Your heart pumps blood around your body to carry oxygen and nutrients to every cell. When your arteries become inflexible, blocked, or narrowed, the heart must pump harder, resulting in hypertension, a major cause of premature deaths worldwide, with 1 in 4 men and 1 in 5 women having the condition.
In this blog, I will cover the different presentations of hypertension, why and how the problem occurs, its effects on various body organs and what we can do to prevent and reverse it.
In the UK, hypertension affects 35% of the adult population, 51% of men, 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”.
80% of sufferers can resolve the condition with lifestyle changes, not medication. I meet many patients who say, “I have been on blood pressure pills for years; is there any chance of finding an alternative natural therapy?” The answer is yes.
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 take the angry student’s BP again, and, again, to our great amusement, this time, it was normal.
The professor commented that it would be a grave mistake to make a diagnosis of hypertension based on a single measurement. 24-hour BP monitor is the gold standard in most developed countries.
Risk factors and symptoms of hypertension
Hypertension is expected in obese and overweight people, often incidentally diagnosed in patients presenting with diabetes, high cholesterol, or other metabolic conditions such as gout. 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 women.
Risk factors include family history, especially in people of Asian, African or Afro-Caribbean heritage, being overweight, living in a deprived area, eating salt in processed food, not eating enough fruit and vegetables (high in potassium), doing little physical exercise, drinking too much alcohol or caffeine, smoking, getting too little sleep, or suffering from stress.
Few patients present with lethargy, shortness of breath, headache, light-headedness, or giddiness. High BP can rupture tiny blood vessels in the nose, causing severe nosebleeds.
Let us start with three very different presentations……………..
“Belly fat, high blood pressure and cholesterol and a painful big toe”
This 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. Routine tests confirmed a high BP of 150/90 and high cholesterol at 6.6 (normal is 5 or less.)
He was prescribed Allopurinol (gout pill) but was not keen on taking it. His health was good until a few months previously. But he enjoyed an unhealthy Western diet; he slept six hours a night, with episodes of insomnia; he felt tired in the morning, and his energy level was 6/10 most of the day. He was overweight, with a BMI of 26 and a WHR ratio of 0.99 (high visceral fat.)
The diagnosis was metabolic syndrome (belly fat, high blood pressure and cholesterol) and gout.
He went on a healthy diet of real food, followed intermittent fasting and lost 2 stone. He now enjoys steady energy levels of 8/10, sleeping 7 to 8 hours at night, and feels fully refreshed in the morning.
“An unpleasant burning sensation in her lower legs”
This lady had a 24-hour BP monitor in 2002, which reported slightly raised blood pressure, but no action was taken. It was found to be high again in 2009 when she presented with a stroke.
The stroke resulted in the right leg and hand weakness. This cleared within three months with regular physiotherapy.
Two years later, she started to experience an unpleasant burning sensation in her lower legs. She didn’t feel centred, was dragging her right leg and found it hard to keep her balance whilst walking.
She did not bother to cook and adopted a Western diet, not consuming enough fruit and vegetables. She had six hours of interrupted sleep a night.
She had an enlarged, fatty liver and an abnormal sound (bruit) in the upper abdomen – suggestive of narrowing of the kidney artery. A renal ultrasound scan confirmed renal artery stenosis – another cause of hypertension.
Her main problems were hypertension, balance impairment due to the cerebellar (balance centre) stroke, and peripheral neuropathy with heat sensation in the legs. She had to wake up frequently at night to uncover her hot legs.
“I like my sweets, cakes and chocolate”.
This 62-year-old gentleman had major surgery for a massive aorta dissection (rupture of the main artery) complicated by a stroke. He had very high blood pressure and was prescribed multiple pills to control it.
He smoked rolled tobacco and reported having fluctuations in energy after meals. He had 10 silver fillings (he likes sweets, chocolates, and cakes and hates healthy food).
Interestingly, he was slim with an ideal weight (BMI 22.7) but had fat accumulation in the middle (waist/hip ratio 0.97). He had an enlarged liver – fatty liver is part of metabolic syndrome.
He had left-side body neurological signs consistent with a stroke. Initially, the patient could walk a few steps with a stick and minimal support. Limited by intermittent claudication (calf cramps) – due to diminished blood supply to the calf muscle, which stopped him from walking more than a few steps due to the accumulation of lactic acid.
Malignant hypertension, if untreated, is associated with a five-year mortality rate of 95%, with 65% dying from congestive heart failure, 14% from renal failure, 11% from heart attack and 5% from cerebral haemorrhage.
How does hypertension damage the body?
