Hypertension is high blood pressure, a very common condition in older adults. Blood pressure is the physical force exerted by the blood as it pushes against the walls of the arteries. Blood pressure readings are written in two numbers separated by a line. The top number represents the systolic blood pressure and the bottom number represents the diastolic pressure. The systolic blood pressure is the pressure in the arteries as the heart contracts pushing the blood forward. The diastolic pressure is the pressure in the arteries as the heart relaxes.

Normal blood pressure is below 120/80. New guidelines from the American Heart Association (AHA) and the American College of Cardiology (ACC) published in November of 2017 consider blood pressure elevated between 120/80 and 129/80. High blood pressure or hypertension is now classified as stage 1 if your systolic reading falls between 130 and 139 or your diastolic reading is between 80 and 89. A measure of 140/90 or higher is now considered stage 2 hypertension. A hypertensive crisis is defined as a systolic rate over 180 or a diastolic rate above 120. An elevated blood pressure means that the heart must work harder to pump blood. High blood pressure can also damage the walls of the arteries. Over time, hypertension increases the risk of heart disease, kidney disease, and stroke. It is estimated that one in three adults in America are affected by hypertension.

High blood pressure is more common in older people. At age 45, more men have hypertension than women. By age 65, this is reversed and more women are affected. People with diabetes have a greater risk of hypertension than those without diabetes. Having a close family member with high blood pressure also increases your risk of developing it. About 60% of all people with diabetes also have hypertension.

Hypertension may not produce any symptoms, even if you have had it for years. That’s why it is sometimes referred to as a “silent killer.” It’s estimated that 1 out of every 5 people with high blood pressure aren’t aware that they have this major risk factor for strokes and heart attacks. If not properly treated, high blood pressure can damage the heart and circulation, lungs, brain, and kidneys without causing noticeable symptoms. Symptoms of high blood pressure may be present in those who have an extremely high blood pressure. Symptoms of extremely high blood pressure include the following:

• Severe headaches
• Fatigue
• Vision problems
• Chest pain
• Difficulty breathing
• Irregular heartbeat
• Blood in the urine
• Pounding in the chest, neck, or ears

Blood pressure is given as a reading of two numbers, such as 110/70. The higher number (systolic) is the pressure when the heart beats. The diastolic, or lower number shows the pressure between the heartbeats, while the relaxed heart is refilling with blood. Normal blood pressure readings are lower than 120/80. The cause of most hypertension is unknown. Occasionally, conditions of the kidney or adrenal gland are the cause of high blood pressure.

There are several factors that may cause high blood pressure, but the exact cause is unknown. The following factors may increase one’s risk for high blood pressure:

• Smoking
• Overweight or obesity
• Lack of physical activity
• Too much salt consumption
• Too much alcohol consumption (more than 1 to 2 drinks per day)
• Stress
• Older age
• Genetics
• Family history of high blood pressure
• Chronic kidney disease
• Adrenal and thyroid disorders
• Sleep apnea

An elevated blood pressure reading means that your blood pressure falls just above the normal level, corresponding to a systolic pressure between 120 and 129 or a diastolic pressure of 80 or less. The new guidelines eliminate the previous category of prehypertension. About one-fourth of Americans have elevated levels and they have two times the risk of heart disease compared with those who have lower blood pressures. Lifestyle changes can help many people with prehypertension lower their blood pressure.

Causes

Factors that increase your blood pressure can cause elevated levels. Medications such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers, and some prescription drugs may cause a temporary rise in blood pressure. The buildup of fatty deposits in the arteries (atherosclerosis) can also lead to prehypertension. Other conditions that may lead to prehypertension include the following:

• Obstructive sleep apnea
• Kidney disease
• Adrenal disease
• Thyroid disease

Symptoms

There are usually no symptoms with elevated blood pressure. The only way to keep track of your blood pressure is to visit your doctor regularly and have your blood pressure checked.

