Hypertension approach
Hypertension is defined as a systolic blood pressure of 130 mm Hg or greater and/or a diastolic blood pressure of 81 mm Hg or greater on two separate consecutive occasions. Severe considered reading of 180 mm HG systolic or above and/or 120 mm Hg diastolic or above.
Hypertension is a condition in which the force of the blood against the artery walls is too high. In systolic hypertension, the force the heart needs to push against peripheral resistance is high. There is excess resistance for the heart to distribute blood to the brain and other organs
In diastolic blood pressure. The force in which the blood returns to the heart is too great.
Long term unregulated blood pressure can cause damage to blood vessels and can lead to long term damage of the heart tissue. Also concerning is the long-term effect of unregulated blood pressure on other end-organs such as the eyes, brain, and kidneys. The changes in flow to these regions increases risk for organ ischemia, cell death, and dysfunction.
High blood pressure often has no symptoms. Yet, many describe a sense of uneasiness and disorientation when their blood pressure is elevated. Or a sense of pressure in the head and neck.
When blood pressure is too elevated a stroke may occur. The acronym FASTER (Facial drooping, Arm weakness, Speech difficulties Time, Eyes, React) has been used by the National Stroke Association and American Heart Association and others to educate the public on detecting symptoms of a stroke.
● F stands for Face, which refers to drooping or numbness on one side of the face versus the other. Ask the person to smile to make the droop more apparent.
● A stands for Arms, which refers to one arm being weaker or more numb than the other. Ask the individual to raise both arms up and hold them for a count of ten. If one arm falls or begins to drop, then this could be a sign of a stroke.
● S stands for Stability, which refers to steadiness on your feet. Sometimes individuals will fall, feel very dizzy or be unable to stand without assistance. Difficulty maintaining balance, trouble walking and loss of coordination are all possible stroke symptoms.
● T stands for Talking, which refers to changes in speech including slurring, garbled, nonsensical words, or the inability to respond appropriately. Individuals experiencing a stroke may be difficult to understand, or they may have difficulty understanding others. Ask the person to repeat a simple sentence like “The sky is blue.”
● E stands for Eyes, which refers to visual changes. These visual changes occur suddenly and can include complete vision loss in one eye, double vision, and partial loss of vision in one or both eyes.
● R stands for React, which is a reminder to call 911 immediately if you recognize any of these symptoms. Call even if the symptoms go away and try to remember when they first began.
This acronym will hopefully alert stroking patients and their caregivers to act on early emergency medical services. The outcomes of stroke recovery are highly dependent on early intervention.
A proper blood pressure reading must be done to accurately assess hypertension. According to the American Heart Association the technique for proper blood pressure recording is as follows.
Be still. Don't smoke, drink caffeinated beverages or exercise within minutes before measuring your blood pressure. Empty your bladder and ensure at least 5 minutes of quiet rest before measurements.
Sit correctly. Sit with your back straight and supported (on a dining chair, rather than a sofa). Your feet should be flat on the floor and your legs should not be crossed. Your arm should be supported on a flat surface (such as a table) with the upper arm at heart level. Make sure the bottom of the cuff is placed directly above the bend of the elbow. Check your monitor's instructions for an illustration or have your healthcare provider show you how.
Measure at the same time every day. It’s important to take the readings at the same time each day, such as morning and evening. It is best to take the readings daily however ideally beginning 2 weeks after a change in treatment and during the week before your next appointment.
Take multiple readings and record the results. Each time you measure, take two or three readings one minute apart and record the results using If your monitor has built-in memory to store your readings, take it with you to your appointments. Some monitors may also allow you to upload your readings to a secure website after you register your profile.
Don't take the measurement over clothes.
In addition to these guidelines, proper cuff fitting is essential. Before selecting a monitor measure around your upper arm to determine proper fit.
There are primary and secondary causes of hypertension.
Primary causes of hypertension (called essential hypertension) usually develops gradually over several years It is thought that essential hypertension may be the result of Inflammaging which is the buildup of inflammation gradually over the lifetime. This inflammation which is largely prevented by diet and lifestyle might reduce key blood pressure regulating components like Nitric Oxide. It is thought that the hypertension is related to increased oxidative stress that affects the endothelial tissue of the arteries. Basically, reducing flow and increasing blood pressure.
