Turning the Tide - Conquering the scourge of high blood pressure part 1 - South Coast Herald

Hypertension is the leading risk factor for premature death worldwide.  It increases the mortality rates associated with diabetes, heart attacks, strokes, kidney disease and eye disease.  What is alarming is the increasing incidence of this disease, especially in South Africa.

As the diet and lifestyle of South Africans changes to adopt a more Western diet, there are dramatic changes.  South Africa has the highest incidence in sub-saharan Africa.  One study done back in 2008 already showed that up to 77% of people in S Africa over the age of 50 years had high blood pressure.

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It is well known that the incidence of hypertension rises with age, but of significance is that there are more and more young people who are now hypertensive.  West and East Africans have much lower incidences of hypertension than South Africans – most probably related to the differences in diet and lifestyle.

What is high blood pressure?

Blood pressure is essential for life.  It is what drives the blood around the arteries and veins in your body to nourish and clean out waste products from all the cells of the body.  Blood pressure is measured with a special device which has a rubber bag in a cuff.  As this is inflated, the rising pressure first creates turbulence in the narrowing arteries, and produces sound (in the same way that rushing water over rocks produces noise, compared to a gently flowing river).  As the pressure in the cuff rises even further, the pressure becomes high enough to block off the flow completely.  The upper pressure – where it blocks off – is called the Systolic pressure, and represents the peak pressure with each contraction of the heart muscle.  The lower pressure where turbulence begins, is called Diastolic pressure, and represents resting pressure in the arteries, between heart beats.  In the past, levels of above 140/90 were considered to represent high blood pressure if persistent, and on repeated testing.  A healthy blood pressure is considered  to be less than 130/80.  The ideal is 110/70 or less, but my experience both seeing my patients and on doing community screening suggests it is rare to find people with that level.

Your blood pressure is constantly changing, depending upon your state of mind and physical condition.  For instance it will be lowest when you are sleeping (unless you are having a bad dream!), and will be highest if you are angry and stressed.  Adrenalin can push up your blood pressure.  Exercise will also increase your blood pressure temporarily, but in the long term helps it to be lower when you are resting.  There is a condition called “white-coat syndrome”, in which when a doctor checks your blood pressure, it tends to be high, but when a nurse or friend checks it, it is normal.  Sometimes patients have to be given mobile monitors for 24 hour monitoring to get a more accurate assessment.

What causes High Blood Pressure (Hypertension)

As mentioned in the opening paragraph, blood pressure often increases with advancing age, because the arteries are being damaged by atherosclerosis, or hardening of the arteries.

This results in less elasticity of the artery walls, and the pressure thus rises – in the same way that pressing your finger over the end of a flowing hose pipe increases the pressure of the water, and allows you to spray much further. 

However it is not obligatory for the blood pressure to go up.  Studies done in rural China 30-40 years back found a high percentage of the elderly population with blood pressure normally below 110/60.  With westernisation this is rapidly changing.

Another common factor that also influences high blood pressure is obesity. The increase in body volume means a greater need for more blood vessels, and a greater requirement for high enough blood pressure to drive the blood through that extra vascular space.

Smoking through the effect of nicotine causes spasm of blood vessels and thus raises blood pressure.  One of the significant effects of stopping smoking is a reduction in blood pressure.

Inactivity is also a cause of high blood pressure.  Thus as part of therapy, increase in movement is important – as we will discuss in a future article.

We all know the effect of anger, anxiety, stress and grudge-bearing on our blood pressures.  These emotions increase the production of adrenalin and cortisol.  Although the effect is normally short-lived, if you harbour resentment and chronic anger, this will result in many effects of excess cortisol and adrenalin – peptic ulcer disease, muscle cramps, headaches, weight changes, high blood pressure and perhaps even greater risks of diabetes and cancer.

There has been some controversy about the role of salt.  For years, it was standard practice to advise patients to reduce salt.  However there are some recent research articles that have suggested that salt has minimal effect.  My impression is that this kind of research is sponsored by big business who has direct interests in people eating the high fat/high salt junk food fare so common out there.  World authorities strongly support the concept of reducing sodium intake as found in prepared foods, fast foods and snacks.  Perhaps equally important though is that by eating a lot of snacks, we avoid the natural antidote to excessive sodium, which is potassium.  This element is common in fruits, vegetables and whole foods.  Your body is able to replace sodium in the blood when there is enough potassium.

