lower	If you have chronic kidney disease, diabetes or coronary artery disease or are at high risk of coronary artery disease
120/80 mm Hg or lower	If your heart isn't pumping as well as it should (left ventricular dysfunction or heart failure) or you have severe chronic kidney disease

* Although 120/80 mm Hg or lower is the ideal blood pressure goal, doctors are unsure if you need treatment (medications) to reach that level.
If you're an adult age 80 or older and your blood pressure is very high, your doctor may set a target blood pressure goal for you that's slightly higher than 140/90 mm Hg.
Changing your lifestyle can go a long way toward controlling high blood pressure. But sometimes lifestyle changes aren't enough. In addition to diet and exercise, your doctor may recommend medication to lower your blood pressure. Which category of medication your doctor prescribes depends on your stage of high blood pressure and whether you also have other medical problems.
The major types of medication used to control high blood pressure include:

• Thiazide diuretics. Diuretics, sometimes called "water pills," are medications that act on your kidneys to help your body eliminate sodium and water, reducing blood volume. Thiazide diuretics are often the first — but not the only — choice in high blood pressure medications. Still, diuretics are often not prescribed. If you're not taking a diuretic and your blood pressure remains high, talk to your doctor about adding one or replacing a drug you currently take with a diuretic.
  If you're age 80 or older, a special type of thiazide diuretic, indapamide (Lozol), may be particularly effective in lowering your blood pressure. In this age group, indapamide has been shown to reduce deaths from stroke, heart failure and other cardiovascular disease causes.
  
• Beta blockers. These medications reduce the workload on your heart and open your blood vessels, causing your heart to beat slower and with less force. When prescribed alone, beta blockers don't work as well in blacks — but they're effective when combined with a thiazide diuretic.
• Angiotensin-converting enzyme (ACE) inhibitors. These medications help relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels. ACE inhibitors may be especially important in treating high blood pressure in people with coronary artery disease, heart failure or kidney failure. Like beta blockers, ACE inhibitors don't work as well in blacks when prescribed alone, but they're effective when combined with a thiazide diuretic.
• Angiotensin II receptor blockers. These medications help relax blood vessels by blocking the action — not the formation — of a natural chemical that narrows blood vessels. Like ACE inhibitors, angiotensin II receptor blockers often are useful for people with coronary artery disease, heart failure and kidney failure.
• Calcium channel blockers. These medications help relax the muscles of your blood vessels. Some slow your heart rate. Calcium channel blockers may work better for blacks than do ACE inhibitors or beta blockers alone. A word of caution for grapefruit lovers, though. Grapefruit juice interacts with some calcium channel blockers, increasing blood levels of the medication and putting you at higher risk of side effects. Talk to your doctor or pharmacist if you're concerned about interactions.
• Renin inhibitors. Aliskiren (Tekturna) slows down the production of renin, an enzyme produced by your kidneys that starts a cascade of chemical steps that increases blood pressure. Tekturna works by reducing the ability of renin to begin this process. The drug is still being studied to figure out its ideal use and dosage for people with high blood pressure.

If you're having trouble reaching your blood pressure goal with combinations of the above medications, your doctor may prescribe:

• Alpha blockers. These medications reduce nerve impulses to blood vessels, reducing the effects of natural chemicals that narrow blood vessels.
• Alpha-beta blockers. In addition to reducing nerve impulses to blood vessels, alpha-beta blockers slow the heartbeat to reduce the amount of blood that must be pumped through the vessels.
• Central-acting agents. These medications prevent your brain from signaling your nervous system to increase your heart rate and narrow your blood vessels.
• Vasodilators. These medications work directly on the muscles in the walls of your arteries, preventing the muscles from tightening and your arteries from narrowing.

