WHAT IS HYPERTENSION? UNDERSTANDING HYPERTENSION AND EMBRACING NON-PHARMACOLOGICAL THERAPIES FOR BLOOD PRESSURE CONTROL.Written by Dr. Amber Rashid.
Have you ever wondered why every visit to the doctor starts with a blood pressure measurement? This is because blood pressure plays such an important role in your overall health. When blood pressure increases above normal, it has a deleterious effect on almost all the other organ systems in the body.
Hypertension or high blood pressure is the ultimate covert operative- it is a completely silent and deadly condition and if left unchecked, can cause considerable damage to the heart, blood vessels, kidneys, eyes and brain. The belief that hypertension is heralded by the onset of severe headaches is a myth. This highlights the need for supreme vigilance, to catch this abnormality at an early stage to reverse any long-term effects.
What is hypertension?
To grasp the concept of hypertension, we must first try to understand the intricacies of how the heart works. The heart is the most incredible pumping machine; it contracts and relaxes an average of 35 million times a year (multiply that by the number of years we live and the result is mind boggling). During each contraction, the heart pushes out blood with force, through the blood vessels. This pressure is read by the sphygmomanometer (blood pressure machine) as the upper number or systolic blood pressure. As the heart relaxes, it fills up with blood brought back from the rest of the body. This is seen as a slight drop in the blood pressure or the ‘diastolic blood pressure’.
So, the next question that arises would be, “What defines normal blood pressure, and when does it enter the realm of hypertension?” Forty years ago, it was common practice to add age to 100 mm Hg and treat that as the normal systolic blood pressure; diastolic blood pressure was often ignored. As our understanding of blood pressure and how it impacts our overall health has improved, more stringent guidelines have been introduced. The American Heart Association currently defines hypertension as a systolic blood pressure over 130 mm Hg and/ or diastolic blood pressure over 80 mm Hg.
What causes high blood pressure and is it reversible?
As we grow older, the blood vessels lose elasticity and become stiffer, perhaps because of deposition of cholesterol, a condition called atherosclerosis, or because of constant wear and tear as the blood gushes through the vessels. This loss of elasticity in the vessel walls forces the heart to pump with greater force in order to propel the blood out. The effect of the higher pressure is two-fold- it creates extra work for the heart, which needs to push with greater force, as well as causes direct damage to the vessel walls, creating a vicious spiral.
There are many, highly effective anti-hypertensive medications available in the market. However, as with all other drugs, they have their share of unwanted side effects. A healthy diet, regular exercise and stress management are an effective first line of defense against hypertension. So, how can we introduce these lifestyle changes into our regular routine?
Is there a Connection between Hypertension and Diet?
Can you DASH it?
The exciting acronym “DASH” stands for “Dietary Approach to Prevent Hypertension”, a landmark study published in The New England Journal of Medicine in 1997, which showed remarkable results in reducing blood pressure. The study participants were given DASH style food and were followed for a period of two months. The patients experienced a significant reduction in the systolic blood pressure of 10 mm Hg and diastolic blood pressure of 5 mm Hg. This result is comparable to the effect of blood pressure medications.
The DASH diet has been proven to be very effective, but following the diet can be challenging. It includes eating 15-18 portions of fruits, vegetables and whole grains, increasing Potassium, Calcium and Magnesium rich foods, cutting down on Sodium and replacing red meat with healthier fish and plant based protein options. Although this diet is not impossible, it may require careful planning and organisation.
Mediterranean diet: A possible DASH alternative:
Although the Mediterranean diet has not been specifically linked to a reduction in blood pressure by specific points over a period of time, it is universally considered a healthy diet. A substantial proportion of the diet comprises of raw vegetables, fruits, legumes, nuts grains and fish, cooked in olive oil and seasoned with interesting herbs and spices, which give the food a rich texture and flavour. Additionally, it tends to be better tolerated and easier to take in the longer term than the DASH diet.
Limit salt intake:
The average American diet contains 4,500 mg of sodium, but meeting the DASH recommendation to limit sodium to 1,500 mg takes dedication. However, there are few easy adjustments that can be incorporated into the daily diet to achieve this goal. Remove table salt from the table; choose low sodium food, whenever possible; substitute salt with herbs, spices, vinegar and low sodium seasoning.
Eat a Rainbow Diet:
Make fruits and vegetables a big part of your daily diet, the more variety and colours, the better. And it goes without saying, use fresh or frozen fruits instead of canned. Use whole fruits and vegetables instead of juices. And definitely use fruits to satisfy your sweet carvings, instead of sugary and processed desserts.
Weight loss is an effective lifestyle change to lower blood pressure. In general, a loss of every kilogram of body weight may result in reduction of blood pressure by 1 mm Hg. If you have tried and failed to lose weight or have been on a yo-yo of weight loss and weight gain, do not despair. Seeking help from a dietitian can be beneficial in reducing calorie intake. (https://kingscollegehospitaldubai.com/service/dietetics/weight-loss-programs/) Keeping a food diary helps; use food apps, such as My Fitness Pal to keep track of the food you consume everyday and ask a dietitian to review this information with you and help you achieve your weight loss goals.
Exercise, Exercise, Exercise!
Regular physical activity plays a key role in lowering blood pressure. The American Heart Association recommends moderate intensity exercise for 150 minutes a week for heart health, which has been shown to lower blood pressure by 5-8 mm Hg. Consistency is extremely important. Some examples of aerobic exercises are brisk walking, running, cycling, or swimming. Alternatively you could try HIIT (High Intensity Interval Training) or strength training.
Last, but not least, activities that help manage your stress can make a long term impact on reducing blood pressure and improving overall health. Incorporating relaxation techniques into your daily routine can be helpful. Online therapies and mobile apps can help you find ways to improve your health.
Effective stress management can have a lasting impact on lowering blood pressure and improving overall health. Incorporating relaxation techniques into your daily routine can be helpful. Online therapies and mobile apps are available resources to help you find ways to improve your health.
For assistance with diagnosing and managing hypertension, as well as screening for preventable diseases like diabetes, coronary artery disease, osteoporosis, and cancer, you can contact King’s College Hospital, Dubai, through our call center (+971 4 247 7777) or send a message via our chat bot.
A dietary approach to prevent hypertension: a review of the Dietary Approaches to Stop Hypertension (DASH) Study. Sacks FM, Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Bray GA, Vogt TM, Cutler JA, Windhauser MM, Lin PH, Karanja N.Clin Cardiol. 1999 Jul;22(7 Suppl):III6-10.
The role of diet for prevention and management of hypertension. Ozemek C, Laddu DR, Arena R, Lavie CJ.Curr Opin Cardiol. 2018 Jul;33(4):388-393. doi:10.1097/HCO.0000000000000532.PMID: 29771736 Review.
Nonpharmacologic therapies that reduce blood pressure: a fresh perspective. Appel LJ.Clin Cardiol. 1999 Jul;22(7 Suppl):III1-5. doi: 10.1002/clc.4960221502.PMID: 10410298