What Your Doctor May Not Tell You about Blood Pressure

COMMON SENSE ABOUT BLOOD PRESSURE
Pay attention to it, and use drugs only as a last resort.

by John R. Lee, M.D.

It’s wise for all of us over 30 to pay attention to and treat high blood pressure (hypertension) because it is an important risk factor for your heart: a rise in blood pressure over time is correlated with the development of heart disease.

Unfortunately, conventional physicians tend to prescribe anti-hypertension drugs any time blood pressure readings fall outside of so-called normal ranges. This is unjustified, and probably does more harm than good in the long run. The most important thing I want to tell you about high blood pressure is that it can almost always be lowered with lifestyle changes such as weight loss, regular moderate exercise, cutting down on coffee and alcohol, and a healthy diet.

But the conventional medical wisdom is that patients won’t make lifestyle changes, and so the automatic response to high blood pressure is to prescribe a drug that will reduce it. I believe—and there is plenty of research to support me—that these drugs have just as good a chance of killing you as the high blood pressure does, especially if you don’t really need them.

My experience as a family doctor was that people are more than willing to make the necessary lifestyle changes if they are given some basic support on how to go about it. That’s why I give very specific suggestions for a healthy lifestyle in my book Optimal Health Guidelines, as well as in my three "What Your Doctor May Not Tell You" books.

First, Keep the Pipes Clean

Up to a point, high blood pressure can be understood using the analogy that water being pumped through pipes is like blood flowing through arteries in the body. If water comes out of the tap with a lot of force, water pressure is high, and if it comes out in a trickle, water pressure is low. If the water pipes get smaller, the water pressure goes up, and if the pipes get larger, the water pressure goes down. If pressure in the pipes gets too high, there’s going to be damage.

The difference in the human body is that unlike water pipes, arteries are very elastic when we are young, which allows blood pressure to rise and fall without excess pressure on the arteries and the heart. As we age, arteries become less elastic, and changes in blood pressure can cause damage.

Several factors, alone or combined, can cause high blood pressure. They are: 1) buildup of cholesterol in the interior of the arteries, 2) diminished elasticity of the blood vessels, and 3) spasm (narrowing) of the arterioles (the small arteries leading to the capillaries, which deliver oxygen and nutrients to the cells), often from chronic recurring stress. You can postpone this process with the lifestyle changes mentioned above, and by not smoking cigarettes, taking a daily multivitamin, and making sure that your diet provides you with a good mineral balance.

Sodium, Potassium and Magnesium: The Three Musketeers of Blood Pressure

Sodium (found in common table salt) has been unfairly maligned as a culprit in raising blood pressure. This is a misunderstanding of how the body works. It’s not sodium per se that causes problems related to blood pressure, it’s the ratio of sodium to the minerals potassium and magnesium, and how they regulate fluid levels inside and outside of our cells, as well as in the blood itself. Hypertension is almost unknown in cultures that still eat whole foods that supply the proper balance of these minerals.

In industrialized cultures this balance has gone awry: we tend to eat far too much sodium relative to not enough potassium and magnesium. Processed foods such as canned and frozen foods, dressings and sauces, bread, soups, cakes and cookies, contain very little potassium and magnesium, and large amounts of sodium. In contrast, the foods that Mother Nature has prepared for us, including whole grains, vegetables, fruit, nuts and seeds, beans, eggs, meat and fish, have a much higher ratio of potassium and magnesium to sodium. Simply switching to a whole foods diet can dramatically lower blood pressure. I also recommend that you take a good magnesium complex with 300 to 400 mg of magnesium.

Other Causes of High Blood Pressure

Common prescription drugs are also often a hidden cause of high blood pressure. (See Sidebar.) Stress is a known cause of high blood pressure, because the substances our bodies produce when we are under stress raise the blood pressure. This is a good plan if you need to run from a saber tooth tiger, but a bad plan if you’re sitting at a desk day after day. While it’s not always possible to remove the causes of stress, most of us already know what we need to do to manage it better.

Some high blood pressure is caused by being 30 pounds or more overweight. If this is you, your blood pressure should drop at least one point in both the systolic and diastolic readings for every two pounds of weight you drop. The heavier you are, the more dramatic the drop in blood pressure will be.

Why Not Just Take a Pill?

I don’t recommend taking an anti-hypertensive drug until you have, at the very least, tried to control your blood pressure by changing your diet, and have maintained the change for six months.

I don’t like anti-hypertensive drugs because their side effects are often worse than the high blood pressure they’re prescribed to treat. In some cases they can make things worse. For example, due to the effect of these drugs, body tissues that are not receiving the blood they need (i.e., they become ischemic) will produce oxidation waste products that signal the heart to beat harder, (raise the pressure) in order to get more blood to them. If blood pressure is lowered by drugs, the blood flow to these threatened tissues will be further reduced, making the situation worse. If the problem tissues are in the brain, ischemic strokes become more likely. Here it is obvious that treating the underlying cause is better than simply lowering the blood pressure.

