Category: Hypertension

Categories
Heart Health Hypertension

Approaching Hypertension

Western medicine refers to elevated blood as essential hypertension, which is a somewhat confusing term, but it means that a patient has a high blood pressure of unknown cause.

Approaching hypertension appropriately requires uncovering why a person has high blood pressure before assuming it’s due to an unknown cause. Here is our approach.

Essential Hypertension

The most common form of hypertension is idiopathic hypertension which Western Medicine calls essential hypertension.

This distinguishes it from secondary hypertension, which has various other causes:

  • kidney disease
  • hormone imbalances
  • pregnancy-induced

However, many clinicians will argue that most of this essential hypertension, in fact, has other known causes which aren’t addressed.

Approaching Hypertension

Our Heart Health Coaching addresses hypertension by reviewing its major risk factors. Both in terms of what can cause it and the major risks of living with elevated blood pressure.

Our goal is in the neighborhood of 120/80, depending on various risk factors and family history.

1. Obesity

Liposuction won’t solve obesity-induced hypertension. The lifestyle changes leading to weight loss seem to be the curative factors for bringing blood pressure back to normal.

2. Elevated Uric Acid

Diets high in fructose and meat tend to elevate uric acid. Even if there are no problems with gout, a lower uric acid is desirable.

Alcohol, especially regular alcohol use, tends to elevate uric acid levels as well.

Some experts recommend keeping this value under 6 mg/dl; others want it as low as 4.

3. Elevated Blood Sugars

It’s hard to know whether elevated blood sugars or elevated insulin levels are the main cause of elevated blood pressure. Either way, we recommend our clients have optimal levels before considering that the blood pressure problem is idiopathic.

4. Sleep Apnea

Sleep apnea goes undiagnosed quite frequently. Good home tests are available these days, but the treatment – sleep apnea device – often has a low compliance rate.

Sleep apnea can cause elevated blood pressure, fatigue, headaches, and difficulty focusing.

5. Fatty Liver

Visceral fat, in general, especially fat around the liver, seems to cause a disruption in the normal hormone cycles of the body.

Non-alcoholic fatty liver disease (NAFLD) is bidirectionally associated with other metabolic disorders. Therefore, we screen for NAFLD in our decision algorithm.

Measuring Improvements

In most, doing even some work towards improving the factors above is likely to yield good blood pressure improvements.

The obvious method is regularly checking blood pressure numbers, focusing on a daily average called ambulatory blood pressure.

A secondary method is to monitor kidney function levels, called glomerular filtration rate (GFR), which creatinine or cystatin C measures.

Categories
Heart Health Hypertension Treatment

Blood Pressure Goals

As with all things in medicine, there is much debate about ideal blood pressure goals. 120/80 or under 140/90?

And as with all things in medicine, it’s an individualized approach. Some patients have enough risk that a 120/80 value makes the most sense.

The current standards consider normal values to be under 120 systolic and under 80 diastolic values.

Avoiding hypertension is an important part of ensuring proper Heart Health and avoiding strokes, heart attacks, erectile dysfunction, heart failure, and kidney disease.

One common problem we see in Western Medicine is that kidney disease is diagnosed too late with rather vague guidelines for renal function. Better tests than serum creatinine are available.

Current Approach to Blood Pressure Checks

My patients have their blood pressure checked when they come into the clinic. Or worse, they check their BP at home when they have a headache, feel dizzy, or have nausea.

At best, in this current approach, we measure someone’s blood pressure only 2-3 times per year. At worst, we check blood pressures when they likely will be high due to pathologic factors.

So, the old method is outdated – too little data or dirty data from which a proper decision cannot be made.

Average Blood Pressure Readings

In comes the average blood pressure. This is a far better approach and method to guestimate someone’s baseline blood pressure.

Baseline, meaning this is the blood pressure they are walking around with when not stressed, when not doing a strict meditation routine.

The goal for this blood pressure should definitely be low – closer to 120/80. This is according to the SPRINT trial.

The average blood pressure can be taken with a cuff which you set to inflate every 30 minutes using a timer. Your doctor can also prescribe an ambulatory blood pressure monitor, which achieves the same automatically.

Interventions That Lower the Blood Pressure

When you’re stressed, your blood pressure goes up. Logically, if you can calm yourself down, your blood pressure should and does indeed decrease.

Blood pressure goals can be achieved with lifestyle changes alone. Weight loss, dietary changes, stress management, better sleep, and correcting underlying pathology such as sleep apnea.

The next step is medications. There is a lot of fear when it comes to medications. It’s understandable. Big pharma can’t always be trusted – perhaps. But they do some good, as well.

It’s important to understand that any chemical is a tool, and when used correctly by the right people, it could be a proper solution.

Otherwise, to achieve the desired blood pressure goals, herbal medications or supplements can also be tried.

