Download High Blood Pressure: A Symptom Not a Disease

High Blood Pressure:
A Symptom, Not a Disease
As of 2013, approximately 30%
of Americans over the age of 20,
and over 50% of those age 55
and older, have elevated blood
pressure or hypertension. While
not a disease in and of itself,
high blood pressure is strongly
associated with conditions affecting the heart and vascular
system health. Because hypertension usually produces
no telltale symptoms, many
people do not realize they
have it. When people are
diagnosed, in all but a
small percentage of
cases, the underlying
cause is unknown.
Instead of a single-minded focus on lowering blood pressure,
Cass Ingram, DO, says medicine
must take a broader approach
to improving the entire vascular
system’s health. “There are no
drugs which heal or
cleanse the heart and
arteries,” he writes.
“Only a natural
approach can heal.”
It seems incredible
that a condition with
no known cause and
no overt symptoms
would receive
aggressive medical
attention. Yet hypertension is considered
so predictive of heart
attack and stroke that
when diet and exercise
changes do not work,
one or more medications are nearly
always prescribed,
despite the potential for serious
side effects.
The vascular
system (also known
as the circulatory
system) is made
up of the heart and
blood vessels, which
can be thought of as a
network of flexible
tubes, arranged in a
tree-like structure from
the largest vessels (veins
and arteries) narrowing
to smaller venules and
arterioles. These are
connected by capillaries,
thread-like vessels where
blood flows slowly
enough to enable
How Blood
Circulates:
A Pressure
Balance
A Network of Blood Vessels
Artery
Vein
Arteriole
Capillaries
Venule
the exchange of gas and nutrients between blood and the
surrounding tissue.
The heart serves as a pump
to move blood through the
vessels. Veins bring carbon
dioxide-filled blood from our
tissues back to the heart. The
heart pumps blood to the lungs
to pick up oxygen and release
carbon dioxide. Blood returns
to the rest of the body via the
other large set of “tubes”—the
arteries.
Because it is a closed loop system, pressure develops, which is
necessary to keep blood flowing
continuously against the force of
gravity. Achieving the proper
Continued on Page 2
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balance of pressure is very important. While uncommon,
there are some conditions, such
as adrenal gland dysfunction,
that can cause blood pressure to
drop too low, causing dizziness
and fainting.
What is High Blood
Pressure?
Blood pressure is the force that
blood exerts on the walls of
your arteries. Readings of this
pressure are given as a fraction
and measured in millimeters
of mercury, such as 120/80
mmHg. The top number refers
to the force when your heart
beats; the bottom number is the
force when your heart rests. For
most adults, readings of 120/80
or less are considered healthy.
A reading of 140/90 or higher
is usually considered hypertensive. Revised U.S. guidelines
published in 2003 added a new
category: prehypertension,
defined as all the readings in
between, because even small
increases in blood pressure appear to correlate to increased
disease risk.
In people with arteriosclerosis
(the general term for hardened, narrowed arteries), blood
pressure rises in order to compensate. The heart must work
harder to move blood through
the tightened arteries, which
weakens it over time. Naturally,
the arteries also take a pounding. High blood pressure is a
strong signal that help is needed to restore optimal vascular
function.
Every cell in the body—from
toenail to brain—is nourished
with oxygen and nutrients from
High blood pressure is a strong
signal that help is needed to restore optimal vascular function.
the blood. When blood flows
properly through the circulatory system, body processes
are properly fueled and toxins
are removed as blood is filtered
through the liver and kidneys.
But as people age, damage to
blood vessels often occurs, making those vessels less efficient in
transporting blood. Over time,
hypertension and poor blood
circulation can lead to a wide
variety of health problems,
including:
n Plaque buildup in blood
vessel walls
n Kidney failure
n Leg pain
n Memory problems
n Heart attacks
n Stroke.
Researchers are just beginning
to determine the chain of events
that leads to vascular disease.
While many links in the chain
have been clearly identified,
other links are just being discovered. Yet the real difficulty lies
in separating these discoveries
into causes and effects. In many
cases, researchers simply know
that certain things go together—that many people with high
cholesterol levels, for example, also have poor circulation,
making each a “risk factor” for
the other. But that doesn’t tell
us whether high cholesterol
causes poor circulation or is in
fact caused by it, or if it’s just a
symptom of another underlying
cause.
Hunting Down
the Causes
A medical mystery like hypertension attracts many
researchers eager to solve it.
Dozens of theories have been
proposed to explain the details
of how hypertension develops.
