Blood Pressure: Six Steps Beyond Food
What you eat—and how much you eat of it—are not the only contributors to high blood pressure, nor is changing them the only way to control it. How you live your life, the way you handle stress, and even what supplements you take all have roles to play. Additionally, for most people with hypertension, medication is a factor.
1. Lifestyle and Habits
In a moment, we’ll get to the most important lifestyle issues affecting blood pressure—exercise and stress. But first, let’s talk about the even more basic topics of sleep, emotions, and habits; the roles they play in your risk of hypertension; and their ability to help you control it.
It should come as no surprise that the most vilified bad habit—smoking—has a deleterious effect on your blood pressure; after all, it’s pretty bad for everything else connected with your health. While it does not cause high blood pressure, nicotine constricts blood vessels and temporarily raises blood pressure. Smoking also damages arteries, increasing the buildup of plaque and making them less flexible. Even chewing tobacco can make it harder to control your blood pressure.
Other consumption-oriented habits—including drinking alcohol and overindulging in sweets or salty snacks—are also uniformly bad for blood pressure health. Alcohol is particularly troublesome for blood pressure, as are being overweight and binging on high-salt or high-sugar foods.
Your emotions also affect your blood pressure. For instance, studies have found that depressed people with high blood pressure have a more difficult time controlling it than those who are not depressed. There are many possible reasons, including the fact that people who are depressed may lose interest in taking their medication and may be less likely to follow the kind of healthy lifestyle necessary to control blood pressure. But researchers suspect there may also be hormonal changes in the brains of people with depression that may affect blood pressure. You don’t have to suffer with depression, however. It is eminently treatable with medication and/or therapy.
How well you sleep also makes a difference when it comes to blood pressure control. When researchers deprived 36 people with mild to moderate hypertension of sleep for one night, then compared blood pressure levels after the sleepless night with those following a good night’s sleep, they found that both blood pressure and heart rate levels were higher after the sleepless night than after a good snooze. The results, researchers note, suggest that sleepless nights may represent increased risk for both organ damage and acute cardiovascular disease.
We could continue, but the point is simple: A healthy, happy lifestyle contributes to healthy blood pressure. Unlike viral infections or allergies, which have clear external triggers and causes that are out of your control, high blood pressure is almost entirely linked to the daily choices you make.
It’s well established that regular physical activity reduces your risk of all forms of cardiovascular disease. It’s less clear whether physical activity on its own lowers blood pressure. But since physical activity is critical to maintaining a healthy weight, and a healthy weight is critical to controlling your blood pressure, we (and all experts) consider exercise and other physical activity to be vital components of any lifestyle program designed to control high blood pressure.
It doesn’t take intense physical activity to benefit your health or your weight. Studies have found that moderate-intensity activity is just as beneficial as high-intensity activity when it comes to blood pressure control, a plus for those of us who prefer a brisk walk to a jog. In fact, a review of 16 studies on walking concluded that a moderate walking program (about 30 minutes three to five times a week) reduced systolic and diastolic blood pressure by 2 percent. Even just increasing the amount of physical activity in everyday life—parking at the far end of the parking lot, for example, taking the stairs instead of the elevator, or walking to the store instead of driving—was as effective for reducing blood pressure as a structured aerobic exercise program.
Also try some popular activities such as yoga and tai chi. Growing evidence suggests these low-intensity exercises may be just as effective as high-intensity workouts for lowering blood pressure. For instance, one study comparing the blood pressure–lowering effects of tai chi with moderate aerobic activity found that both significantly decreased overall blood pressure. Tai chi, of course, is better suited for older, sedentary people, since it doesn’t require the same heart rate elevation as aerobic exercises. Several studies have found similar benefits from yoga.
And don’t forget resistance training, whether with weights and special equipment or simply with certain floor exercises that work against your body weight. While studies to date don’t show any significant improvement in blood pressure from resistance training alone, these muscle-building exercises play an important role in any program to lose weight or maintain a healthy weight.