Hypertension can quietly damage your body for years before symptoms appear. Narrow coronary arteries can result in angina or a full-blown heart attack. In the brain, you can get a transient ischaemic attack (TIA – a temporary blockage of an artery) or a full stroke. It can also cause mild cognitive impairment or full dementia due to damage to tiny blood vessels (vascular dementia). In your aorta, pushing blood at high pressure can result in a partial tear to the artery wall resulting in an aneurysm.
In the kidney, hypertension damages the filtering units causing scarring (glomerulosclerosis), which often progresses to renal failure (ESRF), requiring dialysis. Hypertension can cause small bleeding or infarction (damage due to loss of blood supply) of the retina, which can result in vision loss. It can also cause sexual dysfunction in men and women due to reduced blood flow to the sex organs.
50% of people with high blood pressure also have sleep apnoea. Blood pressure is expected to fall at night but may not if you have sleep apnoea. You experience a cortisol surge every time your oxygen drops, which raises your blood pressure.
Hypertension is underdiagnosed in lean people, who have worse outcomes than overweight or obese people. Efforts to detect hypertension early in these patients will help to prevent serious complications.
Heart (pump) failure
The heart pumps hard against resistance until unable to meet the body’s needs. Hypertension initially causes weakness of the left side of the heart (left ventricular failure) before progressing to right heart failure.
The high pressure generated in the heart impedes the return of blood from the lung resulting in lung congestion; it usually presents with difficulty breathing, particularly when the person lies flat in bed at night. They must put more pillows to sleep in a semi-sitting position and often have coughs with frothy whitish sputum.
Right heart failure is due to the build-up of blood in veins leading to fluid retention. This initially shows up as ankle oedema that progresses over time to swell the genitals and the abdomen, resulting in ascites (fluid accumulation in the tummy).
Home readings
White-coat hypertension is usually explained as doctor-triggered anxiety but could be a sign of more serious blood-pressure issues.
A study revealed that white-coat hypertension could increase the risk of stroke, heart attack, heart failure and other vascular complications.
With the availability of electronic BP apparatus, people can monitor their blood pressure at home.
If possible, when doing so, follow the American Hypertension Society guidelines:
- Empty your bladder and rest for 5 minutes.
- Sit upright with your elbow resting on a table and the BP cuff at heart level.
- Take the reading at the same time every day.
- Take the reading at least 30 minutes away from caffeine, nicotine, alcohol, or exercise.
- Take 2 to 3 readings one minute apart.
- Take the measurement on bare skin, not over clothes.
- Do not talk during the reading.
Management
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 BP above 160/100 should receive BP medication immediately. Such high blood pressure is associated with serious complications.
On the other hand, prescribing drugs for borderline hypertension may be inappropriate. Studies confirmed a high risk of falls and fractures in senior adults.
I observe regularly that obese and overweight people who can attain their ideal body weight also lower their blood pressure. This happening constantly as a side effect of our weight management program.
The natural way
A DASH Diet Plan for Hypertension
Studies have shown that 60% of hypertensive patients could get their BP lowered by just adopting a paleo (nothing processed) diet of whole organic real food, locally produced fruits and vegetables, beans, nuts and seeds, meat, poultry, and fish.
You can increase your potassium intake. Fruits and vegetables are rich in potassium, including bananas, avocados, sweet potatoes, and leafy greens such as kale and spinach.
Reducing sodium, which is high in processed food, would help patients with genetic salt sensitivity. Please do not take refined table salt for other patients, as it is stripped of every beneficial trace mineral. The best salt to take is pink Himalayan or sea salt.
Take more magnesium, which is important for relaxing the blood vessels and converting the amino acid Arginine into the artery relaxant 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!
Vitamin K2 is essential to move calcium from the blood vessels into the bone, where it is supposed to be. 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.
Above all, adopt healthy lifestyles
Undertake physical activity that includes cardio and strength training, together with yoga for relaxation, joint flexibility, and core strength.
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 to enhance the quality of sleep.
I found that many people make a successful transition when they understand their true purpose – like leading their family along the path of health and well-being or being able to play with their grandchildren.
I have met patients who made these changes and who are now well enough not to take their pills, and some are able to give up their overnight CPAP as they recovered from sleep apnoea.
But I must accept that lifestyle management might not work for everyone. There are some patients who haven’t got enough time and would like the job done for them, and hence we must accept that there is a place for medication!
So, my friends, you can understand my urgency in warning you about hypertension – as simple lifestyle changes can prevent or reverse the condition, and that, in some cases, medication may be necessary. As always, please ask any questions in the Comment section below – and please subscribe to the newsletter so that you don’t miss further vital information. Thank you!
References
Hypertension and the ACE gene
https://www.gbhealthwatch.com/GND-Hypertension-ACE.php
High blood pressure
What is the best time of the day to take your blood pressure?
https://www.healthline.com/health/high-blood-pressure/best-time-to-check-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
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