Hypertension: Understanding and managing high blood pressure

January 26, 2025, 1:20 PM IST Lalit Kapoor in FIVE PILLARS OF HEALTH: A Blueprint for Wellbeing, Health, TOI

 

The human body contains over 70,000 miles of blood vessels, lined by a single layer of endothelial cells. This inner lining, called the endothelium, has a surface area equivalent to 6–8 tennis courts, making it the largest organ in the body. A healthy endothelium is crucial for maintaining smooth blood flow and releasing nitric oxide (NO), a gas that reduces friction in blood flow.

Role of Diet and Atherosclerosis 

In infancy, the endothelium is pristine. However, as we grow and consume inflammatory foods, this lining becomes damaged. The body responds by coating the damaged areas with cholesterol, leading to a condition called atherosclerosis. Over time, these deposits narrow the blood vessels, reduce flexibility, and impair the release of NO. This increased resistance raises blood pressure (BP).

With aging, a further complication called arteriosclerosis, occurs as blood vessels harden due to calcification. These changes necessitate higher blood pressure to maintain proper blood flow, particularly after the age of 60–70.

How blood pressure works?

Blood pressure depends on blood volume and resistance. Factors that increase BP include:

•Reduced arterial flexibility.

•Narrower blood vessel openings.

•Higher blood viscosity.

While higher BP in older adults can be a natural adaptation, modern medicine often focuses on lowering it with medications. Unfortunately, few address the root cause—diet.

A Plant Based Solution

Switching to a whole-food, plant-based (PBWF) diet promotes healing. Green leafy vegetables, rich in natural nitrates, improve NO production, enhance blood flow, and clear clogged vessels. Dramatic changes in diet and lifestyle lead to faster recovery. For example, participants in Dr. McDougall’s 10-day program in Santa Rosa saw an average BP drop of 17/11 mmHg, with 90% reducing or eliminating medications.

Blood pressure changes over time

Infancy: Average BP starts at 64/41, rising to 95/58 by age 2.

Childhood: With the introduction of inflammatory foods which causes atherosclerosis, BP increases to an average of 110/70 by age 10.

Adulthood: By 16–18, average BP is 120/80, with a normal range of 110–131 over 64–83. After 18, these guidelines remain unchanged, though BP naturally rises with age due to atherosclerosis and arteriosclerosis.

Historical perspective on hypertension 

In the past, high BP was not always viewed as dangerous.

•Before 1911, levels up to 210/110 were considered benign.

•In 1937, cardiologist Paul Dudley White suggested that high BP might be a compensatory mechanism and should not always be reduced.

•By the 1960s and 70s, with the advent of medications, treating hypertension became standard, though debate over its necessity persisted.

Hypertension treatment guidelines 

The Joint National Committee (JNC) was established in the United States in 1976 to provide blood pressure guidelines. Over the years, these have shifted:

•1997 (JNC-6): Hypertension was defined as BP ≥ 140/90

•2004 (JNC-7): Introduced the concept of “pre-hypertension” (120/80 to 139/89).

•2014 (JNC-8): Relaxed guidelines, recommending BP targets of <150/90 for adults over age 60 and <140/90 for younger adults.

However, these changes reduced pharmaceutical profits and health care providers’ income.  In response, the American Heart Association (AHA) and American College of Cardiology (ACC) issued stricter guidelines in 2017, lowering the hypertension threshold to 130/80, adding 31 million Americans to those needing treatment. This move reflected financial interests rather than public health priorities.

Problems with aggressive BP management

While lowering BP might seem beneficial, excessive reduction, especially in older adults, increases risks. The “J-Curve” phenomenon, documented in a 2008 study (ACCORD Study) showed no additional benefits in lowering systolic BP below 140.

For individuals over 60, BP medication should only aim for a target of 150/90. Lower targets often result in adverse effects, including increased heart disease risk and reduced life expectancy.

Misdiagnosis & errors

Blood pressure readings are frequently inaccurate due to improper techniques or the “white coat effect” (anxiety in clinical settings). A proper measurement protocol includes:

•Resting for 5 minutes.

•Sitting with back support, feet on the floor, and arm at heart level.

•Avoiding caffeine, smoking, or exercise 30 minutes before measurement.

•Using the correct cuff size and averaging multiple readings.

A 2017 study called Systolic BP Intervention Trial (SPRINT) revealed that “research-grade” measurements (automated, after rest) were 12.7 mmHg lower than routine office readings. Ambulatory monitoring, which tracks BP over 24 hours, provides the most accurate results.

Role of PBWF diet in hypertension management 

Switching to a PBWF diet reduces inflammation, repairs the endothelium, and lowers BP naturally within weeks. Compared to medication, dietary changes offer a safer, more effective solution:

•Nitric Oxide production improves, reducing blood vessel resistance.

•The risk of adverse drug reactions and kidney problems is eliminated.

For people over 60, maintaining BP below 150/90 without medication is the optimal goal. Younger individuals should aim for under 140/90.

Conclusion

The modern approach to hypertension often prioritizes pharmaceutical profits over patient health. However, the evidence is clear: a PBWF diet can reverse the root causes of high blood pressure, improving overall health without the risks associated with medication.

For those committed to lifestyle changes, achieving healthy BP levels is one of the easiest, and most rewarding, goals.

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