Once your blood pressure is under control, your doctor may have you take a daily aspirin to reduce your risk of cardiovascular disorders.
To reduce the number of daily medication doses you need, your doctor may prescribe a combination of low-dose medications rather than larger doses of one single drug. In fact, two or more blood pressure drugs often work better than one. Sometimes finding the most effective medication — or combination of drugs — is a matter of trial and error.
Resistant hypertension: When your blood pressure is difficult to control
If your blood pressure has remained stubbornly high despite taking at least three different types of high blood pressure drugs, one of which should be a diuretic, you may have resistant hypertension. Resistant hypertension is blood pressure that's resistant to treatment. People who have controlled high blood pressure but are taking four different types of medications at the same time to achieve that control also are considered to have resistant hypertension.
Having resistant hypertension doesn't mean your blood pressure will never get lower. In fact, if you and your doctor can identify what's behind your persistently high blood pressure, there's a good chance you can meet your goal with the help of treatment that's more effective. You may need to see a hypertension specialist if your primary care doctor isn't able to pinpoint a cause. It may also be that another condition you have that you may not be aware of, such as sleep apnea or kidney problems, is causing your high blood pressure. You may need to be more aggressive in following lifestyle recommendations.
Your doctor or hypertension specialist can evaluate whether the medications and doses you're taking for your high blood pressure are appropriate. You may have to fine-tune your medications to come up with the most effective combination and doses. Your doctor may also prescribe other medications, including a more potent or longer acting diuretic if you're not already taking one. Your doctor may also suggest nonthiazide diuretic drugs, such as spironolactone (Aldactone) or eplerenone (Inspra), which change the way your body absorbs sodium and excretes potassium by blocking the hormone aldosterone. People with resistant hypertension often have higher levels of aldosterone.
In addition, you and your doctor can review medications you're taking for other conditions. Some medications, foods or supplements can worsen high blood pressure or prevent your high blood pressure medications from working effectively. Be open and honest with your doctor about all the medications or supplements you take.
If you don't take your high blood pressure medications exactly as directed, your blood pressure can pay the price. If you skip doses because you can't afford the medication, because you have side effects or because you simply forget to take your medications, talk to your doctor about solutions. Don't alter your treatment without your doctor's guidance.

Lifestyle and home remedies

Lifestyle changes can help you control and prevent high blood pressure — even if you're taking blood pressure medication. Here's what you can do:

• Eat healthy foods. Try the Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes fruits, vegetables, whole grains and low-fat dairy foods. Get plenty of potassium, which can help prevent and control high blood pressure. Eat less saturated fat and total fat.
• Decrease the salt in your diet. Although 2,400 milligrams (mg) of sodium a day is the current limit for otherwise healthy adults, limiting sodium intake to 1,500 mg a day will have a more dramatic effect on your blood pressure. While you can reduce the amount of salt you eat by putting down the saltshaker, you should also pay attention to the amount of salt that's in the processed foods you eat, such as canned soups or frozen dinners.
• Maintain a healthy weight. If you're overweight, losing even 5 pounds (2.3 kilograms) can lower your blood pressure.
• Increase physical activity. Regular physical activity can help lower your blood pressure and keep your weight under control. Strive for at least 30 minutes of physical activity a day.
• Limit alcohol. Even if you're healthy, alcohol can raise your blood pressure. If you choose to drink alcohol, do so in moderation — up to one drink a day for women and everyone over age 65, and two drinks a day for men.
• Don't smoke. Tobacco injures blood vessel walls and speeds up the process of hardening of the arteries. If you smoke, ask your doctor to help you quit.
• Manage stress. Reduce stress as much as possible. Practice healthy coping techniques, such as muscle relaxation and deep breathing. Getting plenty of sleep can help, too.
• Monitor your blood pressure at home. Home blood pressure monitoring can help you keep closer tabs on your blood pressure, show if medication is working, and even alert you and your doctor to potential complications. If your blood pressure is under control, you may be able to make fewer visits to your doctor if you monitor your blood pressure at home.
• Practice relaxation or slow, deep breathing. Do it on your own or try device-guided paced breathing. In some clinical trials, regular use of Resperate — an over-the-counter device approved by the Food and Drug Administration to analyze breathing patterns and help guide inhalation and exhalation — lowered blood pressure. However, some researchers question whether the devices themselves or simply taking 15 minutes to relax are responsible for lowering blood pressure.

