Blood pressure control – take the low road

Take the low road

Parts I and II of this series explain why this is important and how to recognize hypertension. This post is about how to get it all under control.

Your target and how to bullseye it

We need ‘normal’ [young person] levels of <120/<80 to minimise cardiovascular risk. For example, a level of 110/70 would be wonderful.

Two Key Questions:

1. How do we get to that level when our BP is up?
2. Is this degree of reduction safely achievable?

There are lifestyle and medical approaches.

The best approach is a combined one. Don’t say ”I will try the lifestyle approach first and see about medication if that fails”, because any time spent with high BP is damaging, and the acute events like heart attack and stroke that may occur with untreated BP are life threatening. SO do not delay getting your BP down. Fortunately, as modern BP medication is non-harmful there is no reason to be shy of taking treatment. 

The optimum approach is start on medication, get control, do the lifestyle change, too, and maybe later, reduce the meds a bit. Moreover, if you are overweight, a drinker, eat a lot of salt, and have insulin resistance you will only get optimum control by making lifestyle changes to alter those factors alongside your medication. Around 50% of you will need only one drug to get your BP down but equally 50% will need two.

Salt reduction is always helpful but has a low impact; magnesium supplementation at around 300mg daily has a significant effect.

The Short Answer

Reduce alcohol; lose 5-10 Kg depending on how over-heavy you are; try for 10,000 steps a day and a more active life overall; take either candesartan 8mg [potentially increasing to 16mg] or indapamide Slow Release 1.5 mg as your first line agent and add the other drug if you need a combination to get the needed result. It is possible that taking a magnesium supplement as I recommend for all over 60’s may have a beneficial effect.

To get the whole inside story read more

Blood Pressure Part 2: Accuracy counts

How to measure blood pressure accurately

Take your BP regularly at home and you have a reliable and useful record of a major index of your cardiovascular and dementia risk [1], [2].

• It is the only way to identify correct levels of medication for high BP.
• It controls the anxiety and ‘white coat’ effect that increases BP in the surgery or hospital.
• It allows taking 3 measurements to get a more reliable indicator.

Here are the key messages:

• Get the right device
• Be in the right position when you take it
• Always use the same arm
• Have the correct cuff size
• Rest 5 minutes before and measure 3 times at 1-Minute intervals
• Establish a baseline including your BP lying down
• Measure on the first day of every month and record.

Blood Pressure Part 1 - Don’t blow your top

Blood Pressure - Know the risk and check at home

What is your blood pressure today – Yes, what is it right now? Well you don’t know, how could you… unless you measured it today or let’s say within the last 7-10 days.

This is really important: you can only know if you are in trouble if you measure your blood pressure [BP] and find it raised. This is why they call BP ‘the silent killer’. In other words, you get life threatening illness that could have been prevented if only you knew your BP was dangerously raised.

In one recent US study of 7328 individuals 54% had BP above the safe zone, half of those were completely unaware of their problem [1].

Actually 8/10 of the hypertensives had ‘uncontrolled’ BP ie a level that is seriously damaging. Looking at those 8 - there were 5 out of 10 uncontrolled because they didn’t check their BP and had no idea they were ill and 3 out of 10 because they were inadequately treated or not taking their meds.

Most were in the 50+ range and that is my focus, but 12.5% were under 44 so have your adult children get their pressure checked regularly, too, say once a year.

Why do you need to know?

High BP causes heart attack, stroke, dementia and kidney failure and therefore contributes to early death. Treating the BP reduces the risks and prevents the disease[2]. More importantly treating the BP intensively improves the outcome.[3] [4]

Dementia Prevention

You are aware of the curse of dementia [mainly as Alzheimer’s Disease – AD] either as a risk of ageing or more powerfully because of personal experience of a sufferer.

There IS an inherited ie genetic component related principally to the APOE e4 gene. But lots of people who have the gene don’t get AD. The important information is not whether you have the gene [so don’t rush to get a test] but whether the gene is switched on - this is called gene expression.

Reducing Cardiovascular Risk – Blood pressure

Focus on… Self-Management

A normal blood pressure [BP] is 120/80 such as you would have in your 30’s.

This matters because …

BP is a silent killer; you can’t tell from how you feel whether your BP is normal or dangerously sky-high. Raised BP is part of the metabolic syndrome [insulin resistance + raised BP + abnormal cholesterol pattern + prediabetic change] associated with mid-abdominal weight gain and major cause of cardiovascular risk [heart attack and stroke].

Ultra-Processed Foods

All Ultra-processed foods are problematic, even plant-based options

It seems so easy, so modern-day! After a busy workday, your ready meal is in and out of the microwave in 7 minutes. Well - that really helps! Unfortunately, speedy food is not always healthy food.

How old are you actually?

Well I was born on … 

It sounds like simple arithmetic, but your body is like a motor car, it isn’t the year it was made that matters … but how many miles it has done, how hard it has been driven and if it has been serviced and well maintained! Wear and tear is the critically issue. Let’s call this wear and tear your biological age in distinction to your chronological age – the years since you were born. Ideally your biological age is lower than your age at last birthday i.e. your body’s working parts are well maintained.