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Treatment and Prevention of Hypertension



By Roger London, MD

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

Roger is VP and Medical Director of Flagship Global Health. Prior to joining Flagship, 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.

Last Updated June 22nd, 2007.

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team ,Rockers where are you ? 0 Wed. Jun 6, 8:39am
For those committed to regular logging and commenting 0 Wed. Jun 6, 1:33am
Side stitches while running 7 Wed. Jun 6, 12:07am
Sexless Marriage 84 Tue. Jun 5, 11:36pm
busy life, in need of exercise 0 Tue. Jun 5, 11:21pm
LAP BAND 1 Tue. Jun 5, 10:36pm
Question about leaving a group 2 Tue. Jun 5, 10:07pm
Body, Mind, & Spirit Connection 0 Tue. Jun 5, 9:35pm
Grossed out by spouse's table manners 11 Tue. Jun 5, 9:26pm
Need a 1 minute vacation? 6 Tue. Jun 5, 9:22pm
Uber Tan, Bright White, Lipo, Highlighted! 13 Tue. Jun 5, 9:16pm
New Group! Join me 0 Tue. Jun 5, 7:16pm
marketing food to kids should be illegal 8 Tue. Jun 5, 6:04pm
SO DO SKINNY PEOPLE JUST NOT CARE ABOUT FOOD 12 Tue. Jun 5, 5:57pm
PRETZELS 3 Tue. Jun 5, 5:53pm
Dr weigh in? 2 Tue. Jun 5, 4:06pm
off topic 5 Tue. Jun 5, 3:51pm
What is that one thing you always mess up when trying to lose weight? 20 Tue. Jun 5, 3:47pm
How To Start A Blog On Here 0 Tue. Jun 5, 3:44pm
Search function for groups/teams 1 Tue. Jun 5, 3:38pm
contest questions 1 Tue. Jun 5, 3:08pm
Shin Splints!! 4 Tue. Jun 5, 3:01pm
How To Get Fat Without Really Trying 1 Tue. Jun 5, 2:29pm
Cookbook with healthy, tasteful meals 15 Tue. Jun 5, 2:12pm
fruits/veggies that don't go bad quickly 2 Tue. Jun 5, 2:09pm
WW question/ Please help~! 7 Tue. Jun 5, 1:59pm
Stuck On the Last 15lbs - Thinking about OTC Weight Loss Drugs 11 Tue. Jun 5, 1:20pm
The Single Most Important Factor in Weightloss 16 Tue. Jun 5, 11:30am
cool website 0 Tue. Jun 5, 11:30am
New member 4 new members 2 Tue. Jun 5, 11:29am
Sensitive Skin Issues 8 Tue. Jun 5, 9:51am
What happened to???? 0 Tue. Jun 5, 12:28am
How to add photo to team listing? 2 Tue. Jun 5, 12:26am
looking for riders 0 Mon. Jun 4, 11:46pm
grilled veggies? 20 Mon. Jun 4, 11:01pm
flavoured drinks...got any suggestions? bored of plain water! 23 Mon. Jun 4, 11:00pm
QUICK AND EASY HEALTHY SNACKS 18 Mon. Jun 4, 9:31pm
Kiddies in College 0 Mon. Jun 4, 9:31pm
Caloric Needs Calculator 6 Mon. Jun 4, 6:23pm
Trying to stay consistant with diet and exercise. 0 Mon. Jun 4, 6:10pm
Exercise overrated? 12 Mon. Jun 4, 5:58pm
I broke my neck twice can't exercise upper body any answers 4 Mon. Jun 4, 5:42pm
Men of faith: New team 1 Mon. Jun 4, 5:17pm
lets get moving !! 0 Mon. Jun 4, 2:46pm
Okay, I know it's a dumb question.... 0 Mon. Jun 4, 2:46pm
lets get moving !! 0 Mon. Jun 4, 2:46pm
Vitamin Brands 0 Mon. Jun 4, 2:22pm
Calling all Vegans!!!! 0 Mon. Jun 4, 1:54pm
Vitamins 8 Mon. Jun 4, 1:40pm
Commited to loosing those pounds 0 Mon. Jun 4, 11:20am
Working out with sore muscles? 8 Mon. Jun 4, 10:38am
For all those involved in the constant religious/political debate here. 23 Mon. Jun 4, 9:58am
Should I be honest with my daughter? 20 Mon. Jun 4, 9:54am
Delaware Engages: New Group Looking for members 1 Mon. Jun 4, 8:47am
For mothers who need to loose 25 or more pounds please join 0 Mon. Jun 4, 7:32am
help me out 2 Mon. Jun 4, 2:01am
Are you ready to lose and learn??? 0 Sun. Jun 3, 11:29pm
Tasty Protein Powder 9 Sun. Jun 3, 11:16pm
work at home or uncommon work schedule challenges/benefits 4 Sun. Jun 3, 4:06pm