Treatment

If elevated blood pressure levels are accompanied by diabetes, kidney disease, or cardiovascular disease, your doctor may suggest blood pressure medication as well as lifestyle changes. If elevated levels are your only condition, lifestyle changes can help prevent blood pressure from rising. The following are lifestyle changes that may help lower blood pressure:

• Losing weight if overweight or obese
• Eating a healthy, low-salt diet
• Exercise regularly
• Limit alcohol consumption
• Quit smoking

You are considered to have hypertension if your systolic blood pressure measurements are between 130 and 139 or your diastolic measurement falls between 80 and 89. At this level of blood pressure you may not have any symptoms. When blood pressure reaches 180/120 or higher, a serious condition known as a malignant hypertension or hypertension crisis may occur. This can lead to stroke, kidney damage, heart attacks, or loss of consciousness. If you measure your blood pressure and it is this high, rest a few minutes and measure again. If it remains high, call 911.

Malignant Hypertension Causes

High blood pressure is the main cause of malignant hypertension. Skipping doses of blood pressure medications can also lead to malignant hypertension. The following are medical conditions that may cause malignant hypertension:

• Kidney disease
• Collagen vascular disease
• Spinal cord injuries
• Tumor of the adrenal gland
• Birth control pills
• Illegal drugs (cocaine)

Malignant Hypertension Symptoms

The primary symptoms of malignant hypertension are a blood pressure of 180/120 or higher and signs of organ damage. Other symptoms of malignant hypertension include bleeding and swelling of blood vessels in the retina, anxiety, nosebleeds, severe headache, and shortness of breath. Malignant hypertension may cause brain swelling, but this symptom is very rare.

Malignant Hypertension Treatment

Malignant hypertension is a medical emergency and requires immediate treatment. Blood pressure medications will be given through an IV, in hopes of lowering blood pressure within minutes. Oral medication will be given once blood pressure has been lowered to a safe level.

Abnormally elevated pressure in the pulmonary circulation is referred to as pulmonary hypertension. This condition affects the arteries in the lungs and the right side of the heart.

Pulmonary Hypertension Causes

Pulmonary hypertension is caused by changes in the cells that line the pulmonary arteries. These changes cause the walls of the arteries to become stiff and thick, extra tissue may also form. This can reduce or block blood flow through the blood vessels. Increased blood pressure is then caused because it is harder for blood to flow. Pulmonary hypertension can be an associated condition with scleroderma, sarcoidosis, pulmonary embolism, and dermatomyositis.

Pulmonary Hypertension Symptoms

Symptoms of pulmonary hypertension may not present themselves for months or years. Later on, symptoms become worse. Symptoms of pulmonary hypertension may include:

• Fatigue
• Shortness of breath
• Dizziness
• Chest pain or pressure
• Swelling in the ankles, legs, and abdomen
• Bluish color to the lips and skin
• Racing pulse or heart palpitations

Pulmonary Hypertension Treatment

Pulmonary hypertension cannot be cured, but treatments are available to improve symptoms and slow the progression. The following are treatments available for pulmonary hypertension:

• Blood vessel dilators (vasodilators)
• Endothelin receptor antagonists
• Sildenafil and tadalafil
• High-dose calcium channel blockers
• Soluble guanylate cyclase (SGC) stimulator
• Anticoagulants
• Digoxin
• Diuretics
• Oxygen

Atrial septostomy (open-heart surgery) and transplantation are surgical treatments that may control pulmonary hypertension, if medications are unsuccessful.

African-Americans are at greater risk of developing hypertension than people of other races. African-Americans develop high blood pressure earlier in life and have more difficulty achieving blood pressure goals. Some studies suggest that African-Americans may be more sensitive to salt than other races. For those who are genetically prone to salt sensitivity, a small amount (half-teaspoon) of salt can raise blood pressure by 5 mm Hg. Dietary factors and being overweight can also raise blood pressure.

Sodium, a chemical found in salt, raises blood pressure by promoting the retention of fluid by the body. This increases the workload on the heart. The American Heart Association recommends an upper daily limit for sodium consumption of 1,500 mg. Checking food labels and menus can help you calculate how much sodium you are consuming. Processed foods are particularly high in sodium and make up about 75% of our sodium intake. Among these, lunch meats and canned soups have some of the highest levels of dietary sodium.

