First, a quick story and my own experience over the last six months.

For a number of years, I have had my blood pressure in tens (between 110 and 119) for Systolic and in the seventy’s for the Diastolic.  So, my typical BP measurement might be 112/74.

For the last couple of years, however, every time I visited a doctor or clinic, I noticed that it was in the high twenty’s or low thirty’s for Systolic (125 to 135 range) and low eighty’s for the Diastolic pressure. For example, I might see my as BP 128/82. Doctors always called it out as “normal” and I ignored it assuming that those were spurious readings.

About six months ago, I decided to get a BP monitor and started measuring my blood pressure frequently – like every day and even multiple times during a day.  I noticed that the higher readings I had seen during the last couple of years were actually true. I wanted to know if it was inevitable that my BP would be creeping up as I get older.  Or, could I do something about it?

And, so I decided to take a deeper dive into this topic of BP.

First, I asked my wellness doc if he had any ideas. He told me that it was nothing to worry about. When I insisted on understanding why my BP not stay in the tens for Systolic and seventy’s for diastolic, he told me that I was already eating a pretty clean vegetarian diet.  He suggested I could experiment with vegan diet and also suggested a couple of books to read.

Well after about six months of eating vegan (only plant based whole food, no eggs, no dairy, no meat) and daily monitoring my BP, it looks like my BP is nicely settling in the tens range for systolic and in the seventy’s range for diastolic and times even lower.

And, here is a quick synopsis of what I learned along the way about what is optimal BP and how to achieve it. You might find surprising some of  what I learned and am sharing here.

What is Optimal BP?

We have all heard that BP is the “silent killer”. That uncontrolled high BP can injure or kill you. According to American Heart Association website, possible health consequence can happen over time, if left untreated include:

• Coronoary Heart Disease or CHD, i.e., damage to the heart and coronary arteries, including heart attack, heart disease, congestive heart failure, aortic dissection and atherosclerosis (fatty buildups in the arteries that cause them to harden)
• Stroke
• Kidney damage
• Vision loss
• Erectile dysfunction
• Memory loss
• Fluid in the lungs
• Angina
• Peripheral artery disease

I am sure you have also heard that BP less than 120/80 is considered “normal”.  120 – 139 for systolic or 80 to 89 for diastolic is considered pre-hypertension.  And, anything above those numbers is considered hypertension and your doc will say that you must do something to bring it in the lower ranges. NIH National, Heart, Lung, and Blood Institute website publishes this guidance:

Stages of High Blood Pressure in Adults

Stages	Systolic (top number)		Diastolic (bottom number)
Prehypertension	120–139	OR	80–89
High blood pressure Stage 1	140–159	OR	90–99
High blood pressure Stage 2	160 or higher	OR	100 or higher

Well, where do these numbers come from?

As you may already know, if you have been reading these blog posts, that I am always suspect of the word “normal”.  I prefer talking about “optimal”.

 Updated Research on BP

In BMJ 2009, M R Law et al, published a very extensive meta-analysis study of 143 previously completed clinical trials on the use of BP lowering drugs. A meta-analysis study is a study of already published studies to assemble an overall conclusion. A key conclusion of this meta-analysis study was:

“The relative risk estimates of CHD events and stroke in the blood pressure difference trials were similar across all levels of blood pressure before treatment down to 110 mm Hg systolic and 70 mm Hg diastolic, below which there were too few data.”

Basically, from all previous studies they analyzed that the risk of all coronary heart disease and stoke continued to decrease as the BP were lowered to 110/70.  They could not tell if the trend would continue below 110/70, since there was not enough data available for cases below 110/70.

So, 110/70 is definitely better than 120/80 in reducing the risk of CHD and strokes.  Is 105/65 or other lower numbers better than 110/70, they could not prove it due to insufficient data.

