Control of High Blood Pressure

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Two recent breakthrough studies on controlling blood pressure found that:
• Frequent blood pressure variation between one doctor’s appointment and the next is a major risk factor for heart attacks.
• In people with high blood pressure, reducing salt intake can lower their average blood pressure in as little as one week.

Blood Pressure Variability: The ASCOT study followed more than 8,000 patients in the UK with high blood pressure for more than 20 years, and found that variation in systolic pressure over time from one doctor’s visit to another was a strong predictor of a stroke, heart attack or atrial fibrillation in the future (European Heart Journal, January 31, 2024;45). People with high blood pressure that varied from visit to visit were far more likely to suffer a future heart attack than those whose pressure did not vary much from one visit to another, whether blood pressure was controlled by medication, lifestyle changes or both. The authors felt that amlodipine, a calcium channel-blocker blood pressure medication, was specifically effective in controlling blood pressure variation between visits to a doctor.

Salt Intake: Researchers assigned 213 people, ages 50 to 75 years old, to either a high-sodium diet (2,200 mg of sodium added to their usual diet), or a low-sodium diet (500 mg sodium daily) for one week (JAMA, 2023;330(23):2258-2266). They then switched to the opposite diet for one week. The average systolic blood pressures of the participants while they were on their usual diet was 125mm Hg. After a week on the low sodium diet the average was 110 mm Hg. The low-sodium diet reduced systolic blood pressure in nearly 75 percent of the participants. For my more detailed report on this study, see Low-Salt Diet to Help Lower Blood Pressure

Definition of High Blood Pressure
The World Health Organization states that high blood pressure affects one in three people worldwide and usually causes no symptoms until a person suffers a heart attack or stroke. The American Heart Association tells you that fifty percent of North American adults suffer from high blood pressure and one third of those have high blood pressure that is not controlled by three different medications.

High blood pressure is defined as anything greater than 130/80 by almost all of the major medical groups, including the American Heart Association and the American College of Cardiology. The numbers used to be 140/90, but that misses a lot of people who could have been saved from a preventable premature death just by making some lifestyle changes (Annals of Internal Medicine, March 6, 2018). A study called the SPRINT TRIAL showed that bringing blood pressure below 120 significantly reduces heart attack and stroke risk (N Engl J Med, 2015; 373:2103-2116). Having a systolic blood pressure over 130 doubles your chances of suffering a heart attack, stroke, or heart or kidney failure, and puts you at increased risk for developing dementia in later life. Known causes of high blood pressure include diabetes, dehydration, cardiovascular disease, obstructive sleep apnea, kidney disease, thyroid problems and nervous system problems.

Reducing Salt Intake
Reducing your intake of salt by one teaspoon every day can reduce your systolic blood pressure as much as most blood pressure medications, both in people who have high blood pressure and those who have normal blood pressure. The American Heart Association recommends that you take in less than 1,500 milligrams of salt each day. (A teaspoon of salt contains 2,300 milligrams).

People with high blood pressure can reduce their salt intake by changing some eating habits: eating more meals at home and fewer at restaurants, not using the salt shaker at the table or while cooking, and checking food labels when shopping. Food manufacturers know that salt and sugar help to make food taste good, so they usually add them to all kinds of foods. A single pickle can have one-day’s full recommended limit of salt, and a bowl of canned soup can have two days’ worth. Try to avoid high-salt foods: crunchy snacks, processed meats, salted nuts and so forth. Keep them out of your house; if they are there, you will eat them.

My Recommendations
If your average systolic blood pressure is over 130 or your average diastolic pressure is over 85, you should immediately make all of the lifestyle changes that will help to lower it. Your doctor may feel that you need medications to lower high blood pressure, but everyone can help to prevent and control high blood pressure with lifestyle changes, whether or not they are taking blood pressure medications.
• Eat a plant-based diet that is heavy in fruits, vegetables, whole grains, beans, nuts and other seeds. Restrict mammal meat and processed meats, sugar-added foods and drinks, and fried foods.
• Avoid extra salt. Don’t use a salt shaker and check the labels for salt content on processed foods.
• Exercise. Check with your doctor, and try to do aerobic and resistance exercise for at least 30 minutes daily.
• Try to get 7-8 hours of sleep each night.
• Avoid habits and exposure to everything that increases cell damage such as smoke, alcohol, recreational drugs, herbicides, insecticides, air pollution, and so forth.