New Blood Pressure Guidelines Miss the Mark with Nutrition

December 11, 2017 | Linda J. Dobberstein, Chiropractor, Board Certified in Clinical Nutrition

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New Blood Pressure Guidelines Miss the Mark with Nutrition
Just a few weeks ago, new blood pressure guidelines were released by the American College of Cardiology. The new blood pressure standards set the tone for tighter number management, with a much higher emphasis on earlier medication management to lower blood pressure. This change is an attempt to diagnose hypertension and its related diseases before bigger problems set in. These are noteworthy attempts for disease management, yet the push for more medications to lower blood pressure fails to address the problem at the core.

Hypertension statistics increase as American’s health declines associated with sedentary lifestyles, high stress, high calorie/nutrient poor diets, lack of magnesium, substantial toxic burdens, and disrupted gut-immune health. Prescriptions drugs may target the immediate symptom, but fail to address the underlying concerns. Your blood pressure will only be as good as your overall health.

New Blood Pressure Guidelines

The American College of Cardiology (ACC) hypertension guidelines are broken up into new stages.

• Normal BP is defined as <120/80 mm Hg 
• Elevated BP 120-129 mm Hg 
• Hypertension stage 1 is 130-139 or 80-89 mm Hg
• Hypertension stage 2 is ≥140 or ≥90 mm Hg.

Prior to this update, the general consensus was that high blood pressure was anything consistently at 140/90 mm Hg or above. The current guidelines obliterate this cutoff point and say that a BP of 121/80 is elevated and hypertension stage 1 is at 130/80. Low blood pressure is recognized with a blood pressure of 90/60 and lower.

Blood Pressure Testing Guidelines

In addition to the blood pressure numbers, ACC guidelines recommend that all patients should be screened for fasting blood glucose, complete blood cell count, lipids, basic metabolic panel, thyroid stimulating hormone, urinalysis, electrocardiogram with optional echocardiogram, uric acid, and urinary albumin-to-creatinine ratio.

Additional testing is recommended for those who don’t respond to conservative blood pressure management, have new onset or are less than 30 years old and other criteria. Other testing recommends to rule out chronic kidney disease, renovascular disease, primary aldosteronism, obstructive sleep apnea, drug-induced hypertension (nonsteroidal anti-inflammatory drugs, steroids/androgens, decongestants, caffeine, monoamine oxidase inhibitors), and alcohol-induced hypertension. If these are found negative, then another series of tests are recommended to rule out less common disorders. 

Reality Check?

Elevated blood pressure is a symptom. It is important to determine why the symptom is present and the ACC guidelines recommend this. However, I suspect that this level of care within the typical medical office will not occur for many reasons. Most physicians have ten minutes or less to deal with patients who often have multiple concerns. Many physicians may order select lab tests in borderline concerns rather than the recommended list given above.

Then there are patients who experience situational elevated blood pressure such as “white coat syndrome” (the anxiety of seeing a physician) or rush into the office, fighting traffic to get to the appointment. Both scenarios can elevate the blood pressure. (The ACC guidelines recommend repeat blood pressure monitoring in office or home to verify the issue.) Other concerns include how many patients will follow their physician’s recommendations? Will insurance companies pay for extensive testing for someone who has a BP of 130/80? What about lab tests that involve nutritional measurements and blood pressure like homocysteine

My concern is that this change in the blood pressure numbers management becomes another prescription drug merry-go-round like the cholesterol lowering statins. Cholesterol guidelines have gotten increasingly tighter with more statin drugs prescribed. A total cholesterol reading of 220 was considered healthy even 20 years ago, now patients are given a statin drug with a cholesterol level of 220 without second thought. Yet, we now have more heart failure, atherosclerosis, diabetes, stroke and Parkinson’s disease from statin drugs.

The Medication Push

The majority of ACC guidelines focus on medication management. Anyone in stage 1 hypertension (130/80 or higher) is to be put on a blood pressure medication. These include thiazide diuretics like (hydrochlorothiazide), calcium channel blockers, ACE inhibitors, and angiotensin-receptor blockers (ARBs). If the blood pressure is at 140/90 or higher or stage 2 hypertension, patients will be prescribed two or more medications. Other types of medication may be added in here like beta blockers, alpha-1 blockers, and spironolactone.

Drug-Nutrient Depletions

Nutrient depletions caused by these medications are worrisome. Many of these medications rob the body of nutrients critical for blood pressure management and other functions in the body. These same nutrients are likely insufficient to begin with in someone who is unhealthy, has high blood pressure, heart disease, obesity, diabetes or other associated disorders that these guidelines and prescriptions drugs are attempting manipulate. It is doubtful that your practitioner would take the time to relay these concerns or be fully aware of them. Here are some known drug-nutrient depletions.

