Elevated blood pressure, or hypertension, is defined as elevated systolic pressure above 120 mm Hg, elevated diastolic pressure over 80 mm Hg, or both. Elevation of both systolic and diastolic blood pressure increases the risk for heart disease. Unfortunately, a simple blood pressure taken at the doctor’s office can be misleading. For example:
- Some patients experience elevated blood pressure when they get checked in the doctor’s office but not at home, a condition known as “white coat hypertension”.
- Others have normal blood pressure in the doctor’s office but elevated at home when checked with a 24 hours blood pressure monitor; this is known as “masked hypertension”.
- Normally, our blood pressure should be lower at night (dips); those whose blood pressure does not dip at night are at higher risk of heart disease and/or stroke; those which excessive dipping are also at increased risk as well as those whose blood pressure rises (reverse dipping).
- Morning surges of blood pressure increase risk of heart disease and/or stroke.
- Extreme fluctuations in blood pressure over the 24 hour period increase the risk of heart disease and/or stroke.
- Elevated blood pressure in response to exercise indicates extremely poor cardiovascular conditioning.
- Hypertension induced by stress, medication, diet, or supplements.
In our office we do not rely on a single blood pressure reading, but we routinely perform the 24 hour ambulatory blood pressure monitoring (ABPM) for our patients. This is a very simple procedure: a blood pressure cuff is attached to your arm and, through a wire is connected to a small monitor which is hooked to a belt. This will not prevent you from any of your daily activities other than taking a shower or swimming; you will sleep with the ABPM attached to your arm. After 24 hours, you return the ABPM to our office and measurements are downloaded into a computer. A detailed report is created and discussed with you afterwards. ABPM is now the “gold standard” test, providing much more information than the standard blood pressure performed in the doctor’s office.
What causes hypertension?
The last 2 decades of research has shown that hypertension, like heart disease, begins in the arteries and progresses in the following manner:
- Increased oxidative stress in the blood vessels
- Inflammation in the blood vessels
- Autoimmune dysfunction of the blood vessels
- Abnormal vascular biology with endothelial dysfunction and abnormal vascular smooth muscle
Elevated blood pressure also increases the amount of inflammation and oxidative stress in the blood vessels, causing the thickening of the endothelium and increased autoimmune dysfunction of the arteries. Elevated blood pressure it is not only the result of these processes but it also contributes to the further exacerbation of these disease states, i.e., endothelial dysfunction can interfere with the arteries ability to contract and relax at the appropriate times, increasing the blood pressure. Increased blood pressure increases damage to the endothelium thus creating a negative feed forward cycle.
Therefore, hypertension is more than an individual disease, but rather a syndrome linked to problems in multiple body systems:
- Arteries (decreased arterial compliance, endothelial dysfunction)
- Blood clotting mechanism changes
- Accelerated atherogenesis
- Change in the structure and function of the heart (left ventricular hypertrophy and dysfunction)
- Abnormal blood sugar metabolism
- Abnormal insulin metabolism
- Kidneys function changes
- Abnormal fat (lipid) metabolism
- Neurohormonal dysfunction
Most people have no idea that their blood vessels have been already affected. Also, they do not know how easy it is to avoid this fast track to hypertension and heart disease early on. Unfortunately, their doctors tell them how to prevent these degenerative and potentially fatal diseases.
Many people believe that such diseases are in their genes since their parents and/or grandparents have had or died from those conditions. This can’t be further from the truth. The genetic predispositions are not predeterminations; take corrective actions as soon as possible and you will not develop heart problems like other family members.
Some patients take one or more prescription drugs to maintain their blood pressure within normal limits. For some of those people these drugs are lifesavers, but for others may be the beginning to more medical problems. For example:
- Diuretics, which are used as first line therapy in hypertension can cause elevated blood sugar, type 2 diabetes, and kidney insufficiency, increased uric acid and gout, low potassium and low vitamin B1. Examples of diuretics are: thiazide diuretics (Esidrix or Zaroxolyn), loop diuretics (Lasix, Bumex), which do not significantly lower blood pressure, and potassium-sparing diuretics (like Aldactone, Dyrenium). They are often prescribed in conjunction with the other two types of diuretics, but also do not significantly lower blood pressure
- Beta-blockers can trigger fatigue, impotence, memory loss, insulin resistance, type 2 diabetes, low HDL (healthy, happy cholesterol), and more. Examples of betablockers are: Acebutolol (Sectral), Atenolol (Tenormin), Bisoprolol (Zebeta), Metoprolol, Nadolol (Corgard), Nebivolol (Bystolic), Propranolol (Inderal LA)
Due to genetic factors, many patients do not benefit much, if at all, from these medicines. If you have hypertension or any problem with blood pressure of flow, we recommend a customized program which includes the following:
- An anti-inflammatory, heart-healthy diet low in salt (maximum 1500 mg per day)
- Specific exercise for heart disease prevention
- Lose body fat and increase lean muscle
- Improve sleep; test and treat sleep apnea
- Stop smoking (acupuncture is very helpful for smoke cessation)
- Reduce or stop alcohol
- Reduce stress, anxiety, depression using a natural approach for balancing neurotransmitters
- Use specific dietary supplements that address the causes of hypertension and heart disease
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