2015 DEC - Non-Medicated Life
Preventing and Treating Hypertension
By Paul E. Lemanski, MD, MS, FACP
Editor’s Note: This is the 68th in a series on optimal diet and lifestyle to help prevent and treat disease. Any planned change in diet, exercise or treatment should be discussed with and approved by your personal physician before implementation. The help of a registered dietitian in the implementation of dietary changes is strongly recommended.
Medicines are a mainstay of American life and the healthcare system not only because they are perceived to work by the individual taking them, but also because their benefit may be shown by the objective assessment of scientific study. Clinical research trials have shown that some of the medicines of Western science may reduce the risk of heart attacks, strokes and cardiovascular death while others may reduce certain types of cancer.
In the first 67 installments of the Non-Medicated Life, informed diet and lifestyle have been shown to accomplish naturally for the majority of individuals, many, if not most of the benefits of medications in the treatment of chronic medical conditions. This is especially true for hypertension or elevated blood pressure. If caught early and treated aggressively elevated blood pressure for the great majority may be normalized and may be kept controlled without undue reliance on medications.
Hypertension is defined as a sustained elevation in blood pressure. Recently, the guideline definitions for hypertension have changed downward to reflect pressures that safely reduce the risk for heart attacks and strokes without causing other undue risk. In the new study from the National Institutes of Health called the Systolic Blood Pressure Intervention Trial or S.P.R.I.N.T., blood pressure for the top number adjusted with medication to 120 mm of mercury (mmHg) reduced heart attacks and heart failure as well as stroke and reduced the risk of death by almost 25 percent. This is as compared to the old target of 140 mm Hg; this proved especially significant in those over the age of 50 years with at least one additional risk for heart disease. Indeed, NIH stopped the study early because the benefit was so clear that to deny the benefits to the general population was felt to unethically and unnecessarily risk morbidity and mortality that could be avoided.
High blood pressure is of course a combination of systolic and diastolic numbers. The systolic pressure or the higher of the two numbers reflects the pressure in the arteries just after the heart has pumped blood into the aorta, the main artery in the body. The diastolic pressure or the lower of the two numbers reflects the pressure in the arteries just before the next beat of the heart. In those over 50, the systolic is especially important because the aorta, which is an elastic artery and absorbs most of the volume of the heart beat, with age grows less elastic and distensible, and blood pumped into it tends to elevate pressure disproportionately rather than simply increasing the diameter of the vessel while keeping the pressure constant.
The first step in controlling blood pressure is in its accurate measurement. While it is helpful to follow the lead of your health care provider who may suggest that your pressure is indeed elevated, the purchase of an inexpensive digital blood pressure machine, checked for accuracy against that of one’s health care provider, is essential to the process of subsequently tracking blood pressure as you make various dietary and lifestyle changes.
While there are a number of determinants of high blood pressure including genetics, and treatment usually means drugs, what is not always appreciated is that there are a number of ways to both prevent and control high blood pressure that do not rely on pills. Indeed, diet and lifestyle form the basis for all blood pressure control, even in those who do take medication. For example, in those who are salt sensitive, excess consumption of salt can elevate blood pressure. Indeed, two high salt meals or snacks per week in those who are salt sensitive may be enough to elevate pressure for the entire week. A no-added salt or low salt diet, usually less than two grams per day, is an important first step in trying to lower blood pressure without medications.
A somewhat different dietary approach is formalized in a way of eating called the DASH (Dietary Approach to Stop Hypertension) diet. DASH is a diet rich in vegetables, legumes, fruits, and low-fat dairy; at the same time it avoids the saturated fat and total fats contained in sweets, and meat. DASH may lower blood pressure 11 mmHg on the systolic and 5.5 on the diastolic; by combining DASH with sodium restriction even lower pressure drops were seen indeed equaling the blood pressure lowering efficacy seen with medications.
Additionally, elevated body weight also contributes to elevated blood pressures. As little as five pounds of weight loss in an individual who is overweight or obese with hypertension may show a drop in blood pressure. Losses of 15 to 20 pounds can have an even more significant drop in pressure. If an individual has sleep apnea on the basis of increased body weight, sleep apnea can increase the blood pressure. Lowering body weight to treat C-PAP or the use of a C-PAP machine can also dramatically lower blood pressure – again without the use of medications.
Finally, smoking cessation in those with hypertension who smoke can dramatically lower blood pressure as can moderation in the amount of alcohol consumed. Daily aerobic exercise such as walking may substantially lower pressure even in the absence of weight loss. Moreover, relaxation techniques including progressive muscle relaxation and transcendental type meditation, as taught by Dr. Hebert Benson in his book, “the Relaxation Response,” may also substantially lower blood pressure – especially when practiced twice a day and combined with some of the other approaches mentioned above.
In summary, elevated blood pressure is neither inevitable, nor untreatable without medications. By combining the diet and lifestyle changes noted above, many individuals with the help and oversight of their personal physician, may successfully both prevent and treat hypertension. By doing so, they may embrace the non-medicated life and manage one of our most important health problems, without relying on the proverbial bottle of pills so often required.
Paul E. Lemanski, MD, MS, FACP (firstname.lastname@example.org) is a board certified internist at the Center for Preventive Medicine, CapitalCare Medical Group in Albany. He is medical director of the Department of Community Medicine and Population Health at CapitalCare Medical Group. Paul has a master’s degree in human nutrition; he is an assistant clinical professor of medicine at Albany Medical College and a fellow of the American College of Physicians.