One of the most common chronic conditions among Americans is high blood pressure. It is now estimated that one in three Americans has high blood pressure, called hypertension in medical jargon, and one in three Americans is “pre-hypertensive”. Those who list high blood pressure on their initial paper-work when they come to my office often take up to 3 different medications to address this symptom.
High blood pressure is not without controversy within medicine. Are people living longer and living better given the “new normals” for blood pressure readings? Should an 80-year-old have the blood pressure of a 20-year-old? Is every person with high blood pressure a candidate for medication? Should we prescribe medication for those now deemed to pre-hypertensive, that is, we now consider normal blood pressure to be below 120/80. Pre-hypertension is defined to be a systolic (the top number) reading of 120-139 and a diastolic (the bottom number) reading of 80-89. Those with blood pressure readings of 140/90 or above have now earned a diagnosis of hypertension.
However, why do we demonize high blood pressure? While truly high blood pressure can be a risk factor for strokes/heart disease and kidney disease, research now teaches us that those people who have had a stroke have a better survival if their blood pressure is not lowered to a target “normal” reading. Why? Blood pressure is a measure of how our heart perfuses (gets blood to) our organs and tissues. When a stroke occurs, getting blood to the tissue now starved by the clot is beneficial. As we age, our vessels stiffen and blood pressure tends to become elevated as the heart tries to get blood to the tissue. I tell many a patient in their 80s not to worry if their blood pressure is not the same as it was when they were 20.
Lifestyle matters when it comes to our blood pressure readings. Dr. Thomas Moore developed the DASH approach while at Harvard to address elevated blood pressure. This Dietary Approach to Stop Hypertension was designed to address up to 95% of all high blood pressure cases related to our lifestyle choices. Dr. Moore’s approach paid attention to stressing more fruits and vegetables rich in potassium and other minerals and daily activity. What are the lifestyle risk factors I discuss with patients who are worried about their blood pressure? They include:
- Carrying your weight around your mid-section or too much weight is linked to elevated blood pressure
- A lifestyle without regular activity is linked to high blood pressure
- The lack of restful sleep is associated with high blood pressure.
- A stress-filled life is linked to high blood pressure. Prayer, exercise, a variety of stress management techniques, laughter, and meditation are all shown to normalize blood pressure readings.
- Your dietary choices affect your blood pressure. You may carry a genetic risk for high blood pressure that can be triggered by sodium consumption. More fruits and vegetables are important for blood pressure control. Potassium and magnesium are two key minerals found in a plant-based diet that can help lower blood pressure.
One important dietary factor regarding blood pressure I found never discussed with patients relates to the findings that won the 1998 Nobel Prize in medicine. We doctors were surprised to learn the muscle cells that line the blood vessels produce a gas called nitric oxide that helps blood vessels to expand and blood pressure to normalize. Medications failed to address this important mechanism of action behind the development of high blood pressure. L-arginine, an amino acid found in protein, was shown to help the body’s production of nitric oxide. When more nitric oxide was produced, the blood vessel expanded, and the blood pressure dropped!
This approach is sound science so I began to incorporate into my clinical practice. I routinely ask every patient the following questions:
“What do you eat for breakfast? For Lunch? For Dinner? And for snacks?
We then calculate the amount of protein the person generally eats at breakfast, lunch, dinner, and from their snacks. It is apparent to me and to the person sitting in front of me they are eating a lot of foods providing carbohydrates and little protein. Yet, protein is essential for l-arginine, for nitric oxide production, for blood vessel expansion, and normal blood pressure. While baby boomers may think if a little protein is good, more is better, and a great deal is best of all, that is not the case when it comes to protein. The physiology textbooks teach doctors man and women needs 0.8-1.0 gram of protein/2 pounds of body weight. Do you weigh 120 pounds? Your body needs 60 grams of protein every day for normal function and normal blood pressure. It can be derived from vegetable sources, but become educated the combining of certain vegetables and grains is an exact science to insure you get a complete complement of the amino acids we require for health.
With up to 85% of Americans (my patients fit this model) deficient in the good fats (the essential fatty acids in a balance of 1:1-3 Omega 3: Omega 6), it is important to learn that good fats are critical for flexible blood vessels. This is a critical issue to achieve normal blood pressure. My patients use a daily mixture of protein (keep in mind they are not all alike) with the good fats to insure their insulin sensitivity is optimal (they no longer store fat around their mid-section), their blood vessels are flexible and not stiff, and they get l-arginine from protein to optimize the production of nitric oxide. They are excited they start to see blood pressure readings from years ago. We can then begin to wean them from their blood pressure medications.
The steps we took improved their health. The blood pressure is now normal. They were able to reduce or eliminate their high blood pressure medications. I am happy now, too.