Why should Vets be especially vigilant about hypertension and pre-hypertension?
Members of the armed forces bravely face myriad dangers, challenges, and risks that are external in nature. What they may not realize is that they face an internal danger as well. It’s a silent killer that affects millions of Americans, and is found in higher than average rates among active duty military and veterans than in the general population. This life-threatening danger is hypertension.Hypertension, or high blood pressure, is the primary or contributing cause of death in more than 350,000 Americans each year. Because hypertension and pre-hypertension are highly prevalent among those in the military, veterans should be aware of this danger, understand what it means to them and know how to track and manage it.
Hypertension Defined
What is this silent killer? Your blood pressure measurement tells you the pressure in your arteries as the blood flows through them. It is shown as two numbers. The first represents the amount of pressure when your heart beats. The second represents the pressure when your heart relaxes between beats. An ideal reading is 115/75 mmHg.
Various factors, discussed below, can cause this number to increase. Mild blood pressure elevation is referred to as “pre-hypertension.” It is associated with increased cardiovascular risks and is a precursor to full-blown hypertension. Pre-hypertension is diagnosed with readings of 120-139/80-89 mmHg, and hypertension is diagnosed with readings greater than 140/90 mmHg.Hypertension is known as a “silent killer” because many people don’t even know they have it and there are no warning signs or symptoms. Damage to the body is done in a silent fashion. What kind of damage? Heart disease, heart attack, aneurysms, stroke and heart failure as well as kidney failure, dementia, damage to the eyes and sexual dysfunction. It is a serious condition higher-risk veterans should not ignore.
Prevalence of High Blood Pressure Among Active Duty Soldiers and Vets
How prevalent is this problem among the military? According to a survey completed by the Department of Defense, 17 percent of soldiers have reported high blood pressure since entering the Army. Among veterans, over 30% have hypertension.Research has shown that veterans and soldiers who see multiple tours of combat are roughly 33 percent more likely to have high blood pressure. If they witness a death while on active duty, this percentage goes up to 50.
Risk Factors Creating High Blood Pressure In Veterans
Combat Stress and Unhealthy Coping Mechanisms --> Hypertension
The Journal of the American Heart Association reports that combat exposure may have negative long-term effects on cardiovascular health. The related stress has been linked to hypertension. Those who experience no combat exposures are less likely to report hypertension. Those who personally witness death because of war are at increased risk for hypertension.In addition to the actual combat stress, soldiers often turn to unhealthy methods of coping with the stress. Smoking, drinking, and unhealthy eating are all common coping mechanisms that cause blood pressure increases and increased risk for heart disease. The presence of these coping mechanisms in the lives of active duty military and veterans raises the risk for high blood pressure.
Chronic Exposure to Aircraft Noise --> Hypertension
One study’s results suggest that hypertension may be associated with chronic exposure to military aircraft noise. Helicopter noise in particular seemed to be a factor.
PTSD linked to high blood pressure
Posttraumatic Stress Disorder (PTSD) has also been linked with high blood pressure. This makes sense, as stress in general is a cause of increased blood pressure.
Additional Causes of High Blood Pressure In Soldiers and Veterans:
- Smoking
- Diabetes
- Exposure to herbicides such as Agent Orange
- High salt intake
- High alcohol intake
- Vitamin D deficiency
High Blood Pressure: Symptoms To Look For Among Veterans
As we have noted, hypertension is known as the silent killer. In fact, about 33% of those who have high blood pressure are unaware of their condition. The first symptom is often a heart attack. Only when blood pressure readings soar to dangerously high levels (systolic of 180 or higher OR diastolic of 110 or higher) may obvious symptoms occur like headaches, dizziness, severe anxiety and shortness of breath. While these "big symptoms" are rare, there are a few more common indicators of high blood pressure including looking older than your chronological age and sexual dysfunction.Because active duty military and veterans are at higher risk for high blood pressure, it is important to monitor even if no symptoms are noted.
“Young Invincibles” Not Immune To Heart Disease But Reluctant To T
The strong young men and women who serve in our armed forces don’t like to think about this health risk, even when above symptoms are experienced. It’s hard for civilians to consider, so it’s easy to understand why active military personnel and veterans avoid the subject. They are invincible, right? Unfortunately, no. As previously noted, due to the nature of their career, they may be at greater risk for heart disease, rather than less. Also due to the nature of their career, these young recruits are often reluctant to get tested for high blood pressure.In one survey, 12.7 percent reported not knowing their blood pressure reading, and another 1.7 percent reported never having their blood pressure checked.Those in active duty are often worried they will be grounded or disqualified from further duty if diagnosed with high blood pressure. A diagnosis of hypertension can seriously impact their career and opportunity to serve their country. So many avoid getting it checked and therefore never know to start simple lifestyle changes that can bring it back in check before they are "discovered".
Because of this, proper knowledge, tracking of, and lifestyle/diet changes for high blood pressure are essential for those on active duty. Following is the information they need to maintain or develop a healthy blood pressure and avoid disqualification.
