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  • High Blood Pressure

    High Blood Pressure is one expression of a disease-complex caused by the wrong diet and unhealthy lifestyle. For years, excessive sodium salt was associated with hypertension and low sodium diets were recommended to all sufferers. According to the Canadian Coalition for High Blood Pressure Prevention and Control, non-drug strategies should be the priority for hypertension control. Smoking cessation, low fat diet, weight loss, exercise, reduced alcoholic beverage consumption and increased potassium, calcium and magnesium intake with decreased sodium are the important steps to avoid the problem of high blood pressure.

    A normal adult blood pressure is below 130/80. High blood pressure has been defined as over 140/90. The goal of hypertension treatment is to reduce blood pressure to approximate a normal reading of 120/80 or less. Blood pressure varies with activities and time of day. "Normal" values represent resting, relaxed readings averaged over a period. An athlete in top condition may have a blood pressure of 200/120 during peak exertion and a pressure of 90/60 in the morning before getting out of bed. There tends to be a 10% reduction in systolic pressure and a 14% to 17% fall in diastolic pressure during sleep. Continuous blood pressure monitoring has revealed different patterns of elevated pressure during the day and night.

    Blood pressure is a dynamic variable, always changing depending on circumstances. Vigorous exertion raises pressure to pathological highs as does anger. Any threat, fright or uncertainty triggers the flight and fight response which raises both heart rate and blood pressure. The challenge when measuring pressure and comparing each person to a somewhat arbitrary guideline is to decide what measurements, where and when are required to diagnosis disease risk of disease.

    Normal systolic pressure tends to increase with age; an old adage suggested that if the systolic pressure was less than 100 plus your age, everything was OK. Newer evidence demonstrated that lower systolic pressures are healthier. Diabetes 2 increases the need for blood pressure control – the lower the blood pressure, the better the long-term results at all ages. Controlling elevated blood pressure reduces the risk of strokes 35 to 40 percent, heart attacks 20 to 25 percent and heart failure more than 50 percent.

    In the US, 50 million people are thought to have have high blood pressure; about half are receiving treatment and half of the treated are successful at reducing their blood pressure to below 140/90. This leaves about 37 million people in the US with persisting hypertension. The incidence of high blood pressure rises with age; more common in men under 50, but more common in women over age 65. Over age 70, the incidence approaches 2/3s of the population. In Canada 57% of the estimated 4 million people with hypertension are treated by a physician but the overall success of this effort is in doubt.



    Essential Hypertension

    Hypertension is divided into two groups - primary or essential hypertension and secondary to a specific disease. Diseases of the kidney and blocked kidney arteries, for example, can produce high blood pressure as a secondary effect. No specific cause is found in 90% of hypertensives. One explanation is that the population at risk is becoming more sedentary with an increase in obesity. Their food supply is clearly suspect and it is not just the fat in the diet. These arterial problems with different and complex origins link to the diets and lifestyle popular in Europe and North America and occur less often among physically active, vegetable-eating populations who seldom eat dairy products, meat, and other high-protein-fat foods.

    Arteries are muscular tubes that regulate blood pressure and blood flow by constricting and dilating. Their behavior is important to day-to-day function and important to the evolution of disease over decades of living. The arterial system is a branching structure. The smaller branches can contract to increase the resistance to flow, thus increasing blood pressure. To reduce pressure, you dilate the smaller arteries, decreasing peripheral resistance and increasing blood flow. The heart is a muscular pump that pushes blood through the arterial tree against peripheral resistance. As the resistance to flow increases, the blood pressure increases and cardiac work increases. If high blood pressure is persistent, the heart may enlarge to accommodate the extra work. At some point, the work required may exceed the heart muscle's endurance and heart failure occurs.

    Some concerns about BP diagnosis and treatment

    1. BP readings may be inaccurate
    2. BP readings obtained in the doctor's office do not reflect BP levels at home, work and play.
    3. Many readings are required to obtain a meaningful sample
    4. Corrective action taken may be inappropriate or inadequate
    5. The causes of the disease are not removed; only symptoms are treated.