Stress leads to temporary elevations of blood pressure, but there is no proof that stress causes ongoing high blood pressure. Stress may have an indirect effect on blood pressure since it can influence other risk factors for heart disease. People who are under stress tend to engage more in unhealthy habits like poor nutrition, alcohol use, and smoking, all of which can play a role in the development of high blood pressure and heart disease.

Being overweight increases the risk of getting hypertension and increases the workload required of your heart. Diets designed to control blood pressure are often designed to reduce calories as well. Most of these diets require decreasing consumption of fatty foods and sugars while increasing your intake of lean protein, fiber, fruits, and vegetables. A weight loss of just 10 pounds can make a significant difference in your blood pressure.

Drinking too much alcohol is a risk factor for high blood pressure. The American Heart Association guidelines recommend the consumption of no more than two alcoholic drinks per day for men and no more than one drink a day for women. One drink is defined as one 12-ounce beer, 4 ounces of wine, 1.5 ounces of 80-proof spirits, or 1 ounce of 100-proof spirits. Adults who consume more than three drinks in one sitting temporarily increase their blood pressure. However, binge drinking can lead to long-term increased blood pressure.

Caffeine can bring on the jitters, but there is no evidence that it can cause long-term hypertension. However, a caffeinated beverage might bring on a temporary rise in blood pressure. It is possible that caffeine could block a hormone that helps keep arteries widened, which causes blood pressure to rise. It is also possible that caffeine causes adrenal glands to release more adrenaline, causing blood pressure to increase. The exact reason why caffeine causes increased blood pressure is unknown.

Women who do not have high blood pressure before pregnancy may develop gestational hypertension or preeclampsia during pregnancy. Gestational hypertension is high blood pressure that develops in pregnancy. Gestational hypertension generally develops after week 20 of pregnancy. If not properly managed, it may develop into preeclampsia.

Preeclampsia is elevated blood pressure and the leakage of protein into the urine by the kidneys. Preeclampsia can be dangerous to both mother and baby. High blood pressure during pregnancy may lead to decreased blood flow to the placenta, placental abruption, premature delivery, or future cardiovascular disease. After the baby is born, high blood pressure during pregnancy usually returns to normal levels.

Certain medications contain ingredients that can elevate blood pressure. Cold and flu medications that contain decongestants are one example of drugs that raise blood pressure. Other kinds of medicines that can raise blood pressure are steroids, diet pills, birth control pills, non-steroidal anti-inflammatory drugs (NSAIDs), pain relief medications, and some antidepressants. Talk to your doctor about the medications or supplements you are taking that might affect your blood pressure.

The portal venous system contains veins coming from the stomach, intestine, spleen, and pancreas. These veins merge into the portal vein, which branches into smaller vessels and travel through the liver. Portal hypertension occurs when there is an increase in the blood pressure within the portal venous system. When the vessels in the liver are blocked due to liver damage, blood cannot flow properly through the liver. This causes high blood pressure in the portal system.

Portal Hypertension Causes

Cirrhosis of the liver is the most common cause of portal hypertension. In cirrhosis, the scar tissue (from the healing of liver injury caused by hepatitis, alcohol, or other liver damage) blocks the flow of blood through the liver. Blood clots in the portal vein, blockages of the veins that carry blood from the liver to the heart, parasitic infection (schistosomiasis), and focal nodular hyperplasia are also causes of portal hypertension.

Portal Hypertension Symptoms

Symptoms of portal hypertension include the following:

• Gastrointestinal bleeding, which can cause black, tarry stools or blood in stools, or vomiting of blood
• Ascites (fluid in the abdomen)
• Encephalopathy or confusion
• Reduced levels of platelets (blood cells that help form blood clots)

Portal Hypertension Treatment

There is no treatment available for the causes of portal hypertension. However, treatment can prevent or manage the complications. Diet, medication (nonselective beta-blockers), endoscopic therapy, surgery, and radiology procedures can all help in treating or preventing symptoms of portal hypertension. If these treatments are unsuccessful in treating symptoms, transjugular intrahepatic portosystemic shunt (TIPS) or distal splenorenal shunt (DSRA) are two procedures that may reduce pressure in the portal veins. Maintaining a healthy lifestyle may help to prevent portal hypertension.

