How To Live Longer By Lowering Your Blood Pressure
People often refer to ‘quality of life,’ when discussing health. As an emergency medicine physician, I understand this thought process. That being said, what does this term mean? How do we define the quality of a life? Most importantly, how do we achieve a good one?
The quality of our lives depends on more than just our physical health. Our mental health, our relationships, and our sense of purpose and spirituality heavily influence how we perceive our own lives. With that being said, although physical health is not enough to live a quality life on its own, it is a requirement for such a life. Ask anyone who has ever been sick, particularly sick enough to require hospitalization or prolonged treatment. When our body suffers, it becomes incredibly difficult to find joy in life.
For the sake of discussion, let us consider a high quality life to be one that allows us to maintain a high level of function for a long time. Now imagine life after surviving a heart attack or stroke. Picture yourself going to a dialysis center, three times per week, for the rest of your life, as a result of your kidney failure. It is clear that these conditions do not fit into our goal of maintaining function over time. While all of these conditions are treatable, it is much better to prevent them from ever occurring. What do all of these conditions, as well as a number of others, have in common? They are all caused by poorly controlled blood pressure.
Before going further, I want to provide you with some perspective regarding the scale of this issue. According to the World Health Organization (WHO), across the globe an estimated 1.28 billion adults aged 30-79 have hypertension. In addition, nearly half (approximately 46%) of these people do not even know they have high blood pressure. A similar number, or about 42%, of people with high blood pressure are properly diagnosed and treated. While the disease affects more adults in low- and middle-income countries, it still impacts a large percentage of people in higher income countries, making it truly a global issue. (1)
Blood Pressure and Cardiovascular Disease – Overview and Definitions
Blood pressure refers to the mechanical pressure that exists within the blood vessels of your body. Because all of your organs require constant blood flow to support their function, they are all influenced by alterations in your blood pressure. This interconnectedness is both a blessing and a curse. If your blood pressure is chronically elevated, you are at risk for a number of problems, some I have already mentioned. The good news: by keeping your blood pressure under control, you are protecting all of your vital organs, not least of all your heart and your brain!
Primary hypertension, also called essential hypertension and by far the most common form, occurs without an identifiable cause. Secondary hypertension occurs due to another underlying condition. This post will focus on primary hypertension, as secondary hypertension requires additional testing and treatment aimed specifically at the underlying cause.
Conventionally, blood pressure is written as the systolic blood pressure (SBP) over the diastolic blood pressure (DBP). These two numbers can also be used to calculate a single number, called the mean arterial pressure (MAP). The terms ‘systolic’ and ‘diastolic’ refer to systole and diastole, which are the phases of contraction and relaxation, respectively, that occur with each and every beat of our hearts. If you can picture a long tube (your blood vessels) connected to a pump (your heart), then you can understand how pressure is higher as the pump squeezes (systole) fluid (blood) into the tube, and lower as the pump relaxes (diastole) and waits for the next squeeze.
Like in many other aspects of life, numbers matter. With that being said, how high is high blood pressure? Normal blood pressure is defined as less than 120/80 mmHg. Remember, the first number, in this case 120, is our systolic blood pressure, which is measured during contractile phases of the heart. The second number, 80 in this example, is the diastolic pressure, as measured during periods of cardiac relaxation.
Elevated blood pressure is defined as 120-129/<80. Stage I hypertension is defined as a SBP of 130-139 and/or DBP of 80-89. Stage II hypertension is diagnosed when blood pressures reach SBP of 140+ and/or DBP of 90+. Lastly, though the terminology is somewhat ambiguous, even to medical professionals, a hypertensive crisis is defined as a BP of 180+/120+. Believe it or not, some people live with these alarmingly high blood pressures every day, and have no symptoms. While living with significantly uncontrolled blood pressure is definitely not ideal, as it will lead to organ damage over time, it may not be causing a medical emergency at that moment. For this reason, physicians use the term hypertensive emergency, which is commonly accepted to mean a BP of 180+/120+ with end-organ damage.
Figure 2. Chart of blood pressure ranges by the American Heart Association.
