And the big, fat problem is that Hypertension can be more silent – and therefore more harmful – in lean, thin people!
But 80% of high blood pressure sufferers can resolve it with lifestyle changes, not medications
You increase your risk of having high blood pressure if you are overweight, eat more salt in processed food and not enough fruit and vegetables (high in potassium), do little physical exercise, drink too much alcohol or caffeine, smoke, get too little sleep, suffer too much stress, if you have a relative with high blood pressure, if you are of Asian, African or Afro-Caribbean descent, or if you live in a deprived area.
Anyone can be at risk of hypertension: men are more likely than women to have high blood pressure, although, after the age of 65, this is reversed due to the loss of protective oestrogen in females.
I meet many patients who say, “I have been on blood pressure pills for years; is there any chance of settling down high blood pressure or finding an alternative natural therapy?”
How to diagnose hypertension?
I spend enough time to establish whether the person has genuinely high blood pressure (BP) and what is the underlying cause?
Previously, we used the BP apparatus to take three measurements on three different occasions. This is inaccurate, particularly in patients likely to suffer from “white coat hypertension.” In these patients, BP measurements at home are always in the normal range.
Ambulatory blood pressure monitoring has resolved this issue and has become the standard test to confirm the diagnosis in most developed countries.
The second step is to look for the underlying cause. High technology, including genetics and biochemistry, has made it possible to identify most factors contributing to the condition.
Asking difficult questions
My first medical school session on hypertension went like this…… The facility professor selected an anxious student and started asking him a series of difficult questions and, when he could not answer, made negative remarks. The student’s anger escalated. At this point, the professor asked another student to take the angry student’s blood pressure. To our great amusement, it was very high. The professor ignored the issue and went on to deliver the practical session. After a little while, he asked another student to retake the angry student’s BP, and, again, to our great amusement, this time, it was normal.
Traditional medicine classifies hypertension into:
– Primary (essential) in 90% of patients – essential means there is no identified cause, a good reason to justify medications as the first line of treatment.
– Secondary in 10%. These include chronic kidney disease, renal (kidney) artery stenosis (narrowing), adrenal tumours and overactivity, thyroid disease, and rare congenital defects (coarctation of the aorta), meaning there is a narrow segment in the main artery out of the heart.
Hypertension is a serious medical condition and can put affected people at risk of heart disease, stroke, chronic kidney disease and dementia. It is a major cause of premature death worldwide, with upwards of 1 in 4 men and 1 in 5 women – over a billion people – having the condition.
In the UK, hypertension affects 35% of the adult population, 51% of men and 26% of women and 60% of those who are obese or overweight. It is the third leading cause of death.
You can have high blood pressure for years without any symptoms, but even without symptoms, hypertension can damage your organs. One-third of people with hypertension are unaware of it – that is why it is known as “the silent killer”. Routine assessment can detect organ damage at the back of the eye (retinopathy), kidney (microalbumin in urine) and peripheral nerves (neuropathy).
Because of compromised circulation, headache, lethargy, light-headedness, giddiness, and shortness of breath are common symptoms of raised blood pressure. Damage to the tiny blood vessels in the eye can result in poor and often doubled vision. High pressure rarely ruptures tinny blood vessels in the nose, causing a severe nosebleed.
Hypertension is expected in obese and overweight people and is often incidentally diagnosed in patients with diabetes, high cholesterol, or other metabolic conditions such as gout.
Gout – but also belly fat, high blood pressure and cholesterol
A 45-year-old gentleman presented to his GP with a painful big toe. Tests confirmed a high uric acid level, and the diagnosis was gout. The GP observed his blood pressure running high, over 150/90. Other routine blood tests confirmed high cholesterol at 6.6 (normal is 5 or less.)
GP prescribed Allopurinol for gout but was not keen on taking it. He enjoyed a western diet of cereals, dairy, and fried food; he slept six hours a night with episodes of insomnia; he felt tired first thing in the morning, and his energy level was about 6/10 most of the day.
His weight was 79.4 kg, height 174 cm, BMI 26.2 (overweight.) His waist was 40 inches, hip 40.5, making a WHR of 0.99 (belly fat). His pulse was 78, and his blood pressure was 127/82 on blood pressure pills. He had an enlarged fatty liver.
He went on a healthy diet of real food options and adopted intermittent fasting (6 pm to 10 am), lost 2 stone in weight (from 13 to 11 stone), aiming to regain his ideal weight of 10 stone. His energy is a lot better and steady most of the day. He is sleeping better, a good 7 hours per night, and feels fully refreshed in the morning. However, he continued to monitor his blood pressure daily and was delighted to see the trend going down to a normal level.