High Blood Pressure: Treatment for Active Duty Military and Veterans
The good news for those with high blood pressure is that management and reduction is doable. Through tracking, lifestyle changes, stress management, and possibly medication, blood pressure can be kept under control and heart risks can be minimized.
The Veteran Advantage
The other good news: Veterans, like active duty military have been trained to be disciplined. Consequently compared to most civilians, they can be more resolute about taking control of their health. For example Jeff, a 66 year old army vet was able to reduce his blood pressure by more than 10 pts.Stress management – Combat exposure, PTSD, aircraft noise, and other stresses unique to the military life can take their toll on the body.
But, there is hope for stressed veterans. Several effective stress-management techniques are available.
- Eat stress-reducing foods – The right diet can help reduce the impact of stress on your heart.
- Shop – “Retail Therapy” has been shown to relieve stress and reduce blood pressure. Try it out!
- Adopt A Pet – Studies have shown that interacting and bonding with a pet helps lower stress and is good for your heart.
Lifestyle Changes – You know what many of these are. You’ve heard them before. Like most other people, it just hard to get the motivation and commitment to do them. Realizing the increased risk level for veterans when it comes to heart disease can help motivate you to make these changes.
- Try to cut out smoking (or at least cut back to only the smokes that really count)
- Eat healthy foods
- Reduce alcohol intake (1-2 drinks in a day)
- Exercise - even a 15 min walk daily can make a huge difference
- If overweight - lose weight
- Limit sodium in your diet - eat out less and avoid foods in cans
Tracking High Blood Pressure – Fortunately, this one is easier by simply using an App on their iPhone or Android. It’s also essential for good heart health. Active duty military and veterans should be tracking their blood pressure to avoid serious consequences down the road. Let’s take a look at the benefits of tracking.
Reasons To Track High Blood Pressure For Current and Former Military
Monitoring your blood pressure offers a slew of benefits. Tracking is also made easy by apps like Hello Heart (iOS, Android). By keeping tabs on your blood pressure using simple at-home BP monitoring devices, you can decrease your risk for serious heart conditions. Following are some of the benefits of tracking your blood pressure.
Track for awareness
As mentioned, this population is at greater risk than civilians for high blood pressure and heart disease. As is it likely to be present, those in the military should be diligent in tracking their blood pressure to be aware if it is high. As the saying goes, knowing is half the battle.
Track for reduction
Self-monitoring alone can reduce blood pressure by 10 mm Hg systolic on average. The risk of death from ischemic heart disease and stroke doubles for every 20 mmHg increase in systolic blood pressure. This means anything that reduces it by 10 puts cuts that risk in half.
Track for medication management
If you are on medication for high blood pressure, it is important to know if it is working. Are you on the right dosage? Should you try a different medication? By using a blood pressure measuring device regularly, you can monitor the effects of the medication. Tracking your results with Hello Heart (iOS, Android) will give you and your doctor sufficient data to make informed decisions about your medications.By remaining aware of what’s going on with your blood pressure, you can prevent heart disease and reduce your risk of life-threatening conditions. Our active military and veterans should be especially diligent with this, as a population at greater risk for hypertension. Taking steps to monitor blood pressure and making other healthy lifestyle choices will guard against the risk of heart disease among veterans. The military personnel who protect us, also need to protect themselves.
THE GIST
- Rates of prehypertension and hypertension are higher among active duty military and veterans than the general population.
- Combat stress, multiple tours of combat, aircraft noise and chemical exposure contribute to the risk.
- Young soldiers are not immune.
- While you can’t control your predisposition to hypertension because of your military service, you can track and understand your BP to know what measures will give you back control.
1. Gazit T, Gutman M, Beatty AL. Assessment of Hypertension Control Among Adults Participating in a Mobile Technology Blood Pressure Self-management Program. JAMA Netw Open. 2021;4(10):e2127008, https://doi.org/10.1001/jamanetworkopen.2021.27008. Accessed October 19, 2022. (Some study authors are employed by Hello Heart. Because of the observational nature of the study, causal conclusions cannot be made. See additional important study limitations in the publication. This study showed that 108 participants with baseline blood pressure over 140/90 who had been enrolled in the program for 3 years and had application activity during weeks 148-163 were able to reduce their blood pressure by 21 mmHg using the Hello Heart program.) (2) Livongo Health, Inc. Form S-1 Registration Statement. https:/www.sec.gov/Archives/edgar/data/1639225/000119312519185159/d731249ds1.htm. Published June 28, 2019. Accessed October 19, 2022. (In a pilot study that lasted six weeks, individuals starting with a blood pressure of greater than 140/90 mmHg, on average, had a 10 mmHG reduction.) NOTE: This comparison is not based on a head-to-head study, and the difference in results may be due in part to different study protocols.
2. Validation Institute. 2021 Validation Report (Valid Through October 2022). https://validationinstitute.com/wp-content/uploads/2021/10/Hello_Heart-Savings-2021- Final.pdf. Published October 2021. Accessed October 19, 2022. (This analysis was commissioned by Hello Heart, which provided a summary report of self-fundedemployer client medical claims data for 203 Hello Heart users and 200 non-users from 2017-2020. Findings have not been subjected to peer review.)
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