The Most Common Health Condition: Hypertension
Have you noticed that when you go to the doctor, most of the time they will take your blood pressure? That is because at least one in five New Zealanders have high blood pressure and most don’t know they have it.
So, what exactly is high blood pressure or hypertension? This is when the force of your blood against your artery walls is too high, too often. You might hear a few terms used like systolic blood pressure – this is the higher reading and reflects the highest pressure pushing on the walls of your arteries. The diastolic blood pressure is the pressure within your arteries as they relax. This is related to the beating heart – systolic is when the heart beats and diastolic is when the heart relaxes.
You would normally aim for somewhere between 110-130/70-80 for a healthy blood pressure reading. Anything from 140/90 is high and anything from 180/120 is seriously high.
So, why is it important to diagnose and treat hypertension? If left untreated, hypertension leads to stroke, heart attack, heart failure, kidney failure, dementia, vision loss and peripheral artery disease (the narrowing of the arteries in your legs).
How does high blood pressure cause all of these problems to occur? If the pressure in the arteries remains high, the body tries to compensate by thickening the artery walls and as a result, this causes narrowing of the arteries, thus causing stroke, heart attack, kidney failure, dementia, vision loss and peripheral artery disease. Heart failure is due to the heart muscle having to push harder to get the blood around the body against the higher blood pressure in the arteries, and, as a result, the muscle of the heart starts to weaken and the heart starts to dilate, and thus the muscle pump becomes weaker.
How is high blood pressure diagnosed? There are a couple of methods – you could take several blood pressures at home and discuss them with your family doctor. An alternative is 24-hour blood pressure monitoring where you wear a cuff on your arm and it monitors your blood pressure over a 24-hour period to give a natural idea of what your blood pressure is doing over a day. It tends to go up and down at different times. What we don’t want you to do is use just one blood pressure, especially when it is at the doctor’s because it can go up artificially at that time – this is called “White Coat Hypertension”.
What causes hypertension and who is at most risk? Hypertension tends to run in families, so there is a genetic association. In most cases, no cause is found. However, we do know that high blood pressure can also be associated with a poor lifestyle like not enough exercise, too much alcohol and smoking. Poor diet causes nutritional deficiencies and we know that you need adequate amounts of omega 3 and omega 9 (olive oil) as well as zinc, B vitamins, magnesium, vitamin C and other nutrients to keep your blood pressure controlled as well as keep your body healthy.
There is an association between high blood pressure and obesity, diabetes and abnormal cholesterol, and we call this metabolic syndrome. Metabolic syndrome occurs in 30 percent of people over the age of 65 and it is increasing in younger ages. Stress causes high blood pressure because it causes increased sympathetic drive from your autonomic (or automatic) nervous system, which responds to the “threat in your life”. In addition, a person who has any chronic inflammatory diseases like rheumatoid arthritis, osteoarthritis, lupus, diabetes and heart disease, etc. is going to be at more risk of high blood pressure because inflammation is the foundation of many diseases, including high blood pressure.
Are there any hidden causes of high blood pressure? Yes, five to ten percent of high blood pressure can be related to problems with the renal artery being a bit too narrow. This then requires your doctor or a specialist to look at testing for this with special blood tests and urine tests. There can also be issues with the adrenal glands causing too much aldosterone to be released, which causes increased blood pressure. Additionally, an overactive thyroid can cause high blood pressure and sometimes mechanical problems like a narrowing of the aorta at the top of the chest – called Coarctation of the Aorta. Additionally, over-the-counter drugs like decongestants and cold remedies can cause high blood pressure, as well as other drugs that the doctor will prescribe to you such as non-steroidal anti-inflammatory drugs, antifungal drugs, amphetamines, some antidepressants, the contraceptive pill, steroids and appetite-suppressant pills.
Uncommonly thought of conditions behind high blood pressure can include disordered breathing – this is very important because many people breathe with their upper chest without realising it, especially when stressed, and it causes their blood pressure to go up. Another cause is obstructive sleep apnoea – this is important because if you sleep alone, you don’t know whether you are stopping breathing or snoring, and you don’t know why you wake up tired every day, so this might have to be looked into. One of the rare causes of high blood pressure is a rare tumour of the adrenal gland called phaeochromocytoma. In fact, I have only seen one case in my over 40 year career as a doctor.
What is the treatment of hypertension? The first approach is always to be about lifestyle – lose weight, start exercising and control alcohol and smoking. Also, get adequate sleep at the right time, which is between 10:30 pm and 8:00 am because this reduces inflammation. When it comes to diet, avoid salt and use herbs, lemon juice or tamari to flavour foods. Include many different coloured vegetables in your diet because they provide the different vitamins and minerals that you need.
The medications that are used commonly are discussed here. ACE inhibitors for example, lisinopril, cilazapril and quinapril, are general favourites because they have a low side-effect profile and do a very good job as well as helping to prevent heart failure. Additionally, a related drug group called angiotensin receptor blockers work very well too and these include candesartan, losartan and irbesartan. Old favourites such as beta blockers, e.g. metoprolol, bisoprolol and propranolol are also commonly used. Calcium channel blockers like felodipine, diltiazem and amlodipine are also commonly used and often a second line medicine after ACE inhibitors. Diuretics have traditionally been used – these are sometimes called water pills and include bendrofluazide, chlorthalidone and indapamide. It is important that you and your doctor work out what suits you best because some people may not tolerate some medications.
There are also supplements and foods that are very helpful to reduce blood pressure and they do this by supporting nutritional deficiencies. I think everybody should take omega 3 fish oil, a good multivitamin, some vitamin C and then look at whether you need potassium, magnesium and any extra B vitamins.
When it comes to foods, there are a huge array of foods that actually act like blood pressure medications. An example of this is collagen powder, which can be taken as a supplement at night because it not only lowers your blood pressure but it also helps you sleep. Some people like bonito fish, which is dried fish and acts like ACE inhibitors. There are some foods that work to increase nitric oxide in your blood, which is a special gas that dilates your arteries and these foods include beetroot, pomegranate and green vegetables. Other foods that lower blood pressure include, soy foods, bananas (high in potassium), kumara (potassium and magnesium), white beans (potassium, magnesium and fibre), milk and yoghurt, quinoa (potassium and magnesium), oats, dark chocolate, berries and extra virgin olive oil, as well as garlic.
Although the dice may be stacked against you because of family history, there is much that a person can do to reduce the need for medications by working on adequate sleep, good exercise and a healthy diet containing a great variety of blood pressure-reducing foods that can help support you for your blood pressure. Ultimately, it is always a good thing to focus on leading a quiet, low-stress life.