Some people have high blood pressure caused by an underlying condition (Secondary Hypertension). This type of high blood pressure, tends to appear suddenly and can cause higher blood pressure than does primary hypertension. Various conditions and medications can lead to secondary hypertension, including:
● Obstructive sleep apnea
● Blood vessel problems (usually bruits are heard on physical exam)
● Kidney disease
● Adrenal gland tumors
● Thyroid problems
● Certain defects you're born with (congenital) in blood vessels
● Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs
● Illegal drugs, such as cocaine and amphetamines
In addition, some people have hypertension secondary to stress and anxiety.
When under chronic stress and anxiety the body produces excess catecholamines (norepinephrine and epinephrine). These hormones are vasoconstricting and can increase blood pressure.
There are established guidelines about medications for hypertension and if your provider is unable to help you regulate your blood pressure with diet, lifestyle, nutrition, and herbal medicine then the JNC8 guidelines might be recommended.
If secondary causes for hypertension have been identified, they must be addressed specifically.
Essential hypertension, however, may be targeted by supporting vasodilation, vasoconstriction, endothelial tissue, nitric oxide release, and reduction of inflammation through diet, lifestyle, nutrient, and herbal measures.
The first step in a lifestyle recommendation is to identify if there are any potential causes of stress that could be contributing to hypertension. This is assuming secondary causes of hypertension have been ruled out. As mentioned, stress/anxiety are involved with catecholamine release which raise blood pressure. If identified practices such as:
● NuCalm
can be followed to help with regulation of the autonomic nervous system.
Since stress and its impact on blood pressure happens without our direct awareness; learning how to train the autonomic nervous system through meditation and other mind-body techniques can be helpful in learning self-regulation.
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Weight gain may be playing a role in blood pressure increases. Research has shown a 2-kg loss in weight over a 6-month period resulted in a decline of 3.7 mm Hg in systolic and 2.7 mm Hg in diastolic blood pressure.
Sleep plays a critical role in blood pressure and stress management. An emphasis should be placed on achieving 7-9 hours of sleep per night. As mentioned earlier a contributing factor of sleep apnea may be involved with hypertension. Screening and testing for sleep apnea if waking unrefreshed is always advised. There are new apps that allow you to self-screen for snoring and possible airway issues such as Snore Lab and Sleep Score.
Cardiovascular exercise 150-300 minutes weekly is always recommended in the hypertensive patient. The neurochemical and cardiovascular effect of exercise is well documented in lowering blood pressure as well as reducing the harmful effects of hypertension.
Nutrition and dietary approaches for hypertension involve inclusion of cardiac supportive nutrients and avoidance of excess of nutrients and food items known to contribute to hypertension.
The most common diet for lowering blood pressure is called the DASH diet: Which stands for Dietary Approaches to Stop Hypertension. This diet is low in salt and rich in fruits, vegetables, whole grains, low-fat dairy, and lean protein. Salt sensitivity can be a major cause of dietary related hypertension. On the Dash diet we limit sodium to 3500mg or less per day. The inclusion of fruit and vegetables leads to the increase of potassium in the diet.
Evidence supports the possibility that potassium modifies central or the peripheral neural mechanisms that regulate blood pressure. In addition, high potassium diets could reduce blood pressure by relaxing vascular smooth muscle and reducing peripheral vascular resistance directly.
Here is a list of the best sources of potassium.The DASH eating plan is designed to be rich in potassium, with a target of 4,700 mg potassium daily.
The complete list can be found here.
Americans consume 3 to 4 times the sodium and about one third the magnesium and potassium that is recommended by current guidelines. A high intake of potassium, magnesium, and possibly calcium through increased consumption of fruits and vegetables may be the key dietary component in lowering blood pressure. Omega-3 fatty acid intake is also a key factor in cardiovascular health.
It is also important to focus on magnesium-rich Foods: such as, dark leafy greens, nuts, seeds, fish , beans, avocado, and whole grains. Magnesium appears to be critical nutrient for endothelial tissue health. The western population is chronically low in magnesium.