Are you a Type A or a Type B? A person whose patience is tried by every salesclerk with a room temperature IQ, or a laid-back, take-whatever-comes kind of person? The answer is important when it comes to your blood pressure. A pretty solid body of research supports the commonsense theory that stress, anxiety, and hostility play substantive roles in the development and progression of cardiovascular disease, particularly hypertension.
Researchers have always suspected that stress and anxiety contribute to hypertension, but they’re coming to realize more clearly that the effect is due not to the events that cause the stress per se, but rather to the way you react to them.
For instance, researchers involved with the landmark Framingham Heart Study, which has been following residents of Framingham, Massachusetts, for more than 50 years to evaluate their heart health, found that participants who had high levels of anxiety in middle age were twice as likely as those with low anxiety levels to develop hypertension over the
following 20 years.
Another study found that young adults who had a strong sense of time urgency and impatience (the kind who blow their horns when they’re stuck in a traffic jam), also had a significantly increased risk of developing hypertension later in life. And those who ranked high on hostility tests were 84 percent more likely to develop hypertension 15 years after they were studied than those who ranked lowest.
Physiologically, the stress/personality/blood pressure triumvirate works something like this: When you’re stressed, you have the classic “fight or flight” reaction, a throwback to the days when stress meant something life-threatening, not a missed deadline at work. The human body, however, reacts to modern stresses in the same ways it did to long-ago dangers. That means that you breathe faster (to bring in more oxygen), and your heart pumps harder (to send extra oxygen to the rest of your body). This combination results in a narrowing of blood vessels and an increase in blood pressure.
In the short term, this reaction won’t kill you or even necessarily cause lasting harm. But if you’re constantly stressed, anxious, or impatient, a different mechanism kicks in, and you begin breathing more shallowly and quickly. This changes your blood chemistry as more carbon dioxide builds up and you begin retaining more sodium. Combined with the high amounts of sodium most of us get in our daily diets, that sounds like a recipe for high blood pressure—and indeed, studies with animals have found that the combination is enough to generate progressive hypertension in a matter of days.
Now, we know there’s no way you can change your personality overnight (although there is evidence that your personality changes as you age). Instead, what seems to work is implementing stress-reducing, mind-body exercises such as meditation and yoga over time to reduce your anxiety levels and curb your impatience. In one study, researchers found that nearly 70 percent of participants with mild to moderate hypertension who used techniques to reduce stress were able to reduce their medication after six weeks; after one year, 55 percent required no medication.
The best place to start is with a phone call to your local hospital. Many hospitals today offer stress-management programs, sometimes at no charge. And they really do work. One analysis of 37 studies that examined the effects of health education and stress management found a 34 percent reduction in deaths from cardiovascular events, a 29 percent reduction in heart attacks, and significant positive effects on dietary and exercise habits, weight, smoking, cholesterol, and blood pressure. Another study found that when people who already had coronary artery disease received stress-management training, they had fewer recurrent coronary events (heart attacks and angina) after five years than those who received only basic care.
Along the same lines as managing stress is the idea that proper breathing is critical to blood pressure control. Slower breathing reflexively leads to a lower heart rate due to a complex set of involuntary nervous connections between the lungs, brain, and heart. Blood pressure, among other things, is a function of heart rate, so when your heart rate decreases, so does your blood pressure. In addition, taking longer, deeper breaths allows more blood to return to the heart because of changes in the pressure in the chest. This means that your heart doesn’t have to work as hard to move blood from the arteries to the veins and back again.
The focus on breathing in many stress-reduction exercises may be one reason that numerous studies find a correlation between calming practices such as meditation and blood pressure reductions.
Now there’s actually an FDA-approved, over-the-counter device to help you breathe properly. It’s called RESPeRATE, and clinical trials have found that it reduces blood pressure solely through breathing exercises. www.resperate.com.
We talked quite a bit in the previous chapter about the role of individual nutrients in maintaining healthy blood pressure. Ideally, you’ll get these nutrients—vitamin C, calcium, magnesium, potassium, and CoQ10—from the foods you eat. As we noted, though, depending on your diet, you may want to talk to your doctor about taking them in supplement form. At a minimum, consider taking a good-quality multivitamin with minerals each day as a low-cost, no-risk insurance policy to make sure you get all the nutrients you need.
