Hypertension

Definition: 
Hypertension (HTN) is high blood pressure. The systolic blood pressure is the top number and the diastolic pressure is the bottom number. Systolic pressure is the pressure in your arteries when the heart beats. It comes from the cardiac output (how much blood the heart pumps x heart rate). The diastolic pressure is the pressure on the arteries in between beats and is highly correlated with total peripheral resistance (how elastic your blood vessles are). 

American and European guidelines are different in what constitutes high blood pressure. In Europe the cut off is 140/90 and in the US it’s 130/90. What makes this challenging is the guidelines on what defines hypertension change every couple of years and the inconsistencies between guidelines. This can make it frustrating for patients when the expectation is exact measurements and definitions. We now have conditions like prehypertension or elevated blood pressure defined as a systolic blood pressure between 120-129 and a distolic pressure between 80-90. 

Why we care: 
High blood pressure over time can lead to multiple negative health conditions inluding heart failure, stroke, intracerebral hemorrhage (brain bleeds), heart attacks, dementia and chronic kidney disease. 

This condition is highly modifiable through lifestyle, supplements and medication. 

Causes: 
The majority of cases of HTN are idiopathic (no determined cause). Some are caused by rare changes in blood supply to the kidney. There is some thought about this having to do with compliance of the aorta. There are potential underlying causes of extreme elevations in blood pressure. The workup for high blood pressure should be determined by your health care provider.

How often should you be screened:
At least annually after the age of 18. This can be done at office, at the pharmacy, or with a home blood pressure cuff. Some people get anxious at the doctor’s office and it can raise blood pressure. There is a proper way to check blood pressure and many health care providers do not screen patients properly. 

If you have high blood pressure you should at least be seen by your healthcare provider on an annual basis. 

Treatment:  
Lifestyle should always be the first treatment offered to improve blood pressure. This can include improving sleep, regular exercise, and reduction in processed food intake. If you’re a smoker or drink excessively (more than 2 drinks daily), discontinuation of these habits can significantly improve your blood pressure. 

Commonly missed conditions that lead to HTN include obstructive sleep apnea, poor sleep quality, and chronic stress. Getting these conditions controlled can significantly improve blood pressure without the need for medications. 

There are lots of medications that can reduce blood pressure. My opinion is that ACE inhibitors and Angiotensin Receptor Blockers (ARBs) should be the first line medications to reduce blood pressure. They may be correlated with longevity, protect the kidneys, and improve cardiac remodeling. Calcium Channel Blockers (CCBs) are another medication that may be slightly more effective at reducing diastolic blood pressure. 

I am less a fan of diuretics and betablockers. As a general concept, medications that cause vasodilation tend to have better outcomes and neither of these medications contribute to that. Beta blockers also contribute to weight gain, have the side effect of fatigue and can contribute to sexual dysfunction. They are not “bad” medications, but I try to avoid when possible or choose agents in those classes with less association with side effects. 

Integrative Approach:
Supplements like Magnesium, Aged Garlic Extract, Taurine and Potassium can all support a reduction in blood pressure. Prior to initiation, I would recommend speaking with a health care provider to determine effective dosing. 

Supplements that improve nitric oxide production may also be beneficial to improve blood pressure. 

The most commonly recommended diet to reduce blood pressure is the DASH diet. In summary, they recommend reducing salt intake and increasing fruits and vegetables. 

Most low stress exercises like walking, Tai Chi and Yoga are great for reducing blood pressure. These exercises are great to start a movement practice and can be highly restorative.

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