High blood pressure

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High blood pressure, hypertension

blood-pressure

Description: the heart pumps blood around the body through a series of pipes called the arteries. As the heart beats the pressure goes up( the systolic pressure), and when it relaxes the blood pressure falls (the diastolic pressure). Ideally, the blood pressure should be below 140/80 mmHg as measured on the blood pressure cuff or sphygmomanometer. There are a number of causes of high blood pressure such as kidney disease, hormonal abnormalities, and disease in the arteries.

High blood pressure usually has no symptoms, and can only be measured with a sphygmomanometer; it has been called “the silent killer.” It damages the arteries, the brain, the heart, the eyes and the kidneys – and untreated is a major cause of disease.

What doctors can do

  • Investigations - a thorough physical examination including checking over the kidneys for bruits (the sound of blood squeezing through narrowed arteries),  blood and urine tests, chest X-ray, kidney ultrasound, ECG, are usually arranged. In most cases to see if there is a cause for the high blood pressure. In most cases, no cause can be found, and this is ‘reassuringly’ called “essential hypertension.”
  • Drugs are the treatment usually recommended by doctors. Today these are very effective and have few side effects (thiazide diuretics, beta blockers, calcium blockers, ACE inhibitors, A2 inhibitors), and in many cases two or more are given together in lower doses, which reduces their side effects.  The JCN8 2014 guidelines (see below) recommends "initial antihypertensive treatment should include a thiazide-type diuretic, calcium channel blocker (CCB), angiotensin-converting enzyme inhibitor (ACEI), or angiotensin receptor blocker (ARB)".  I would agree with this approach, preferably adding a second or even third drugs in preference to giving a high dose of any one drug.   This reduces the side effects and is more effective.  The best combination for high blood which is hard to control is a combination of - ACE inhibitor, calcium channel blocker (dihydropyridine group) and a thiazide diuretic.  Interesting although beta blockers have been used for decades in many cases as first-line drugs, research now shows that they are must less effective than the drugs above, and do nothing to lower complications - so they are no longer recommended. (click here)

What you can do

Lifestyle

  • The name of this condition − hypertension − gives a clue on the best therapy: ‘hyper’ means too much, and ‘tension’ speaks for itself. Reduce the tension of life, relax, meditate and take time out – and frequently the blood pressure will come down.
  • In some people, reducing the salt in the diet will lower blood pressure.
  • Alcohol can raise blood pressure, any more than two glasses per day is too much, but a glass per day (appropriate glass for the drink) is fine.
  • Regular mild exercise, like walking, can also reduce blood pressure .
  • Lose weight if overweight, it really can lower the BP.

Remember that two major complications of high blood pressure are heart attack and stroke, so the aim of treatment is to prevent these.

Notes on hypertension - 

  • There is much debate on when to treat high blood pressure and what levels to aim for.  The current advice is 140/90 is the upper desirable level, and probably aim, if treated to reach at least this level.   It may be beneficial to go to 130/80 but again there is debate.  To quote the JNC 8 2014 (Joint National committee - its 8th meeting on the topic) "There is strong evidence to support treating hypertensive persons aged 60 years or older to a BP goal of less than 150/90 mm Hg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than 90 mm Hg; however, there is insufficient evidence in hypertensive persons younger than 60 years for a systolic goal, or in those younger than 30 years for a diastolic goal, so the panel recommends a BP of less than 140/90 mm Hg for those groups based on expert opinion."
  • Lowering pressure too low in older people, especially those with early dementia may aggravate this condition (click here) , so in these people, also use drugs which do not affect brain function and probably accept higher levels.  However high blood pressure in the middle years 50 - 60s has a higher incidence of developing dementia click here.
  • Confused ?   Then join the rest of the world.   It seems so simple to reach a conclusion, but there have been 8 JNC world conferences and each one has reached a different conclusion.  There are debates on how to measure blood pressure - mercury manometers are banned, the aneroid machines are now pretty reliable, but also most trials are using the automatic oscillatory measurement technique (AOBP), not the old stethoscope.   The AOBP records about 5-10mmHg lower than using a stethoscope which further creates uncertainty.   Currently the recommendations which are being debated furiously in the literature are the JNC8:
  • JNC 8 BP level recommendations -  aged less than 60 years - aim for 140/90;  over 60 aim for 150/90
  • A further statement is expected in 2016/17 which I am sure will be different, and we wait for this with baited breath.

Nutritional supplements

  • A good multivitamin/multimineral makes sure that the heart and tissues have all the nutrients and minerals they require.
  • Magnesium is absolutely crucial for treating high blood pressure. It is essential to allow the blood vessels to relax and in opening up reduce the blood pressure. Take 800-1,000mg/day, and over time the BP will come down.
  • Omega 3 fish oils, 1–2 grams daily is not only protective of the heart, but can also lower the BP
  • Coenzyme Q10 - this energy enzyme found in the cells has been show to also lower the BP ( 60 - 100mg per day)
  • Garlic and Hawthorne** are both claimed to have a BP lowering action, with some trials suggesting that this may be true. Hawthorne - has been used for heart disease for many centuries, and in many countries of Europe is part pf conventional medical therapy.  It has a number of confirmed actions including  stabilise heart rhythm, helps open arteries, improved heart function and has a mild sedative action.  (Note it can interact with digoxin, and because it lowers the blood pressure any drugs which also lower BP may be enhanced).

The Nutritional supplements I use and recommend to my patients

For Hypertension patients - USANA - Cellsentials *, Biomega, Active Calcium plus, Coquinone and vitamin D  -   

Hawhorne

Other therapies

There are a number of other therapies which you might like to look at.  They have not been specifically included with this disease because some are a form of treatment which is applicable to most diseases and many focus on the mind, body, spirit, and the universe. These include - acupuncture, Ayurvedic medicine, energy healing, homeopathy, naturopathy, prayer, visualisation and some people with this condition might like to look at these topics (I have described them more fully on another page on this website click here .) With my personal experience and reading, I do not think that I can comment of whether one or a number of these might help.    They fit well with most conventional and complementary treatments and I suspect some or even all of them can be extremely powerful - if performed by an experienced practitioner.    My only caveat is that if in the course of one of these therapies, you are given potions or herbs, do check with your health practitioner that they will not interfere with other treatments or drugs you are receiving.

Nutritional supplements

I believe in today's world that nutritional supplements are so necessary as to be an essential component of any form of both prevention and treatment. Not only is today's food lacking in nutrients because of the way it was grown and processed, but also most of us make the wrong choices in diet. It is virtually impossible to obtain optimal levels of most of the vitamins, minerals and other nutrients although many people try to do so, and even then fresh produce is not available all year round. *There are many quality supplements available on the market, including –Thorne, NFS, Douglas Labs, Xtend Life, True Star Health, USANA, and Metagenics. There are others, but do your due diligence before choosing one. USANA Health Sciences has added a new adjunct to its multivitamin and multi mineral called CellSentials. These are a patented blend of phyto-nutrients which they believe affects cell signaling and growth, and increases the production of preventative antioxidants within the cell. These should add to the value of the multi, so these are the multivitamin/mineral preparation I recommend.  

 

** Hawthorne - a good preparation of standard extract, 300mg/day