Some people can eat a bag of salty pretzels and their blood pressure remains normal; for others, just thinking about salt wreaks havoc with their blood pressure. An estimated 20 to 30 percent of people with hypertension have a condition called salt sensitivity, which means they have a severely pronounced response to sodium. Sodium restriction is extremely important for these people, as they not only have four times the risk of developing hypertension compared with people who respond normally to salt, but even small amounts of sodium can trigger a dramatic rise in blood pressure. Researchers are still looking into the mystery of salt sensitivity. Who gets it? What causes the condition? Is there a gene responsible? Although many theories exist, we still don’t know for sure. Some of the possible mechanisms include kidney insufficiency, adrenal sensitivity to angiotensin, hereditary causes, or a sensitivity to the chloride fraction of salt (sodium chloride).

When I see patients who have been told they have resistant hypertension (abnormally high blood pressure that does not come down despite treatment with at least three drugs), I always suspect salt sensitivity. I have found that resistant hypertension can often – though not always – be remedied by strictly curtailing dietary sodium and supplementing with extra potassium. To find out if you are salt sensitive, check with your doctor or simply monitor your blood pressure response to dietary sodium changes. If you are sensitive to salt, you’ll need to severely curtail your sodium intake and increase your potassium consumption.

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Protect your physical health. Eat well, sleep enough, cut alcohol and smoking down or out. Exercise as much as possible; just going for a walk is great exercise. Relax when you can: read, watch a movie, do relaxation exercises. Take good care of your body. If you have HIV, give your body a chance to fight the infection. If you are a caregiver, you also have to take care of yourself. Lisa said, “I am very careful about exercise and food. You owe it to the people you’re caring for.”

Be kind to yourself emotionally. Steven gives himself pep talks: “When I feel good,” he says, “I let myself know that. I tell myself, ‘Steve, you feel great today.’ ” Dean says that every day he rates how he feels on a scale of one to ten: “It’s mostly nines and tens,” he says. Helen says that her best support is herself. “Basically, it comes down to me,” she says. “I want to survive this. So I have to support myself, and when I do something well, I pat myself on the back.”

If an emotional problem seems too severe or does not go away, or if you are seriously considering suicide, or if you simply want someone to whom you can express all your feelings, see a mental health professional.

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“With this disease,” says Steven, “you need an escape hatch. Sometimes I zombie out in front of the TV. Or get a hot fudge sundae and eat it slowly.” Lisa goes for long walks, reads what she describes as “trashy love stories,” and drives out into the country. People go away for a weekend, plan an evening away at a play, opera, concert, sports event, movie. For a while, they let themselves drop their worries, they say, and think of nothing except the pleasure of the moment. Some, like Helen, take advantage of the mind’s ability to distract itself with pleasant thoughts. She has learned to recognize these moments of pleasure as they occur and to say to herself, “At this minute I happen to be happy, so I’ll enjoy this minute.”

A lot of people do relaxation exercises and say that relaxation gives them the necessary distance from their problems. Relaxation exercises are part of performing artists’ training, some psychotherapies, meditation routines, and yoga practices. All exercises are pretty much the same. Lie down and get comfortable. Beginning with your feet and working up to your face and scalp, muscle by muscle, first tense the muscle, then relax it. Repeat the tension and relaxation with each muscle several times before going on to the next muscle. Eventually you will notice that you breathe more slowly and regularly, that your body relaxes, and finally, that your mind relaxes. In this state of relaxation, imagine yourself in a place that is comforting to you, a place where you are free and happy, where you feel safe and calm. You can either do this relaxation on your own or buy recorded tapes that direct you through the relaxation or join a group that does the exercises together. In any case, mental health professionals often know where you can get help learning the exercises.

Caregivers especially need to take breaks. “I had no time to think of myself,” said Lisa. “I couldn’t get away from it, it was all-consuming. For a long time, I felt crazy. I just went five hundred miles an hour.” Caregivers often feel guilty about taking breaks, but breaks are essential to good caregiving. Without breaks, caregivers start burning out. Find other supports: nurses, social workers, hospice staff, groups, buddies, home health aides, clergy, all can take some of the heat off, give you some time out. “One of the greatest things a caregiver can do,” said June, “is cry for help. I see myself getting hyperactive and losing control, and I call the doctors or my pastor or my friends who know. I’ve learned to admit weaknesses. With all my wisdom and intelligence and backbone I’m so proud of, there are still things I can’t handle.”

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