The Silent Killer

By John Diaz

Sounds like the title of a new thriller only this one is for real. Hypertension or high blood pressure has been given the designation of the silent killer because it has no symptoms, no warning signs and most people afflicted don’t even know they have it. Getting scared yet, you should be?  Consider about one in three adults is hypertensive. So, what exactly is hypertension anyway?

We all know that our hearts are essentially a pump that circulates blood throughout the body. Each time our heart beats the force pushes blood out into the arteries. These arteries are made of muscle and semi flexible tissue not unlike elastic that will stretch to accommodate the force of the pump. Blood pressure is simply the measurement of outward force on the arterial walls.

Blood pressure is actually measured with two numbers. The first, the larger of the two, is the systolic pressure (this is the pressure during the heartbeat) and the second number is the diastolic pressure (measured between beats) as the heart rests. So, your blood pressure reading could be for instance 120/80. A number below 120/80 is considered normal and good.  A blood pressure of 120/80 plus is now considered to be prehypertension, 140/90 plus is Stage 1 hypertension, while 160/100 plus is Stage 2 hypertension and 180/110 plus is crisis level and requires immediate medical attention.

A single elevated reading is not a cause for concern as many factors can cause a temporary rise, factors such as recent activity or exercise, stress, anxiety and posture to name a few. If you note an elevated reading the best bet is to test again a few times over the next few days with the testing arm at heart level, both feet flat on the floor and after a few minutes of calm. If you yourself note a consistency in elevated readings it’s time to consult your doctor.  When using the free monitors offered at places like CVS and RiteAid be sure to ask if the device has been recalibrated within the last month or so as they can be grossly off when not maintained.

The main concern about hypertension is that over time excess force can over stretch the arteries beyond a healthy point, damaging them. This can cause weaknesses in the walls, scarring, blood clot formation, and plaque build-up. The associated narrowing can damage organs by restricting blood flow.  The heart will compensate by pumping harder thus increasing blood pressure further.  This increased pressure will in turn damage the heart itself.  Hypertension is also a major risk factor for stroke and aneurysms. 

In about 5% of cases hypertension is caused by an underlining condition such as kidney disease or thyroid disease. In such cases your doctor would have followed other accompanying symptoms in evaluating your condition and in prescribing the best course of treatment.

The vast majority of hypertension cases have no obvious medical cause.  Think of your elevated reading more as a call for lifestyle change. Here are a quick five: 1) attain a normal body weight, 2) reduce sodium intake, 3) engage in activity/exercise regularly, 4) limit alcohol consumption and 5) eat a healthier diet.

If you practice 3, 4 and 5 number 1 should be a result. Number 2 (limiting sodium) requires a bit of knowledge and effort.  Know that adding a little salt at the table isn’t the problem, it’s the salt you didn’t think of, that ridiculous amount found in fast and processed foods. That’s where your effort comes in, read the labels and avoid the foods with high sodium amounts. According to the CDC and AMA you should aim for 1500 mg per day.  Obviously the easiest way to achieve this is to prepare your food at home and limit prepackaged items.

On the subject of diet, fruit, vegetables, beans, sweet potatoes, fish, poultry, nuts, low fat dairy, dark chocolate and whole grains are all beneficial for lowering blood pressure. These foods are high in potassium, magnesium, calcium and protein. 

There are several supplements that have exhibited benefit in a handful of studies. These are: Omega 3’s, Coenzyme Q10, Garlic, Vitamin C, Calcium and Magnesium. If you are eating a healthy balanced diet including the foods mentioned above most of these should be covered naturally.  If not take the supplement.

Since weight loss is a goal (even a small decrease can significantly lower BP) we need to cut out or back on useless calories. Cutting carbohydrates such as corn, rice, pasta, breads, white potatoes and simple sugars is still the most effective way to do this.  Start easy, don’t over reach. Aim for about a 10% reduction in what you normally eat.  After this is a no-brainer if you want to go further aim for maybe a total carbohydrate ratio of 40% of all calories. Your ratios would be 40% low glycemic carbs, 30% lean proteins and 30% healthy fats.  See our blog posts 411 on Protein and Good Carb/Bad Carb for more info.

Like dietary changes add exercise amounts slowly.  Consistency is the key here.  Start with walking it’s the most natural movement to the human body.  Swimming, cycling and yoga are also great and help reduce stress.  If you are already a gym goer don’t forget to change up your routines regularly to get the most benefit.  Sameness will lead to stagnation.  Out of ideas get yourself a personal trainer for at least a couple of sessions to learn some new moves.

For those not getting their numbers down with lifestyle change medication may be the answer. Generally, you have to have numbers above 160/100 to gain benefit, but in some case such as those with heart disease or a history of stroke you can be given one or more of various medications.

Let’s take a look at some of the types of medication available.

1)      Diuretics - flush excess water and salt from the body.

2)      Vasodilators - relax the muscles in the vessel walls.

3)      Beta blockers – help the heart beat more slowly and with less force.

4)      Alpha blockers – reduce nerve impulses that tighten blood vessels.

5)      Alpha-beta blockers – reduce nerve impulses  and slow heartbeat

6)      Ace inhibitors – inhibit production of the hormone angiotensin 2 which causes the blood vessels to narrow.

7)      Calcium channel blockers – prevent calcium from enters the muscle cells in the heart and blood vessels allowing them to relax.

As you can see there are many options depending on your need. Doctors will generally take the most conservative approach to minimize medication side effects.  Know that taking medication is not a liberty on diet rather it’s prescribed in addition.

In conclusion, hypertension is the most preventable risk factor for death worldwide.  Properly managed you can expect a long, healthy and active life.

May 2019 Update:

Ketogenic diets have exhibited the ability to significantly lower blood pressure. The likely reason may have to do with lower water storage as ketogenic diets
are partially dehydrating. For every gram of sugar your body stores it also stores 3 grams of water. With keto style diets your glycogen stores shrink and so does your body hydration. As you lose the water you also lose salts. The decrease in body salinity and the likely significant weight loss from these diets combine to lower blood pressure.

References:

                       The Mayo Clinic – High Blood Pressure

                       Dr. Weil – High Blood Pressure – Hypertension

                        American Heart Assoc. – Understanding Blood Pressure Readings

                        British Hypertension Society – Guidelines for the Management of Hypertension