High blood pressure: What I tell my patients

High blood pressure is extremely common. According to the Centers for Disease Control, nearly half of adults in the United States have hypertension. What’s worse is that only about 1 in 4 adults with hypertension have their condition under control.

Controlling high blood pressure is important because those elevated readings accelerate the wear and tear on your arteries and your heart. You can think of high blood pressure acting like a hammer that’s hitting your artery walls.

The higher the pressure the more forceful the hammer — and the more likely that your arteries sustain damage especially with repeat hammering over many years. High blood pressure accelerates the build-up of plaque, predisposes to aneurysm formation and increases the risk of stroke. High blood pressure’s effects on heart muscle are equally damaging over time: Uncontrolled hypertension is the leading cause of heart failure in our country.

How high blood pressure adds up

In the vast majority of cases, hypertension is “essential,” meaning it’s not just due to one thing.  It’s not like if we just cut a nerve or opened an artery or cut out a tumor blood pressure would immediately come right back down to normal. Those circumstances are very very rare.  

Instead, hypertension is typically multifactorial and akin to putting straws on a camel’s back. Put too many straws on, the camel falls over — and you have high blood pressure. (The happy caveat is that if you take a few straws away, the camel can stand back up and your blood pressure problems go away!)

The straws include:

1. A family history of high blood pressure
2. Increasing age
3. Kidney and/or thyroid disease
4. Pain
5. Nonrestorative sleep (including sleep apnea)
6. Stress
7. Smoking
8. Inactivity
9. Excess weight
10. Low fruit and vegetable intake
11. Excess sodium
12. Excess caffeine and
13. Excess alcohol

There’s nothing you can do about age and family history (those straws are put on and stay on), but there’s a lot that can be done about the other factors. Thyroid and kidney issues, pain and sleep apnea are conditions physicians can help with.  But the rest — it mostly falls on you.

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Bringing the numbers down

The good news is that by doing your part you can absolutely reduce the number of medications needed to control blood pressure readings — or eliminate the condition altogether!

The approximate range of improvement in systolic (top number) readings associated with some of these lifestyle modifications is as follows:

• Losing weight: 5-20 mmHg decrease per 20 lbs weight lost
• Eating a healthful diet: 8-14 mmHg decrease
• Reducing sodium: 2-8 mmHg decrease
• Regular physical activity: 4-9 mmHg decrease
• Reducing alcohol consumption: 2-4 mmHg decrease

So put it all together — and you can realize anywhere from a 20 to 55 mmHg drop by simply changing lifestyle!  That’s the same results you’d get from being on a bunch of drugs.

Different people respond differently to each of these lifestyle interventions (for example, some people are exquisitely salt-sensitive while others are not), but even if you don’t see massive blood pressure improvements by eating more fruit or exercising regularly, you are still improving your overall health, setting yourself up for healthy longevity — and helping your medications work better. After all, it’s much easier for a drug to overcome high blood pressure if it doesn’t have to also overcome excess weight and two cans of Mountain Dew.

If some of this sounds suspiciously similar to what I advise for lowering cholesterol, it’s because it is! Healthful lifestyle habits help improve EVERYTHING, especially the number of prescription bottles sitting in your medicine cabinet.