I’ve been getting a lot of enquiries about high blood pressure lately. Many come from more senior patients concerned that their cocktail of pharmaceuticals could be doing more harm than good.
They could be right. As a holistic practitioner I have to ask: what is going on here?
The hype about hypertension
High blood pressure, or hypertension, is named as one of the leading causes of death in the Western world, as it leads to cardiovascular problems such as heart attack, stroke and vascular dementia.
This is a serious issue that reflects the perils of leading a sedentary Western lifestyle, high on stress, sugar, alcohol and/or coffee, and low on critical nutrients, sleep and the key ingredient to health: happiness.
Unfortunately, it has instead led to over-diagnosis and over-treatment with pharmaceuticals, which itself is pretty serious.
When blood pressure medications hit the market, only truly hypertensive patients were offered them (160/100 mm Hg). Nowadays, a blood pressure reading of 140/90 mm Hg is a cause for concern, and is medicated accordingly.
However, there is robust evidence that adults with mild hypertension (systolic 140-159 mmHg and/or diastolic BP 90-99 mmHg) and no history of cardiovascular disease derive no benefit from blood pressure medications.
In fact, a 2015 study by the University of Alabama at Birmingham concluded that taking a cocktail of these drugs actually doubles your risk of having a stroke.
"You're in as much trouble by the time you are on three medications that achieve excellent control as you are when you have hypertension and it is untreated, which is amazing," Professor George Howard said.
Unfortunately, I often see patients on multiple medications whose hypertension is far from excellently controlled - and most of them are in their senior years.
Hypertension in later life
Age poses another common problem dubbed ‘isolated systolic hypertension’. This is when the systolic reading is high (over 150 mm Hg) and the diastolic reading is comparatively low (below 60 mm Hg). This can also be described as a ‘wide pulse pressure’.
Low diastolic pressure has been linked to a greater risk of heart disease and progressive kidney disease, because it reflects stiffness in the arteries.
This stiffness can be a natural consequence of aging, or a result of atherosclerosis - a common disease process by which the arteries are damaged over time and plaque builds up in the walls.
Most cases of atherosclerosis are caused not by high cholesterol levels as once thought but by inflammation and insulin resistance - the precursor to diabetes. This brings us back to the beginning: exercise, a plant-based diet, a healthy lifestyle with adequate sleep and above all, happiness.
However, almost none of these essentials are ever mentioned. Patients are invariably prescribed blood pressure medications, which lower both the systolic and the diastolic pressures, with potential dangers.
The cholesterol conundrum
If cholesterol readings are high, statins are also frequently used to lower heart disease risk in the elderly. Whilst these drugs are helpful in people who have already had a heart attack or stroke, there is limited evidence that they provide any benefit in people who haven’t.
It has also been shown that in the over-65s, unless there is already a history of heart disease, high LDL (‘bad’ cholesterol) levels are not an issue and treatment with statins is ineffective.
In fact, this extra fatty covering around the cell is protective of many disorders, and if cholesterol is treated with statins over the age of 75, death rates increase.
What you can do about it
There are a few important things to do if you are worried about your risk of heart disease.
First of all, get a coronary calcium score and ask your doctor to check your levels of lipoprotein (a). These are both better predictors of cardiovascular risk than cholesterol levels, and will help your doctor decide whether or not statins are appropriate for you.
Second: look at what your blood pressure readings are really telling you, and think about the factors in your lifestyle or diet that may be contributing. A good natural health practitioner can help you do this.
Third: read next month’s article - in it I’ll be talking about holistic treatment for high blood pressure including effective lifestyle measures, nutritional supplements and herbal medicines.
In the meantime, get in touch if you have any personal blood pressure worries and would like a quick chat about it. Alternatively, book a consultation here.