High blood pressure is a very big deal. According to the American Heart Association, it affects up to 65 million Americans (nearly one in three adults). The majority (more than 70 percent) are not controlling it adequately. For the most part, the experts are still trying to figure out what causes this common condition and why it becomes so widespread as people age.
If you were to reduce traditional medical wisdom on hypertension to its essence, it would probably come to these four points:
- High blood pressure is bad! It contributes to atherosclerosis and leads to strokes, heart attacks, kidney damage, and dementia.
- Low blood pressure is good.
- Eat less salt.
- Take your pills.
Wouldn’t it be wonderful if it were that simple? Like so many things, though, blood pressure (BP) is complicated. For one thing, your blood pressure is not a single, solitary number that remains stable day in and day out. If you were to monitor your BP every few minutes throughout the day and night you would likely discover enormous variability. Over the course of 24 hours, readings could change by as much as 50 points.
Some people may have relatively low blood pressure in the morning when they first get up. After drinking coffee and dealing with rush hour traffic, however, their BP may go up by 10 or more points. A stressful interaction with a co-worker or family member can jack it up even higher. Exercise (including sex) pushes up blood pressure dramatically, but after a strenuous workout, pressure often comes down below where it started. And blood pressure can vary while you are asleep, depending upon whether you are dreaming, sleeping peacefully, or snoring (with sleep apnea).
Even the day of the week can affect your blood pressure. One study revealed that readings are substantially higher on Monday and Tuesday compared to Saturday and Sunday. That’s presumably because people relax on the weekends and are under a lot less stress at home than at work.
Then there’s the whole issue of “white coat hypertension,” so named because it is triggered by the presence of a health professional wearing a white coat. Some years ago Italian researchers demonstrated that when a doctor walked into a patient’s room, systolic blood pressure (the first, or top, number of a blood pressure reading) went up an average of 27 points within 2 minutes. This increase occurred in 47 out of 48 subjects regardless of whether they started with normal blood pressure or had a history of hypertension. Sitting in a doctor’s exam room in a goofy gown with your butt hanging out while you wait forever to see the doctor is not designed to put you at ease. The minute he knocks on the door and comes rushing in, you are likely to feel even more stressed out.
The point is that blood pressure is a constantly moving target. Relying on a single measurement in a doctor’s office would be like looking at a still shot from a 90-minute movie and trying to decipher the plot. If you happened to catch a love scene, you might think the movie was romantic. If the actors were laughing, you might assume it was a comedy. In reality, though, you could not predict how the movie would play out based on a couple of quick snapshots. Likewise, trying to draw conclusions about someone’s blood pressure based on a few readings in a doctor’s office is virtually impossible.
- High blood pressure is common. The chances are very good that you or someone you love has this condition. It increases the risk of serious health problems like stroke, heart attack, dementia, and kidney disease.
- Measure your blood pressure properly. Purchase at least one digital device and plot your numbers in a diary or on a computer.
- Monitor your stress level. Purchase a mood ring or a Bio-Q Thermal Biofeedback and Stress Monitoring Ring. Take time-outs, exercise, and breathe deeply whenever you notice that you’re stressing out.
- Never forget to make new friends but keep the old; one is silver and the other gold. Social support is crucial to good health!
- Lose weight and exercise. If you can do these two things, you may not need medication. Losing the belly and the love handles will do more to keep you healthy than almost anything else we can think of. The DASH diet, which is heavy on vegetables and fruits, can lower blood pressure by as much as some medications.
- Drink tea and avoid coffee and soft drinks. Drink some pomegranate or purple grape juice daily. Indulge in a little dark chocolate.
- Maximize your minerals: calcium, magnesium, and potassium. Get them from your diet if you can. You may need a magnesium supplement (300 to 500 milligrams daily) if you are taking a diuretic.
- Beware of the beta-blocker blues. Do not let your medicine cause fatigue, depression, or forgetfulness. Discuss the latest findings about beta-blockers for hypertension with your physician. Do not stop taking a beta-blocker suddenly! Check with your physician before stopping any medication.
- Diuretics are the first choice for most blood pressure regimens. Chlorthalidone is at the top of our list. It works well and is affordable. Potassium-sparing diuretics such as triamterene and hydrochlorothiazide (found in Dyazide and Maxzide) or spironolactone (Aldactone) may offer similar benefits without risking potassium depletion.
- The best ace up your sleeve is an ACE inhibitor. These drugs represent some of the best treatments modern medicine has to offer for high blood pressure.
- If you need additional antihypertensive treatment, work closely with your health-care professionals to find the approach that will best control your blood pressure without causing unacceptable side effects.