In addition to supplemental nutrients, certain herbs have been used throughout history to control blood pressure. We list several below. A word of warning: Don’t try any of these or other herbs or supplements without first talking to your health care provider. Some may interact with prescription medications you’re already taking.
In addition to garlic, some of the more common herbal preparations believed to lower blood pressure include:
Black cumin seeds. Extracts of this herb have a long history of use in folk medicine as diuretic and blood pressure–lowering agents, and animal studies have found that cumin has actions comparable to those of common diuretics, such as furosemide (Lasix) and nifedipine (Adalat).
Coleus. The active ingredient in this herb is forskolin, a substance that relaxes muscles, thus providing a relaxing effect for arteries. However, it may interact with blood thinning medications such as warfarin (Coumadin).
Hawthorn. This herb contains combinations of chemicals that improve the heart’s pumping action and dilate coronary blood vessels. Give it time, though; it may take up to four weeks before you see any effect. Also be careful with the dosage; too much could cause a dangerous drop in blood pressure.
Indian snakeroot. Forget the common perception of snakeroot as a hoax. This herb is cultivated especially for the medicinal use of its 30 phytochemicals, many of which have antihypertensive properties. They are believed to work by controlling nerve impulses along certain pathways that affect heart and blood vessels, thus lowering blood pressure. Several clinical studies have shown significant reductions in blood pressure when various extracts were used.
Olive leaf extract. This herb contains several phytochemicals, including oleuropein, a complex structure of flavonoids, and other chemicals that act as vasodilators, opening blood vessels and thus lowering blood pressure and preventing angina attacks. In one study of 30 people with hypertension who received the extract for three months, all had a statistically significant decrease in blood pressure, with no side effects.
Stevia. This perennial South American shrub has leaves that are naturally sweet. While stevia has been widely used as a sweetener and flavor enhancer for centuries, its legal status in the United States is confused and controversial: allowed as a dietary supplement, but banned as a sweetener. Animal studies have shown that stevia may lower blood pressure, and tests on people have generally been positive as well. Stevia appears to have three positive effects. First, it contains several chemicals that cause blood vessels to widen. Second, it may improve the muscle tone of the heart. Third, it promotes the loss of water from the body.
One of the greatest success stories in the history of health care has been the dramatic decline in deaths from heart disease in this country over the past 30 years. Some of that is due to healthier living—the number of people who smoke, for instance, has dropped from 42 percent in 1965 to 22 percent in 2001—but much of it is a result of discovering better treatments for heart disease and the precursor conditions that contribute to it, such as high cholesterol and high blood pressure.
Nowhere has this been more successful than in the treatment for hypertension. Today, more Americans take prescription medications for hypertension than for any other medical condition.
If you fall into the category of Stage 1 hypertension—with systolic blood pressure of 140 to 159 mmHg or diastolic pressure of 90 to 99 mmHg—talk to your doctor before starting on any medication. If, after six months, you still exhibit consistently high blood pressure, or if you have Stage 2 hypertension (a systolic reading of 160 or higher or a diastolic reading of 100 or higher), you’re likely to need a bit more help in the form of medication. In fact, most patients with hypertension eventually require two or more drugs to control it.
This doesn’t mean that you have failed. It just means that given your genetic history and your individual health status, altering your lifestyle and diet alone isn’t enough to get you into the safe zone. For instance, if you have diabetes, organ damage, or other cardiovascular risk factors, your doctor is going to be much more aggressive in treating you than if your only health problem were hypertension. Also, if you’re African-American, chances are you’ll need to take at least two blood pressure medications, since studies find that blacks don’t respond as well to single-agent pharmaceutical therapy as other ethnic groups.
Every study ever conducted shows additional benefits from the kind of lifestyle changes included in the plan compared with simply taking medication alone. Taking blood pressure medication without implementing a healthier lifestyle is like being treated for lung cancer without quitting smoking. It just makes no sense.
Keep making the recipes in this book, maintain your activity levels, and look for ways to moderate your reaction to stress. At the same time, adhere strictly to the medication schedule that your doctor prescribes. Here’s what you need to know about current and future treatments for hypertension.