Come on and join us! 0 Sun. Jun 3, 3:17pm
Anyone have advice for finding cheap airfare? 12 Sun. Jun 3, 2:56pm
Abusive relationships 2 Sun. Jun 3, 2:19pm
Let's work together to break the "binge/guilt" cycle! 0 Sun. Jun 3, 10:23am
Does drinking coffee make one more likely to drink alcohol? 12 Sun. Jun 3, 9:55am
What waist size is a "size 4"? 19 Sun. Jun 3, 9:44am
Depo shot 16 Sat. Jun 2, 11:53pm
How do you make it past plateaus? 25 Sat. Jun 2, 11:33pm
loving your physical therapist 2 Sat. Jun 2, 11:17pm
STILL LOOKING FOR..... 1 Sat. Jun 2, 10:03pm
Never maintained healthy habits? 0 Sat. Jun 2, 9:01pm
Eating Habits 0 Sat. Jun 2, 7:33pm
Looking for team to achieve our fitness goals together! 0 Sat. Jun 2, 6:51pm
OT - Need a nice dress in a plus size 13 Sat. Jun 2, 5:53pm
Scared to lose weight? 19 Sat. Jun 2, 5:37pm
Hard to lose lbs with SLOW results 0 Sat. Jun 2, 1:52pm
Any great recipes for making "energy bars" at home? 1 Sat. Jun 2, 1:46pm
Over 35 Mom's 0 Sat. Jun 2, 9:26am
Serious Team looking to Seriously lose 52 Sat. Jun 2, 8:31am
Wheat or oat in ceral for breakfast? 2 Sat. Jun 2, 7:31am
When you don't get support at home 13 Sat. Jun 2, 1:28am
Do you count the weight/calories of food before or after cooking? 7 Sat. Jun 2, 12:45am
Sweat marks 6 Sat. Jun 2, 12:23am
Advertising a New PEERtrainer Group 0 Fri. Jun 1, 11:06pm
TUCSON, AZ 0 Fri. Jun 1, 8:21pm
Please join our group 0 Fri. Jun 1, 7:13pm
Stay at home moms to lose 30+ pounds 0 Fri. Jun 1, 6:56pm
Is 1000 calories/day enough?? 14 Fri. Jun 1, 6:13pm
please join our group 1 Fri. Jun 1, 6:01pm
Is it running or is it jogging? 8 Fri. Jun 1, 5:26pm
Very filling bars 7 Fri. Jun 1, 5:15pm
GOOD WORKOUT SONGS! 18 Fri. Jun 1, 4:38pm
Wanting to constantly feed other people just because i'm on a diet... 6 Fri. Jun 1, 2:49pm
Did you find out about PT from people magazine?? 30 Fri. Jun 1, 1:26pm
Nutrisystem is just weird 1 Fri. Jun 1, 1:25pm
Weight Watchers points system FAQ 5 Fri. Jun 1, 1:24pm
O'Donnel vs Hasselback 33 Fri. Jun 1, 1:04pm
Do you gain calories while cooking? 8 Fri. Jun 1, 12:13pm
Calling all Vegans!!!! 2 Fri. Jun 1, 11:30am
when to measure 2 Fri. Jun 1, 11:14am
How many people weigh daily? 14 Fri. Jun 1, 10:08am
Moms: How do you avoid or get out of the 3:00 pm slump? 8 Fri. Jun 1, 9:39am
help with weight loss 4 Fri. Jun 1, 1:45am
For those over 50 yrs old and have more than 100 lbs to lose 7 Fri. Jun 1, 12:12am
Sex and Weight Issues 16 Thu. May 31, 10:26pm
adkins regain 3 Thu. May 31, 9:47pm
Lovin' Life and Losin' old Habits 0 Thu. May 31, 8:10pm
Get Healthy! 0 Thu. May 31, 6:55pm
things I won't miss about being fat... 50 Thu. May 31, 6:20pm
The Real World- How Old Should Kids be to watch? 23 Thu. May 31, 5:48pm
Sciatic Nerve 7 Thu. May 31, 5:23pm
35+ year old women who live in the midwest 0 Thu. May 31, 5:19pm
young mothers looking to loose 20 lbs or more 0 Thu. May 31, 5:07pm
Excess Protein Leads to Calcium Loss? 4 Thu. May 31, 5:03pm
Loosing weight and looking for support in Canada 4 Thu. May 31, 3:57pm
Kids menus in restaurants 4 Thu. May 31, 3:30pm
What is a 5 K 1 Thu. May 31, 2:48pm
healthy workout or hiking snacks 8 Thu. May 31, 2:48pm
Having issues lossing the hard 10 or 20 lbs 0 Thu. May 31, 2:18pm
red faced during exercise . . . 16 Thu. May 31, 12:49pm
OT: Watch out for Kinz Clubhouse in WebKinz 4 Thu. May 31, 12:41pm
Women- what body part do you find most noticeable? 10 Thu. May 31, 12:21pm
Master Cleanse 1 Thu. May 31, 10:09am