Many think multiple causes are
at work because the treatments
shown to help lower high blood
pressure in individuals include
more than 100 different medications, as well as supplements
and lifestyle changes. Yet for
many, a cure proves elusive,
particularly when the standard
medications may not be well
tolerated.
Some people even find that antihypertensive drugs can make
the problem worse. Sherry A.
Rogers, MD, describes the common scenario where physicians
prescribe diuretics (medications
that reduce water and salt), thus
lowering the total volume of
blood flowing through the
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vessels, which lowers the pressure, the same way turning
down your spigot reduces the
pressure in a garden hose. Unfortunately, diuretics may also
create imbalances such as a depletion of potassium. “For some
folks, an improperly diagnosed
potassium deficiency is often
the underlying cause of the high
blood pressure,” she explains
in The High Blood Pressure Hoax.
“Taking a medication that silently lowers potassium even
further leads to higher blood
pressure and guarantees the
need for even stronger medications in a few years.”
progesterone, testosterone
and cortisol. They are also
very sensitive to a steroid hormone that acts as a precursor
to all of these, called DHEA
(dehydroepiandrosterone).
This brings us to our interest
in understanding more about
the factors that affect blood
pressure. The following theories show promise for restoring
normal blood pressure and improving vascular function.
Estrogens and Progesterone
The Hormone
Connection
The incidence of high blood
pressure in women increases
dramatically after menopause,
suggesting a connection to hormones. As the body’s chemical
messengers, hormones orchestrate our metabolic processes by
stimulating changes in cells—
including those in our blood
vessels. Hormones, which
originate in various glands,
circulate throughout the body
in the blood, bathing our tissues. Receptors within our cells
are sensitive to particular hormones, causing a reaction.
In our blood vessels, receptor cells are particularly
sensitive to several hormones, including estrogens,
Cardiovascular problems have
been linked to deficiencies in
DHEA, thyroid, and other hormones, including Vitamin D.
Both heart rate and arterial tone
are controlled by the glands,
says Dr. Ingram. “It is the disruption of glandular function
that is at issue...when this system is dysfunctional, blood
pressure disorders develop.”
For decades, estrogens have
been thought to protect premenopausal women from
heart disease. The theory was
simple: estrogens lower “bad”
cholesterol and raise “good”
cholesterol, reducing atherosclerosis—the buildup of plaque in
artery walls that causes them to
harden, narrowing and restricting blood flow to the body’s
tissues.
Researchers were so excited by
this theory that they proposed
that menopausal women consider hormone therapy solely to
protect heart health. However,
when the national Women’s
Health Initiative (WHI) ran a
large clinical trial to test this
theory from 2002–2004, they
found that participants taking Prempro®, a combination of
synthetic progestin and estrogens derived from horse urine
(Premarin®), actually showed a
slight increase in heart attacks,
stroke, blood clots and breast
cancer. However, there were
several limitations to this study,
such as the fact that the progestin used in the WHI study was
previously linked to coronary
artery spasms, while progesterone itself relaxes the arteries.
Research indicates that Premarin alone, or Premarin combined
with biologically identical
progesterone, may be more effective in increasing HDL (good
cholesterol) than Prempro. In
fact, results from an ancillary
study of WHI participants,
“It is the disruption of glandular function that is at issue...
when this system is dysfunctional, blood pressure disorders
develop.”
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published by The New England Journal of Medicine in
June 2007, found that women
aged 50 to 59 who received
estrogen (Premarin) had lower levels of calcified plaque in
their coronary arteries, compared to participants who
received a placebo. Further
research is needed to determine if even better results
can be achieved by using
only biologically identical
hormones.
Although the effects of various estrogen therapies on
blood pressure have been
controversial, sometimes
contradictory, and often confusing, there is reassuring
news. In 2006, a University of Wisconsin pharmacy
student reviewed several
studies and found that postmenopausal women taking
biologically identical estrogens and/or progesterone
did not have a statistically
significant change in blood
pressure. And, a 2006 editorial in Menopause: The Journal of
the North American Menopause
Society suggests that “the
type of estrogen influences
the hypertensive response,”
such as estrone and estradiol
showing reductions in blood
pressure.
Testosterone
and Cortisol
For over 40 years, scientists
and practitioners have been
debating the role of cholesterol in atherosclerosis.
Dr. Jens Møller, the former
President of the European
Organization for the Control of Circulatory Diseases,
argues that high cholesterol
is a symptom of deterioration in circulation. Dr. Møller
details how a deteriorated
circulation system and high
cholesterol levels can be
treated with testosterone to
decrease the “stickiness” of
the plaque and reduce overall cholesterol levels.
