Ask The Doctor: High Blood Pressure

QuestionI am a 45-year-old man in relatively good health, maybe 20 pounds overweight, a little stiff, a little tired. I have recently been diagnosed with hypertension (high blood pressure). My doctor found that my blood pressure is in the 150-160/95-100 range over a number of visits. He has suggested that I go on blood pressure medicine, which he indicated may be for the rest of my life. Is there any way to threat this condition without using drugs?

Answer: This question comes up often in my practice. The long answer could fill a medical textbook. The short answer begins with a definition of hypertension—which has changed a number of times during my 20-year career in medicine. In medical school we learned that the top or systolic number was normal if it was less than 100 plus the age of the patient. Thus 170 would be normal for a 70-year-old man. The bottom or diastolic number was considered normal if it was under 90. About ten years ago, a number of studies seemed to show that the bottom number was more important than the top number in predicting adverse outcomes such as stroke and kidney disease. For years physicians mostly ignored the systolic pressure and focused on normalizing the diastolic pressure but lately a few studies have shown that both numbers are important for predicting outcomes. Also, we no longer say that 100 plus the patient’s age is normal; rather, 140 is said to be the safe limit, regardless of the age of the patient.

The issue of whether hypertension needs to be treated has also vexed researchers for many years. If the pressure of the blood inside the arteries is too high, leading to kidney damage and stroke, it would seem that we should try to lower blood pressure. But the studies show that while it is clear that having normal blood pressure is better for your long-term health than elevated blood pressure, lowering pressure with medicines does not demonstrably improve the outcome. Furthermore, many of the drugs in use to treat hypertension have unfortunate side effects. Diuretics cause the loss of valuable electrolytes (minerals), thereby predisposing the patient to cardiac arrhythmia. Beta-blockers alter lipid levels and can worsen the tendency to type-II diabetes, which can lead to the same adverse outcome as elevated blood pressure. Similar problems have been found with calcium channel blockers and even with the new ACE inhibitors.

High blood pressure is, therefore, best treated without drugs. If we consider the fact that in this condition, the circulation is working too hard to nourish the cells, then it seems reasonable that some of the causes include excess weight, electrolyte imbalances, lack of exercise, fluid overload (due to poor kidney function), stress and fatty-acid imbalances. The last cause usually involves deficiency of omega-3 fatty acids and too much trans fat in the diet. These trans fats replace saturated fats in the cell walls with the result that they become too stiff.

These imbalances must be corrected and maintained for the life of the patient. In practical terms, this means following the diet recommended in  Nourishing Traditions with its emphasis on traditionally prepared whole foods; the use of mineral-rich Celtic sea salt; and a supplement of omega-3 fatty acids, usually in the form of a small amount of flax oil. Restriction of carbohydrates, as outlined in The Schwarzbein Principle, will help with weight loss and will also lower insulin levels, thereby helping your body eliminate excess fluid and burn excess fat. A regular exercise program is important. Finally, studies have repeatedly shown that the regular practice of some sort of meditation or relaxation response can be very successful in treating hypertension. The classic work in this field is still The Relaxation Response. Following these guidelines at least 90 percent of my patients have successfully lowered their blood pressure without resort to drugs.