• Hydrochlorothiazide (diuretic) strips out coenzyme Q10, folic acid/folate, magnesium, potassium, phosphorus, sodium, and zinc.

• Other diuretics like Lasix or loop diuretics deplete calcium, magnesium, potassium, sodium, vitamin B1, vitamin B6, vitamin C, and zinc.

• ACE inhibitors, i.e. Lisinopril/Zestril, benazepril/Lotensil, etc. deplete zinc and sodium.

• ARBs, i.e. Cozaar/losartan, Benicar/olmesartan, etc. deplete zinc.

• Beta blockers like propranolol deplete coenzyme Q10 and melatonin.

• Calcium channel blockers i.e. Norvasc/amlodipine, Cardizem/Diltiazem, etc. have numerous adverse effects and can even cause hypertension as an adverse effect. Magnesium and potassium are natural calcium channel blockers.

The effects of drug-nutrient interactions worsen with multiple medications. These effects do not take into account how factors like malabsorption, poor digestion, gene SNPs that may magnify nutrient need by 2 -100 fold, or other drug effects caused by acid-blocker/PPI, aspirin, NSAIDs and antibiotics that affect gut and kidney function. These ultimately impact blood pressure. A frightening end-result of this mass medication approach without regard for nutrition is the sick get sicker.

Natural Blood Pressure Management

There are many natural ways to healthfully manage blood pressure. History shows us that blood pressure medications may actually raise blood pressure or medication benefits have been doubted. These medications have also been linked to increased rate of death. Here are several resources.

• Wellness Resources Health Topics: Blood Pressure

Potassium is Key for Healthy Blood Pressure

• Hypertension: Natural Alternatives To Calcium Channel Blockers

• Brain Inflammation Increases Blood Pressure

• Blood Pressure Meds and Natural Alternatives

• Blood Pressure Therapy Called Into Question

• Why Blood Pressure Medication Often Raises Blood Pressure 

• Blood Pressure Medication Linked to Increased Rate of Death

New Horizons on Blood Pressure Management

In addition to the resources listed above, emerging information shows us that gut flora plays an enormous role in blood pressure management. Probiotics and their fermented products have been found to modulate nitric oxide, reduce free radicals like reactive oxygen species (ROS), decrease cholesterol, inflammation, and modulate the renin-angiotensin system. (This is the system related with kidneys and blood pressure which are influenced by medications ACE/ARB inhibitors). Information published in the journal Pharmacological Research November 2017 which correlates with the release of the ACC blood pressure guidelines, shows that gut bacteria are vital to protecting the heart from high blood pressure that may lead to heart attacks. Healthy gut bacteria reduce the inflammation and damage from a heart attack, regulate cholesterol, blood pressure, heart cell death, and overall cardiac survival.

One main reason for ACC medication push is the epidemic level of obesity and diabetes linked with heart disease and hypertension, but studies show that healthy flora can change this. Animal studies show that healthy gut flora supported with prebiotics and probiotics improved blood pressure, heart function; reduced inflammation caused by obesity and insulin resistance. Probiotics buffered oxidative stress and mitochondrial dysfunction that lead to the symptom of hypertension.

Randomized controlled human trials showed that probiotics are beneficial in controlling hypertension and elevated cholesterol in type 2 diabetic patients. Research from 2002 published in the American Journal of Clinical Nutrition showed that the probiotic Lactobacillus plantarum 299v led to significant reduction in systolic blood pressure, leptin, and fibrinogen in smokers. (Fibrinogen is compound related with inflammation and blood stickiness, which increase the risk for blood clots.)

Imbalanced gut flora is a rampant problem across America. Between antibiotic use, GMO and processed foods, food intolerances, and the effect that Roundup/glyphosate has on the gut, the digestive tract takes a beating. Combine imbalanced gut flora with dismal fruit and vegetable intake, sedentary lifestyles, and high stress levels and one has a recipe for hypertension. Simultaneously, changing these fundamental elements can make a substantial difference in health.

Essential Resources

Individuals with hypertension concerns need to take a nutritional approach to support the core of their health. Basic support includes magnesium, potassium, B vitamins, and probiotics. More intensive support may include coenzyme q10, DHA omega-3 oil, resveratrol, arginine, and grape seed extract.

Replenishment of nutrients stripped out by medications is recommended. Those who are on multiple medications need to talk with their medical provider or pharmacist to avoid overmedication and too low blood pressure which is not good for the brain, kidneys, and coordination.

There is no doubt in my mind that hypertension concerns can respond to healthy changes. The aggressive nature of ACC guidelines is an attempt to help an at risk population, but at what future cost? There are no statin drug deficiencies in the body when referring to cholesterol lowering medications. The same can be said of blood pressure medication, i.e. there are no blood pressure medication deficiencies. Be proactive about your blood pressure with these tools. It can make a substantial difference.

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