Dr. Møller also reminds us
that cholesterol is “the precursor of many hormones,
including the vital substance
testosterone itself. Decreasing the cholesterol level
alone may in fact result in a
decrease in the production
of testosterone, which plays
a vital role in maintaining
a normal circulation.” The
link between testosterone
and the “stress hormone”
cortisol provides the mechanism for Dr. Møller’s theory.
The problem, he says, is that
cholesterol is not a dietary
problem, but a sign of a biochemical problem—how the
body synthesizes cholesterol.
Excess cortisol is to blame,
he says. It interferes with the
normal metabolism of carbohydrates in food, which can
lead to insulin resistance and
plaque build-up, and eventually cardiovascular disease.
The solution, he says, is restoring testosterone, which
helps to keep cortisol levels
in check.
Thyroid Hormones
Dr. Broda Barnes concurs
with the belief that cholesterol is not the cause of heart
disease, but a symptom of
another problem. In his view,
thyroid deficiency is “firmly
established as the cause of
atherosclerosis.”
In Solved: The Riddle of Heart
Attacks, Dr. Barnes reports
how atherosclerosis is almost
always accompanied by thyroid deficiency, whereas high
cholesterol levels, even at an
early age, do not necessarily
result in a heart attack or cardiovascular disease.
Dr. Barnes claims that thyroid therapy, when given
early enough in the course
of the disease, prevents cardiovascular disease and
increases life expectancy.
There is a clear link between
thyroid hormones and normal heart function. For
example, the majority of thyroid deficient patients exhibit
hypertension. There is also
a relatively high incidence
of heart attacks and strokes
among patients with thyroid
deficiencies, and an extremely high rate of atherosclerosis
among patients who have
had their thyroid removed.
DHEA
The adrenal gland hormone
DHEA (dehydroepiandrosterone) is a precursor of both
testosterone and estrogens. It
supports muscle growth and
energy metabolism—the rate
at which our body absorbs
nutrients from our food.
Like testosterone, DHEA is
a steroid hormone that acts
to balance the effects of the
stress hormone, cortisol. It is
now well known that chronic
stress leads to an outpouring
of cortisol, and with that, a
gradual depletion of DHEA.
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Over time, this hormonal imbalance can lead to hardening
of the arteries, thinning bones,
increasing waistline girth, and
impaired functioning of the
immune system. By restoring
proper DHEA levels, the normal balance between DHEA
and cortisol can be restored.
Chronic
Inflammation
DHEA may also help to reduce inflammation. Proper
levels of DHEA promote a
healthy immune system by
helping to achieve the proper
balance among the various
types of cytokines.
Cytokines are proteins that
act as chemical messengers
in the body (much like hormones, except that they act
locally). They are especially
important for regulating inflammatory and immune
responses.
As early as the late nineteenth
century, a German physiologist proposed that heart
disease was caused by inflammation of the heart and
arteries. Rudolph Virchow,
called the “father of pathology,” originated this theory
after noticing that the hearts
of deceased heart attack victims looked like bruised and
infected flesh, relates Nancy
Appleton in Stopping Inflammation: Relieving the Cause of
Degenerative Diseases.
Medicine has come back
around to Virchow’s view,
as there is now widespread
acceptance of the role that
inflammation plays in the
development of atherosclerosis. Research in the 1980s
led to the development of
this now popular model: inflammatory immune-system
cells burrow into an arterial wall, where they are fed
by fat deposits. “These cells
form a plaque that is weakened by inflammation,”
Appleton writes. “Then the
fibrous cap ruptures, spilling
everything into the bloodstream, including cytokines
that encourage blood clotting ... thus changing a stable
cholesterol plaque into an
unstable lesion.”
Appleton also describes
newer research linking high
blood pressure to high cytokine production (indicating
an inflammatory response)
and also to allergens. By removing allergens, some
people have been able to end
their hypertension, possibly
by eliminating the trigger to
their body’s inflammatory
response.
What You Can Do
to Enhance Your
Vascular Health
Monitor Blood Pressure
Because blood pressure varies depending upon the time
of day, as well as your physical activity and stress levels,
a single reading may not
accurately represent your average blood pressure level.