A simple illustration:  What happens to exposed salt when there is high humidity in the air?  Of course it gets damp and draws water out of the air. 

It is hydrophilic (water-loving).  Imagine if there is a lot of salt in your body.  It makes it more difficult to excrete water, and thus you tend to increase your fluid volume in your blood.  By replacing sodium with potassium, you are better able to excrete that excess fluid.

Health of the endothelium – the lining of the blood vessels – is vital for cardiovascular health, and for that matter general health.  When our blood vessels, which are the main conduit of nutrients to the cells, and removal of waste products away from the cells, are not healthy, the whole body is affected. See this article:https://drjoelkahn.com/endothelium-secret-health-boost/ .  One of the most important functions of the endothelium is the production of Nitric Oxide.  This chemical is a powerful arterial vasodilator, and this reduces excessive blood pressure and improves blood flow to the tissues.  It has been shown that fats and oils in our diet diminish the production of Nitric Oxide.  Thus a diet high in processed foods, and thus fats predisposes to high blood pressure, apart from the high sodium content in those same foods.  What has been surprising is that even olive oil (for so long touted as heart healthy) has been shown to temporarily reduce Nitric Oxide production.  Fortunately though, when olive oil is combined with good quantities of vegetables, the effect is counteracted.  So the benefit of the Mediterranean diet is not because of olive oil, as much as the high intake of fruits and vegetables that are the most important part of that diet.

Other Causes of High Blood Pressure

Sometimes there are other medical conditions that cause high blood pressure.

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Chronic kidney disease results in the production of more renin/angiotensin that causes vaso-constriction and reduces the ability of the kidneys to excrete excess water and salts.   Also Andy disease that causes narrowing of blood vessels feeding the kidneys can also result in kidney-generated hypertension.

Vascular abnormalities such as coarctation of the aorta – where there is narrowing of the main blood vessel taking blood to the bulk of the body causes high blood pressure in certain parts of the body – the right side of the body and brain.

Endocrine conditions – Cushing’s syndrome, excess aldosterone production and Phaeochromocytoma.  These are all fancy sounding conditions, and fortunately quite uncommon, but nevertheless are causes of high blood pressure.

The vast majority of patients with high blood pressure have conditions that are brought on by lifestyle practices, and are thus amenable to lifestyle interventions to reverse them.

This is what we will be covering in the next few articles.

If you have high blood pressure, become intelligent about what factors in your life are contributing to that disease, and what you can do to reduce the risks.  If you don’t know your blood pressure numbers, go for a visit to your doctor, or to the clinic, or even pop in at one of the chemists who offer that service.  If you are really shy, or too busy, you can buy your own BP measuring device for regular screening.  Not all are reliable, but it may be worthwhile for screening.

To a week in which you consciously contemplate your personal health and how you can improve it.  It is an investment worth pursuing.

Dave Glass

Dr David Glass – MBChB, FCOG (SA)

Dr David Glass graduated from UCT in 1975. He spent the next 12 years working at a mission hospital in Lesotho, where much of his work involved health education and interventions to improve health, aside from the normal busy clinical work of an under-resourced mission hospital.

He returned to UCT in 1990 to specialise in obstetrics/gynaecology and then moved to the South Coast where he had the privilege of, amongst other things, ushering 7000 babies into the world. He no longer delivers babies but is still very clinically active in gynaecology.

An old passion, preventive health care, has now replaced the obstetrics side of his work. He is eager to share insights he has gathered over the years on how to prevent and reverse so many of the modern scourges of lifestyle – obesity, diabetes, ischaemic heart disease, high blood pressure, arthritis, common cancers, etc.

He is a family man, with a supportive wife, and two grown children, and four beautiful grandchildren. His hobbies include walking, cycling, vegetable gardening, bird-watching, travelling and writing. He is active in community health outreach and deeply involved in church activities. He enjoys teaching and sharing information.

 

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