Here is another conclusion:

“This, the largest meta-analysis of randomised trials of blood pressure reduction to date, shows that lowering systolic blood pressure by 10 mm Hg or diastolic blood pressure by 5 mm Hg using any of the main classes of blood pressure lowering drugs, reduces CHD events (fatal and non-fatal) by about a quarter and stroke by about a third, regardless of the presence or absence of vascular disease and of blood pressure before treatment, with no increase in non-vascular mortality. Heart failure is also reduced by about a quarter. Proportional disease reduction for a given blood pressure reduction independent of pretreatment blood pressure.”

Translated it means the risk of CHD and strokes decreases at the same rate no matter what the starting point is. So, when you lower your systolic BP from 140 to 130, or 130 to 120 or from 120 to 110, you decrease you risk by the same amount, of CHD by 25% and strokes by 33%.

The following example from the research paper illustrate this calculations.

“At age 60-69, the relative risk of stroke is 0.43 (57% decrease) for a 20 mm Hg decrease in systolic blood pressure. For a blood pressure decrease twice as great (40 mm Hg), the relative risk of 0.43 effectively applies twice (0.43×0.43, or 0.43²), which is 0.18 (an 82% decrease).”

That is quite amazing, isn’t it?

Do you have to take meds to lower your blood pressure?

Short answer is: of course, not.

Michael Gregor, M.D. in his book, “How not to Die”, Chapter 7: How Not to Die from High Blood Pressure, very succinctly lays out who the villains and heroes are in the epic story of BP.

Villains are Sodium and all the foods that sneak sodium in the form of salt into our diet. Mechanism seems simple enough. Sodium causes water retention and body raises blood pressure to try to expel the excess retained water from the body.

There is a plethora of research that shows that if you lower your sodium intake to less than 500 mg a day, you can achieve a 110/70 BP.

Heroes are anti-oxidant, potassium and nitrate rich foods that provide antidote to sodium and the damage it does to the cardiovascular system. Adding the following foods to your diet will further lower or make it easier to bring it in the right range:

• Rhubarb
• Leafy green vegetables;, arugula, cilantro, butter leaf lettuce, Mesclun greens, beet greens, basil, oak leaf lettuce Swiss chard
• Beets
• Ground flaxseed
• Whole Grains
• Hibiscus Tea

Does the BP have to go up as we age?

Short answer is: NO.

Yes, the phenomenon of BP going up with age is what has been observed in “normal” situations. However, citing lots of existing research, Dr. Gregor demonstrates that the idea that BP has to go up as we age is a myth. With proper food intakes we can have a healthy BP for life.

Bottom line

There is extensive research available to establish that high Blood Pressure is indeed the silent killer it is made out to be. Consequences of high BP if left unchecked for extended period of time can cause many health issues beyond coronary heart disease and strokes.

120/80 may be considered “normal”, but is not actually optimal. Clear evidence exists that by lowering BP to 110/70, you can further reduce risks of CHD and stroke.  Further, benefits of lowering BP to less than 120/80 are significant.  There is not enough evidence at this time that numbers lower numbers than 110/70  further reduce the risks.

Meds are not the only means to lower BP. You can use lifestyle changes to lower BP to 110/70 or lower.

 Reducing sodium intake dramatically, lower than 500 mg per day, can lower the BP to 110/70.

Anti-oxidant, potassium and nitrate rich foods provide antidote to sodium and the damage it does to the cardiovascular system. Adding the following foods to your diet will further lower or make it easier to bring it in the right range:

1. Rhubarb
2. Leafy green vegetables;, arugula, cilantro, butter leaf lettuce, Mesclun greens, beet greens, basil, oak leaf lettuce Swiss chard
3. Beets
4. Ground flaxseed
5. Whole Grains
6. Hibiscus Tea

AHA’s website offers a neat little tool for you to see how much BP you can expect to lower with different recommended lifestyle changes.

 

So there you have it, results of my experience and deep dive into this topic so far!

What are your thoughts on this subject?

Would love to hear from you and learn from you.

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