Hypertension is a common disease in this country, and we often don’t know why it occurs for a person. We do know that it is a risk factor for further cardiovascular disease such as heart attack and stroke, and this is why we set goal numbers for patients. Learning parameters for a healthy blood pressure is not difficult, and for many, treatment brings their numbers into a “normal” range fairly easily.
What can be confusing, however, is the changing value of “normal.” In 2014, parameters for normal blood pressures were raised to allow anyone over the age of 60 and without risk factors to maintain a blood pressure up to 150/90. These standards were set by the Joint National Committee and meant that we, as practitioners, were able to allow patients over 60 to have a slightly higher blood pressure than the previous parameters of 140/90. I was so elated at the time I wrote a celebratory article. After all, should we not expect your blood pressure to rise slightly as you age? And, if this expected rise does not seem to significantly lead to disease, why over-treat much of the population just to get ideal numbers that may not even be feasible for most 60 year olds?
I’m not at all against pharmaceuticals as a viable option to treat many dysfunctions, but I think we can all agree that overuse of them is typically not a good thing. So you might have guessed at this point, the celebration is over.
In the last few months the American Heart Association has redefined the norms again, and this time, the guidelines have gone lower than ever. Citing the review of a multitude of studies, they have recommended that high blood pressure be defined as anything above 130/80. This new number means that a whopping 46% of adults in America (all adults, not just those over 60) are now defined as hypertensive. Now, I’m not here to discuss conspiracy theories, so I’ll let your mind take it from here in considering who benefits from lowering parameters such as these, but what I do want to do is help you navigate the waters from here.
First, to repeat: hypertension increases cardiovascular risk, no one would argue with that. And, to give more benefit of the doubt, maybe there could be a psychological benefit for people to lowering the guidelines. If you see early on that your numbers are creeping up, you might be more inspired to begin to make changes to control them. In fact, authors of the study report that this compilation was “designed to help people take steps to control their blood pressure earlier,” as the main goal. They go on to say this shouldn’t necessarily be through immediate introduction of medication if you are still under the 140/90 range.
The problem with prescribing these medications before it is needed (or when it is not ever needed) is that they aren’t without side effects. Many of the medications cause a dry cough; some can lead to edema, digestive disturbance, erectile dysfunction, or changes in electrolytes; others cause fatigue, dizziness, and even anxiety. Again, this is not to say that treating hypertension is not necessary. It is. We just don’t want to over-treat hypertension, and if we define 46% of our population as having high blood pressure, we just might be headed down that path.
So, what should you do next? First, advocate for yourself. If you have an un-medicated blood pressure below 140/90, and you are being prescribed a medication, talk to your doctor. Ask them first if it is being prescribed because of other risk factors. Make sure that they have gathered 2-3 different readings at different visits before diagnosing you as hypertensive. Monitor at home to make sure that you aren’t having white-coat elevations in your numbers. And then ask them if you can take steps to lower it on your own before beginning a medication.
The basics to lowering your blood pressure are to stop smoking and lose weight if you need to (often even a small weight loss can alter your readings significantly). Improve your diet by eating a lot
of fresh veggies. Cutting out processed foods will decrease your sodium intake. Increase your activity with at least 4 to 5 days weekly of 30 minutes of aerobic activity like brisk walking or jogging. Findings from multiple studies indicate that exercise can lower blood pressure as much as some drugs. Decrease alcohol consumption for women to one glass daily, for men, to two. Decrease consumption of high fructose corn syrup (check for HFCS in your soda, sweetened drinks, sauces, and dressing). Studies have shown that those who consumed 74 grams or more per day of fructose (about 2 sodas) had a 77 percent greater risk of having blood pressure levels of 160/100 mmHg. Get tested for sleep apnea, especially if your partner reports that you are restless in your sleep or that you seem to have cessations in your breathing. Finally, control your stress through stress relieving activities like meditation, yoga, or exercise.
You should also strive for a diet high in magnesium and potassium. Both have a relaxing effect on the smooth muscle surface of your arteries, thus lowering pressure. Magnesium rich foods include whole grains, leafy greens, beans, nuts, and chocolate. Potassium rich foods include sweet potatoes, tomatoes, orange juice, potatoes, bananas, kidney beans, peas, cantaloupe, honeydew melon, and dried fruits such as prunes and raisins. If lifestyle changes alone don’t help to decrease your number enough to reach to the norm, many nutrients and herbs can be helpful. Magnesium is an easy addition to your supplement regime and is typically taken at 200-300mg once to three times daily. Make sure that you pick up a citrate or glycinate form for better absorption. Magnesium can cause digestive disturbance in high dosage, and as with any supplement, you should okay it with your treating physician.
Other nutrients and herbs that have shown to improve blood pressure include CoEnzyme Q10 (CoQ10) which, when taken in the form of ubiquinol, will typically shave a few numbers off of
your levels. You should consider this one anyway as it protects against heart failure, which can sometimes occur after long-standing hypertension. Fish oil, likewise, will lower hypertension and decrease other cardiovascular risk factors, especially inflammation (please note fish oil is a blood thinner for those who are not good candidates). Hawthorne and similar herbs can also be very effective as treatment alternatives.
The changing blood pressure guidelines can be confusing. It can also be frustrating to realize you might be subject to treatment based on a guideline that didn’t exist a year ago and might change again. Advocate for yourself, and if you aren’t already doing them, begin the healthy lifestyle habits that will control your blood pressure and lead to other health improvements too. Then you win, whether or not those limits stand over time.
Stay healthy & be well!
-Amy Whittington, NMD