Alternative medicine

Although diet and exercise are the best tactics to lower your blood pressure, some supplements also may help decrease it. These include:

• Alpha-linolenic acid (ALA)
• Blond psyllium
• Calcium
• Cocoa
• Cod-liver oil
• Coenzyme Q-10
• Omega-3 fatty acids
• Garlic

While it's best to incorporate these supplements in your diet as foods, you can also take supplement pills or capsules. Talk to your doctor before adding any of these supplements to your blood pressure treatment. Some supplements can interact with medications, causing harmful side effects.
You can also practice relaxation techniques, such as yoga or deep breathing to help you relax and reduce your stress level. These practices can temporarily reduce your blood pressure.

Coping and support

High blood pressure isn't a problem that you can treat and then ignore. It's a condition you need to manage for the rest of your life. To keep your blood pressure under control:

• Take your medications properly. If side effects or costs pose problems, don't stop taking your medications. Ask your doctor about other options.
• Schedule regular doctor visits. It takes a team effort to treat high blood pressure successfully. Your doctor can't do it alone, and neither can you. Work with your doctor to bring your blood pressure to a safe level — and keep it there.
• Adopt healthy habits. Eat healthy foods, lose excess weight and get regular physical activity. Limit alcohol. If you smoke, quit.
• Manage stress. Say no to extra tasks, release negative thoughts, maintain good relationships, and remain patient and optimistic.

Sticking to lifestyle changes can be difficult — especially if you don't see or feel any symptoms of high blood pressure. If you need motivation, remember the risks associated with uncontrolled high blood pressure. It may help to enlist the support of your family and friends as well.

Wrist blood pressure monitors

Wrist blood pressure monitors can be accurate if used exactly as directed. However, according to the American Heart Association, it's best to use a home blood pressure monitor that measures blood pressure in your upper arm. Devices for the upper arm are also easier to check for accuracy than are wrist monitors.
Wrist blood pressure monitors are extremely sensitive to body position. To get an accurate reading when taking your blood pressure with a wrist monitor, your arm and wrist must be at heart level. Even then, it's thought that because of differences in the width of the arteries in your forearm, and how deep the arteries are under your skin, blood pressure measurements taken at the wrist are usually higher and less accurate than those taken at your upper arm.
It's not uncommon for blood pressure readings taken at home on any type of monitor to be different from those taken at your doctor's office. If you have a wrist blood pressure monitor, it's a good idea to take your monitor to a doctor's appointment. Your doctor can then check your blood pressure with both a standard upper arm monitor and a wrist monitor in the correct position in the same arm to check your wrist blood pressure monitor's accuracy.

home blood pressure monitoring

Checking your blood pressure at home is an important part of managing high blood pressure (hypertension). The American Heart Association and other organizations recommend anyone with high blood pressure monitor his or her blood pressure at home. Home monitoring can help you keep tabs on your blood pressure in a familiar setting, make certain your medication is working, and alert you and your doctors to potential health complications.
Because blood pressure monitors are available widely and without a prescription, home monitoring is an easy step you can take to improve your condition. Before you get started, it's important to know the right technique and to find a good home blood pressure monitor.

Why do I need to monitor my blood pressure at home?

Monitoring your blood pressure at home offers several benefits. It can:

• Help make an early diagnosis of high blood pressure. If you have prehypertension, or another condition that could contribute to high blood pressure, such as diabetes or kidney problems, home blood pressure monitoring could help your doctor diagnose high blood pressure earlier than if you have only infrequent blood pressure readings in the doctor's office.
• Help track your treatment. Home blood pressure monitoring can help people of all ages keep track of their condition — including children and teenagers who have high blood pressure. Self-monitoring provides important information between visits to your doctor. The only way to know whether your lifestyle changes or your medications are working is to check your blood pressure regularly. Keeping track of changes can help you and your health care team make decisions about your ongoing treatment strategy, such as adjusting dosages or changing medications.
• Encourage better control. Taking your own blood pressure measurements can result in better blood pressure control. You gain a stronger sense of responsibility for your health, and you may be even more motivated to control your blood pressure with an improved diet, physical activity and proper medication use.
• Cut your health care costs. Home monitoring may cut down on the number of visits you need to make to your doctor or clinic. This can reduce your overall health care costs, lower your travel expenses and save in lost wages.
• Check if your blood pressure is different outside the doctor's office. Your doctor may suspect that your blood pressure goes up due to the anxiety associated with being at the doctor's office, but is otherwise normal — a condition called white-coat hypertension. Monitoring blood pressure at home or work, where that kind of anxiety won't cause those spikes, can help see if you have true high blood pressure or simply white-coat hypertension.
  Home and workplace monitoring may also help when the opposite occurs — your blood pressure seems fine at the doctor's office, but is elevated elsewhere. This kind of high blood pressure, sometimes called masked hypertension, is more common in women and those with cardiovascular risk factors, such as obesity, high blood cholesterol and high blood sugar.
  

Not everyone can track blood pressure at home. If you have an irregular heartbeat, home blood pressure monitors might not give you an accurate reading. In some cases, the type of monitor you use could depend on your physical condition. If you're overweight or very muscular, you'll need to find a monitor with a larger arm cuff. If you have hearing loss, a monitor with a digital display may be more suitable.
Talk to your doctor, nurse or other health care professional about whether home monitoring is a good option. Keep in mind that a family member or friend who is properly trained may be able to take blood pressure measurements for you.

Types of home monitors

Today, most pharmacies, medical supply stores, and some Internet sites sell home blood pressure monitors. All monitors have the same basic parts — an inflatable cuff or strap, a gauge for readouts, and sometimes a stethoscope, depending on the type of monitor you choose.

• Cuff. The cuff consists of an inner layer made of rubber that fills with air and squeezes your arm. The cuff's outer layer is generally made of nylon and has a fastener to hold the cuff in place.
• Gauge. Blood pressure monitors are either digital or aneroid. The aneroid monitors have a gauge with a dial on it that points at a number related to your blood pressure. Some older gauges look similar to a thermometer and contain mercury. Mercury devices should never be used in the home.
• Stethoscope. Some blood pressure monitors come with a stethoscope. It's used to listen to the sounds your blood makes as it flows through the brachial artery in the crook of your elbow. However, without proper training, it's difficult to interpret those sounds. Digital blood pressure cuffs usually have a built-in sensor that records the information for you.

There are two types of home blood pressure monitors:

• Manual devices. Manual blood pressure monitors use a stethoscope and an inflatable arm cuff connected by a rubber tube to a gauge that records the pressure. To measure your blood pressure, you inflate the cuff that goes around your arm by pumping a bulb at one end of the tube. You then check your blood pressure with a stethoscope — listening to the sounds of blood flow through the main artery in your upper arm as the pressure decreases in the cuff. Manual monitors are usually less expensive than digital monitors, but can be more difficult to use.
• Digital devices. Digital monitors have a cuff and a gauge that records the pressure. The cuff automatically inflates at the touch of a button. These devices automatically calculate heart rate and check your blood pressure by measuring the changes in the motion of your artery as the blood flows through the artery while the cuff deflates. Some even give you an error message if you aren't wearing the cuff properly. Digital monitors also deflate automatically.
  Digital monitors can be fitted on the upper arm, wrist or finger. Arm devices are the most accurate. One use for wrist monitors is for those people for whom a large upper arm cuff is too small or can't be used because of shape or pain from the pressure of the cuff when it inflates. Be sure your arm is at heart level when using a wrist monitor. Devices that measure your blood pressure at your finger are not recommended.
  

Talk over the choices with your doctor or nurse so that you pick the monitor that's best for your situation.