For men, a distressing and common side effect of some anti-hypertensive drugs is erectile dysfunction (ED). Erections are a matter of blood hydraulics and contraction of smooth muscles of the penis, so if the drug blocks these contractions, ED is the result.

Anti-hypertensive drugs work in one of several ways. Some, such as propranolol and other beta blockers), will partially weaken the force of the heartbeat to reduce the surge of blood with each beat. Others, such as hydralazine, partially paralyze the muscles at various sites within the arterial system so that the arteries become more dilated and allow a larger vascular bed for the blood flow. These drugs can cause orthostatic hypotension, or low blood pressure, which causes dizziness or even fainting when you get up from lying or sitting down. These drugs are also dangerous because just a slightly elevated dose can cause heart failure, and dozens of factors can raise or lower drug levels in the body.

Diuretics such as furosemide and hydrochlorthiazide) trick the kidneys into making more urine than usual. This reduces the watery component of blood volume, but also depletes the minerals necessary for good heart function. Furosemide causes the loss of potassium, magnesium and calcium, but hydrochlorthiazide doesn’t lead to loss of calcium, so it is preferable, if you must take it.

Calcium channel blockers prevent rapid smooth muscle contraction, ACE inhibitors such as captopril inhibit angiotensin I-converting enzyme, which signals the body to raise blood pressure. Methyldopa and clonidine block stress centers in the brain or impair the nerves that carry stress messages to arteries. Both calcium channel blockers and ACE inhibitors can cause a nagging cough that can disturb sleep. All of these drugs have potentially dangerous side effects, but if you are taking them and want to stop, please don’t stop taking them suddenly. Your body needs time to adjust. Taper them off slowly, preferably with a doctor’s supervision.

After reading about all these risks and side effects, the advantage of using the dietary approach should be obvious.

Low Blood Pressure Isn’t Good

From middle age on, low blood pressure can be just as harmful as high blood pressure, causing fatigue, poor circulation, dizziness and fainting. Low blood pressure is much more common in women than in men, and doctors tend to ignore it.

Most disturbing is that the commonest cause of low blood pressure in men is an overdose of an anti-hypertensive drug! In middle-aged and older women, poor adrenal function is most often the cause of low blood pressure, a topic covered in my menopause and pre-menopause books.

This is not a recommendation to ignore excessively high blood pressure -- it’s a recommendation to make the lifestyle changes as a first resort to bring it down. I often advised my patients to buy a blood pressure cuff, because regular readings at home are more reliable than a single reading in the doctor’s office which is often higher than normal due to anxiety (the "white coat" phenomenon). If you are taking anti-hypertensive drugs, you may find your blood pressure is too low at home, indicating that the dose of the drug is too high. Also, home monitoring might give you a good idea of what is raising your blood pressure.

When to Worry About Blood Pressure

The connection between high blood pressure and heart problems is not a direct one. The eventual appearance of heart problems (due to high blood pressure) is not correlated with any specific or absolute blood pressure reading; it is correlated with an observed rise in blood pressure from whatever the earlier blood pressure was.

For example, if your usual blood pressure is, say, 120/80 and it is found to rise over time to 140/90, the eventual heart disease risk is the same as that in someone whose blood pressure rose from 140/90 to 160/90. If your blood pressure is 160/90 and shows no rise in the ensuing years, this is not a sign that heart disease problems exist or are likely to occur without other more important risk factors.

Blood pressure readings show two numbers: the systolic pressure, which is the greatest amount of pressure exerted when the heart pumps or contracts, and the diastolic pressure, which is the lowest amount of pressure when the heart is in-between beats, or relaxed. A "normal" blood pressure reading for an adult is 120 (systolic) over 80 (diastolic), also shown as 120/80 mm Hg (millimeters of mercury, under pressure).

But these numbers can vary widely among healthy individuals, and blood pressure naturally rises as we age, as a healthy compensation for other changes that are taking place in the body (see above). Here’s a general guideline: if you’re under the age of 60 and your blood pressure is "severely" elevated (above 160/120), there is little to no evidence that anti-hypertensive drugs will prevent heart disease or reduce your risk of dying. Once you’re in your 70s, numerous studies have shown that anti-hypertensive drugs do more harm than good, even if your blood pressure as high as 220/120.

Drugs that Can Raise Blood Pressure

  • Aspirin, ibuprofen and other NSAIDS (non-steroidal anti-inflammatory drugs)
  • Corticosteroids, e.g. Prednisone
  • Etidronate (Didronel), for osteoporosis
  • Bronchodilators, e.g. epinephrine and ephedrine
  • Nasal decongestants, e.g. phenylpropanolamine
  • The migraine drug sumatriptan (Imitrex)
  • The benzodiazepine anti-anxiety drugs (Valium, Ativan, Xanax)
  • Many antidepressants, but especially venlafaxine (Effexor) and MAO inhibitors (Nardil, Parnate)
  • Excess estrogen can cause edema, or water weight, which can raise blood pressure.