High blood pressure or in the medical field it is known as hypertension. There are basically two types of hypertension primary (essential) hypertension and secondary hypertension. About 90-95% of hypertension falls under the category of essential hypertension and 2-10% falls under the category of secondary hypertension. Secondary hypertension is usually caused by other complications in the body such as, adrenal gland tumors, defects in blood vessels, severe hormonal imbalances, various kidney diseases, sleep apnea and several types of medications. However, our discussion will be confined to essential hypertension.
According to the American Heart Association in 2013 it is estimated that 77.9 million Americans or about 1 in 3 have elevated blood pressure. The Centers for Disease Control (CDC) in 2009 estimated as well about 31% of the US population has hypertension. Approximately 47% of those with hypertension have their blood pressure under “control”. It is interesting to note that under the age of 45 more men than women have hypertension, but over age 65 more women than men have hypertension. It is also more common in people of Afro- American descend than Caucasian or Hispanic backgrounds. What is further interesting is that hypertension levels in many non-industrial countries is significantly less than in the US.
The CDC also estimated about 1,000 deaths per day or 348,000 Americans died in 2009 from hypertension as the primary contributing cause of death. Of those who had their first heart attack, 7 out of 10 had hypertension. Stroke effects 8 out of 10 with hypertension.. Hypertension also effects 7 out of 10 with chronic heart failure and most with kidney diseases.
How is blood pressure measured? Usually with a device that is called a sphygmomanometer or commonly known as a blood pressure cuff. The pressure is often measured at the left or right arm or both. The blood pressure is measured by two numbers. The first is called systolic and the second is diastolic. An example is 118/76.
Systolic pressure is that pressure generated primarily by the contraction of the heart. Diastolic is the pressure caused by the resistance or tone of the main blood vessels and “thickness” or viscosity of the blood.
Blood pressure is categorized as follows: Normal : below 120/ below 80 Prehypertension: 120-139/ 80- 89 Stage 1 hypertension: 140- 159/ 90-99 Stage 2 hypertension: at or above 160/ at or above 100 Often drug therapy will be instituted at the stage 1 level and sometimes at the prehypertension level.
RISK FACTORS FOR HYPERTENSION
Well you guessed it, one of the factors is uncontrolled stress. Here are some of the other major risk factors:
- Age it increases especially after age of 55.
- Family history of increased blood pressure
- Being overweight
- Lack of regular exercise
- Excessive alcohol usage
- Tobacco use either by smoking or chewing
- Usage of medications such as NSAID like ibuprofen, naproxen, Voltaren or Celebrex.
- Cough medicines containing pseudoephedrine or phenylephrine.
- Ethnic background increased if AfroAmerican
- Too much salt, not enough calcium, not enough potassium , not enough magnesium
- Low Vitamin D levels and lack of direct sunlight
- Certain chronic conditions such as kidney disease, diabetes or sleep apnea.
- Coumadin pulls calcium out of the bone and helps deposit it in heart valves and coronary arteries
- Decreased magnesium from heart burn meds
SYMPTOMS AND COMPLICATIONS
What are the main symptoms of hypertension? NONE!!!!! That’s right there are no specific symptoms for high blood pressure. The occurrence of nosebleeds, headaches, dizziness, facial flushing are not specific or reliable markers for hypertension. Often most people do not even know that they have high blood pressure. The
only true method for evaluating for hypertension is to measure it.
Hypertension is very important as it causes many health problems. Here is a listing of some of the main complications:
1.Heart enlargement, heart attack and heart failure.
2.Brain hemorrhage, dementia and stroke
- Aneurysm or rupture of blood vessels
4.Retinal or eye damage
- Increased atherosclerosis
- Erectile dysfunction
BASIC COMPONENTS OF BLOOD PRESSURE
There are three basic components that effect blood pressure and many of the medications prescribed address these components. The first, is the force and rate at which blood is pumped out of the heart. This initial wave of pressure is called systolic pressure This can be influenced by the strength of the heart/cardiac muscle, volume of blood forced out and the resistance of the main blood vessel ,the
aorta. Often when there is increased blood pressure the heart has to work harder and it will initially cause an enlargement of the left ventricle of the heart.
