High Blood Pressure - 7 ways to take control

50% of Americans have high blood pressure according to the new guidelines from American College of Cardiology and the American Heart Association.

Lost in the debate about whether this makes sense to label so many people with a disease was the recognition that normal blood pressure is now defined as 120/80 and the acknowledgement that the risks from blood pressure increase progressively, and linearly from levels as low as 115/75 in people from 40 to 89 years of age.  

For every increase of 20 mmHg systolic and 10 mmHg diastolic there is a doubling of mortality from both heart disease and stroke. 

Here is the Wellness Garage strategy for high blood pressure:

1. Know your blood pressure:

• be confidant that your blood pressure is normal. 
• If you get high readings in the doctor's office - get an automated BP cuff for home.
• If your doctor is not using an automated cuff - ask her why?  New guidelines are clear that physicians should be using automated cuffs.
• If your arm is large be sure to have a large cuff - make sure the doctor uses a large cuff.

2. Know whether you have insulin resistance:

• if your blood sugars are abnormal then you already have insulin resistance
• if your blood sugars are normal and you have abnormal lipids (high triglycerides and low HDL) and a waist size of >102 cm (40 in) in men or >88 cm (35 in) in women - you likely have a degree of insulin resistance
• insulin resistance disrupts one of the key hormonal systems regulating BP - the Renin-Angiotensin system (RAS)
• if you have insulin resistance - decreasing carbohydrates through a low carb, whole food approach makes the most sense - see #3
• if you are diabetic these changes should be medically supervised

3. Get moving - exercise is key

• aerobic exercise has been shown to lower BP 5-7 mmHg 
• resistance exercise lowers BP 2-3 mmHg
• these effects rival first line drug therapy and lower risk by themselves 20-30%
• recent evidence shows that exercise is superior to drug therapy in preventing death from stroke and is equal to drugs in prevention of heart disease mortality.

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4. Eat better - lose weight

• optimizing your nutrition to lose weight makes a big difference - real whole foods with adequate protein, healthy fats and low glycemic carbodyrates. 
• studies show that in overweight or obese people a weight loss of 8kg will lower BP by 8.5 mmHg systolic and 6.5 mmHg
• these effects rival drug therapy and are though to be independent of exercise

5. Salt - stop eating packaged food and decrease how much you eat out - see #3

• for years the linkage between salt (sodium) intake and elevated BP has been clear and part of the established recommendations for preventing and treating hypertension
• more recently this has been challenged on at least two fronts
  • there is great variability between people on the basis of race, gender, age and dietary factors - resulting in the observation that some people at some times are salt sensitive - meaning that their BP increases with salt intake.
  • there is little convincing evidence to link decreased salt intake over time with better health outcomes.
• our advice is to start by eliminating the real culprits in the high salt world we live in - restaurants (especially fast food) and packaged food.  Eating real whole foods that you prepare yourself will result in a significant reduction of salt intake and will help with #3. 

6. Reduce Stress - meditate

• there is growing empirical evidence that the exposure to chronic psychological stress leads to the development of high blood pressure
• while many relaxation therapies are recommended and are effective in reducing stress, so far only meditation has been shown to reduce stress and lower blood pressures
• learning to meditate has never been easier with the introduction of apps like Headspace and Calm - finding 10-15 min per day to meditate will reduce stress and help you improve your blood pressure

7. Sleep - develop a great sleep routine

• depriving people of sleep in the short-term clearly increases blood pressure
• chronic sleep deprivation of < 5hrs per night doubles the risk of hypertension, while 
  • insomnia and restless leg syndrome have also been shown to increase incidence of high blood pressure
• if you snore regularly or stop breathing during the night -see you physician and get assessed for Obstructive Sleep Apnea
• develop a great sleep routine - get 7-8 hrs of high quality sleep

This 7 step strategy will allow you to take control of your blood pressure and do everything you can to either avoid medication or take as little as possible.

Backgrounder on Hypertension:

What is it?

• When your heart beats, blood is pushed through your arteries and veins.  The pressure the blood exerts on the walls of the artery is appropriately called blood pressure (BP) - systolic BP represents the pressure during the heart's contraction phase, diastolic BP the pressure during the relaxation phase, and BP is recorded as systolic/diastolic.  Blood pressure is controlled by two variables: the amount of blood pushed out of the left ventricle of the heart (cardiac output) and the resistance of the circulatory system to the flow of blood (peripheral resistance). This resistance is managed through complex mechanisms mediated by our autonomic nervous system that dilate or constrict our blood vessels.  At the same time our blood volume is adjusted by our kidneys with the retention or excretion of salt and water.  
• Blood pressure, like all of our physiology is homeostatic - meaning that stability is generated through a balance or equilibrium of seemingly competing systems.

How is it defined?

• Blood pressure is measured in mm of mercury (Hg). The American College of Cardiology and the American Heart Association recently released new guidelines (2017) that will increase the number of people diagnosed with hypertension to over 50% of the US population.
  • Normal - systolic < 120 AND diastolic < 80
  • Elevated - systolic between 120-129 AND diastolic < 80
  • Stage I Hypertension - systolic between 130-139 OR  diastolic 80-90
  • Stage II Hypertension - systolic greater than 140 OR diastolic greater than 90
  • Hypertensive crisis - systolic >180 OR diastolic >120
• These guidelines reflect evidence that normalizing blood pressure to a target of 120 decreases risk significantly.

Why is it important?

• Left uncontrolled high blood pressure can damage your arteries, increasing the risk of atherosclerosis, a disease where plaque builds up in the wall of your artery narrowing blood flow, and potentially blocking flow completely through plaque rupture or extreme narrowing and occlusion.  Atherosclerosis has multiple outcomes depending on the arteries affected:
  • in the arteries of the heart: angina (chest pain)  and myocardial infarction (MI or Heart Attack),
  • in the brain: stroke, from blockage or bleeding
  • in the kidneys: kidney failure
  • in the aorta (and other vessels) - ballooning (aneurysm) or rupture
• Hypertension also can damage the heart, initially causing the heart muscle to expand and the heart to dilate (Left ventricular hypertrophy and dilatation) resulting in heart dysfunction and congestive heart failure
• In addition to damaging the larger arteries of the kidney - hypertension damages the glomeruli - the small blood vessel clusters that are the filtration units of the kidney; and as a result of the effect on both the large and small arteries, hypertension is one of the most common causes of kidney failure.
• These same effects to small blood vessels also damage the blood vessels of the retina (retionopathy) resulting in vision loss and even blindness

What causes it?

• Most hypertension is from causes unknown and is characterized as primary hypertension.
• The risk factors for primary high blood pressure are:
  • family history
  • age
  • race
  • obesity
  • physical inactivity
  • kidney dysfunction
  • high sodium diets
  • excessive alcohol
• Causes of secondary hypertension
  • Medications - oral contraceptives, anti-inflammatories, antidepressants, decongestants being among the most common
  • Drugs - cocaine, metamphetamine
  • Kidney failure 
  • Endocrine disorders - both hypothyroid and hyperthyroidism and a multitude of other more rare.