The silent disease
High Blood Pressure
"I have a terrific pain in the back of my head..."
Okay I’ll read this but whatever you do, don’t talk politics. My blood pressure can’t handle it.
President Franklin Deleanor Roosevelt’s last words were…
You didn’t hear me. NO POLITICS!
Can I finish? President Franklin Deleanor Roosevelt’s last words were…“I have a terrific pain in the back of my head.” He died of a brain hemorrhage. Just prior to D-day, his blood pressure spiked to 240/120mmHg. At the time of his 3rd election he had “decreased” to 200/130mmHg. At the time of his famous last words, his blood pressure was >300/190mmHg. The medical team had no medicine to treat high blood pressure and must have felt like a gunless security guard watching their own bank robbed.
Okay that wasn’t so bad. Now, without talking politics, what’s the blood pressure number to prevent a heart attack?
Some studies suggest that the risk of heart attacks and strokes begins to increase above a systolic blood pressure (top number of the blood pressure) of 115mmHg. In 2015, a recent study evaluating people at high risk of heart disease, or people who had heart disease, showed that a systolic blood pressure <130mmHg was better than <140mmHg. After this study I’m shooting for <130mmHg in most of my patients who aren’t diabetics.
Is the blood pressure measured in my arm really a real measure of my true blood pressure?
When we measure blood pressure in your arm, we’re simply guesstimating at what your “real” or aortic blood pressure is. The blood pressure that really matters is the aortic blood pressure. In fact, in any given number of people with the same arm blood pressure, the aortic pressure can vary by a lot. Why is this is important? Because even though blood pressure medications can reduce blood pressure in all people in the arm, their effects on the aortic pressure differ quite a bit.
I’m falling asleep again. What does the aortic pressure have to do with anything?
Not all blood pressure medications are created equal. For example a study out of Australia compared the combination of a diuretic + beta blocker with a calcium channel blocker + ACE-Inhibitor. In spite of the same reduction in arm pressure with both regimens, the calcium channel blocker +ACE-Inhibitor combination lowered systolic aortic pressure by 4mmHg more.
And your point is…?
My point is that not all blood medications are equal. That’s why certain medications are considered first and second line drugs and others are given if three or four medications are needed to lower blood pressure. My practice is to generally use two medications at lower doses to prevent side effects from the higher doses.
For every 2 pounds of weight lost, the blood pressure drops by 1 point.
Beyond Medications.
I thought this was a website on lifestyle and all you’re doing is pushing medications on me!
How much can lifestyle lower blood pressure? Let me review for you the best evidence we have to date.
In an analysis of over 25 studies between 1966 to 2002, a weight loss of 10 pounds lowered blood pressure by about 5mmHg. It did not matter if the weight loss was through exercise or cutting calories. That’s a 1mmHg in blood pressure for every 2 pounds you lose.
So weight loss can lower blood pressure. Please say that bacon will lower blood pressure.
What type of diet lowers blood pressure? One such diet is rich in fruits and vegetables, low fat dairy foods, and reduced in saturated fat, total fat, and cholesterol. One study showed that this diet alone, without any weight loss or change in salt intake lowered systolic blood pressure by 11mmHg after 8 weeks in people with high blood pressure, and 3mmHg in people without high blood pressure.
I’ve given up on you ever telling me I can eat bacon. Tell me that watching 8 hours of television a day will help too.
How much can exercise lower blood pressure? It really depends on the type. Exercise that gets your heart rate up is probably better than weight training. According to one review, people with high blood pressure who did exercises for more than 4 weeks like jogging, swimming, or cycling lowered systolic blood pressure by 8mmHg, while weight lifting lowered it by around 3mmHg.
Anything else lower blood pressure?
There are other ways to lower blood pressure beyond the three pillars of lifestyle change. Reducing sodium (3mmHg), increasing dietary potassium (3mmHg), reducing alcohol intake if you drink more than 2 drinks per day (5mmHg), and treating sleep apnea may all lower blood pressure.
Now that you don’t like me because I told you to cut back on your drinking, I’ll conclude. Get your blood pressure down, so your last words won’t be about a pain in the back of your head.
In Summary
Ideal blood pressure is <120/80mmHg. If you’ve had a heart attack and don’t have diabetes keep your blood pressure <130/85mmHg. If you have diabetes keep your blood pressure <140/90mmHg.