The second component has to do with the diameter and flexibility of the blood vessels. The more narrow the blood vessel the higher the blood pressure. As the blood vessels lose flexibility it will cause an in
crease in pressure. This is why atherosclerosis is a major contributor to hypertension.
Thirdly, as the total volume of blood and thickness/viscosity increase so does the blood pressure. It is more difficulty to pump blood through when it becomes more viscous. The amount of water, electrolytes/ minerals, protein content and number of red blood cells all effect blood pressure.
BLOOD PRESSURE MEDICATIONS
We will briefly discuss some of the major categories of medications to treat hypertension. The first is diuretics. They are designed to cause the kidneys to excrete extra sodium and water. This effectively reduces the blood volume. Some commonly used diuretics are, hydrochlorothiazide, Lasix, spironolactone and others.
The next category are beta blockers. They block the effects of adrenalin and slow the
heart and reduce the tone of the arteries. Some examples are, atenolol, carvedilol, metoprolol and propranolol.
The next category are calcium channel blockers. They dialate the arteries and can decrease the force of contraction of the heart. Some examples are, amlodipine, Cardezim and verapamil.
The next group are called ACE inhibitors or Angiotensin Converting Enzyme inhibitors. Angiotensin can normally
increase blood pressure. Essentially, ACE inhibitors cause dilatation of blood vessels, decrease blood volume and decrease heart output. Examples are, Accupril, lisinopril, Vasotec and others.
The last major category are angiotensin 2 receptor blockers or “ARBs”. They also dilate blood vessels. An example, is Losartan. Many of the above medications are combined together as well for proper therapeutic effect.
BALANCING HYPERTENSION NATURALLY
Hypertension is multifactorial, so a singular approach is often met with failure. This is why a combination of medications and lifestyle changes are so essential. We will discuss some of the factors involved with hypertension.
This is commonly known as plaque build up in the arteries. The plaque build up especially in the coronary arteries or blood vessels of the heart can decrease the delivery of blood to the heart causing it to not work properly. Atherosclerotic changes in the rest of the arteries decreases proper smooth flow of the blood and decreases the diameter of the arteries and arterioles leading to increased blood pressure. As the plaques grow there is also decreased flexibility of the blood vessels which can increase blood pressure and result in some of the plaques rupturing causing clots or emboli. Additionally, increasing
atherosclerosis significantly effects the kidneys, furthering hypertension. It an also lead to hemorrhaging of small blood vessel in the brain.
In our earlier newsletter, “Cholesterol”, we did discuss atherosclerosis and the importance of reducing inflammation especially in the blood vessels walls and balancing the proper levels of cholesterol, and other lipoproteins in the blood. Another important factor that accelerates and contributes to atherosclerosis is insulin resistance and diabetes.
There are a few non invasive tests that can be performed to give you an idea of the level of atherosclerosis such as, Doppler ultrasound imaging of the carotid arteries of the neck, measuring the Doppler waveform of the peripheral arteries, and evaluating the retinal blood vessels in your eyes. There are more invasive techniques such as angiography
and electron beam computed tomography that can reveal your “calcium score”. The higher your score the more calcium is found in your coronary arteries and plaques.
A much better noninvasive method is to have a through blood test that contains not just your “good” and “bad” cholesterol, but one that breaks down the different sizes of the cholesterol and lipoproteins found in the blood and it is called a VAP test. Some inflammatory markers such as homocysteine, fibrinogen, ferritin, free testosterone ( in men) and Creactive protein are also very important and are good predictors of atherosclerosis. A good test I recommend is called the CardioION test from Genova Diagnostics. This panel is very comprehensive and is geared to assess cardiovascular risk.
So what can be done naturally for atherosclerosis, first stop smoking, exercise regularly.