    Drugs

    A large number of drugs and drug combinations have appeared for the treatment arterial disease. The battle for market share is fought among the drug producers with double blind controlled studies that compare drugs to placebo and drugs to one another. The studies are designed to provide favorable news thru press releases to doctors and their patients. The drug industry prefers that medical doctors only think in terms of drug therapy and the producers aggressively market their newest and most expensive drugs. Smart patients prefer to change their diet, lose weight and exercise, rather than become drug users.

    The battle for drug market share is fought with double-blind controlled studies that compare drugs to placebo and drugs to one another. Despite years of research, thousands of publications, hundreds of conferences and billions of dollars spent; there is still doubt about the best way to manage hypertension. The drug industry prefers that medical doctors only think in terms of drug therapy and specific drug companies aggressively market their newest and most expensive drugs. Agencies that pay prescription bills would prefer that medical doctors prescribe older, less expensive generic drugs. Smart patients prefer to change their diet, lose weight and exercise, rather than take any drugs.

    Diuretics

    For many years, some experts have suggested that older, simpler, less expensive drug treatments such as low dose diuretics and beta blockers may be the best or initial treatment. The value of low dose diuretics was supported by the largest ever drug study, the Antihypertension and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT). The trial investigators announced that thiazide-like diuretics "are unsurpassed in lowering blood pressure, reducing clinical events, and tolerability, and are less costly," They suggested that chlorthalidone or hydrochlorothiazide should be considered first for pharmacologic therapy in patients with hypertension. In addition, treatment with diuretics reduced the risk of fractures caused by osteoporosis. Chlorthalidone 50 mg per day was used in the study.

    The ALLHAT randomized, double-blind, active-controlled, clinical outcome trial was conducted between February 1994 and March 2002 in 33,357 hypertensive patients aged 55 years and older with at least 1 other cardiovascular risk factor. Patients were randomized to amlodipine 2.5-10 mg, lisinopril 10-40 mg, or a diuretic, chlorthalidone, 12-25 mg for a mean follow-up of 4.9 years. Other medications could be subsequently added to achieve goal blood pressures less than 140/90 mm Hg.

    For the overall trial results, the primary outcome (combined fatal CHD or nonfatal myocardial infarction and a number of secondary outcomes did not differ between the 3 treatment groups. Compared with chlorthalidone, amlodipine was associated with higher rates of heart failure and lisinopril with higher rates of combined cardiovascular disease, stroke, and heart failure.

    The investigators of the ALHAT study provided additional evidence in 2008 that the diuretic, chlorthalidone was superior to other drugs as the initial treatment of hypertension. They stated that: "In no subgroup analysis from ALLHAT has the calcium-channel blocker, the ACE inhibitor, or the alpha blocker been shown to be more effective than the thiazide-type diuretic in preventing the primary outcome or any other major cardiovascular or renal outcome." They described especially disappointing results with lisinopril in black patients with metabolic syndrome: "The magnitude of the excess risk of end-stage renal disease (70%), heart failure (49% and stroke (37%) and the increased risk of combined cardiovascular disease and combined coronary heart disease strongly argue against the preference of ACE inhibitors over diuretics as the initial therapy in black patients with metabolic syndrome." (The ALLHAT Officers and Co-ordinators for the ALLHAT Collaborative Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin converting enzyme inhibitor or calcium channel blocker vs diuretic. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002;288:1981-1997.)

    Spironolactone, Aldosterone Blocker

    A relatively neglected and potentially helpful drug, spironolactone, is prescribed to lower blood pressure, treat heart failure and reduce sodium and water retention in liver disease. In a review of mineralcorticoid blockers, mainly spironolactone, Swaminathan et al stated:” “The renin-angiotensin-aldosterone system (RAAS) has long been a target of pharmacological approaches for the control of blood pressure and increasingly for heart failure, myocardial infarction, nephropathy and diabetes. Clinical trials involving the renin-angiotensin-aldosterone axis have traditionally focused on angiotensin-converting enzyme (ACE) inhibitors or angiotensin (Ang) II receptor blockers, thereby laying the emphasis on inhibiting Ang II. It is now acknowledged that aldosterone is also an important culprit in addition to Ang II. Recently, major intervention trials in heart failure have demonstrated the marked cardiovascular beneficial effect of aldosterone antagonism over and above ACE-inhibitor therapy, underscoring the harmful effects of aldosterone in cardiovascular disease. The RAAS plays an important role in BP and sodium regulation. This system acts on multiple target tissues to modulate a variety of actions. Activation of the system causes the enzyme renin to be released from the juxtaglomerular cells in the kidney. Renin catalyses the conversion of angiotensinogen, produced by the liver, to the inactive peptide Ang I. ACE catalyses the conversion of Ang I to Ang II, which is a key mediator of circulatory homeostasis.