Although it’s most common in older adults, hypertension can also affect children. The normal blood pressure for a child is dependent upon the child’s age, gender, and height. Your doctor can tell if your child’s blood pressure is abnormal. Children are at higher risk for hypertension if they are overweight, African-American, or if they have a family history of the condition. Children with high blood pressure may benefit from the DASH diet and taking medications. Children with high blood pressure should also maintain a healthy weight and avoid tobacco smoke.

Dietary changes can help control blood pressure. One diet designed to promote lower blood pressure is known as the DASH diet. This stands for Dietary Approaches to Stop Hypertension. The DASH diet recommends eating more vegetables, fruits, whole grains, low-fat dairy products, poultry, nuts, and fish. Red meat, saturated fats, and sweets should be avoided. The DASH diet can lower blood pressure within 2 weeks. It can also help to reduce your intake of sodium. The following is the DASH diet suggested daily intake:

• 7-8 servings of grain
• 4-5 servings of vegetables
• 4-5 servings of fruits
• 2-3 servings of low-fat or fat-free dairy products
• 2-3 servings of fats and oils
• 2 or less servings of meat, poultry, and fish

On the DASH diet, nuts, seeds, and dry beans should be limited to 4-5 servings per week. Sweets should be limited to less than 5 servings per week.

Exercise is another lifestyle factor that can lower blood pressure. It’s recommended that adults get about 150 minutes per week of moderate exercise. This can include cardiovascular exercises such as walking, bicycling, gardening, or other aerobic exercise. Muscle-strengthening activities are recommended at least twice a week and stretching makes you more flexible and helps prevent injuries. Check with your doctor if you are currently inactive and want to start exercising. Make exercise fun by doing activities you enjoy or find an exercise buddy to join you!

If diet and exercise are not sufficient to lower blood pressure, the first medications recommended are often diuretics or so-called “water pills.” These reduce sodium and fluid levels in the body to lower blood pressure. Taking diuretics means you will urinate more frequently. Sometimes, diuretics deplete potassium levels as well, which can lead to muscle weakness, leg cramps, and tiredness. Other side effects of diuretics can include elevated blood sugars in people with diabetes. Less commonly, erectile dysfunction can occur.

Natural Diuretics

Dandelion, ginger, parsley, hawthorn, and juniper may have a diuretic effect that can reduce sodium and water retention, which helps lower blood pressure. It is very important to consult with your doctor before taking any natural diuretics. Certain herbs and supplements may actually worsen your medical problems.

Beta-blockers are another drug class used to treat hypertension. They block the effects of the sympathetic nervous system on the heart. This reduces the workload of the heart by requiring less blood and oxygen, which slows the heart rate. They can be used to treat other conditions as well, including abnormal heart rate (arrhythmia).

Beta-Blocker Side Effects

Side effects of beta-blockers can include the following:

• Dizziness
• Insomnia
• Fatigue
• Cold feet and hands
• Erectile dysfunction
• Slow heartbeat
• Edema (swelling in ankles, feet, or legs)
• Trouble breathing
• Depression

ACE (angiotensin converting enzyme) inhibitors are another class of antihypertensive drugs. They reduce the body’s levels of angiotensin II, a substance that narrows blood vessels. This means that arteries are more open (dilated) and the blood pressure is lower. ACE inhibitors can be used alone, or with other medications such as diuretics. Side effects of ACE inhibitors can include skin rash, dry cough, dizziness, and elevated potassium levels. Women who are pregnant, planning to get pregnant, or breastfeeding should not take ACE inhibitors.

Angiotensin receptor blockers prevent the actions of angiotensin II on the arteries. This means the arteries stay more open and blood pressure is lowered. ARBs can take a few weeks to work. Side effects can include dizziness, muscle cramps, insomnia, and elevated potassium levels. As with ACE inhibitors, women who are pregnant, planning to get pregnant, or breastfeeding should not take ARBs.

