Hypertension
High blood pressure is something that I used to hear all the adults worry about in the 1970’s and 1980’s. Just my observation, I don’t hear as much fuss about it these days. I’m unclear why?
What is optimal blood pressure?
The systolic blood pressure is the top number, and that is looking at how much pressure your arteries are seeing when your heart contracts and pushes blood forward. Diastolic blood pressure is the minimal pressure your blood vessels see when your heart relaxes, allowing your heart to fill with blood to then send through the body in systole (this is the phase where the heart contracts).
Young people get more vascular risk with high diastolic pressure, but in middle aged and older individuals, the systolic blood pressure is probably the more important number. Both, however, need to be considered.
So why worry about this? Well vascular disease (heart attack, stroke, disease of other arteries) are the most common cause of death and disability!
Every year one lets their blood pressure not be optimal = one more year of potentially irreversible, or difficult to reverse damage.
What is optimal blood pressure? 110-120 mmHg systolic and 70-75 mmHg diastolic would be the best answer.
Look at this publication: https://www.frontiersin.org/articles/10.3389/fcvm.2021.677189/full
Look at the following figure 3 from this article, it is fascinating to look at the increased risk of death with systolic blood pressure in this study. A hazard ratio of 1 is their baseline, and one can see that as systolic blood pressure got even to the high 120’s the risk of death was almost 50% higher, and other studies show this trajectory of rapid increase goes up with blood pressure. This graph specifies that they controlled for other confounders, so this was purely a blood pressure issue.
Other interesting resources are:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7646937/
https://www.amjmed.com/article/0002-9343(73)90130-7/fulltext
We note in the second reference above 325% increased risk of adverse outcome for BP of>=150/100 in men under 40 years, and 225% in men over 40 years.
Ultimately, the approach is to recognize the range of things that can be due to lifestyle that might influence blood pressure. Weight is the primary item – if you are overweight – lose weight.
What are the supplements that might be sensible to try IF you don’t like pharmaceuticals:
-Hawthorne Extract
-Aged Garlic (Kyolic)
There are lots of other options – but pharmaceuticals work, and generally are the best choice for a consistent result. A trial of weight loss and dietary change can be utilized.
The strategy I recommend is a low dose of multiple medications, as this minimizes side effects and hits the receptors on your blood vessels, gently in a few ways. Pushing the dose of a single medication and then adding another is the route to maximizing side effects. I generally look to minimize side effects and maximize benefits. It is not unusual to have someone who has significant hypertension on 4 medications, at low dose.
The goal is to minimize risk of death and disability.
