Tag Archive for: BP

How Isometrics Help Lower Your BP

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If you have a home blood pressure monitor, try a little experiment on yourself. Set up your monitor and cuff and sit quietly in a chair. After five minutes or so, take a deep breath, exhale, and hit the Start button on the monitor while breathing normally as your BP is taken. Record the results. Make sure the cuff deflates completely and continue sitting for another five minutes.

Then repeat the deep breath, exhale, and hit the Start button. This time, I want you to contract the muscle in the opposite arm as much as you can and hold the contraction until the BP is done, breathing normally the entire time. Do you notice a difference in the BP without and with contracting your opposite arm? Unless you lift heavy weights on a regular basis, you probably did.

When you contract the opposite arm, you’re restricting blood flow to that arm, thereby increasing the resistance. When you relax, there should be an increase in blood flow to that tissue. When you do isometric exercises regularly, that’s what happens in every muscle group involved.

How Isometrics Can Lower BP

Let’s return to the study. The researchers did a secondary analysis to see if they could find the exercise that lowered BP the most. The wall sit or wall chair worked best to lower systolic blood pressure, while running lowered diastolic blood pressure the most.

What’s the wall sit? It’s depicted in the photo above. The idea is to stand a foot or so from the wall, lean back until your back contacts the wall, and slide down to a sitting position for five to ten seconds, then slide back up. Repeat ten times several times per day; the key is to never hold your breath while you do it. The quadriceps and the gastrocnemius are a substantial amount of muscle. Restricting blood flow with isometrics will increase the resistance on the heart and blood vessels. The benefit is that you will get a training effect on both that lowers BP.

What’s actually going on with the nervous, cardiovascular, and muscular system isn’t quite clear, but knowing why won’t help you do them. If you don’t have orthopedic issues (and you don’t hold your breath while performing the isometrics), no matter what muscle groups you use, you may help lower your BP. I think the wall sit works the best due to total muscle mass involved, but every muscle group will help.

The Bottom Line

Will isometrics make you super fit? No. Super strong? No. There are also limitations as to the angles where strength will increase due to specificity of training. But there seems to be an emphasis on improving health with short episodes of exercise. Isometrics fit that niche quite well and as the study demonstrated, quite effectively as related to BP. We’re not done yet because two other studies have focused on activities that involve movement. We’ll talk about those next week. In the meantime, have a great Labor Day holiday.

What are you prepared to do today?

        Dr. Chet

Reference: British J Sp Med Online July 2023. doi: 10.1136/bjsports-2022-106503

Guidelines for Lowering Your Blood Pressure

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When guidelines for any condition are changed, especially one as common as high blood pressure (HBP), it raises several questions. One question would be: is this is just a way for the medical and pharmaceutical businesses to promote and sell more drugs? Another would be: will this throw more people into the pre-existing condition category and thus hinder their ability to get health insurance? I can’t answer those questions, but I can condense the American Heart Association’s 481-page guidelines to a few points.

Environmental Causes of HBP

The nice thing, if you can call it that, is that most of the causes of HBP, also known as hypertension, are environmental; they’re caused by the way we interact with our environment in a personal way. I’ve listed the causes in the order presented in the AHA’s guidelines; they’re not ranked by significance.

  • Being overweight or obese contributes to HBP. Going back to the insurance actuarial tables, there is a distinct relationship between excess body fat and HBP. This observation has been confirmed in several large epidemiological studies over the years. If you carry extra body weight, your risk for HBP is higher.
  • Excess sodium intake is associated with HBP. The reasons can vary, but let’s look at it this way. Cells must be in a specific ionic balance to function properly. If one ion, sodium, is increased, the body must retain more fluid to keep the ionic balance. When fluid levels go up, there’s an increase in the force exerted against the inside of the arteries to handle the extra fluid. Hence, blood pressure goes up.
  • One that may surprise you is that a decreased potassium level is also associated with HBP. As a nation, we are potassium poor because we don’t consume the necessary plant material in the form of vegetables and fruit. Potassium is also an ion involved in many strategic chemical reactions. Because we take in much more sodium than potassium, the balance is thrown off and BP increases.
  • Fitness level directly affects the cardiovascular system; when fitness declines, everything from the heart’s ability to contract to the number of small blood vessels is modified in a negative way. That can increase BP.
  • Finally, excess alcohol intake is related to an increase in BP. While a little alcohol may be beneficial to help reduce stress levels, too much can increase BP.

Let’s take a look at the treatment recommendations for Elevated and Stage 1 Hypertension.

Treatment Recommendations

The initial recommendations for Elevated BP and HBP Stage 1 are lifestyle recommendations. The goal in both cases is to see how the person responds to lifestyle changes first before any medications are recommended.

There is one exception: if the person’s 10-year risk for a heart attack and stroke is greater than 10%, the recommendation is lifestyle plus medication. You can take this assessment at the link in the second reference to determine your risk. However, most physicians will give you three to six months to change your lifestyle, and then reassess whether you need the medication at all.

The important point is that it’s lifestyle change that’s recommended first, not medications. So how are you going to reduce your risk?

