By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.
Between 20 to 25 percent of all American adults, and 26 percent of people worldwide, have hypertension. Hypertension, which characterizes chronically high blood pressure, has also been nicknamed “the silent killer.” Almost a third of all people with hypertension are asymptomatic, which means that the first recognizable symptom in them may be a stroke or heart attack! Not only is hypertension the primary cause of strokes, it triples one’s risk of cardiovascular disease, and can increase one’s chances of kidney damage, blindness and an enlarged heart.
Prevention and early detection of hypertension are crucial for cardiovascular health. The good news about hypertension is that it is highly preventable through various lifestyle habits like stress management, an anti-inflammatory and low-salt diet, a moderate exercise program, and targeted supplementation. Most health practitioners will check for high blood pressure during routine visits. Knowing one’s typical blood pressure measurements as well as which lifestyle practices help lower or maintain blood pressure can jump start a strategic plan against hypertension.
Essential and Secondary Hypertension
Health professionals describe high blood pressure as being either essential or secondary. Secondary hypertension occurs as the symptom of a diagnosed underlying problem such as an overactive thyroid gland, abnormal kidney function, an adrenal gland tumor, or congenital defect of the aorta. Generally, secondary hypertension disappears when the underlying condition is corrected. Essential hypertension, on the other hand, accounts for 90-95 percent of all cases and characterizes high blood pressure with “unknown” causes. In the last few years, we have recognized that oxidative stress and endothelial cell dysfunction are the primary causes of what was once “essential” hypertension.
What Are the Causes of Essential Hypertension?
Weight gain or obesity, physical inactivity, a high sodium and nutrient-deficient diet, and chronic emotional stress are all considered risk factors for essential hypertension, though none have actually been scientifically proven to directly cause high blood pressure. However, studies have shown that combined lifestyle modifications including weight loss, regular moderate exercise, stress management, and optimal nutrition can help reduce blood pressure. It follows that adopting these measures preventatively should help limit hypertension risk.
Avoiding cigarette smoking and other exposure to smoke can also help reduce one’s risk of hypertension, stroke and heart attack. By constricting blood vessels, nicotine forces the heart to work harder to pump oxygen and nutrient-rich blood throughout the body, which, over time, paves the way for high blood pressure. Carbon monoxide and nicotine in cigarettes also decrease blood oxygen levels, which can cause plaque and clots to accumulate within arteries and possibly result in life-endangering blockages. The more chronic the smoking habit, the greater the chances of cardiovascular disease. (See “How to Quit Smoking.”)
Heredity, age, sex/gender, and race/ethnicity also appear to play roles in the development of hypertension. People whose parents or other close relatives have high blood pressure are more likely to develop hypertension, as are those over the age of thirty-five years. While men are more prone to hypertension between ages thirty-five and fifty, women have the same chances as men after menopause, at approximately fifty-five years of age. By age seventy-five, women have a greater risk of hypertension than men. Statistically, hypertension is more also prevalent among Hispanic and African Americans than Caucasian Americans.
Do I Have High Blood Pressure?
A normal blood pressure reading shows systolic pressure of less than 130 and a diastolic pressure which remains below 80 (expressed as 130 over 80 or 130/80). Blood pressure that exceeds 140/90 indicates mild to moderate hypertension for which treatment is advised; about two-thirds of all heart attacks occur in people with mildly elevated blood pressure.
Hypertension’s Long-Term Effects on the Heart and Blood Vessels
Chronically high blood pressure harms both the heart and blood vessels. By forcing the heart to constantly work harder to send blood to all the body’s cells, hypertension causes the heart to gradually enlarge. In time it can literally run out of energy and start to fail. Congestive heart failure characterizes a heart so weak it that cannot pump adequate amounts of blood to meet the body’s needs, and can result in fatal strokes and heart attacks. Congestive heart failure is most commonly caused by coronary artery disease and/or blockages in the arteries.
Many risk factors associated with hypertension, such as chronic emotional stress, obesity, insulin resistance, and a sedentary lifestyle are also linked to compromised arterial structure and function. Hypertension can not only result from diseased arteries, but it further contributes to their detriment by eroding artery walls and causing a chain of subsequent accumulation of toxic substances and inflammation.