Blood Glucose Monitoring

If you have diabetes, blood glucose testing is a way of life. Blood glucose meters are small battery-operated devices that make it convenient for people to check their blood sugar levels anywhere. They are also smaller, faster, and require less blood than in the past.
Blood glucose meters require that you prick your finger or alternative site and put a drop of blood on a test strip that is inserted into the meter. Testing regularly allows you to look for patterns to see if your blood glucose is in a safe range. If not, a change in diet, increase exercise, or a visit to your healthcare provider for medication to lower blood sugar and your risk of complications may be needed.
Blood glucose monitoring can also tell you if your blood sugar is too low, a potentially dangerous situation that requires you to eat or drink something with 10-15 grams of carbohydrates.

How to choose your meter
 
You have probably seen many advertisements for blood glucose meters and are wondering which meter is the best one for you. Most meters are accurate in how they measure your glucose but they differ in type and number of features that they offer. The American Diabetes Association provides several tips for finding the blood glucose meter that best fits your needs and lifestyle:

• Insurance — Many health insurance companies will only pay for specific meters or have limitations on cost. Check with your insurance company to see what it will pay for and if they cover the cost of test strips.
• Budget — The cost of blood glucose testing is often a barrier to regular testing. Before buying a meter, check the cost of meter test strips, especially if your insurance does not pay for them. A meter may be the cheapest one on the market, but is not a good deal if the strips cost twice as much.
• Ease of use — Larger meter or small? Small meters are more convenient for carrying, but also require more dexterity to use. Look at the packaging for the test strips; are they easy to open? If you have vision problems, look for a meter with a larger display or voice module. Size of strips may also be a consideration, Are the strips so small that you can't get a good grip on them? You might want to consider a meter that uses cartridges instead of individual strips.
• Blood sample size — Check to see how big a blood sample is needed for blood glucose testing. Blood sample size ranges from 0.3 (amount that would fit on the head of a pin) to 4.0 microliters.
• Check during the night? — Consider a meter that has a backlight.
• Alternate site testing — Many new meters on the market today allow you to use alternate sites such as the palm or forearm for testing.
• Support — Many meter manufacturers include a toll-free number on the back of the meter or packaging that you can call for help. Look for a meter that includes clear instructions that demonstrate the correct way to use the meter.
• Smart meters — Some meters store a certain number of blood glucose results in memory. You can find meters with sophisticated data management systems that track diet and exercise as well as your blood glucose.
• Download blood glucose readings to a computer — Most meters offer the ability to download your blood glucose readings to the computer and email the test results to your doctor. However, not all companies offer software that is compatible with Apple computers. Check out compatibility with the manufacturer before you buy

Know your target range

Your doctor will set your target blood sugar range. For many people who have diabetes, target levels are:

• Fasting at least eight hours (fasting blood sugar level) — between 90 and 130 milligrams per deciliter (mg/dL) or 5 and 7 millimoles per liter (mmol/L)
• Before meals — between 70 and 130 mg/dL (4 and 7 mmol/L)
• One to two hours after meals — lower than 180 mg/dL (10 mmol/L)

Remember that your target blood sugar range may differ, especially if you're pregnant or you develop diabetes complications. Your target blood sugar range may change as you get older, too. Sometimes reaching your target blood sugar range is a challenge. But the closer you get, the better you'll feel.

You may become frustrated or obsessed if you don't have the "right numbers" or feel like a failure if your blood glucose numbers are high. Blood glucose monitoring may seem hard to do at first, but as you learn to use the results to understand your body better and manage your treatment, it will become easier. Here are some general tips:

• There's no "right" or "bad" numbers. Blood glucose testing is a tool to help you track how well your treatment plan is working.
• Strive for consistency. Eat at the same time of day and try to eat the same amount of food. What you eat, how much you eat and at what time you eat all affect your blood glucose level.
• Look for patterns in your blood glucose numbers and think about possible causes for your blood glucose patterns or changes from your usual pattern. No matter how well you're managing your diabetes, your blood glucose readings won't be perfect every time.
• You're the most important member of your health care team. Call your health care provider if problems arise or if there are major changes in your glucose test results, or if you have low blood glucose reactions for reasons you don't understand.

