A friend was told by his doctor that he has pre-hypertension recently. The doctor will start to prescribe him with hypertension medication if he cannot get his blood pressure (BP) in check soon. My friend was worried and seek my advice.

Age is associated with an increased risk of hypertension. In Singapore, about one in five men between the age of 40-49 have hypertension [1]. Therefore, as we age, the risk of hypertension increase. For my friend to have such a condition at the at the age 48 is quite common. Nevertheless, with a change in lifestyle, diet, and combined with suitable nutritional supplements, it is possible to lower the BP and prevent the condition to deteriorate. Indeed, according to the latest medical guidelines, a patient who is detected to have higher than normal blood pressure in clinics is to be put on “trial of lifestyle modification” for 3 months first, before the prescription of any medication [2].

Defining pre-hypertension

Pre-hypertension, as the name implies, is a precursor of being officially diagnosed to have hypertension. How blood pressure (BP) is being categorised is shown in the following table [2].

[table caption=”Blood Pressure Classification For Adults” ]
BP Category, Systolic BP, And/Or, Diastolic BP
Normal, <120 mm Hg,and, <80 mm Hg
Elevated (Pre-hypertension), 120-129 mm Hg, and, <80 mm Hg
Stage 1 Hypertension, 130-139 mm Hg, or, 80 – 89 mm Hg
Stage 2 Hypertension, ≥140 mm Hg, or, ≥90 mm Hg
[/table]

Both pre-hypertension and hypertension both known to associate with increased risk of cardiovascular diseases such as stroke and heart attack. The risk of death from cardiovascular diseases is doubled with every increment of 20 mm Hg in systolic BP or 10 mm Hg in diastolic BP [2]. 

So, what causes the blood to pump around the body at a pressure higher than it should? 95% of the time, the pressure simply develops gradually over many years and doctors simply can’t find the cause. Only about 5% of hypertension is caused by some other underlying conditions such as kidney or thyroid problems [3].

Questions to ask yourself if you have elevated BP

The fact that your BP is elevating is a clear sign that your current lifestyle and diet are not conducive to your health. To identify how best to lower your BP, you should ask yourself these questions:

1. Am I overweight? – Being overweight or obese is associated with higher BP. You simply need more blood to supply oxygen and nutrients to your tissues. Higher circulating blood volume in the blood vessels create high pressure on the artery walls [3]. If you are overweight, a mere 1 kg reduction in body weight is expected to reduce systolic BP by about 5 mm Hg [2].
2. Do I exercise enough? – If you rarely exercise and physically inactive, your heart needs to pump faster to supply blood to the body. The increases in heart rate exerted a stronger force on the artery walls, leading to an increasing BP [3]. Increasing physical activity can help to lower BP naturally.
3. Am I drinking too much alcohol? – Drinking too much alcohol can damage the heart over time. For men, more than two drinks a day can affect the BP adversely, whereas, for women, more than drink a day can be detrimental to the BP [3]. So, drink moderately.

4. Do I smoke or am I expose to second-hand smoke regularly? – Nicotine in tobacco can raise BP when it is absorbed into the bloodstream, it can also scar the lining of the artery walls and narrowing the arteries, leading to permanent damage [3]. Stop smoking and try to avoid second-hand smoke if you ever want to reduce your BP.
5. How is my stress level? – Long-term exposure to psychological stress can result in the increase of BP. If you are constantly experiencing stress from work and the daily environment, it is important for you to find ways to destress to lower your BP.
6. Am I eating healthily? – Nutrition plays a very important role in helping the body to regulate BP. Too much sodium, saturated fat, and added sugar as well as insufficient intake of potassium, calcium, magnesium, fibre, and omega-3 fatty acids can cause an imbalance in the BP regulation [4]. A healthy diet is a must for a healthy BP.

Dietary recommendation

So, what constitutes a healthy diet that can help to improve BP management? Here are some elements that should be incorporated in your diet [5]:

• Maintain a vegetarian diet if possible, otherwise, try to reduce red meat and saturated fats, and eat more fish, vegetables, beans, nuts and seeds.
• Eat foods high in potassium, such as fish, bananas, potatoes, tomatoes, peaches, avocados, and orange juice.
• Eat foods high in calcium, including skim or low-fat milk, spinach and broccoli.
• Eat magnesium-rich foods, including cooked dried beans and peas, dark green leafy vegetables.
• Eat foods that can low blood pressure: celery, garlic, onions, fatty fish or fish oil, and olive oil.
• Avoid added sugar and restrict salt intake.

Nutritional supplements to consider

Here are some herbal and nutritional supplements that may be useful to prevent the rising of BP:

• Garlic extract – reduce blood pressure through the increase of natural relaxants (e.g. Nitrate Oxide) for the blood vessels [6].
• Celery seed extract – lower arterial pressure by lowering levels of circulating stress hormones and decreasing the resistance of blood vessels [6].
• Hawthorn extract – a traditional herb for cardiovascular health with many effects including antihypertensive [6].
• Red yeast rice extract – a natural statin that helps to reduce cholesterol and BP [7]; high cholesterol is commonly associated with hypertension.
• Essential Fatty Acids (EFAs – flaxseed oil, fish oil, omega-3 oil complex) – reduce BP, maintain blood vessels elasticity [5].
• Coenzyme Q10 – improve heart oxygenation function leading to lowering of BP [5].

Conclusion

Elevated BP is a sign of deteriorating health with an increased risk of cardiovascular diseases that should not be overlooked. It is important to investigate your current lifestyle and diet to identify how best to lower your BP. A change in lifestyle, diet, and combine with nutritional supplements might help to keep the BP in check before having to rely on medication for life.

References

[1]        Ministry of Health Singapore, National Health Survey 2010, Singapore, 2010. https://www.moh.gov.sg/content/moh_web/home/Publications/Reports/2011/national_health_survey2010.html.

[2]        P.K. Whelton, R.M. Carey, W.S. Aronow, D.E. Casey, K.J. Collins, C. Dennison Himmelfarb, S.M. DePalma, S. Gidding, K.A. Jamerson, D.W. Jones, E.J. MacLaughlin, P. Muntner, B. Ovbiagele, S.C. Smith, C.C. Spencer, R.S. Stafford, S.J. Taler, R.J. Thomas, K.A. Williams, J.D. Williamson, J.T. Wright, 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task F, Hypertension. 71 (2018) 1269–1324. doi:10.1161/HYP.0000000000000066.

[3]        Mayo Clinic, High blood pressure (hypertension) – Symptoms and causes – Mayo Clinic, (n.d.). https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-causes/syc-20373410 (accessed August 13, 2018).

[4]        H. Nguyen, O.A. Odelola, J. Rangaswami, A. Amanullah, A Review of Nutritional Factors in Hypertension Management, Int. J. Hypertens. 2013 (2013) 1–12. doi:10.1155/2013/698940.

[5]        P.A. Balch, Prescription for Nutritional Healing, 4th ed., Avery, New York, NY, 2006.

[6]        M.A. Anwar, S.S. Al Disi, A.H. Eid, Anti-hypertensive herbs and their mechanisms of action: Part II, Front. Pharmacol. 6 (2016) 1–24. doi:10.3389/fphar.2016.00050.

[7]        X. Xiong, P. Wang, X. Li, Y. Zhang, S. Li, The Effects of Red Yeast Rice Dietary Supplement on Blood Pressure, Lipid Profile and C-reactive Protein in Hypertension: A Systematic Review, Crit. Rev. Food Sci. Nutr. 57 (2015) 00–00. doi:10.1080/10408398.2015.1018987.