Calcium channel blockers are drugs that reduce the movement of calcium into cells of the heart and vessels. This reduces the strength of heart contractions and relaxes the arteries, allowing them to remain more open, lowering blood pressure. Side effects of calcium channel blockers can include heart palpitations, dizziness, swollen ankles, and constipation. Calcium channel blockers can be taken alone or with other blood pressure medications. They should be taken with food or milk. Because of potential interactions, those taking calcium channel blockers should avoid alcohol and grapefruit juice.

There are even more medication types that can lower blood pressure. Some of these are alpha blockers, vasodilators, and central alpha agonists. Your doctor may prescribe these medications if other medications have been ineffective or if you have another condition along with hypertension. Side effects can include fast pulse, palpitations, dizziness, diarrhea, or headaches.

It has been shown that meditation and other relaxation techniques can help lower blood pressure. Yoga, tai chi, and breathing exercises can also help reduce blood pressure. It’s best when these are combined with changes in diet and exercise. Tell your doctor if you are taking any herbal remedies, since some of these preparations can actually raise blood pressure or interact with your blood pressure medications. The following are supplements that may lower blood pressure:

• Coenzyme Q10 (CoQ10)
• Omega-3 fatty acids
• Amino acids

Hypertension often lasts a lifetime, so following a careful management plan is essential. Keeping your blood pressure under control can lower your risk of heart disease, stroke, and kidney failure and can improve your quality of life. The following are tips to manage your blood pressure:

• Take blood pressure medicine as directed, if prescribed to you
• Increase physical activity (at least 30 minutes five days a week)
• Maintain a healthy weight
• Read nutrition labels and consume low salt and sodium foods
• Eat more fruits, vegetables, grains, and low-fat dairy
• Limit alcohol consumption

High blood pressure increases the risk of heart disease and stroke. High blood pressure is medically referred to as hypertension. Keys to the treatment of high blood pressure are exercise, weight management, and a healthy diet. In fact, exercising makes blood pressure medications more effective. See your doctor before starting a new fitness program.

Benefits of exercise can be achieved with workouts of just 30 minutes a day. Riding bikes with the kids, doing housework, gardening, using the stairs, and carrying groceries all add up to exercise that benefits your heart. Try increasing your activity by parking at the end of the lot, or walking to your destination!

Gym environments are not mandatory for your workouts. However, trainers can benefit you with safety tips and encouragement. Check with the trainer if you feel the exercise maneuver is improper or causing pains. Your routine will depend on your underlying health, your capability, and your endurance.

Resistance training is beneficial in boosting your metabolic rate, reducing body fat, and increasing muscle mass. There are many ways to perform resistance training, including using weight machines, free weights, exercise bands, or abdominal crunches or curl-ups. Losing as little as 10 pounds can reduce or help prevent high blood pressure in many overweight individuals. See your doctor before starting a new weight-training program.

Aerobic exercise that causes the heart to beat faster is important for lowering blood pressure. Try swimming at your local YMCA or fitness center if you don’t like the heat. Swimming can lower your blood pressure and pulse rate.

It is possible that with regular exercise, high blood pressure can be prevented or controlled. Sometimes moderate-level aerobic activities, such as brisk walking for 30 minutes a day, may be enough to decrease or eliminate medications. Exercise definitely can help medications work more effectively. Exercise itself can reduce blood pressure readings by as much as 5-15 mmHg. A gradual increase in the intensity of the workout is best for safety and effectiveness of lowering your blood pressure.

If you haven’t exercised in a while, start slowly to prevent injuries. Begin with 10 to 15 minutes of exercise you enjoy, such as walking around the block or on a treadmill. Increase the duration and intensity of your workout until you reach the goal of 30 minutes each day. Avoid cramming your workout routine into a couple of days in an attempt to “catch up.”

When you are new to exercise, you must pace yourself. Go low intensity and enjoy the ride up! Try yoga, cycling (leisurely), gardening, mall walking, water aerobics, or moderate swimming. Increase the intensity and duration gradually as you become more fit. Your body and your blood pressure will both be in more ideal condition.

Modify your routine to match your busy schedule. Try working out while the kids are at their sports practice, before or after work, or even during your lunch break! Even if you are housebound, consider getting a stationary bike or treadmill to move your body while watching the evening news or when the baby naps.

For efficiency of your time, you could do 10-minute mini-workouts at different points of your busy day. Options are up to your imagination and include jogging in place, calisthenics, or actively vacuuming your house for 10 minutes with dance music on! The three 10-minute mini-workouts are your needed 30 minutes of daily exercise — enough to help to optimize your heart’s health.

No time to make it to the gym? Design a home exercise program. Purchase a step bench, free weights, exercise bands or tubes, and/or yoga or fit ball. You’ve got a gym! If you like, also get a treadmill or stationary bike to help you burn fat and build endurance. Helpful hint: try out all exercise equipment in a gym environment before purchasing your own.

Warming up before exercise and cooling down after are important for people with high blood pressure according to the American Heart Association. This allows your heart rate to increase and decrease gradually. Just walking in place or on a treadmill for 10 minutes is adequate for warming up before exercise and also for cooling down after.

Gadgets can help you focus and stay on target. Heart rate watches let people quickly assess their pulse rate. To use one: Apply the band that comes with it onto your chest underneath your shirt. You can see your actual heart rate as you work out by looking at the watch during exercise. This is an accurate measurement and is a good alternative to taking your pulse manually. Optimal training zones for pulse rate vary significantly. Ask your doctor to recommend the best target heart rate zone (or training zone) for you.

Medications used for heart problems and high blood pressure can slow your heart rate. These include beta-blockers or calcium-channel blockers. If you take these medications, see your doctor and determine the best target heart rate zone for you during exercise.

Be aware of your limitations! When an exercise or activity hurts, stop! If you experience dizziness or discomfort in your chest, arms, or throat — stop! Be realistic! Go slower on hot and humid days or exercise in an air-conditioned facility.

When you have been sedentary, overweight, or have a high risk of coronary heart disease or other chronic health problem, you must have your doctor’s approval before starting a fitness program. Have your blood pressure measured by a health care professional. They can advise you as to how often to have it rechecked.

The DASH diet (Dietary Approaches to Stop Hypertension) has been shown to lower systolic blood pressure (the top number in a blood pressure reading). Studies have shown a DASH diet can reduce systolic blood pressure by as much as 14 points. The DASH diet is rich in fruits, vegetables, and low-fat dairy products and is 2,000 calories a day. DASH is also low in saturated fat, cholesterol, and total fat.

If you are overweight, losing as few as 10 pounds can help you reduce or prevent high blood pressure. Weight loss results from taking in fewer calories than you use each day. See your doctor or a registered dietitian about how many calories you need daily for weight loss. Increase your exercise to burn even more calories!

National blood pressure guidelines recommend limiting sodium to no more than 2,300 milligrams a day. This is about one teaspoon of table salt or 1,500 milligrams a day. A sodium-restricted diet can lower your systolic blood pressure (top number of the blood pressure reading) 2 to 8 points. Low-salt diets can also enhance the effects of blood pressure medications. Try substituting herbs for salt when cooking, and avoid processed meats and canned foods.

The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends that people moderate their alcohol intake. They set the limit to no more than two drinks per day for men and no more than one drink per day for women. They define a drink as 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof liquor.

Multiple sclerosis (MS) is an autoimmune disease in which the body’s immune system attacks its own central nervous system (the brain and spinal cord). In MS, the immune system attacks and damages or destroys myelin, a substance that surrounds and insulates the nerves. The myelin destruction causes a distortion or interruption in nerve impulses traveling to and from the brain. This can result in a wide variety of symptoms.

Multiple sclerosis is estimated to affect 2.8 million people worldwide. Most people are diagnosed between the ages of 20 and 50, though it can also occur in young children and the elderly.

MS in Women

Multiple sclerosis is three times more common in women than in men. In addition, nearly all women afflicted with MS get the condition before menopause. This could mean that hormones play an important role in the disease’s development.

MS in Men

Usually, MS in men is more severe than it is in women. They typically get MS in their 30s and 40s, just as their testosterone levels begin to decline.