Lifestyle Modifications to Lower BP

  • Lose weight. There’s no single correct way to do that. Use the DASH Diet or go low fat, follow the USDA MyPlate plan or go ketogenic, use the AHA guidelines or go low carb. Whatever you can do to lose weight and keep it off, do it. For every kilo (2.2 pounds) you lose, you can expect BP to decrease by 1 mmHg, both systolic and diastolic (top and bottom numbers).
  • Eat healthier by following the DASH Diet. It focuses on vegetables, healthier fats, more fruit, nuts, fish, and whole grains. You can expect to decrease BP from 3 to 11 mmHG.
  • Reduce sodium intake to 1,500 mg per day. If that’s too difficult, shoot for a reduction of 1,000 mg per day from your current intake. Expect to reduce BP between 2 and 6 mmHg.
  • Increase potassium intake by eating more foods containing potassium—and the best source is most vegetables. It’s more than just eating bananas! Expect to reduce BP by 2 to 5 mmHg.
  • Exercise regularly and that means 4 to 5 days per week. Aerobic gets the biggest results, but weight training and even isometric exercise will reduce BP between 4 and 8 mmHg. Fun activities like dancing, tennis, and playing with the grandkids count as exercise if you keep moving and increase your heart rate.
  • Reduce excess alcohol intake. Men should have no more than two drinks per day while women should have no more than one. Expect to reduce BP 3 to 4 mmHg.

Any one of these lifestyle changes doesn’t seem too hard, but you’ll get the best results by combining a few changes. As always, I’d advise a stepwise approach: change one thing, and a week or two later change another one. If you do that and stick with it, you can reduce your BP by 10 to 15 mmHg and that will get you into the desirable range—no medication necessary.

The Bottom Line

I think the new guidelines for diagnosing and treating BP are spot on. The emphasis is on lifestyle first and foremost, so these guidelines have put the ball squarely in your hands. Take the ball and run: change your lifestyle, for good. The real benefits will be how much better you’ll feel and the knowledge that you’ve reduced your risk of heart disease and stroke considerably.

What are you prepared to do today?

Dr. Chet

 

References:
1. Hypertension. 2017;00:e000-e000.
2. http://www.cvriskcalculator.com.

 

Blood Pressure: Getting It Right

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The change in the clinical guidelines for diagnosing high blood pressure, as described in Tuesday’s memo, requires that your BP reading is done correctly. That could be a problem.

In a JAMA Medical News report published in August, medical students were asked to take the BP of volunteers. Only one out of 159 got all the steps correctly. It’s not that they were poor at the actual mechanics of taking the BP, but they didn’t follow all 11 steps. Yes, 11 steps. Here they are:

  1. Five minutes of rest; that eliminates the rise in BP from getting to the office, checking in, getting weighed, etc. This is the step most often missed.
  2. The correct size cuff should be used. If your upper arms are large, and the nurse or doctor doesn’t use a large cuff, your BP reading will be higher. That’s because the bladder inside the cuff will have an artificially high pressure, which is reflected in the reading.
  3. The cuff should be placed over a bare arm, not over clothing. It’s your job to remember to wear something with a loose sleeve that won’t get in the way.
  4. The arm should be supported on a desk or a table, not hanging free.
  5. The patient should be asked not to talk. The doctor has to be able to hear the sounds clearly to get an accurate reading. This is not the time to discuss new restaurants.
  6. Legs should be uncrossed because that can affect blood flow.
  7. Feet should be flat on the floor.
  8. No reading or cell phones during measurement. There are a couple of reasons for this one. Holding the phone or book is an isometric contraction albeit a small one; nevertheless, it can raise the BP reading. The other reason is that if you’re checking email or something like that, it can affect your reading if your heart rate gets elevated.
  9. The BP in both arms should be checked.
  10. The arm with the higher reading should be noted.
  11. Finally, the physician should note in the records which arm is to be used in future readings.

Who knew taking a BP was so complicated? The photo above gets at least three steps wrong. Now that you know, you can make sure you do your part whether you’re told to or not.

But what’s going to happen if you hit higher numbers? I know many people suspect this is just a way to push more BP meds. We’ll look at treatment regulations on Saturday.

What are you prepared to do today?

Dr. Chet

 

Reference: JAMA Online. Abassi 08-30-2017.

 

Do You Have High Blood Pressure?

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On Monday November 13, you may have awakened with normal blood pressure, and by that afternoon, you may have joined the ranks of those with high blood pressure (HBP). That’s when the American Heart Association (AHA) released their new HBP clinical practice guidelines at their national conference. With the new guidelines, close to half of all adults will be diagnosed with HBP.

The guidelines are the topic for this week’s Memos. I downloaded the entire document—all 481 pages—and three important parts warrant discussion. The first is AHA’s new guidelines for diagnosing HBP, and those numbers are in the graphic above.

While there are numerous questions, the first one is this: is your BP being taken correctly? That’s the topic for Thursday’s Memo, and you’ll be surprised at how often it’s done poorly.

What are you prepared to do today?

Dr. Chet

 

Reference: Hypertension. 2017;00:e000-e000.