We should generally strive for 400 mg-450mg of magnesium per day from the diet.
Some foods are naturally medicinal and may be termed functional foods natural diuretics such as celery sticks. A diuretic food may be especially helpful in lowering some of the excess blood volume that happens with high salt and alcohol intake.
Polyphenols, in particular flavanols in cocoa products, have been shown to increase the formation of endothelial nitric oxide, which promotes vasodilation and consequently may lower blood pressure. Other polyphenols includes berries, beets, and pomegranates.
Omega-3 fatty acids improve endothelial function and lower blood pressure. Assessment of endothelial function may be useful in guiding therapy for hypertension. To optimize blood pressure levels in hypertension and for cardio protection, the evidence indicates that fish oil doses of 4 grams/ day may be needed.
Some foods can increase blood pressure due vasoconstricting effects such as caffeine containing beverages which should generally be reduced to 1-2 cups per day. The effect of caffeine on blood pressure is transitory but can contribute to higher blood pressure
General tips for reducing hypertension:
● Try and include 1 serving of BEET JUICE daily for nitric oxide release . I like the brand Lakewood available at Whole Foods
● 1 square (30 grams ) of dark chocolate per day. Midnight chocolate, vegan, dairy free. I like the brand HU.
● Include 4 cloves of garlic per day in your diet. The active ingredient in garlic is known to be allicin (diallyl thiosulfinate). Garlic's ability to lower the blood pressure is multifactorial and includes: increasing the availability and activities of nitric oxide, inhibiting ACE thereby reducing a number of pathways that are known to decrease plasma volume and vasoconstriction, and lastly, increasing the production of H2S that results in hyperpolarization of vascular smooth muscle cells.
● Snack on 6 ½ stalks of celery per day. Celery is a natural diuretic. Celery contains a unique chemical called butylphthalide, which research suggests has strong diuretic properties, stimulating the kidneys to excrete more urine and flush away excess water and salt.
● Rotate the following drinks (Drink Hibiscus Tea 1-2 cups per day, Drink Green Tea 1-2 cups daily, Drink Beet juice 4 oz daily, 4 oz pomegranate juice daily (Pom)). These polyphenol rich drinks release nitric oxide and have other endothelial beneficial effects.
● Strive for low Sodium intake (ideally less then 3500mg of salt daily) Especially if your hypertension is salt sensitive. Switch to Wright Salt (no sodium Salt) as a sodium alternative.
● Decease alcohol to no more than 1 serving of alcohol per day ( the equivalent of 24 oz of beer or 10 oz of wine, or 2 oz of 100 proof of whiskey daily)
● Drink 2 Liters of water per day for kidney health
Supplements can be employed while dietary changes are being made or in addition to dietary changes. Many have been well researched to lower blood pressure. As mentioned, severe uncontrolled hypertension likely will require conventional medications but mild-moderate may be attempted to be controlled with the measures discussed in this article under the supervision of a licensed healthcare provider. Here is a list of the top supplements used in practice for hypertension.
For anxiety and stress related hypertension, the herbal medicine Rauwolfia serpentina (Indian Snakeroot) is often used. Rauwolfia works on blood pressure from a central nervous system perspective. Along with Rauwolfia, I generally prescribe B-complex vitamins with catecholamine and cortisol calming agent’s taurine, ashwagandha, valerian, passionflower, L-theanine, and magnesium
Natural options are good to consider as an option as an alternative or in conjunction with conventional approaches. Long term effects of conventional blood pressure medicine are not widely mentioned, however, a few noteworthy side effects like melatonin disruption by beta blockers are well documented. Lisinopril (an-Ace Inhibitor) often has a dry hacking cough that develops. That may be bothersome.
Blood pressure management should be part of a larger cardiovascular preventative approach and should be discussed with your provider. A well rounded cardiovascular evaluation should minimally include diet and exercise history, physical exam, and measurements of cholesterol, homocysteine, fasting insulin, fasting glucose, comprehensive metabolic panel, and cardiac-specific c-reactive protein
Blood pressure should be measured at least once per month at home for anyone who is 40 and over and at least twice per day for anyone with known hypertension