For this reason, Dr. Susan
Lark, a researcher in clinical
nutrition, recommends using a digital blood pressure
machine to check your blood
pressure at home, in addition to routine monitoring
during medical appointments. When seeing your
healthcare practitioner, discuss your blood pressure,
especially if your home
readings are significantly
different than the blood
pressure reading at your
appointment. Be aware,
however, that some variation across blood pressure
devices is common.
Watch Your Diet
Two major federally-supported studies concluded
that those who eat many
fruits and vegetables,
whole-grain breads, lowerfat dairy foods and small
amounts of meat are the
least likely to develop high
blood pressure. Following this plan, known as the
DASH (Dietary Approaches
to Stop Hypertension) diet,
has been shown to significantly lower blood pressure.
This winning diet is all
about balance—in complex carbohydrates, fats,
proteins, vitamins and minerals— especially potassium
and magnesium.
Get Some Exercise
Exercise is also highly recommended for reducing
hypertension. As little as 30
minutes of walking or other
aerobic exercise per day has
been shown to reduce blood
pressure levels, allowing
some people to go off medication. Of course, getting fit
also helps you lose weight
and relieve stress.
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Reduce Stress
n Natural Cures for High Blood Pressure by Cass Ingram, DO; Knowledge House Publishers, 2005.
Achieving a healthy emotional balance can
also reduce blood pressure. Dr. Lark’s patients
report success using a variety of non-drug treatments such as meditation, deep breathing and
especially biofeedback, a training technique
whereby people can learn to improve their
health using signals from their own bodies. Dr.
Lark describes a British study in which industrial workers with hypertension lowered their
blood pressures after only eight weeks using
biofeedback.
n “Address the Hidden Causes of High Blood
Pressure” by Susan Lark, MD; Women’s Wellness
Today; May 2007.
n The High Blood Pressure Hoax by Sherry A. Rogers,
MD; Sand Key Company Inc., 2005.
n “Vitamin D and blood pressure connection: update on epidemiologic, clinical, and mechanistic
evidence” by L.A. Martini and R.J. Wood; Nutrition Reviews; Vol. 66, Issue 5; May 2008.
n “Sex hormones and hypertension “by R. K.
Dubey, et al.; Cardiovascular Research, Vol 53, Issue
3; February 2002.
Seek More Information
n “Estrogen Therapy and Coronary-Artery Calcification” by J.E. Manson, MD, et al.; The New
England Journal of Medicine, Vol. 356:2591-2602,
No. 25; 2007.
We may not know everything there is to know
about what causes high blood pressure, but we
do know that normal blood pressure can be restored and vascular health improved. Consult
with your healthcare practitioner to explore the
potential underlying causes and learn about
the treatment options available. Be an informed
healthcare consumer, and realize that restoring testosterone, progesterone, estrogens, and
maintaining thyroid and DHEA may be an important element in creating a healthy vascular
system.
n Student paper by Deepika R. Pereira, University
of Wisconsin Pharmacy School, 2006.
n “What is the effect of estrogen on blood pressure
after menopause?,” an editorial in Menopause: The
Journal of the North American Menopause Society,
Vol. 13, No. 3, 2006.
n Cholesterol: Interactions with Testosterone and Cortisol in Cardiovascular Diseases by Jens Møller, MD;
Springer-Verlag Berlin Heidelberg, 1987.
References
n Solved: The Riddle of Heart Attacks by Broda O.
Barnes, MD, PhD, and Charlotte W. Barnes, AM;
Robinson Press, Inc., 1992.
n “Beat High Blood Pressure the Natural Way!” by
Robert E. Kowalski; Total Health, Vol. 29, No. 1;
March/April 2007.
n Stopping Inflammation: Relieving the Cause of Degenerative Diseases by Nancy Appleton, PhD; Square
One Publishers, 2005.
Connections is a publication of Women’s International Pharmacy, which is dedicated to the education and management of PMS, menopause, infertility, postpartum depression, and other hormone-related conditions and therapies.
This publication is distributed with the understanding that it does not constitute medical advice for individual problems.
Although material is intended to be accurate, please seek proper medical advice from a competent healthcare professional.
Publisher: Constance Kindschi Hegerfeld, Executive VP, Women’s International Pharmacy
Co-Editors: Julie Johnson and Carol Petersen, RPh, CNP; Women’s International Pharmacy
Writer: Kathleen McCormick, McCormick Communications Illustrator: Amelia Janes, Midwest Educational Graphics
Copyright © August 2013, Women’s International Pharmacy. This newsletter may not be reproduced or distributed
without the permission of Women’s International Pharmacy.
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For more information, please visit www.womensinternational.com or call (800) 279-5708.
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