Hypertension and Syndrome X
If a person has gained weight, and has impaired carbohydrate tolerance and abnormal blood fats (low HDL and high triglycerides) in addition to high blood pressure, he or she may have insulin resistance syndrome, or Syndrome X. This becomes problematic because pharmaceutical treatment of hypertension that is a symptom of a core problem like insulin resistance or Syndrome X may be ineffective. Additionally, treating all the issues simultaneously with a cocktail of drugs may cause a domino effect of nutrient depletion and other health complications to occur. With hypertension and Syndrome X, lifestyle modification becomes especially important to help manage and reverse both conditions and avoid medication overload.
Treatment for High Blood Pressure
Conventional treatment of high blood pressure generally includes any combination of over sixty-five different medications. These medications help lower blood pressure by altering body physiology: they may relax or dilate blood vessels, decrease blood volume, or interfere with the production of hormones which increase blood pressure. Such medications might include ACE inhibitors, A-II receptor blockers, calcium channel blockers, beta blockers, diuretics, and alpha-adrenoceptor blockers.
While such medications can help reduce blood pressure, they also potentially subject patients to unpleasant side effects like impotence, loss of libido, fatigue, nutritional deficiencies, drowsiness, dry-cough, light-headedness, and even depression. These side effects can be unbearable for some patients and make compliance with medication use problematic. Many hypertension patients who are asymptomatic become frustrated with new side effects and stop taking their medications entirely. Medications also do nothing to address the lifestyle habits, or controllable risk factors, which may contribute to hypertension, the same ones that, when reversed through deliberate practice, have been shown to help reduce blood pressure.
The reality is that people with serious hypertension usually need some type of medication, especially if they have other cardiovascular diseases. Reducing or eliminating the need for these medications through an integrative strategy can preserve and enhance quality of life. Such a strategy for lowering blood pressure in patients with hypertension involves lifestyle modification in conjunction with optimal pharmacologic therapy. Weight loss, a nutritious diet and appropriate supplementation with vitamins, antioxidants, and minerals, reduction of emotional stress, regular moderate exercise, judicious use of alcohol, and complete cessation of tobacco and caffeine are all elements of a lifestyle which supports healthy blood pressure.
Making Integrative Lifestyle Changes
Avoidng high blood pressure is entirely possible and probable through a heart-healthy lifestyle. Starting with what one chooses to consume each day and then tackling how one moves and manages stress are simple, little steps that, when habitually practiced, can significantly impact blood pressure. Becoming an active participant in one’s healing can mean a lot less time, if any, spent in the doctor’s office or hospital.
Preventing the weight gain and insulin resistance that can lead to high blood pressure and cardiovascular disease is absolutely within one’s reach through the adoption of an anti-inflammatory diet full of nutrient-rich fresh fruits and vegetables. Knowing the facts about inflammation and insulin resistance may help inspire a commitment to such a diet. Eating foods containing omega-3 fatty acids or those containing fats which convert to omega-3’s in the body also can create positive cardiovascular effects which support healthy blood pressure. Hypertensive people should also read food and beverage labels to avoid sodium consumption.
Supplementation with Vitamins A, C, and E, calcium, magnesium, L-carnitine, and coenzyme Q10 can also protect against high blood pressure. Consuming these nutrients not only helps one protect blood vessels, it also assists the body in generating ATP (energy) needed for metabolic processes, which helps prevent congestive heart failure. Appropriate supplementation can also help offset nutritional deficiencies resulting from medications used to treat high blood pressure.
Managing emotional stress is extremely important for maintaining a healthy blood pressure. Regularly engaging in mind-body practices, like yoga, meditation or Tai Chi, can induce beneficial autonomic nervous system activity (also known as a “relaxation response”) which facilitates lowering of blood pressure. Likewise, recognizing emotional stress and breathing deeply and/or taking a “time out” to deal with it, can help prevent the fight or flight response which, when habitual, can contribute to high blood pressure.
Engaging in regular, moderate exercise can also help relieve stress and tension, as well as promote other beneficial physiological effects. Not only does exercise help reduce high blood pressure, it enhances sleep, relieves constipation, supports musculoskeletal health, and protects against depression, insulin resistance and weight gain. It is important that exercise be non-strenuous, as overdoing it can actually compromise health. By engaging in exercise that is fun, such as dancing or walking with friends, pets or loved ones, you better your chances of sticking to it as a heart-healthy lifestyle choice.
Note: Patients taking medication for high blood pressure should always discuss any potential lifestyle modifications with their physicians before changing any current blood pressure lowering strategies.
- Kotchen TA, Hypertension Control: Trends, Approaches, and Goals. Hypertension. 2007; 49:19.
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