Tag Archive for: high blood pressure

What Is ACE?

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Angiotensin-converting enzyme—ACE—is the enzyme that converts angiotensin I into angiotensin II (ANG2). You’re probably thinking, “Well, that clears it up!” Here’s the problem: under the right conditions, ANG2 causes vasoconstriction and sodium and water retention, and the result can be hypertension because the overwhelmed kidneys can’t get rid of sodium or fluids.

However, it gets more complicated. There are two ANG2 receptors, A1 and A2, but A1 creates the problems related to blood pressure. It also contributes to pulmonary hypertension and pulmonary fibrosis under the right conditions. The problem is that we don’t know exactly what those conditions are.

What we are finding out is this: the lung contains A1 and A2 receptors, and it just so happens that the COVID-19 virus can use those receptors to allow the virus entry into cells. Once there, the viruses can multiply and may contribute to the extreme immune response of the lower lungs.

For people who are being treated for hypertension and are taking an ACE inhibitor, it would seem prudent to take your medication on schedule. If you take a medication whose name ends in “pril”—that’s your ACE inhibitor. We don’t know for sure that it will help and there’s a lot of research to go, but we will find out. Until then take your BP medications and do all those other things you’re supposed to do to lower BP.

What about the rest of us? Is there something we can do? Maybe and I’ll cover that on Saturday.

Reminder: my audio High Blood Pressure: Getting It Down is half price this week, CD or MP3. Learn more about what you can do to control your blood pressure.

What are you prepared to do today?

        Dr. Chet

References:
1. DOI: 10.1101/2020.02.24.20027268.
2. doi: https://doi.org/10.1101/2020.01.26.919985.

High Blood Pressure and COVID-19

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If you have hypertension, commonly called high blood pressure, and you’re taking a medication called an ACE inhibitor (angiotensin-converting enzyme inhibitor), make sure you take it regularly. It may—and I repeat, may—provide some protection against the COVID-19 virus. I’ll spend the rest of the week explaining why, but I want you to have that information first because you have no idea what you’ll be exposed to between now and Saturday.

What prompted this urgency? I read a Research Letter in JAMA Network that reported the comorbidities of people who died in 21 hospitals in Wuhan, China, between January 21 and 30, 2020; comorbidities are the simultaneous presence of two chronic diseases or conditions. The first indicator of morbidity (death) was age and try as we may, we can’t change that. The top modifiable morbidity was hypertension; half the people who died had high blood pressure. The second was diabetes.

Near the end of the short paper, the authors noted that hypertension is not a typical risk factor for sepsis, the uncontrolled immune-system response seen in the most serious cases of COVID-19. They commented that prior research had demonstrated that ACE receptors were discovered in the lungs; perhaps ACE inhibitors could be used as a potential treatment for the COVID-19 infection. More research is needed. I’ll examine this issue the rest of the week.

Insiders, remember there’s a Conference Call tomorrow night. I’ll explain this research and address some of the outlandish claims being made by so-called experts about cures for COVID-19 as well. If you’re not an Insider, go to the Store at drchet.com to check out how you can become one now.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Network Open. doi:10.1001/jamanetworkopen.2020.5619

It’s All in the Dash

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In this Memo, we’re going to pretend the survey’s treatment options for high blood pressure are real. The choices were a pill, a cup of tea, exercise, and an injection once a month. If they were real, which one might be the best option for you? To me, it all comes down to The Dash.

You’ve probably heard about The Dash before. It’s a story about a person’s life such as yours. On your gravestone, there’s a dash between the day you were born and the day you died; your life is in the dash. How does this relate to the treatments offered in the survey, even though hypothetical?

What treatment option will give you the best potential quality of life? Not just adding a month, year, or even five years; what will those years be like? Will you just be alive or will you be really living?

It’s a no-brainer. Whether real or imaginary, the treatment that offers you the best chance to really live during those five years is exercise. A cup of tea may provide some good phytonutrients. A pill or an injection may affect an organ or a system to keep your blood pressure under control. But regular exercise will actually treat the systems involved in hypertension: the heart, blood vessels, muscles, nerves, and even hormone levels. Exercise is not a salve to make you feel better. It’s going to have profound effects and give you the best chance at a good quality of life during those extra five years.

I know the study was just a pilot survey and no treatment can guarantee you that you’ll live longer. But what I said about exercise is real. It gives you the best chance at having a better quality of life, not just during a potential extra five years, but all the years before then as well. What do you want your dash to be like? It just depends on the answer to one real question:

What are you prepared to do today?

Dr. Chet

 

Reference: AHA http://bit.ly/2uXd6qH

 

The Survey’s Most Surprising Results

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Before I get into what I found surprising, I want to point out that this was a survey about hypothetical treatment options. It was just a preliminary or pilot project just to see how people would answer; the head researcher said as much. The other factor was that subjects were 45 and younger. If an older population were asked the same questions, the results could be different. Or maybe not.

What surprised me was that even when asked about something as simple as drinking a cup of tea every day, less than 100% of the people said they would do it for an extra five years of life. The 7% who said they wouldn’t do anything stuns me. It’s a survey! You could misrepresent your answers—go ahead and lie!—who would know? Maybe it’s a function of the under-45 population surveyed; maybe they hadn’t yet started to be concerned about their limited lifespans.

What’s amazing is that most subjects already had high blood pressure according to the report. They knew the treatments were hypothetical, and yet some still couldn’t be bothered to try to add five more years of life. If they care that little about a hypothetical treatment, how are they approaching actual treatment?

On Saturday, I’ll focus on those who said they would do something to live five years longer and which option might be the best—assuming they were real. It all comes down to The Dash.

What are you prepared to do today?

Dr. Chet

 

Reference: AHA http://bit.ly/2uXd6qH

 

What Would You Pay for More Time?

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What price would you pay if you could gain an extra month of life? How about a year? How about five years? I think the longer you get, the more incentive to pay a higher price. It seems a large group of subjects agree with me according to a study reported this past weekend at the American Heart Association’s Quality of Care and Outcomes Research Scientific Sessions 2018.

Researchers surveyed over 1,300 people to determine what price they would be willing to pay for a longer life if they were diagnosed with high blood pressure. Subjects could choose from a daily pill, a daily cup of tea, regular exercise, or a monthly injection. The kind of treatment didn’t matter; the more additional time they got, the more willing the respondents were to consider the treatment.

Which was most appealing? The pill and the cup of tea. The least appealing? The injection. All treatments exceeded 93% if they would give a person an extra five years.

How about you? If you’re diagnosed with hypertension, what would you be willing to do for an extra month, year, or five years? While you think on it, Thursday’s Memo will be about something I found surprising in the study.

What are you prepared to do today?

Dr. Chet

 

Reference: AHA http://bit.ly/2uXd6qH

 

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.

 

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.

 

The Silent Killer

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On Tuesday, I told you about an article sent to me by a long-time reader. Today’s message is about an email sent to me the same day as the other, but it’s quite different.

In the second email, a woman let me know that her husband had passed away in his sleep several months ago. He was not overweight and seemed healthy. When the medical university nearby did an autopsy, they found he had an enlarged heart, most likely due to high blood pressure. That’s one of the reasons hypertension is called the silent killer.

I . . .

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