Lean people present with serious complications of hypertension
Hypertension is underdiagnosed in lean (normal weight) people, who, for this reason, can present late with serious complications as the first sign of hypertension. Research has suggested that lean people had worse outcomes than overweight or obese people
A study from the University of Michigan has found that a quarter of normal-weight adults had a high risk of heart disease and hypertension.
Explain the process of hypertension
The blood circulation is powered by the heart. When blood vessels are flexible, the heart exerts a gentle contraction to push blood through the body. When the blood vessels become hard, stiff, or calcified, the heart has to push harder to overcome the resistance. As the heart continues to push harder, the BP goes up.
High blood pressure is necessary to overcome resistance due to stiff and inflexible blood vessels. Over time, this can damage sensitive organs like the eyes, kidneys, and the brain, resulting in poor vision, chronic kidney disease that often progresses to renal failure (ESRF) requiring dialysis, and vascular dementia.
The blood vessels hardened due to the development of arteriosclerosis or calcium deposition. The latter benefits from taking vitamin K2, which removes calcium from soft tissues like blood vessels and puts it in bone.
The macrovascular complication of hypertension
Narrow coronary arteries can result in angina or full-blown heart attack. In the brain, you can get transient ischaemic attack (TIA) – mini-stroke with temporary blockage of an artery or a full stroke. Hypertension can cause peripheral vascular disease and sexual dysfunction in men and women due to reduced blood flow. In the aorta, pushing blood at high pressure can result in partial tear to the artery wall resulting in an aortic aneurysm.
This 62-year-old gentleman had major surgery for a massive aorta dissection, complicated by a stroke and peripheral vascular disease. After surgery, he was prescribed multiple pills to control his high blood pressure.
He smoked rolled tobacco and reported fluctuating energy after meals with a significant afternoon slump (a sign of a sugar problem). He had 10 silver fillings (the patient likes sweets, chocolates, and cakes and hates healthy food).
He was slim, weighed 72 kg, height of 178 cm, and had a BMI of 22.7 (ideal weight). His waist was 40.8 inches, hip 42 inches, making his waist/hip ratio 0.97 (belly fat). His pulse was 47 BPM (he’s on B-blockers), and his blood pressure was 168/85. He had an enlarged liver – fatty liver is part of metabolic syndrome.
He has left-body neurological signs consistent with a stroke. Initially limited mobility due to intermittent claudication of the calf muscles – diminished blood supply to the muscles, stops him from walking more than a few steps due to the accumulation of lactic acid.
Heart failure is a common complication of hypertension with a poor prognosis, worse than cancer. Working against resistance, the heart muscle gradually becomes thickened and weak and unable to meet the body’s needs.
The left heart fails to pump enough blood to meet tissue oxygen demand; with lung congestion, patients have difficulty breathing, mainly when they lie in bed at night. They be obliged to put more pillows to sleep in a semi-sitting position.
Right heart failure is characterised by the build-up of blood in veins leading to fluid retention. This shows up initially as ankle oedema and can progress over time to swell the genitals and the abdomen, resulting in what is known as ascites.
Hypertension can cause pump failure with loss of muscle function after a heart attack or development of abnormal heart rhythm such as atrial fibrillation,
50% of people with high blood pressure also have sleep apnoea. Normally your blood pressure falls at night but may not if you have sleep apnoea. Every time your oxygen drops, this causes a stress hormone surge that raises your blood pressure.
Pharmaceutical drugs cause hypertension, including pain relief (NSAIDs), contraceptive pills, cold cure pills, and illegal drugs such as amphetamines and cocaine.
What about salt?
High salt intake and high calorie in processed food, together with lack of physical activity, is a recipe for obesity and hypertension. In contrast, hypertension is rare when salt intake is very low (below 50 mEq/day). One study showed that hypertension is rare even with a relatively high salt intake in a rural setting with continued exercise and lean body habitus.
The genetic hypertension
Genetically determined salt sensitivity in AGT and ACE variants increase sodium and blood volume to raise blood pressure. Carrier of these variants can effectively reduce their risk for hypertension with a low sodium diet.
The endothelial nitric oxide synthetase (eNOS) gene produces Nitric oxide (NO) from amino acid L-arginine. NO plays a significant role in regulating vascular tone and controlling blood pressure. Smoking and alcohol put the carriers of this variant at risk of hypertension.
APOE gene variant make the carrier susceptible to inflammation and oxidative stress – the two major causes of vascular damage and atherosclerosis (hardened arteries).
How to measure your blood pressure?
Home BP readings are helpful, and I encourage my patients to record their BP regularly and share BP charts with their GPs and at hospital appointments.
Systolic blood pressure (top number) measures the blood pressure during heart contractions.