For example, patients who present to the emergency room with strokes often have very high blood pressures. For one thing, these patients frequently have hypertension as a chronic medical condition for years prior to having a stroke. Hypertension is, after all, a significant risk factor for having a stroke. In addition, their blood pressure is likely elevated to an even greater degree in response to the stroke, though I will save a more in-depth discussion of those mechanisms for another time. It is not unusual for patients suffering from stroke to have systolic blood pressures well over 200 mmHg. In this situation, the doctor may address the blood pressure with blood pressure lowering medications, depending on certain features of the stroke (not all strokes are the same).
The above example is very different from one in which someone has extremely high blood pressure but does not have any symptoms. Specifically in this example, we are talking about a person with BP >180/120, who is not having a stroke. While it is still important to lower the blood pressure, the reason for doing so is to prevent all of the known, long-term complications of high blood pressure. On the other hand, our goal in lowering blood pressure in patients experiencing a stroke is to prevent worsening of the stroke. This distinction is critical, as it affects the type of medication used, the route it is given (intravenous versus oral), the urgency with which the BP is addressed, and whether or not the patient needs to be admitted to the hospital.
Treatment
When people think of managing high blood pressure, many think of medication. No doubt, blood pressure lowering medications are critically important in treating this disease, and are necessary for many people. However, there are a number of other potential treatments, most of which fall under the category of lifestyle modification. First and foremost, stop doing things that raise your blood pressure!
Listen, it is no mystery that smoking is bad for your health. While the effects of cigarettes and other tobacco products on long-term blood pressure is not entirely clear, it is well documented that nicotine-containing products cause an acute, or immediate rise in BP and heart rate. Over time, these changes contribute to stiffer arteries, and as a result smokers with high blood pressure may be more resistant to treatment. I should also mention that cigarette smoking has a number of other detrimental effects on your cardiovascular system, independent of its impact on blood pressure. If you care about your health, you have to stop smoking (and chewing, dipping, etc.).
Other lifestyle interventions include losing weight, particularly in obese people. In addition, decreasing excessive alcohol consumption can help to lower BP, as can reducing how much salt you consume. Speaking of diet, we should moderate the amount of total and saturated fats we consume (and eliminate trans fats entirely), and consume more fruits and vegetables. We should, of course, perform regular physical activity, preferably a combination of aerobic activity and resistance training, as they both offer unique and complementary benefits.
This article is largely a general overview. I will delve more into the finer details of many of these lifestyle interventions in the future. In addition, the medical management of blood pressure is a huge topic, and will require dedicated blog posts to properly address. For now, I want to propose a general framework for treatment. For early stages of hypertension, it makes sense to attempt some or all of these lifestyle modifications, as they can in many cases eliminate the need for medication. If blood pressure is still high, these lifestyle changes can decrease the number of medications and the amount of drug needed. Lastly, there are many effective blood pressure lowering medications, and it is far better to find a medication that works for you than to live with untreated hypertension.
Conclusion
I find it interesting how often we try to over complicate our lives. We are constantly bombarded with content regarding advanced nutritional strategies, novel medications, and “breakthrough” exercise routines. While human progress is both amazing and undeniable, sometimes we just need to take care of the basics. I am particularly fond of the term, “low hanging fruit.” Why are you climbing to the top of the tree, when there is a perfectly good piece of fruit at the bottom, which can be easily reached?
Managing blood pressure is actually a fairly simple concept. The problem is that it requires proper habits over a long period of time, which means that, while simple, it is not always easy. Take the low hanging fruit, the solutions to the obvious problems, and you will maximize the return on your investment. While it may be difficult to change your diet or to begin an exercise routine, it becomes so much easier with time. Eventually, these things do not require any willpower, as they have become part of your life, and you will expect to do them! I will leave you with a quote that I love, and which I hope you will enjoy. Thank you for taking the time to read this article, and please, check your blood pressure! Future you will thank you.
“We are what we repeatedly do. Excellence, therefore, is not an act, but a habit.”
-Aristotle
References:
- https://www.who.int/news-room/fact-sheets/detail/hypertension
- https://www.ncbi.nlm.nih.gov/books/NBK470371/#:~:text=Symptoms%20such%20as%20a%20headache,be%20investigated%20to%20direct%20treatment.
- https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings