High blood pressure (hypertension) has often been called the “Silent Killer” because it can lead to stroke, heart attack, or kidney failure without causing any symptoms along the way. Most individuals who have dangerously high blood pressure are unaware that their arteries are being damaged until their pressure has been checked with a device called a sphingomanometer.

Syphingomanometers were initially constructed by connecting an inflatable cuff to a pool of mercury into which a glass tube had been placed. When the cuff was placed around a person’s upper arm and inflated the mercury would rise in the tube. Blood pressure was determined by measuring the height of mercury in the glass tube. Today blood pressure is still reported in millimeters of mercury (mm/Hg) even though most blood pressure measuring devices use coil springs or electronic systems to determine the pressure. The blood pressure numbers I quote in this article are mm/Hg, but for brevity I will simply provide the numbers without the mm/Hg designation.

Two blood pressure numbers are recorded. The top number, which is the point at which blood flow is first detected as a cuff is deflated, is called the systolic blood pressure. It is the pressure in arteries when the heart is contracting to pump blood throughout the body. The lower number, which is the point at which the sound of blood flow disappears, is called the diastolic pressure. It is the pressure in arteries while the heart is filling for the next beat.

Blood pressure is very dynamic. It rises with physical activity, anxiety, and when pain is present. This is why it is not uncommon for blood pressure to be elevated at the time of an emergency room visit, since anxiety and pain are usually present. I have seen many individuals who were placed on a blood pressure medication by an overzealous emergency room physician only to become weak and light-headed from low blood pressure once the crisis had passed.

Some people experience a rise in blood pressure simply by entering a medical office. The phenomenon is called white coat hypertension. Even though I don’t wear a white coat I have seen patients whose blood pressure is markedly higher in my office than when checked at home or at a store. Since the systolic pressure response to anxiety tends to be greater than that of the diastolic pressure one clue to the presence of white coat hypertension is a wide separation of the top and bottom blood pressure numbers. The difference between the systolic and diastolic blood pressure is called the pulse pressure. Pulse pressures are usually between 40 and 50. A pulse pressure of 60 or greater is suggestive of white coat hypertension.

If white coat hypertension is suspected, the blood pressure should be checked outside of a physician’s office at different times of day and under a variety of circumstances. While some individuals will find that they have normal blood pressures outside of a medical setting others will discover that they do have hypertension. A pulse pressure that remains over 60 in a non-office setting is of great concern; a study of over 5,000 European men found that those with a pulse pressure greater than 69 were three times more likely to have coronary artery disease than men with a pulse pressure less than 50.

Blood pressure has a circadian rhythm, meaning that it varies depending upon the time of day. It is usually lowest around 3 or 4 a.m. and highest in the early afternoon. It is therefore necessary to check blood pressure at different times of day to determine whether it is remaining in a safe range. I have known individuals who felt that their blood pressure was normal when it was actually quite high. They had always checked their pressure shortly after arising in the morning, but never later in the day. Only when their blood pressure was checked during an afternoon visit to a doctor’s office was the challenge discovered.

Blood pressure also rises as we age. Systolic pressures in twenty-five year olds normally range from 109 – 135 with the average being 122. Systolic pressures in sixty year olds, however, typically run from 120 – 150, with the average being 140. Those who are at an increased risk of having a heart attack, stroke, or other adverse outcome are those who are outside the upper range for their age. A thirty year old with a systolic blood pressure of 140 is at greater risk of a future cardiovascular event than his or her peers, but a sixty year old with the same systolic pressure is not at a higher risk that other sixty year olds.

This is why the medical term for high blood pressure is “essential hypertension.” Essential means of the utmost importance, needed, or necessary. The term arose many years ago because it was believed that the natural rise in blood pressure with aging was needed to maintain adequate circulation as arteries stiffened and narrowed with age. Unfortunately, this natural rise in blood pressure is unrecognized by most physicians and ignored by many authorities. For example, the National Institutes of Health has issued the following statements about blood pressure:

· “Normal blood pressure is a systolic pressure of less than 120 and a diastolic pressure of less than 80.”

· “A blood pressure level of 140/90 mmHg or higher is considered high. About two-thirds of people over age 65 have high blood pressure.”

· “Those who do not have high blood pressure at age 55 face a 90 percent chance of developing it during their lifetimes. So high blood pressure is a condition that most people have at some point in their lives.”

I do not believe that health and well-being are served when people are labeled hypertensive solely on the basis of their age-based blood pressure. Recommending that nearly everyone be placed on blood pressure medications may provide a windfall for pharmaceutical companies, but it results in a lower quality of life in many individuals. Unwarranted blood pressure lowering can actually trigger a heart attack or stroke and lead to an earlier death in some who are treated for an imaginary disease.

Another phenomenon that is being ignored by most physicians today is what is known as the “J-Curve” or “U-Curve” of hypertension treatment. The J-Curve effect refers to the fact that as blood pressure is lowered the risk of a heart attack or stroke decreases to a point after which further lowering results in an increased risk of those same outcomes. The J-Curve has been found in several studies including those called “Invest,” “On-Target,” and “Value” trials.

The J-Curve was confirmed in a recent study called the “Treatment to New Target” (TNT) trial, which showed that the number of strokes and heart attacks increased as medication was used to lower the blood pressure below 140 systolic or 80 diastolic. Even more shocking was the finding that the number of deaths from all causes steadily increased as blood pressure was lowered from a high of 170/100 to a low of 110/60.

The risks of overaggressive blood pressure treatment are profound. When Dr. Franz Messerli analyzed 22,000 people treated for hypertension he found that the fewest deaths and non-fatal heart attacks occurred with a diastolic blood pressure of 84. The risk of death or non-fatal heart attack increased 20 % when diastolic blood pressure was lowered to 70 and 80% if it was brought down to 65. Those who had their diastolic pressure lowered to 60 or less had a fourfold increased risk of heart attack or death!

It appears that brain function is best maintained with a blood pressure of 150/85. A 15 point drop in blood pressure to 135/70 triples the risk of Alzheimer’s Disease or other dementia.

While overtreatment is unwarranted and dangerous, excessively high pressures significantly increase the risk of dying or becoming disabled. Most people with hypertension have no symptoms. Some will experience a dull headache, dizziness, or nosebleeds, but they are the exception. Long-term complications of hypertension include heart attack, heart failure, stroke or transient ischemic attack (TIA), kidney failure, eye damage with progressive vision loss, peripheral arterial disease, and aortic aneurysm.

Hypertension is divided into two classes. The first, essential hypertension, has no recognized cause. Ninety percent of people with elevated blood pressure have essential hypertension. The other class is called secondary hypertension, because it is due to an identifiable cause. Some causes of secondary hypertension are a narrowing of the aorta called a coarctation, kidney disease, an adrenal tumor called a pheochromocytoma, and drug use. Drugs known to elevate blood pressure include oral contraceptives, decongestants, non-steroidal anti-inflammatory drugs (NSAIDS), acetaminophen, amphetamines, some antidepressants (Effexor, Nardil, Wellbutrin, Norpramin), caffeine, and cocaine.

Common risk factors for essential hypertension include a family history of hypertension, black race, male gender, excessive weight, a sedentary lifestyle, consuming alcoholic beverages on a regular basis, using tobacco in any form, and living with unremitting stress. Many physicians would include sodium intake, but, as I will discuss later, this is rarely the case.

A number of conditions can lead to hypertension. These include insulin resistance (the metabolic syndrome), a high homocysteine level, mineral deficiencies, and sleep apnea. If the underlying causes are corrected, blood pressure will often return to normal. Unfortunately, they are often overlooked and unaddressed by physicians who are only taught to prescribe antihypertensive medications.

A number of strategies should be employed before resorting to medication for blood pressure control. When these measures have been taken blood pressure can be controlled using fewer medications at lower dosages than if they are not in place.

Blood pressure management should begin with good hydration. This is accomplished by drinking enough pure water to keep the urine pale. When the body is well-hydrated the viscosity of the blood is lower and it is able to be pumped more easily.

Diet also plays an important role in maintaining a healthy blood pressure. My basic dietary rules are that meals should be colorful, consist of foods that would remain edible at room temperature, be unrefined, inclusive of oils, free of additives, preservatives, and artificial sweeteners, and that meat portions be limited to the size of the palm of the hand.

An abnormal sodium/potassium ratio can raise blood pressure. This is why it is best to avoid adding sodium chloride salt to food at the table. Potassium-containing salt substitutes may be used and can actually improve blood pressure. Potassium-rich foods include avocados, bananas, cantaloupe, honeydew, grapefruit, nectarines, oranges, asparagus, broccoli, cabbage, cauliflower, green peas, potatoes, squash, onions, garlic, & celery. Some spices, specifically saffron, fennel, oregano, peppers, basil, & tarragon, contain substances that are capable of lowering blood pressure so using them in cooking can be helpful.

Physical activity can be very beneficial in obtaining and maintaining a normal blood pressure. Getting the body moving and keeping it moving for 30 minutes daily is the most helpful form. This can be accomplished safely by following three simple rules. Move at a pace that can be maintained for 30 minutes without stopping to rest. See that you are able to carry on a conversation or count out loud to ten periodically. Finally, do not push so hard that you awaken the next day feeling as stiff as a rusty tin man or woman who was left out in the rain.

Weight loss can substantially lower blood pressure. It is important to recognize that it is generally not necessary to reach what is termed an “ideal” weight to significantly lower blood pressure. Often a loss of as little as ten to fifteen pounds will have a major impact.

It is important to avoid tobacco use. This is true for both smoking and chewing. It is also important to limit alcohol intake. I have seen high blood pressure develop from consuming as little as one to two alcoholic beverages daily. Eliminating the daily alcohol intake allowed the blood pressure to fall to normal levels.

Stress can raise blood pressure significantly. It is therefore important to incorporate stress management strategies into any hypertension treatment plan.

Nutritional supplementation plays an important role in blood pressure control. While American medicine tends to focus on restricting sodium in the diet, the cause of high blood pressure is less likely to be sodium excess than it is to be deficiencies of other minerals including potassium, magnesium, and calcium.

I recommend that people with high blood pressure begin with a comprehensive vitamin, mineral, and amino acid supplement, just as I recommend for anyone. Additional calcium and magnesium should be taken. Magnesium is the most important, as it relaxes muscles including those in the walls of arteries. Magnesium supplementation has an effect similar to that of a family of antihypertensive drugs called calcium channel blockers. Start with 200 to 300 mg. of a chelated form (citrate, aspartate, acetate, or taurate) twice daily.

Coenzyme Q10 and L-carnitine are nutrients that support energy production in the heart and supplementation can improve blood pressure. Typical amounts are 100 mg. of coenzyme Q10 and 500 mg. of L-carnitine twice daily.

Drugs that inhibit the action of a substance called angiotensin converting enzyme (ACE) are among the most effective at lowering blood pressure. Certain proteins extracted from fish also have an ACE inhibiting effect. While not as potent as the pharmaceutical agents, fish peptides can often lower blood pressure to an acceptable level without causing any adverse effects. One brand was originally called Sea Ace but the manufacturer was forced to change the name to Sea BP because the FDA did not want the name to reflect its mechanism of action and so suggest that it might be used in place of a prescription drug. One capsule is taken two or three times daily.

The herbs Hawthorne berry and cayenne can improve blood pressure. Garlic is often promoted for this purpose, but I have not seen it effectively lower blood pressure. When I use herbs in the management of blood pressure I recommend a product called Herbal Combination # 13, which contains Hawthorne, cayenne, valerian, peppermint, and passion flower. Two capsules are taken two or three times daily.

Insulin resistance, which is referred to as the metabolic syndrome, is characterized by a waist size over 40” in a man or 35” in a woman, a fasting blood sugar of 100 mg/dl or greater, a triglyceride level of 150 mg/dl or greater, an HDL cholesterol below 40 in a man or 50 in a woman, and blood pressures of 130/85 or higher. To reverse insulin resistance it is necessary to avoid refined foods and get the body moving for at least 30 minutes daily. Several years ago I formulated a product, Chromium Plus, to address insulin resistance. One or two capsules are taken twice daily. Irvingia gabonesis, an extract from West African wild mango is also helpful in overcoming insulin resistance.

Homocysteine is a substance that can accumulate in the body when it cannot be converted to useful compounds. While the average level of homocysteine in the United States is 10 mmol/L, a desirable level is 7.2 or less. Higher levels of homocysteine prevent arteries from opening up and therefore cause blood pressure to rise. HCY Formula was developed to lower homocysteine levels. The starting amount of three capsules twice daily may be increased if homocysteine is still at an unsafe level when it is rechecked after three months.
Sleep apnea is a condition in which a person stops breathing repeatedly during sleep. This causes oxygen levels to fall and blood pressure to rise. The standard treatment for sleep apnea is the use of a device called a CPAP machine, which forces air into the airways to keep them open during sleep. Other strategies that may improve sleep apnea include sewing tennis balls into the back of a night shirt to prevent sleeping on the back, use of a lubricating throat spray at bedtime, and learning a technique called circulatory breathing, which is employed by those who play bagpipes or the Australian Aboriginal instrument the didgeridoo.

Since high blood pressure causes damage over a period of months and years rather than days or weeks most individuals can give diet, activity, and nutritional supplementation several months to lower blood pressure to an acceptable level. If blood pressure remains high, medication should be added, but care should be taken to see that it does not result in a blood pressure that is excessively low. When treating hypertension with medication the goal should be to maintain a diastolic pressure in the 80 to 85 range that has been shown to carry the lowest risk of premature death and disability. I address antihypertensive medications in the article Blood Pressure Medications.