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YOUR HEALTH | 40 to 49

Pressure Building

Doctors discover that prehypertension now could mean a heart attack later.

Annual blood-pressure checks are crucial as you age, Dr. Richard W. Nesto says.
Annual blood-pressure checks are crucial as you age, Dr. Richard W. Nesto says. (Globe Staff Photo / Pat Greenhouse)

It used to be that you either had high blood pressure or you didn't. Now, doctors advise people in their 40s to watch for prehypertension, or blood-pressure readings in the high-normal range, between 120/80 mmHg and 140/90 mmHg. A study in the journal Stroke this summer showed that people with these slightly elevated readings have three times the risk of heart attack as people with lower blood pressure.

The problem is that blood pressure naturally rises as you age. So a mildly high reading in your 40s can climb to dangerous levels as the years pass, says Dr. Richard W. Nesto, chairman of the department of cardiovascular medicine at the Lahey Clinic in Burlington. It's important to get annual blood-pressure screenings because prehypertension and hypertension are symptom-free. "It's a totally silent thing," Nesto says. In fact, many people are oblivious until they have a heart attack or stroke.

If your blood pressure falls into the prehypertension range and you are overweight, your doctor will advise you to slim down. Shedding just 10 pounds can reduce your blood pressure by as much as 10 points, Nesto says. You may also benefit from cutting back on salt and following the Dietary Approaches to Stop Hypertension regimen (better known as the DASH diet), which involves eating less fat and more produce. Regular exercise is essential. "The best prescription for heart health is about 20 minutes of exercise, three times a week," he says. "You don't have to pound the pavement. Brisk walking is enough, if you do it consistently."

Your doctor won't prescribe blood-pressure reducing drugs for prehypertension; it's not clear that they're effective in this early stage. But weight loss, diet changes, and regular exercise are worth the effort. "You'll be preventing further rises down the road," Nesto says. "The doctor may still write the word `prehypertension' in your chart, but you want to make sure it's still `pre' 10 years from now."

Film-screen versus digital mammogram
Researchers say that digital mammograms give a more detailed image of the breast than film mammograms.

A Better Mammogram

New digital mammograms may be better than standard film mammograms at catching breast cancer in women in their 40s. A study published this fall in the New England Journal of Medicine found that digital mammograms - which store breast images on a computer, instead of on film - were more likely than standard mammograms to reveal tumors in younger women. Women under 50 tend to have dense breasts, which makes it difficult to identify tumors. "The power of digital is that you can lighten, darken, and magnify the image and get a higher level of confidence that something really looks benign," says Dr. Robyn L. Birdwell, head of the division of breast imaging at Brigham and Women's Hospital. Digital mammograms are conducted just like standard film mammograms, she says. Several major hospitals in Boston offer digital technology, but it's not yet available everywhere. That shouldn't stop 40-something women from getting annual mammograms. "For a woman to avoid getting a mammogram because she can't have digital is not a good choice," Birdwell says.

Preserving Your Memory

Forgot a colleague's name? Little memory lapses are a normal consequence of reaching your 40s, says Dr. Robert C. Green, director of Boston University's Alzheimer's Disease Clinical and Research Program. But you can help slow memory loss. For starters, keep your blood pressure and cholesterol levels low and maintain a healthy weight. Not only are hypertension, high cholesterol, and being overweight risk factors for heart disease and stroke, Green says, "but they also appear to increase the risk for microscopic processes that may accelerate Alzheimer's disease," the most common memory disorder in older Americans. Also, eat antioxidant-rich foods like leafy greens and blueberries, which may help protect the brain. Consider fish, too. A new study found that people who ate one fish meal a week had a 10 percent slower annual decline in mental abilities. Finally, maintain your mental health. If you suspect that you're depressed or feel particularly stressed, visit a mental-health professional. "Those who get treatment," Green says, "can experience a significant improvement in memory."

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