Harnessing Hypertension

Does having hypertension automatically consign one to taking medications for the rest of one's life?  What about all of the side effects of taking medications?  Aren't they bad for you?  Knowing the risks posed by high blood pressure (see my previous post), what can be done to keep the pressure down?  answers to these questions are not always straightforward and can only be answered correctly on an individual basis.  Let me discuss some generalities first.

It is always better to control blood pressure without medications.  Always.  It may not always be possible to lower blood pressure enough with healthy living alone, but doing so will certainly decrease the number and or the dose of medications needed to keep it under control.  There are four basic precepts to keep in mind in harnessing hypertension.

First, if you smoke you must quit.  Nothing else you do will matter much if you keep smoking.  You may have a perfectly normal blood pressure, controlled with medications but your risk of heart disease and stroke will not go down significantly if you keep smoking.  Nicotine is a vasoconstrictor.  This means that it narrows the blood vessels.  Think of your garden hose.  If you want to increase the pressure in the hose to wash off your deck you apply a device at the end of the hose that narrows it.  Every time a cigarette is smoked the blood vessels narrow for about twenty minutes.  I see this all the time in my office.  A patient will come in with a higher than normal blood pressure.  One quick sniff tells me that they likely had one last cigarette before walking in the door.  At the end of the visit, I'll recheck the blood pressure and it will have come down.  In the beginning these changes are reversible.  With time, the stress on the walls of the blood vessel cause it to become thickened.  This is like taking that garden hose and turning it into a pipe.  As there is no elasticity or give in the blood vessel wall, pressure shoots up even more.  This whole cascade is caused from cigarette smoking.  I know that it is hard.  You must quit smoking.

Second, regular cardiovascular exercise is as good as taking a medication.  The side effects are much better.  It will not give you a cough, make your ankles swell or take away your sex drive.  It will give you more energy, relieve stress and help you sleep better.  The biggest side effect from exercise is injury, of course.  Start slow and gradually build up.  Consistency is the key.  To effectively lower blood pressure some sort of exercise needs to be done at least four days of the week.  During exercise, the blood pressure will actually go up.  This is normal.  The muscles need more blood flow during exercise to provide fuel and oxygen to the muscles.  The heart responds by contracting more quickly and with a greater force.  As the heart itself gets in better shape, it pumps more efficiently.  A well conditioned athlete will have a very low heart rate and excellent blood pressure readings. This is a sign that the blood vessels are relaxed and the heart is not burdened.

If you want to avoid taking medications or limit the number that you need, make sure that the fuel you give your body is of the highest quality.  In particular, limiting the salt content in your food will help your blood pressure.  The sodium in salt causes your body to retain more water in the kidneys.  This is equivalent to turning up the knob on the garden hose.  The higher the volume in the tubes, the higher the pressure.  You must first break the habit of salting your food.  This includes tomatoes and cantaloupe.  In addition, much of the food that we eat has a lot of salt in it to begin with.  Make the effort to look at everything that you eat in a day.  Look at the labels, find out how much sodium is in all that you eat.  Your total sodium intake in a day should be less than 2000 mg.  It is easy to find a website to tell you how much salt is in common foods (here's one).  If it is in a package, a wrapper or a can, it likely has salt in it.  If it says "low fat" it likely has salt in it.  Guess what has not salt in it at all?  Fruits and vegetables.  In fact, fresh fruits and vegetables are naturally high in potassium.  When potassium is delivered to the kidney it exchanges with sodium, excreting it in the urine.   By eating fruits and vegetables you are actually getting rid of salt.  The best diet to lower your blood pressure is the DASH diet (dietary advice to stop hypertension).

Lastly, limit the toxins in your system.  Admittedly this includes nicotine and salt but those two are so important they get their own category.  In addition, alcohol can be an issue.  Up to four glasses of red wine has been shown to have a beneficial effect on cholesterol levels but not more, and not any other kind of alcohol.  No amount of beer, vodka or other forms have been shown to have any beneficial effect.  The alcohol molecule itself can have adverse effects on the heart.  Alcohol also contains sodium and "empty calories" (they don't do your body any good).  Caffeine is not as bad as nicotine but it is a stimulant.  It will artificially raise the heart rate.  The only safe way of doing this is through exercise.  Just this week I saw a patient in follow up who has dramatically reduced his blood pressure by eliminating soda, coffee and adding exercise.  Many medications can make blood pressure worse.  Anti-inflammatory medications such as Aleve (naproxen) or Advil (ibuprofen) can have a deleterious effect, especially in older individuals. ADD drugs such as Aderall and Ritalin can also raise blood pressure.  The anti-depressant Effexor also must be used with care in addition to the migraine medications like Imitrex.  Decongestants are especially bad for hypertension and should not be used.  This is just a sample.  Look on the labels of anything that you take and make sure it does not give warning in regards to high blood pressure.

In summary, I have not given any advice in this post that I have not given previously.  I have tailored it specifically to high blood pressure.  The advice remains simple, putting it into practice is difficult.  Choose on thing that you can do better and work on that.  Make a positive step in your health today.