Hypertension

Hypertension (high blood pressure) is unquestionably one of the most significant issues in healthcare. At least 50 million Americans have hypertension, and the majority of them do not attain sufficient control of their pressures. Hypertension is a major independent risk factor for coronary artery disease (CAD), stroke, and kidney failure. Each increase of 20 mmHg in systolic blood pressure and 10 mmHg in diastolic blood pressure, over the range of 115/75 to 185/115, doubles the risk of a fatal coronary (heart) event. Most high blood pressure (95%) is classified as essential hypertension. In traditional settings, this means no obvious reversible cause. Interestingly, there is epidemiologic evidence that hypertension exists almost entirely in developed countries. Thus, much of what we call essential is likely due to diet, obesity, inactivity, tobacco abuse, stress, and alcohol consumption.

The Joint National Commission on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure is the primary body that sets definitions of hypertension, guidelines for control, and treatment recommendations. Their most recent publication, JNC Report VII, came out in May 2003. It identified a normal blood pressure as below 120 (systolic) over 80 (diastolic). Pre-hypertension is systolic levels between 120-139 or diastolic levels between 80-90. Hypertension is defined as a blood pressure above 140/90.

In our system, as with most diseases, treatments focus primarily on prescription drug therapy. These medications are in fact important and necessary for many people. There are multiple research studies that show treatment with prescription medications to defined goals lower risk of heart attacks, strokes, kidney failure and death. Thus, for patients with elevated blood pressure, medication is imperative if levels remain above goals. However, there are a wealth of non-prescription drug therapies that are extremely valuable in preventing and controlling hypertension. The JNC VII report focused on several of these, including weight loss, alcohol moderation, salt restriction, and increased physical activity.

One aspect that was notably overlooked was the impact of daily stressors and the positive effects of various mind-body activities. The research on such activities has generally been of poorer quality than that of modern pharmaceutical trials so it has been hard for organizations to embrace these tools. However, incorporating mid-body activities into ones' daily routine not only can lower blood pressure, but also have psychological benefits, improve sleep, reduce inflammation and pain, and positively impact hormonal systems. One simple mind-body technique that everyone can use is slow, deep breathing. There are studies showing that people who breath less times per minute have lower blood pressures than others. Taking 3-5 minutes at least twice daily to stop what your doing and do breathing exercises where you take 3-4 seconds to inhale and 3-4 seconds to exhale can be quite powerful. Other more involved mind-body methods include yoga (where breathing is paramount), biofeedback, medication, and simply anything that relaxes you (exercise, music, writing, dance, etc).

The dietary measures that are valuable for blood pressure are nearly identical to how we want all people to eat, all the time, regardless of active medical issues. These include the following:

1. avoidance of processed foods

2. eating primarily plant-based foods

3. ensuring a large variety of fruits and vegetables (7-10 servings daily)

4. using 100% whole grains and limiting processed, low fiber flours

5. liberal use of healthy fats (mono- and poly-unsaturated fats) such as olive oil, nuts, seeds, cold-water fish, avocado, and flax

Some dietary measures that are important to all but specifically beneficial to those with hypertension are limiting sodium (salt) and having liberal use of potassium and magnesium.

If you can make one single dietary change for blood pressure, limiting salt to less than 2000 mg daily (about 1 teaspoon) should be the one. Furthermore, it's pretty hard to find unhealthy foods that are low in salt. Thus if you actively avoiding salt, you're probably doing a pretty good job on everything else.

A specific diet known as the DASH diet has been shown in research studies to have as profound amounts of blood pressure lowering as do medications. A thorough review of that diet can be found here: www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf.

For many people blood pressure remains elevated despite aggressively pursuing lifestyle and mind-body methods. For others, achieve consistency with these methods is challenging and blood pressure control is not reached. In these situations, further treatment may be needed. For younger individuals at low cardiovascular risk, non-prescription supplements may be tried. If goal pressures are not reached in 6-12 months, advancing to prescription medication is needed. For others, starting with prescription agents may be the best route.

Common non-prescription agents used for blood pressure include the folllowing:

1. coenyzme q-10

2. omega 3 fatty acids (DHA+EPA) supplements

3. magnesium and potassium supplements

4. hibiscus tea

5. garlic

6. green tea

Prescription agents fall into several classes. Most studies have not shown a difference in classes as long as blood pressure goals are reached. I generally start patients with a group called ACE inhibitors or diuretics. Often I'll use these two medications together in combination pills. Most classes of blood pressure prescription medication are well tolerated though side effects remain possible for any agent. Compliance with a prescribed regimen is imperative so discussing potential side effects is important to ensure you have an effective regimen in place.

Hypertension is one of the most dangerous medical problems there is. Most patients have no symptoms from hypertension and thus are not acutely aware of their blood pressure. Uncontrolled pressure, even in one's early years can have dramatic ramifications down the road. Additionally, hypertension often co-exists with other diseases such as high cholesterol, diabetes, obesity, and sleep apnea. The lifestyle measures that are effective for controlling and preventing hypertension are also valuable in these other conditions.

You should have your blood pressure checked yearly. Most people first develop high blood pressure between the ages of 35 and 60. Implementing healthy behaviors of proper diet, regular exercise and effective control of stress are imperative both for prevention and treatment. When those measures are not sufficient, both prescription and non-prescription medications may be needed.

Hypertension (HTN) Links

Portal Page to Multiple HTN Articles

Salt Reduction

Natural Methods for HTN

DASH Diet