Blood Pressure Part 2 - Medicine With Heart

Introduction

In this article, the critical role of blood pressure in disease, wellness, and health optimization continues to be explored.

In part 1 of this series, the following aspects of blood pressure were reviewed:

What blood pressure is
The range of blood pressure: normal, optimal, elevated, and low
Measuring blood pressure
Devices for blood pressure monitoring

Here, in part 2 of the blood pressure series, the following components will be reviewed:

Causes of blood pressure dysregulation
Preventing blood pressure issues
The impact of lifestyle factors on blood pressure

Blood Pressure: Causes and Risk Factors

Blood pressure is regulated by two factors: the amount of blood pumped by the heart and how difficult it is for blood to move through the arteries. The greater the amount of blood the heart pumps and the narrower the arteries, the higher the blood pressure.

There are a variety of factors that contribute to hypertension, some easier to identify than others. Hypertension falls into two main categories: primary hypertension and secondary hypertension.

Primary/Essential Hypertension

For many adults, there’s no clearly identifiable cause of high blood pressure. When a cause isn’t known in medicine, it is classified as ‘idiopathic’. This version of high blood pressure is called primary or essential hypertension as there isn’t a specific disease that causes it. It is often caused by more general lifestyle factors such as:

A high sodium diet (in susceptible individuals)
A sedentary lifestyle
Caffeine
Alcohol consumption
Smoking and nicotine use
A family history
Obesity
Stress
Older age

Its progression usually develops slowly over many years as the impact of lifestyle factors are generally gradual and not sudden.

Another factor that can cause a gradual rise in blood pressure over the course of years is atherosclerosis. When plaque builds up in the arteries, it increases the risk of high blood pressure as there is less space for the blood to travel through (like with a pinched hose). This can be a vicious cycle as high blood pressure can also contribute to arterial damage, which can potentially initiate the process of further atherosclerotic plaque formation.

In functional medicine, the root cause or network of causes is sought so a more fundamental approach to treatment can be implemented.

Additional causes that may be considered in functional medicine include:

The balance of various electrolytes (such as potassium, magnesium, and sodium)
Dysbiosis (an imbalance of the microbiome)
Toxic heavy metals, such as mercury, cadmium, and lead
Stress levels
Micronutrient imbalances

Secondary Hypertension

An additional form of high blood pressure is caused by an underlying and potentially identifiable health condition. It is called ‘secondary’ as the hypertension is secondary to the primary cause. It tends to appear suddenly and often results in higher blood pressure than primary hypertension. Conditions and medicines that can lead to secondary hypertension include:

Adrenal gland tumors
Blood vessel problems present at birth, known as congenital heart defects
Cough and cold medicines, some pain relievers, birth control pills, and other prescription drugs
Illegal drugs, such as cocaine and amphetamines
Kidney disease
Obstructive sleep apnea
Thyroid disorders

It is also important to note that just being in a doctor’s clinic and having blood pressure checked there can result in ‘white coat syndrome’ which is the rise in blood pressure caused by the stress of being in a medical setting.

Through knowledge of potential causes of hypertension, a greater capacity to make decisions that minimize the risk of this prevalent disorder arises.

Blood Pressure: Prevention

Prevention of disease is always more desirable than attempting to treat a disease after it arises. Not only is the disease itself undesirable – it is also much more difficult and sometime untenable to reverse the disease process significantly. As the saying goes, ‘an ounce of prevention is worth a pound of cure’.

In the case of blood pressure, there are wide variety of approaches to preventing the disorder and most involve either avoiding certain factors that predispose one to the condition or lifestyle factors that can be implemented.

Factors to avoid include:

Being overweight or obese
A sedentary lifestyle
Unhealthy eating habits
Smoking and nicotine use
High stress levels
Fatigue
Excessive alcohol intake
Illegal drugs such as cocaine and amphetamines
Development of disorders such thyroid and kidney conditions

Factors to encourage include:

Maintaining a healthy body weight
Regular exercise
A healthy nutrition plan
Sleep and rest
Stress management
Healthy circadian rhythms

The impact of healthy lifestyle habits in terms of blood pressure levels is significant. Below are examples of how implementing and achieving certain lifestyle factors and goals can have direct and measurable correlations with maintaining optimal blood pressure levels.

Blood Pressure: Optimization and Management Through Lifestyle

Healthy Body Weight

There is frequently a direct correlation between weight and blood pressure levels – as weight increases, blood pressure often does, too.

Excess weight can also potentially cause disrupted and even stalled breathing while you sleep, which is known as sleep apnea. Sleep apnea can have a significant impact on elevating blood pressure levels.

Weight loss or maintenance of healthy weight is a potent lifestyle factor for blood pressure control. In the case of being overweight or obese, the weight loss can have measurable benefits. In general, blood pressure may be reduced by about 1 mm Hg with the loss of each about each 2.2 pounds of body weight.

In addition to weight, waist size can also show a correlation with blood pressure levels.

In general:

Men are at risk if their waist measurement is greater than 40 inches
Women are at risk if their waist measurement is greater than 35 inches

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Exercise

An additional important means of maintaining healthy blood pressure or reducing elevated blood pressure is exercise. Regular physical activity can potentially reduce high blood pressure by about 5 to 8 mm Hg. To maintain benefits, it is important to continue exercising regularly as blood pressure may otherwise start to rise again. For blood pressure control, a minimum of 30 minutes of moderate exercise daily is recommended though a greater amount than this is often even more optimal.