The blood glucose number is a reminder, if used correctly, and will help you take control of your diabetes and not allow your diabetes to take control of you. Monitoring and controlling your blood glucose delays the development of long-term complications.

A normal fasting blood glucose target range for an individual without diabetes is 70-100 milligrams per deciliter (mg/dL) or 3.9-5.6 millimoles per liter (mmol/L). The American Diabetes Association recommends a fasting plasma glucose level of 90-130 mg/dL (5.0-7.2 mmol/L) and after meals less than 180 mg/dL (10 mmol/L). The Mayo Clinic endocrinology department has 3 standardized blood glucose target ranges.
Fasting blood glucose targets:

Standard target	80-120 mg/dL (4.4-6.7 mmol/L)
Modified target	100-140 mg/dL (5.6-7.8 mmol/L)
Pregnancy target	60-100 mg/dL (3.3-5.6 mmol/L)

When to test your blood sugar

How often you test blood sugar levels depends on many factors, including the type of diabetes you have, your individual diabetes treatment plan, and how well your blood sugar is controlled.

• Type 1 diabetes. Your doctor may recommend blood sugar testing at least three times a day — perhaps before and after certain meals, before and after exercise, and before bed. You may need to check your blood sugar level more often if you're ill or you change your daily routine.
• Type 2 diabetes. If you take insulin to manage type 2 diabetes, your doctor may recommend blood sugar testing one to three times a day, depending on the number of insulin doses you take. If you manage type 2 diabetes with other medications or with diet and exercise alone, you may be able to test your blood sugar level less often.

How to test your blood sugar

Blood sugar testing requires a blood sugar monitor. Some monitors are large with easy-to-handle test strips, while others are compact and easier to carry. Some monitors track the time and date of each test, the result and trends over time. If you're unsure which blood sugar monitor is best, ask your doctor or diabetes educator for a recommendation.
To test your blood sugar, follow the instructions that come with your glucose meter. In general, here's how the process works:

1. Before pricking your finger, wash your hands with soap and warm water. Then dry them well.
2. Remove a test strip from the container and replace the cap immediately to prevent damage to the strips.
3. Insert the test strip into the meter.
4. Place the tip of the special needle (lancet) on your finger. Stick the side of your finger, not the tip, so that you won't have sore spots on the part of your finger you use the most.
5. Hold your hand down to encourage a drop of blood to form. When you have a drop of blood, carefully touch the test strip to the blood (avoid touching your skin with the test strip) and wait for a reading.
6. Within a few seconds, the meter will display your blood glucose level on a screen.

Your fingertips contain a lot of nerve endings, so make sure to rotate the sites where you stick your fingers. If you have a newer glucose meter, you'll have the option to test your blood glucose from other sites, such as your forearm or thigh. But check with your doctor or diabetes educator first to find out if alternative site testing is appropriate in your case.

Troubleshooting problems

When used correctly, you can count on your blood sugar monitor to provide accurate readings. If you think something's not right, start with the basics:

• Check the test strips. Throw out damaged or outdated strips.
• Check the monitor. Make sure the monitor is at room temperature, and the strip guide and the test window are clean. Replace the batteries in the monitor, if needed.
• Check the code number on the test strips. Some monitors must be coded to each container of test strips. Be sure the code number in the monitor matches the code number on the container of test strips.
• Check your technique. Wash your hands with soap and water before pricking your finger. Apply a generous drop of blood to the test strip. Don't add more blood to the test strip after the first drop was applied.

If you're still not sure what's wrong, do a quality control test according to the manufacturer's instructions and check the owner's manual for other troubleshooting issues. You can bring the monitor to your next doctor appointment as well.

Recording your results

Each time you perform a blood test, log your results. Record the date, time, test results, medication and dosage, and diet and exercise information in a notebook, record book or journal. Better yet, you may be able to download the information to your computer or transfer the information to a mobile device or an online tracking program. The more complete your records are, the more useful they'll be.
This information helps you see how food, physical activity, medication and other factors affect your blood glucose. As patterns occur, you can begin to understand how your daily activities affect your blood sugar levels. This puts you in a better position to manage your diabetes day by day and even hour by hour.
If your blood sugar readings are consistently higher or lower than your target range — or blood sugar extremes don't respond to adjustments in diet or medication — you may need to revise your treatment plan. In some cases, your doctor may suggest changing your diet or including more physical activity in your daily routine. If that's not effective, you may need to take medication or adjust your medication dosage.