Categories
Diet Heart Health Hypertension

Carbs and Blood Pressure

The human gut benefits from a balanced diet. It can withstand quite a poor diet for short periods. But, in the long run, there has to be a balance; otherwise, we suffer health side effects. Carbs and blood pressure are an example of this improper balance.

Carbs and high blood pressure correlate closely. It doesn’t mean you have to cut out carbs, but it’s important to choose carbs wisely and get plenty of fiber or protein in the diet.

Blood Pressure and Diet

It’s not that you are trying to hurt yourself, but some of your diet decisions may not be ideal for your unique physiology.

Functional nutrition is a branch of medicine focusing on each person’s unique physiology and microbiome. One person does well with a lot of processed carbs, while another suffers health consequences from the same diet.

I have patients whose blood pressure isn’t affected by salt. They might suffer other issues, such as vascular stiffness, but their blood pressure doesn’t falter.

Carbohydrates – specifically processed carbs – seem to affect most of us negatively over the long term. Carb consumption has a reasonably direct relationship with our blood pressure.

Carbs and Blood Pressure

Fortunately, it doesn’t mean you have to adopt a ketogenic or carb-free diet.

The balance of your macronutrients could help protect against the downsides of a high-carbohydrate diet that is mostly processed.

Certain foods have carbohydrates that digest slower than other carbohydrates. You can test it out by wearing a CGM or checking your blood sugar every 30 minutes after certain meals.

Some carb-rich foods will spike your blood pressure. A continuous blood pressure monitor is helpful for this. But checking your blood pressure every 30 minutes will be as effective.

A Balanced Diet

Some nights I eat a late meal that’s heavy in processed carbs. For example, it might be a homemade burrito with white flour and white rice.

The timing of this late meal, combined with the high glycemic index, often leads me to snore heavily at night, wake up congested the next day, and raise my systolic blood pressure by at least 10 points.

But if the tortilla is a whole-wheat tortilla and I have brown rice with plenty of veggies and go easy on the salt, my body handles it much better.

Heart Healthy Diets

There is no single diet out there that works for everyone. Many argue that diets as a concept of achieving health don’t make sense.

Chances are there are many foods you can eat and remain healthy. However, a dietary adjustment may be needed to achieve Heart Health once you are dealing with a particular cardiovascular disease.

Schedule a session with me today to discuss how to experiment with your diet to figure out what foods are best avoided and which to consume more of.

Categories
Heart Health Hypertension

The Basics of Hypertension

An overview of high blood pressure should get you on the same page as your doctor. Managing this condition is a team approach and needs to happen slowly.

Pharmacologic Treatment

If you treat your hypertension, you will manage it through lifestyle means or by taking prescription medications. You might also try herbal treatments, of which there are a few good options out there—more on that in another article.

There are reversible causes that are addressed before assuming the diagnosis is essential hypertension, aka idiopathic hypertension.

Treatments for hypertension decrease the pressure exerted on the heart and the vascular system. Some medications work by removing the amount of water in the vascular system (diuretics); others decrease the tightness of the vessels (vascular dilators). Some medications also reduce the output from the heart (beta-blockers).

The downside to medications is that they have side effects and need to be monitored. There is also no way to know which medication will work immediately for you.

The other downside to managing hypertension with pharmacology alone is that we don’t focus on the underlying causes which led to hypertension in the first place. For some, it’s an aging heart. For others, it’s genetic, yet it’s an issue with vascular resistance.

Lifestyle Treatment

Lifestyle management of hypertension would include focused activity for the individual. It’ll need to be cardiovascular training; for others, it’s resistance training.

Dietary treatments, such as salt and alcohol intake, can also make a difference, but not for everyone. When going down the diet, you must be okay with a trial and error factor. 

I prefer lifestyle treatment options because it puts the individual at the helm. One learns a lot about their body when experimenting with their lifestyle to see how their health is affected. 

I will add meditation and breathing and general stress and sleep management. These can be significant factors for some while minimally effective for others. 

Diseases Associated with Hypertension

We forget that continued high blood pressure can lead to various diseases, from heart failure to heart attacks and strokes. It can cause erectile dysfunction and kidney disease. And it can hasten dementia or other cognitive issues. 

It is also among the leading accuses of eye problems and circulation issues such as peripheral vascular disease. 

I mention all of these because treating a single condition such as hypertension can improve your health immensely. You get a significant return on effort investment. 

Diagnosing Hypertension

The easiest way to diagnose hypertension is to slap a cuff on your arm. The problem is that this will miss several hypertensive individuals and overdiagnose some.

A 24-hour blood pressure monitor is probably the best thing to invest in. This can be done by wearing a blood pressure cuff that auto-inflates every couple of hours or by having your doctor order the proper 24-hour blood pressure monitoring device.

A person with a few elevated readings does not mean they have a hypertensive disease. And just because you happen to see regular readings when you check, it doesn’t mean your blood pressure doesn’t get unbelievably high during specific episodes in your life, such as when you first wake up or after or during stressful events.