Nutrition

Consuming a nutritionally dense diet rich in vegetables, low glycemic index fruits, healthy oils such as olive and avocado oils, omega 3 fatty acids, and healthy protein sources may be able to lower blood pressure significantly – up to 11 mm Hg. Well known examples of nutrition plans that may help control blood pressure include the Dietary Approaches to Stop Hypertension (DASH) diet and the Mediterranean diet. At Medicine with Heart, we often recommend modified versions of these diets to optimize outcomes even further based on personalized, data-driven nutritional frameworks.

Salt and sodium are a controversial topic in relation to blood pressure. It is generally being recognized that the response of blood pressure to sodium is very individual and may be a cause for concern for some but not others.

If sodium is a concern, potassium in the diet can potentially reduce the effects of sodium on blood pressure. Ideally, potassium should be obtained from the diet though supplementation may be recommended in certain circumstances. A dietary intake of around 3,500 to 5,000 mg a day is a minimal goal to aim for and this may lower blood pressure by up to 4 to 5 mm Hg.

Healthy nutrition is a method to support healthy blood pressure and the recommended plan for this also supports a variety of other health factors.

Sleep and Rest

Getting optimal sleep and rest regularly is essential and foundational for overall health. During sleep, when the body is resting and rejuvenating, blood pressure tends to be lower for most people, allowing for less pressure on the cardiovascular system.

In addition to lower blood pressure while sleeping, it has also been demonstrated that healthy sleep at the right times assists with maintaining optimal blood pressure. Interesting, both short and excessively long sleep durations have been shown to negatively impact blood pressure.

A metanalysis (an overview of studies) demonstrated that relative to the group of the people with 7 h daily sleep, all other sleep durations groups (≤ 5 h, 6 h, 8h, and ≥ 9 h groups) were accompanied by some higher risk of hypertension with those sleeping less than 5 hours at the highest risk 1.

It is consistently recommended by sleep experts for individuals to get at least 7 hours of sleep per night for optimal health. Although those who slept more than 8 hours per night also demonstrated an increased tendency towards hypertension, it is important to note that higher amounts of sleep are also often caused by underlying disease processes that may correlate with hypertension – more sleep may be representative of another cause rather than being the cause itself. Generally allowing the body to sleep as needed is an optimal approach.

Tied with sleep are circadian rhythms, which may also have an impact on blood pressure levels.

Circadian Rhythms

Circadian rhythms (timing of components such as light exposure, sleep, nutrition, and exercise) are an essential and ancient component of human biology and following a regular circadian rhythm has a wide range of health benefits.

Healthy circadian choices are important, and our physiology follows its own internal rhythms down to the cellular level. Blood pressure itself follows a circadian rhythm and an altered rhythm may be indicative of other health conditions such as sleep apnea, kidney, or thyroid disease.

Regarding sleep, when the circadian rhythm of blood pressure is healthy, it starts to rise a few hours before the time a person wakes. It continues to rise during the day with a peak around midday. In the late afternoon and evening, blood pressure begins to drop with a low generally occurring during sleep overnight. A blood pressure measurement at night is known as nocturnal blood pressure.

Examples of an irregular blood pressure circadian rhythms may include:

High blood pressure during the night
High blood pressure early in the morning
Less than 10% drop in blood pressure overnight, called non-dipping blood pressure

A rise in blood pressure overnight to early morning has been linked to an increased risk of heart disease.

In addition to disordered circadian rhythms being a potential indication of underlying disorders, maintaining healthy circadian lifestyle rhythms may also cause elevated blood pressure.

For example, a study demonstrated that Circadian misalignment, compared with circadian alignment, increased 24-h systolic blood pressure (SBP) by 3.0 mm Hg and 24-h diastolic blood pressure (DBP) by 1.5 mmHg 2.

Effects of circadian misalignment on blood pressure and heart rate levels. DBP, diastolic blood pressure; HR, heart rate; SBP, systolic blood pressure; TP, test period; TSW, time since wake. Gray bar, sleep opportunity. Probability values are based on 24-h analyses. Data are represented as mean ± SEM.

Source: Circadian misalignment increases cardiovascular disease risk factors in humans

This demonstrates that maintaining circadian rhythms as well as viable can be a helpful tool in the process of optimizing blood pressure levels.

Summary

There are a variety of causes of blood pressure dysregulation and a range of lifestyle factors that can assist with preventing blood pressure issues.

In this article, the following aspects of blood pressure have been reviewed:

Causes of blood pressure dysregulation
Preventing blood pressure issues
The impact of lifestyle factors on blood pressure

In part 3 of the blood pressure series, additional approaches to optimizing blood pressure will be explored, including:

Nutraceuticals and blood pressure
Medications and blood pressure

Additionally, testing for root causes of blood pressure dysregulation will be considered as understanding what may be causing issues on an individual level is a vital component of effectively managing and optimizing blood pressure.

References

Wang, Y., Mei, H., Jiang, Y. R., Sun, W. Q., Song, Y. J., Liu, S. J., & Jiang, F. (2015). Relationship between Duration of Sleep and Hypertension in Adults: A Meta-Analysis. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 11(9), 1047–1056. https://doi.org/10.5664/jcsm.5024
Morris, C. J., Purvis, T. E., Hu, K., & Scheer, F. A. (2016). Circadian misalignment increases cardiovascular disease risk factors in humans. Proceedings of the National Academy of Sciences of the United States of America, 113(10), E1402–E1411. https://doi.org/10.1073/pnas.1516953113

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