    The deleterious effects of Ang II are mediated through Ang II receptor type I. These effects include aldosterone synthesis, vasoconstriction, vascular smooth muscle proliferation, cardiac hypertrophy, sodium reabsorption and sympathetic nervous system activation.” Another review stated:” Treatment resistant hypertension (TRH), defined as a blood pressure above goal despite treatment with optimally tolerated doses of 3 antihypertensive agents of different classes, ideally including a diuretic, remains a significant problem and its management an area of uncertainty for physicians. One hypothesis is that resistant hypertension is due to abnormal sodium retention, mediated by aldosterone breakthrough occurring despite blockade of the renin-angiotensin-aldosterone system with angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB). Thus, there has been renewed interest in the use of mineralocorticoid receptor blockers (MRB) to treat this condition. This article critically evaluates new evidence supporting the use of MRB in TRH published in the last 3;years. We conclude that there is now sufficient evidence to recommend MRB, in particular spironolactone, as the first choice medication to treat this condition, and for its inclusion in future guidelines.” (Krishnan Swaminathan; Justine Davies; Allan Struthers. Aldosterone Antagonism in Type 2 Diabetes Mellitus– A New Therapeutic Approach to Diabetic Macrovascular Disease? Br J Diabetes Vasc Dis.; 2008;8(1):16-19.
    New Evidence Supporting the Use of Mineralocorticoid Receptor Blockers in Drug-Resistant Hypertension. Current hypertension reports. 2016, DOI: 10.1007/s11906-016-0643-8, PMID: 27072827)

    Description of High Blood Pressure

    Discussion of Blood Pressure Readings

    The Solution Diet Revision

    The 50 million Americans and 4 million Canadians who have high blood pressure and arterial disease should seek the benefits of complete diet revision therapy! To improve the health of modern citizens and to reduce, at the same time, the increasing costs of health-care, self-responsibility for disease-prevention is required. Each person will have to alter disease-causing habits, change poor eating habits, stop smoking and drinking, and become more physically active. We have no difficulty in recommending aggressive diet revision, vigorous enough to prevent vascular disasters. Imagine that you live in a little cottage by the sea, think quiet thoughts, walk everywhere, tend your organic vegetable garden, cultivate fruit trees (never sprayed) and go fishing once or twice per week. Now you have a perfect setting and a perfect diet for enduring good health.

    Current recommendations for fat intake are shrinking progressively from 35% of total calories to 20%; for people with high risk of heart disease, fat intake should go below 10% of daily calories. Typical American diets contain as much as 37% fat, an extravagant surplus. A total of 15-25 grams of fat per day supplies our needs. The minimum requirements are 1-2% of total calories for adults and 3% for infants. Sodium restraint is considered a primary strategy of reducing high blood pressure. Increased intake of calcium and potassium may lower high blood pressure and extra potassium may protect against stroke-associated death. North American diets tend to offer sodium levels 10 times higher than actual need (minimum of 1100 mg/day, adults). Average consumption of sodium salt is over 10 grams/day. The proper ratio of Sodium to Potassium is not obvious. Most diets have sodium disproportion, tending toward sodium excess of 3-10 parts Sodium to 1 Potassium. The foods in Phase 1 and 2 of the Alpha Nutrition Program automatically improve the sodium/potassium ratio and increase intake of magnesium.


  • Topics from the book Heart & Arterial Disease The author is Stephen Gislason MD 2018 Edition: 190 Pages

    Major diseases originate from eating too much of the wrong food and damage is done to many organs simultaneously. The evidence does suggest that some interventions are beneficial in terms of preventing heart attacks and strokes and that disease progression can be halted by important changes in diet and increased exercise. The occurrence of a heart attack or stroke confirms that atherosclerosis is advanced, damage has been done and that the rules of intervention have changed. We suggest that a prudent person suffering early vascular dysfunction symptoms would be wise to pursue vigorous, thorough diet revision at the earliest opportunity.

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