 Diabetes and exercise
Before jumping into a fitness program, get your doctor's OK to exercise — especially if you've been inactive. Discuss with your doctor which activities you're contemplating and the best time to exercise, as well as the potential impact of medications on your blood sugar as you become more active.
For the best health benefits, experts recommend 2.5 hours a week of moderately intense physical activities. Examples include fast walking, lap swimming or bicycling. Be sure to check with your doctor to see if these recommendations are safe for you.
If you're taking insulin or medications that can cause low blood sugar (hypoglycemia), test your blood sugar 30 minutes before exercising and once again immediately before exercising. This will help you determine if your blood sugar level is stable, rising or falling and if it's safe to exercise. Consider these general guidelines relative to your blood sugar level — measured in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L).

• Lower than 100 mg/dL (5.6 mmol/L). Your blood sugar may be too low to exercise safely. Eat a small carbohydrate-containing snack, such as fruit or crackers, before you begin your workout.
• 100 to 250 mg/dL (5.6 to 13.9 mmol/L). You're good to go. For most people, this is a safe pre-exercise blood sugar range.
• 250 mg/dL (13.9 mmol/L) or higher. This is a caution zone. To make sure it's safe to exercise, test your urine for ketones — substances made when your body breaks down fat for energy.  Excess ketones indicate that your body doesn't have enough insulin to control your blood sugar. If you exercise when you have a high level of ketones, you risk ketoacidosis — a serious complication of diabetes that needs immediate treatment. Instead, wait to exercise until your urine ketones test kit indicates a low level of ketones in your urine.
• 300 mg/dL (16.7 mmol/L) or higher. Your blood sugar may be too high to exercise safely, putting you at risk of ketoacidosis. Postpone your workout until your blood sugar drops to a safe pre-exercise range. 

During exercise: Watch for symptoms of low blood sugar

During exercise, low blood sugar is sometimes a concern. If you're planning a long workout, check your blood sugar every 30 minutes during exercise — especially if you're trying a new activity or increasing the intensity or duration of your workout.
This may be difficult if you're participating in outdoor activities or sports. However, this precaution is necessary until you know how your blood sugar responds to changes in your exercise habits.
Stop exercising if:

• Your blood sugar is 70 mg/dL (3.9 mmol/L) or lower
• You feel shaky, nervous or confused

Eat or drink something to raise your blood sugar level, such as:

• Two to five glucose tablets
• 1/2 cup (118 milliliters) of fruit juice
• 1/2 cup (118 milliliters) of regular (not diet) soda
• Five or six pieces of hard candy

Recheck your blood sugar 15 minutes later. If it's still too low, have another serving and test again 15 minutes later. Repeat as needed until your blood sugar reaches at least 70 mg/dL (3.9 mmol/L). If you haven't finished your workout, continue once your blood sugar returns to a safe range.

After exercise: Check your blood sugar again

After exercise, check your blood sugar right away and then several times during the next few hours. Exercise draws on reserve sugar stored in your muscles and liver. As your body rebuilds these stores, it takes sugar from your blood. And the more strenuous your workout, the longer your blood sugar will be affected. Low blood sugar is possible even hours after exercise.
If you do have low blood sugar after exercise, eat a small carbohydrate-containing snack, such as fruit or crackers, or drink a small glass of fruit juice.

 Where/which meter to buy


You can buy blood glucose monitoring meters in most pharmacies, medical centers and hospitals.  Links for popular brands in Malaysia you can check out are :

Lifescan(Malaysia) selling OneTouch meters
Roche diagnostics (M) selling Accuchek meters 
Abbott Malaysia selling Optium meters