Diastolic blood pressure (button number) measures the blood pressure during heart relaxation.
Blood pressure of 180/120 mm Hg and over (hypertensive crisis) increases your risk of complications. You should seek immediate medical advice.
Tips for taking an accurate BP at home
– Choose the electronic blood pressure monitor that suits you
– Empty your bladder and rest for 5 minutes in a warm and comfortable place before you take your blood pressure
– Sit upright on a chair with your elbow resting on a table and the BP cuff placed at your heart level
– Roll up your sleeve to measure on bare skin, not over your clothes
– Take 2 to 3 blood pressure reading for comparison one minute apart
– Take your blood pressure at least ½ an hour away from caffeine, nicotine, alcohol, or exercise.
– take the blood pressure reading at the same time every day, for example, before or after work or bedtime.
– Do not talk while you’re taking the measurement
“I can’t imagine living the rest of my life not eating bread, sugar or cheese or enjoying a glass of wine”
Sticking to a healthy lifestyle will be much easier when you consider the great benefits you will reap – winning against disease, clearing the family’s legacy of illness, and extending an enjoyable life span, for example, being fully functional and independent in your 90s.
I found that many people make a successful transition when they understand their true purpose – like leading the rest of their family into the safety of health and well-being.
I have met patients who made these changes and are now well enough not to take their pills, and some are able to give up their overnight CPAP as they recover from sleep apnoea.
But I must accept that lifestyle management might not work for everyone. Some patients haven’t got enough time and would like the job done for them; therefore, we must accept that there is a place for medications!
Studies show that BP medications control BP in 30% of patients taking them. We also know that 20% of patients fail to respond to diet and lifestyle interventions, and they would be good candidates for BP medications.
Any patient with a BP above 160/100 should receive BP medication immediately. Such high blood pressure is associated with serious complications such as heart attack or stroke, so medications may be lifesaving in this situation.
On the other hand, prescribing drugs for borderline hypertension, particularly in frail older people, increases the risk of falls and fractures.
How to lower your blood pressure the natural way
Simple observation shows that obese people who can attain their ideal body weight also lower their BP. I observe this constantly happening as a side effect of our weight management program.
You can increase your potassium intake, to reinstate sodium and potassium balance. For every 500 mg of potassium you take daily, you lower your systolic BP by 1 mm of Hg and diastolic by 0.5 mm of Hg. Fruits and vegetables rich in potassium like bananas, avocados, sweet potatoes, and leafy greens such as spinach.
Reducing sodium intake would help patients with genetically determined salt sensitivity carried in the ACE & AGT genes (see below). Processed food is high in sodium.
Take more magnesium, which is vital for relaxing the blood vessels and converting the amino acid Arginine into nitric oxide. Foods rich in magnesium include seeds, nuts, and dark chocolate.
Vitamin D is known to stabilise both systolic and diastolic BP. Treat those people with low vitamin D with supplements and regular daily sunshine, free of charge!
As mentioned above, vitamin K2 is essential to move calcium from the blood vessels into the bone. The dose is 180 micrograms per day. Foods rich in vitamin K2 include egg yolk, grass-fed butter, and cheese.
Hibiscus tea is wonderful for lowering BP. Take 2 to 3 cups every day.
Other supplements include COQ10, Arginine, tryptophan, 5HTP, GABA, Theanine, cod liver oil, garlic, and Macca, depending on individual nutritional status.
And of course, I would fail in my duty to you if I did not also say…………
Adopt a healthy diet: studies showed that 60% of hypertensive patients could lower their BP by adopting a paleo diet of whole organic real food, locally produced.
Undertake physical activity that includes cardio, strength training, and yoga for relaxation, joint flexibility, and core stability.
Lower your stress level by practising meditation, deep breathing, listening to your favourite music and humour, taking Epsom salt baths, and walking in nature.
Get adequate sleep in a dark room and enjoy the sunshine during the day to establish a good circadian rhythm.
Hypertensive people share a western diet of processed, highly refined food, a low intake of fruits and vegetables, a genetic tendency and low vitamin D (we live in England!)
The answer, as almost always, my friends, is to eat more healthily, reduce alcohol, lose weight if you’re overweight, exercise regularly, cut down on caffeine and stop smoking.
And if you have any questions or would like to share your hypertension experience (whether you are lean or not!), I would be delighted to hear from you. And your contribution may help someone else along their path to a longer, healthier life.
Hypertension and the ACE gene
High blood pressure
What is the best time of the day to take your blood pressure?
Hypertension and the AGT gene
Genetics of hypertension
Endothelial nitric oxide synthetase genetic polymorphisms and the risk of hypertension in an Indian population