Although MS is more common in women than men overall, one form of the disease contradicts this pattern. People with primary progressive (PP) MS are about as likely to be male as female. (The four main types of MS are described later).

Multiple Sclerosis and Smoking

People who smoke are more likely to develop MS, and to develop it more severely and with a faster progression.

MS is more prevalent among Caucasians than other ethnicities. MS is believed to have a genetic component as people with a first-degree relative with the disease have a higher incidence than the general population.

We don’t know exactly what causes multiple sclerosis, but it is believed to be some combination of immunologic, environmental, infectious, and/or genetic factors. Some theories have been proposed, though there is not enough evidence to establish any one cause. Theories as to what causes MS include:

• Exposure to mercury and other heavy metals
• Allergies, including pet allergies
• Exposure to chemical solvents such as amines, esters, ethers, and ketones
• Viruses such as Epstein-Barr virus (EBV) and human herpes virus 6 (HHV-6)

Multiple sclerosis (MS) is an autoimmune disorder in which the immune system mistakenly perceives its own myelin (the protective sheath around the nerves) as an intruder and attacks it, as it would a virus or other foreign infectious agent. To understand how this harms the body, it helps to understand how nerves work.

Nerve Anatomy

A nerve can be seen by the naked eye, but it is made up of hundreds or even thousands of microscopic nerve fibers wrapped by connective tissue. Nerves conduct messages to and from the brain by way of electrical impulses.

Often the nerve fibers that make up a nerve are all individually wrapped in myelin, a protective sheath that causes electric impulses to conduct down the nerve much faster than fibers that lack myelin. (The same principle is used to improve electric wires by covering them with a plastic outer layer.)

How Does MS Destroy Myelin?

In multiple sclerosis, the immune system’s T cells attack the myelin sheath. By attacking myelin, the immune system in a person with MS causes inflammation and degeneration of the myelin that can lead to demyelination, or stripping of the myelin covering of the nerves. It can also cause scarring (the “sclerosis” in the name “multiple sclerosis”). This causes electrical impulses to travel more slowly along the nerves resulting in deterioration of function in body processes such as vision, speech, walking, writing, and memory.

While multiple sclerosis is not hereditary, genetics are believed to play a role. In the U.S., the chances of developing MS are one in 750. Having a first-degree relative (parent, sibling) increases the risk to up to 5%. An identical twin of someone with MS has a 25% chance of being diagnosed with the disorder. It is thought there is an outside trigger, as genetics only makes certain people susceptible to getting MS, which is why the disease is not considered hereditary. Genes may make a person more likely to develop the disease, but it is believed that there still is an additional outside trigger that makes it happen.

There are four different types of multiple sclerosis that have been identified and each type can have symptoms ranging from mild to severe. The different types of MS can help predict the course of the disease and a patient’s response to treatment. The four types of MS are discussed on the next four slides.

Relapsing-remitting multiple sclerosis (RR-MS, RRMS or RMS) is the most common type of MS, affecting about 85% of MS sufferers. RR-MS is defined by inflammatory attacks on the myelin and nerve fibers causing a worsening of neurologic function. Symptoms vary from patient to patient, and symptoms can flare up (called relapses or exacerbations) unexpectedly, and then disappear (remission).

Common Symptoms of RR MS

• Fatigue
• Numbness
• Vision problems
• Muscle spasms or stiffness
• Bowel and bladder function problems
• Cognitive difficulties

Primary-progressive multiple sclerosis (PP-MS, PPMS) is characterized by steady worsening of neurologic functioning, without any relapses or remissions. There may be occasional plateaus, but overall, the progression of the disability is continuous. This form of MS occurs equally in men and women, and the age of onset is about 10 years later than in relapsing-remitting MS.

Secondary-progressive multiple sclerosis (SP-MS, SPMS) is a form of MS that follows relapsing-remitting MS. Most people diagnosed with RR-MS will eventually transition to having SP-MS. After a period of relapses (also called attacks, or exacerbations) and remissions the disease will start to progress steadily. People with SP-MS may or may not experience remissions.