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Hypertension or High Blood Pressure

Summary Of Risks, Prevention and Treatment

By Roger London, M.D.

What Is Hypertension?

Hypertension, or high blood pressure, means that the force of the blood inside your blood vessels is too high. It makes your heart work harder than it needs to. Hypertension effects 25% of adults worldwide, and is the major risk factor for heart disease. This article contains a wide variety of information related to hypertension, and discusses approaches for treatment and prevention.

Treating Hypertension without Drugs

If blood pressure levels are close to 130/80 (within 10mmHg) then a behavioral approach alone may be used. Behavior changes recommended include dietary sodium restriction, weight loss, increased physical activity, quitting smoking, and moderation of alcohol intake. Dietary changes that massively increase the consumption of fruits, vegetables and beans while dramatically lowering the consumption of everything else is critical. The loss of one kilo of weight results in a decrease of arterial blood pressure of ~1 mmHg. Physical activity also lowers blood pressure. The odds of successfully implementing and following through with behavior changes goes up with participation in programs that engage the person in self-monitoring and group support such as PEERtrainer. Daily logging alone on PEERtrainer increases your odds, and daily group participation boost these odds further.

Treating Hypertension with Drugs

Patients with blood pressure higher than 140/90 are considered candidates for drug treatment for hypertension in addition to behavioral treatment, according to the American College of Cardiology. At currently perscribed doses, most anti-hypertensive drugs will produce a reduction in overall blood pressure of between 5 and 10% in people with mild or moderate hypertension. Many people will need more than one drug, many people will need three or more. Drugs that are considered appropriate include ACE inhibitors, angiotensin receptor blockers, low-dose thiazide diuretics, and beta blockers. ACE inhibitors tend to be the first drugs perscribed.

Side Effects Of Blood Pressure Medication

The benefits of lowering your risk of a catastrophic event should be clear, but there are side effects with different hypertension medications. This is a link to Pateint Discussion on The Side Effects of Blood Pressure Medications

The Latest Research--The Interplay Between Sodium and Potassium

In their recent review article on sodium and potassium in the pathogenesis of hypertension in the New England Journal of Medicine, Drs. Adrogue and Madias make several important points regarding the role of dietary intake and the development of hypertension. Hypertension is a significant health problem world wide affecting one in four adults which is expected to grow to 3 in five adults by the year 2025. 95% of all hypertension is known as primary, essential or idiopathic and results from internal derangements and the external environment. The authors cite recent evidence as well as classic studies which point to the interaction of sodium and potassium, as compared with an isolated surfeit of sodium or deficit of potassium, as the dominant environmental factor in the pathogenesis of primary hypertension and its associated cardiovascular risk. They conclude their review with recent recommendations from the Institute of Medicine concerning the dietary intake of sodium and potassium.

Implications for Prevention and Treatment

A modified diet that approaches the high potassium:sodium ratio of the diets of human ancestors is a critical strategy for the primary prevention and treatment of hypertension. Weight loss with diets rich in fruits and vegetables has been attributed both to the low caloric density and to the high potassium content of these diets, which tend to increase the metabolic rate.95

In its 2002 advisory, the coordinating committee of the National High Blood Pressure Education Program identified both a reduction in dietary sodium and potassium supplementation as proven approaches for preventing and treating hypertension.96 The Institute of Medicine recommends an intake of sodium of 65 mmol per day (approximately 3.8 g of sodium chloride per day) for adults 50 years of age or younger, 55 mmol per day (approximately 3.2 g of sodium chloride per day) for adults 51 to 70 years of age, and 50 mmol per day (approximately 2.9 g of sodium chloride per day) for those 71 years of age or older. The institute also advises adults to consume at least 120 mmol of potassium per day (approximately 4.7 g of potassium per day, which is about twice the current U.S. average).10 These targets would require modifications for special groups, including competitive athletes, persons working in hot environments, patients with chronic kidney disease or diabetes, and persons taking medications that affect potassium balance. Adoption of the institute's recommendations would increase the dietary potassium:sodium ratio by a factor of 10, from approximately 0.2 to approximately 2.0, which is much closer to our ancestral standard.

The concern that sodium restriction might increase cardiovascular risk by activating the sympathetic and reninangiotensin system and by adversely affecting blood lipids and insulin sensitivity appears to be groundless for the recommended sodium intake.10 Forms of potassium that do not contain chloride, such as those found naturally in fruits, vegetables, and other foods, offer larger cellular entry in exchange for sodium and greater antihypertensive effects.10,97

Following these recommendations would require a comprehensive, culture-sensitive campaign targeting both the general public and health care professionals. Food processing drastically changes the cationic content of natural foods, increasing sodium and decreasing potassium. Only approximately 12% of dietary sodium chloride originates naturally in foods, whereas approximately 80% is the result of food processing, the remainder being discretionary (added during cooking or at the table).98 Apart from educating the public, an agreement by the food industry to limit the deviation of the cationic content of processed foods from their natural counterparts is essential.

The Effect of Hypertension/ High Blood Pressure in People with Diabetes

Hypertension is extremely common in people with diabetes, it is estimated that two out of three adults with diabetes have high blood pressure. Both high blood pressure and diabetes increase your risk of heart disease, stroke, eye problems, kidney problems and nerve disease. Most people with diabetes do not know this. A recent survey among people with diabetes found that 68% were not aware of their increased risk. Unsurprisingly, the survey showed that people are largely unaware of ways to reduce their risk, (which generally involve taking the right medications and making the right changes in lifestyle).

Diagnosis and treatment of hypertension is important in preventing macrovascular events such as heart attacks and strokes. Studies show that people with both hypertension and diabetes have roughly twice the risk of cardiovascular disease and mortality as non-diabetic people with hypertension. According to the Diabetes & Cardiovascular Disease Review, the greatest reduction in cardiovascular mortality occurs at a diastolic blood pressure level of ~80 mmHg, and a systolic blood pressure level below 130 mmHg. Anyone with diabetes should work to aggressively control blood pressure.

About The Author

Dr. London was VP and Medical Director of the Lenox Hill Healthcare Network and VP Quality and VP Medical Management for Oxford Health Plans of NY/NJ/CT. He helped found, direct, restructure, and refinance Atlantic Stem Cell Technologies, which merged with Anthrogenesis Corporation and was then acquired by Celgene Corporation. He has served as a consultant to Amgen, Fresenius Medical Care, and two start-up companies, Covance and Colorado Biosciences. He holds a BA in History from Cornell University and an MD from Mount Sinai School of Medicine. After completing his internship and residency at Columbia Presbyterian Medical Center, he did post doctoral research in renal physiology and a clinical nephrology fellowship at Yale University. He also holds an MBA from Columbia University and is board certified by the American Board of Internal Medicine.
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