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Hypertension: Controversy Resolved

In a way, high blood pressure is like every other health problem: it can usually be resolved through lifestyle changes. When those don’t work, attending to some systemic problems (lack of sleep, low thyroid, and others) can often solve the problem. Supplementation directed by a knowledge of genetics and general supplement principles is a good next step. As a last resort, pharmaceuticals may be needed. Prescriptions for hormones are the most physiological type of intervention; actual drugs are the last step and while they can save lives, they all come with unwanted side effects varying from minor to life-threatening.

Conventional medicine will be using a lot more of those actual drugs in the near future because for now, at least part of the controversy regarding the appropriate level of treatment has been resolved.

Background on Treating High BP

Blood pressure regulation has received a fair amount of attention in the last few years, recommendations swinging widely (not wildly!) regarding the wisdom of treating moderate hypertension. In 2010, a world-wide study of risk factors placed high blood pressure as the most dangerous condition, out of 67 studied, for death and disability. While general agreement exists that very high blood pressure (160/100 and higher) requires immediate intervention to reduce a very real risk of stroke and heart disease, we have had a harder time reaching consensus on moderately elevated blood pressure.  

Uncertainty has reigned in the zone of moderate hypertension, where blood pressures ranging from over 120/80 to 159/99 have been considered both tolerable and hazardous. Studies following people in the real world have suggested a threshold of 115 systolic (“upper number”) beyond which risk was increased, but when subjected to randomized, controlled trials, results failed to identify benefit from lowering the systolic below 150.

What’s necessary, below 115 or below 150? That wide discrepancy is very relevant to the many people who find themselves (particularly common in older folks) with a high systolic number (135-160) which would indicate a treatment benefit, but a concomitant very low diastolic number (60-75) which would make them very vulnerable to adverse side effects of medication to lower blood pressure. The uncertainty presents a serious dilemma. If we withhold treatment, patients could suffer from strokes and heart attacks. On the other hand, if we treat aggressively, we cause some light-headedness that then results in a significant number of falls and fractures, as well as general complaints of weakness and malaise, preventing exercise that could be beneficial.  

Resolving the dilemma was the priority of an expert panel convened in 2007 studying people over 50, with blood pressure levels of 130 to 180 mm Hg, and an increased risk of cardiovascular events. So if your cardiovascular health is excellent other than high blood pressure, the study doesn’t apply to you. If, on the other hand, you have chronic kidney disease, abnormal lipid values, or prior evidence of cardiovascular disease, listen up, as these findings relate to you.

The study design, reported here, included over 9000 participants who were treated to lower their blood pressure either below 140 systolic or below 120. In the 140 group, physicians treated to keep blood pressure between 130-140, eliminating or adding drugs as needed. The 120 group, they did all that was needed to keep BP below that level.

They took the BP correctly, and you should, too! Meaning, you should be sitting for at least 5 minutes, the numbers should be checked at least twice, with your arm at the level of your heart.

Everyone received lifestyle modification as well.

They stopped the study early, just half way into it, as the complication and death rates were so distinctly different that it would have been unethical to continue.

Bottom line, if you have other cardiovascular risk factors, your blood pressure should hover at or below 120 mm Hg, that is your sweet spot for disease-free survival.

Getting to Golden

The question remains, though, as to the safest way to get there, as there are legitimate side effects and the study participants had to tolerate an average of three drugs taken daily to achieve the improved outcome results. So while deaths went down an impressive 1.2%, complications such as fainting and renal failure went up by about the same amount, 1.1 and 1.3% respectively.

Of course, there’s a better way that works for many people. You can read more about it in my hypertension article here, but let me summarize and add a bit more. Let’s just say I doubt that the study described above did justice to what I would consider “lifestyle modifications.”

  1. As Dr. Andres puts it so well on his website The Diet Doctor, “Cure the Western disease” or more specifically, the modern lifestyle disease! Following a low-carbohydrate diet leads to improved weight, blood sugar, and for many patients, their blood pressure and metabolic syndrome resolves as well.
    • Avoid insulin boosting foods such as refined carbohydrates, grains, and most dairy.
    • Eat lots of potassium-containing foods, vegetables! And fruits as tolerated.
  2. Exercise helps lower blood pressure, and for this exercise benefit, exercise of any sort seems to be helpful.
  3. Our need for different nutrients is always complex: we never use a nutrient for just one thing. Meaning that if you are low in any of these nutrients, and resolve an identified problem by taking a supplement, you are probably also helping other problems not yet identified.
    • ​​Omega-3 fats may lower blood pressure somewhat, particularly the systolic or upper number, reported here
    • Normalize vitamin D for help with blood pressure and practically everything else. A level of 40-65 ng/mL is what’s needed.
    •  Magnesium may be helpful: choose magnesium taurate if you have any irregular heart beats and magnesium glycinate if you want help sleeping.
    • CoQ10, or Ubiquinol if you are over 50, has been seen to lower blood pressure over a period of months, it’s not quick. Take 200-300 mg daily.
  4. ​​Sleep and stress management are important as well. If either one of those is a challenge for you, you derive multiple benefits, including lower blood pressure, by resolving the problem.
  5. Homocysteine appears to be an independent risk factor for hypertension. Normalizing homocysteine levels is optimally achieved through understanding and addressing your methylation status as defined in a 23andMe genetics test.

Bottom Line

If you have any concomitant cardiovascular disease, your blood pressure should be at or below 120/80. You should check it yourself at home and do everything you can to normalize your own blood pressure, following the suggestions listed above. If those are not helpful, please consult with your physician about finding a well-tolerated pharmaceutical medication.

If you don't have co-existing cardiovascular disease, the above life-style measures are safe and usually provide other benefits. Wouldn't hurt to give them a try.



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