High Blood Pressure or Hypertension
Hypertension (high blood pressure) is defined as systolic blood pressure (BP) greater than 140mm Hg and diastolic BP greater than 90mg Hg. Hypertension is a risk factor for heart disease, stroke, renal failure, and peripheral vascular disease, and lowering an elevated BP can decrease risk of developing these diseases. In about 90-95% of cases, the cause of hypertension is unknown. In approximately 5-10% of cases the cause is due to conditions such as chronic kidney disease, hypothyroidism, or hyperthyroidism.
Conventional treatment for hypertension is mainly the use of medications one or more of the following: beta-blockers, diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin-receptor blockers and calcium channel blockers. If the patient is overweight, lifestyle modifications are also recommended.
Environmental Factors
Lead: Several studies have shown a connection between blood pressures and blood levels of lead in men and especially postmenopausal women. While leaded gasoline was banned in the U.S. in the 1970’s, there still exists plenty of lead in the environment. Many canned foods contain lead, glass manufacters, printers, plastics or battery manufacturers and construction workers are all exposed to lead.
Cadmium: Animal studies show a correlation between cadmium exposure and elevated BP. Sources of cadmium include cigarette smoke, water pipes (both metal and plastic), and fertilizers made from sewage sludge. Occupational exposure to cadmium may also occur as in manufacturing of plastics, batteries, paints, textiles and fertilizers.
At my clinic patients are tested for evidence of heavy metals in the body, and if found, are treated for detoxification. This treatment can benefit to the hypertensive patient.
Diet
Obesity: Being overweight and obese is a risk factor for hypertension. Patient weight loss usually results in a significant reduction of BP. Therefore, a first-line therapy of diet and lifestyle y provided to my patients to achieve their weight loss prescription.
Salt: Limiting salt intake can decrease BP in some patients with hypertension. Only 30-50% of patients are salt sensitive, so this restriction does not benefit all hypertensive patients. Moderate sodium restriction to 2.3g to or 5.8 gm. of salt/day, can be achieved by avoiding high-sodium foods, and by not adding salt to food during cooking or at the table. This level would help the salt sensitive patient and at the same time be of no consequence to the salt insensitive hypertensive patient.
Note: intake of sodium chloride seems to rise BP and other forms of sodium like sodium bicarbonate or citrate or ascorbate appear to have little effect on BP.
Sugar: Rats fed high sugar diets developed increases in BP. The same diet given to human volunteers classified as carbohydrate-sensitive also resulted in elevated BP’s. The hypertensive patient must be counseled on the importance of consuming a low glycemic load (sugar) diet.
Caffeine: Numerous studies have looked at the effects of caffeine on BP. While the effect of caffeine consumption on BP is usually modest, in some cases caffeine is a major contributing factor to hypertension.
In my clinic, the hypertensive patient undergoes an elimination diet that removes, among several foods, caffeine. After 3 weeks, each food or drink is re-introduced in a “challenge” or large amount over one day. In this manner my patient can determine if the caffeine is indeed a major contributor to the hypertension.
Alcohol: Numerous observational studies have found a positive association between alcohol consumption and hypertension. This is also something I have my hypertensive patient eliminate for 3 weeks to determine if this they are sensitive to alcohol.
Food Allergy: While scientific evidence is lacking, numerous clinicians (myself included), have found a connection with hypertension certain foods or drink by simply doing an elimination diet, or food allergy blood test, or both.
Various Diets: Different diets have been studied and found to be of benefit in lowering BP in patients. DASH or Dietary Approaches to Stop Hypertension is an effective diet which is low in saturated fat, total fat and refined sugar. It is also high in fruits and vegetables content. The Mediterranean diet is generally what I prescribe based on the patients caloric expenditure as measured in my office through equipment. This measurement helps me customize an appropriate calorie diet for my patient. The Mediterranean diet has been shown to lower BP as well as improve other cardiovascular risk factors like blood glucose, serum cholesterol, and C-reactive protein (CRP) levels. Vegetarian diets, including vegan and lacto-ovo-vegetarian diets have been studied and found to be effective at lowering BP. Raw Foods diet has shown positive results too.
Specific Foods and Supplements have been studied and found to be of benefit in BP lowering. The hypertensive patient who visits my clinic will definitely go home with a diet prescription, with specific foods and specific dietary supplements to take as well.
Thyroid Hormone
When indicated, thyroid hormone can also help lower a patients blood pressure (please see section on thyroid hormone).
At My Clinic
These non-pharmacological approaches can usually help the hypertensive patient improve or normalize the BP. By looking at environmental exposures, food allergies, conducting the elimination diet, and finally prescribing a customized Mediterranean diet along with various supplements and specific foods. Sometimes thyroid hormone is also prescribed to the patient.