High blood pressure: Don’t jump straight to medications

High blood pressure is a reading from 120-129 / 80 mmHg. Stage 1 hypertension is defined as a blood pressure of 130-140/80-90; Stage 2 >140/>90. Two readings gathered more than 8 weeks apart confirms the diagnosis. Many found problematic the 2017 ACC/AHA guideline that reclassified hypertension: “The prevalence of hypertension among US adults is substantially higher when the definition in the present guideline is used versus the JNC 7 definition (46% versus 32%)1.” Blood pressure is cyclical throughout the day, and many worried patients present to the ER with elevated numbers despite lack of symptoms. For a formidable but fascinating exposition of the “meaning of blood pressure,” see this article2. The 80 million US adults with hypertension are at risk for the most prevalent causes of death in the US (and the world), costing almost $50 billion annually3.

One high BP reading might not be reason to worry. But over many years, elevated blood pressure takes a toll on the vessels in your heart, kidneys, brain etc. Blood pressure control targets a “disease-oriented” outcome, albeit a very evidence-based one. For example, cholesterol studies often use LDL reduction as an outcome and claim success, but the intervention may not provide a mortality benefit. Healthcare professionals must consider “patient-oriented” outcomes both in clinical practice and in research4. Lowering the invisible molecule circulating in your bloodstream will not matter if you are disabled or dead. This doesn’t mean CRP, HDL, albumin and coronary blockages are not important, but doctors should consider the whole picture. Blood pressure does happen to be a pretty darn good surrogate / predictive outcome measure. Most of the studies cited below also evaluate claims on cardiovascular and overall morbidity and mortality.

This brief overview below abides by few rules: prioritization of clinical trials rather than retrospective studies, focus on causation over correlation, large sample sizes, and emphasis on systematic reviews and meta-analyses.

Diet

A rational approach to diet and lifestyle, with prioritization of circadian rhythm5, is paramount for most clinically relevant outcomes6,7. Follow the advice in the Perfect Health Diet8, to obtain most of your nutrients from a balanced, unprocessed, primal diet. Obtain as much protein as possible from cold water fish. Most experts believe the high omega 3 content improves many cardiovascular outcomes beyond blood pressure effects9. Shop at the grocery for a diverse selection of “superfoods”: nuts10, beets11, blueberries12, chocolate13, multiple14 teas15, and seaweed16 (also provides iodine). Consume foods high in magnesium (avocados, bananas, leafy greens, chocolate). Most people are subclinically deficient and should take a magnesium supplement17-19. Seek sources of vitamin K2 (grass-fed butter, hard cheeses, yolks, dark chicken, fermented soy), and dive into the evidence on K2 to reduce overall mortality20. Vitamin D has considerable effects on blood pressure, but is ideally obtained from the sun rather than a pill21.

Lifestyle

Reduce stress, give meditation a chance, even listening to music can reduce your blood pressure22,23. Weight loss in general24, and most forms of exercise25 have beneficial effects. Introduce a gratitude exercise26. Walk as often and as much as you can27, especially after a meal28.

Supplements

Several supplements with reasonable safety profiles appear to reduce blood pressure. Taurine has considerable evidence to reduce BP and minimal chance for adverse effects29-31. CoQ1032 and garlic33 have impressive data, both with favorable effects beyond blood pressure. Chen et al provide a description of numerous different herbal supplements that can help with blood pressure: L-arginine, chlorogenic acid, allicin from onions, soy and fish protein, ginkgo, theanine, and ginger14.

Conclusion

Of course, half of these research findings are false – who knows what future studies will find34. Nassim Taleb wisely argues that a historical framework of nutrition and fitness is more likely to remain accurate going forward35. Taleb also saliently addresses the iatrogenic effects of blood pressure medications, encouraging patients to adopt lifestyle changes they can stick with36. The human body is Antifragile37: just the right amount of stress (and just the right amount of blood pressure in our vessels) sends a signal that we better live longer or we will go extinct38. One of those healthy hormetic stressors is (intermittent) fasting itself, which of course has a role in blood pressure reduction, and researchers have some insight into the mechanisms39.

In summary, blood pressure (like everything else on earth) is cyclical40, so do not jump to conclusions when you see one high number. Visit an open-minded physician who will help you explore the impressive selection of lifestyle, diet, and supplement options before entering a long-term, dependent relationship with the pharmaceutical industry.

Here are two figures from a 2023 paper: Charchar, Fadi J.et al. Lifestyle management of hypertension: International Society of Hypertension position paper endorsed by the World Hypertension League and European Society of Hypertension. Journal of Hypertension. 2023. | DOI: 10.1097/HJH.0000000000003563

Reference List

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