Hypertension – High Blood Pressure – AKA The Silent Killer. Almost half of adults in the United States (108 million) meet the criteria for diagnosis of hypertension. Hypertension is defined by the American College of Cardiology and the American Heart Association as a systolic blood pressure, or “the top number,” of around 130mmHg and diastolic blood pressure, or “the bottom number,” of around 80mmHg1. Systolic blood pressure is the pressure while the heart is beating and the diastolic pressure is the pressure while the heart is relaxed. Healthcare practitioners will take both measurements into account while assessing your blood pressure.
High blood pressure is often asymptomatic, not having any symptoms, unlike many other disease processes. Therefore many people have a false sense of “feeling fine.” However, if untreated hypertension increases the risk of stroke, heart attack and heart disease, kidney disease, vision loss and sexual dysfunction. Increased pressure in the cardiovascular system can overtime put stress on and damage various organs in the body. In 2018, nearly half a million deaths in the United States included hypertension as a primary or contributing cause.2 The good news is there are many things that can be done to help reduce blood pressure including medication and non-medication therapies.
Most often when I meet with patients regarding hypertension we start by discussing lifestyle and dietary considerations. Overall wellness and health should be at the forefront of any treatment considerations for hypertension or any disease state. Focusing on some of these non-pharmacological options promotes overall health and are often very cost effective when considering long term care. As Americans age expenditure on healthcare, including medication therapy, becomes increasingly burdensome. Patients with a diagnosis of hypertension face over $2000 higher annual healthcare expenditure compared to those who don't have hypertension3. I encourage patients to think of their choices as investments in their future health rather than a newly acquired cost.
A diet high in salt can be a major contributor to hypertension – this has been well established overtime. The exact mechanism, whether water retention causing increased pressure, effects via the kidneys, or changes to how the vasculature responds to pressure changes, may differ between persons. However, it has been established that lower sodium intake has a direct relationship to reducing blood pressure values4. “The American Heart Association recommends no more than 2,300 milligrams of salt a day and an ideal limit of no more than 1,500 mg per day for most adults, especially for those with high blood pressure. Even cutting back by 1,000 mg a day can improve blood pressure and heart health5.” Reducing sodium can reduce systolic blood pressure by 2-8mmHg.
Sodium is of course found within our salt shakers at home and while dining out. However, salt can also hide in some surprising places. Long known for its ability to preserve food, many processed foods are persevered with salt. This includes canned soups and vegetables – using fresh or frozen vegetables would be optimal along with homemade soup or low-sodium broth soups. This allows you to control the amount of sodium yourself. Fast foods can also be another large source of sodium- particularly in sandwiches. Choosing a half-sandwich and half salad may be a great alternative to a full sandwich and fries. Many fast food burgers can contain up to your entire daily value of recommended sodium in one meal! Breads, pizza, sandwiches, cured meats, soups, tacos , snacks (chips, crackers, popcorn etc), pre-prepared chicken , and cheeses are all recognized by the FDA to be likely contributors to sodium.
Brushing up on reading a nutrition label can help compare and contrast food choices while shopping. You will want to look for “Sodium” on the label to correctly identify salt content. Buying fresh fruits, veggies, meats, poultry and seafood is recommended. Trying to avoid any “instant products or packaged sauces or mixes may help to reduce sodium intake as well. Washing any canned foods including beans, fish or vegetables is recommended. One last place I recommend to watch for sodium intake is in the dressings – consider dressings salads with oil and vinegar rather than a bottled dressing. This also follows many of the recommendations for the Dietary Approaches to Stop Hypertension (DASH) Diet that is recommended by the American Heart Association as well. This may sound more time consuming and possibly an added cost to buy fresh – but remember – think of it as an investment to limit the possibility of adding medication therapy.
Exercise is another key component in reducing blood pressure. Just like any other muscle group, the heart and vascular system are more fit for service the more they are used. Getting at least 150 minutes of moderate intensity aerobic exercise or 75 minutes of vigorous exercise weekly is recommended in order to reduce blood pressure and cardiovascular risk7. Adding 2 per week of resistance exercise to build muscle strength can also help pay dividends.
Moderate physical activity may include brisk walking, dancing, gardening, tennis or slow biking. Intensive aerobic exercise can include hiking, running, biking, swimming laps, or jumping rope. Simply being more active throughout your day will also help – the goal is to move more often and sit less. Moderate physical activity can lead to a 4-9mmHg reduction in blood pressure7. Combining efforts of dietary choices and increased physical activity often can lead to weight loss. For every 10kg (22lbs) lost, you may reduce blood pressure by 5-20mmHg.
Despite all these efforts many people do require pharmacological therapy. There are many different classes of medications that can be used to help control blood pressure numbers – each class with their own considerations that should be weighed between you and your provider. Many medications used as first and second choices also offer additional benefit than just lowering blood pressure – these can include lowering cardiovascular event risk or preventing or mitigating worsening kidney disease. Every decision would be based on your personal health history and risks.
One last important step to your cardiovascular health is Self-Measured Blood Pressure (SMBP). When combined with clinical support from your provider or pharmacist, home monitoring of blood pressure can “enhance the quality and accessibility of care for people with high blood pressure and improve blood pressure control9”. Studies have show that “white-coat hypertension” is a valid occurrence – where a patients blood pressure may be elevated in office, but normal at home. It may be an important consideration to factor when assessing therapy needs and may be recommended by your physician.
If your provider recommends SMBP as part of your healthcare treatment you can visit one of CHI Health's 12 retail pharmacy locations for reliable blood pressure monitors at a great price (see our current coupon). CHI Health pharmacists would be happy to familiarize you with your monitor and offer personalized counseling.
As we walk through the door into 2021, remember to invest in yourself and your healthcare. Untreated high blood pressure can have serious consequences. Focusing on your overall wellness and cardiovascular health can be an important part of keeping you in best form for all the new opportunities new year can bring.
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