High blood pressure? Read on ...

Two months after my 41st birthday (in March), I seized the offer of a free heart function check that was heavily promoted on Sydney Radio 2GB. That test was short and sweet. And inconclusive.

A follow up - and not inexpensive - echocardiogram (heart ultrasound) - revealed both good news and bad news. The good news was that my heart was OK. The bad news was that my blood pressure was high. Way too high.

At my general practitioner’s insistence, I had my BP rechecked, and in no time was hooked up to a 24-hour BP monitor that confirmed my hypertension.

While I knew that the condition was hereditary, I thought that I’d “inherit” the malady later in life. Like when I’m 60 or older.

Given diet is a major influence on BP, I was safe in the knowledge that mine was always somewhere between “OK” and “good”. I don’t smoke and don’t drink. I run three times a week and am not overweight. I even pop Omega 3 pills and multivitamins now and again. And so I couldn’t fathom why I should now inherit this condition. If ever.

On a visit to the GP, my BP was checked. It was parked at 164/94 (or 164 over 94). Not a good reading. A subsequent test, a week later, registered 150/80. My GP noted that normal blood pressure is less than 120 over less than 80, and prescribed an angiotensin-2 receptor antagonist of the type “irbesartan”, sold commercially as Avapro.

Medically, hypertension can be treated with a range of different drugs, including:

• Diuretics, which make you pass urine more often and get rid of excess fluid;
• Beta-blockers, which make the heart beat more slowly and less strongly; and
• Angiotensin-Converting Enzyme (ACE) inhibitors and angiotensin-2 receptor antagonists, which in general relax the blood vessels. This is the family of drugs to which Avapro belongs.

After popping one tablet a day for two months (and noting the side effects: dizziness and a diminished libido), while on holiday in the United States, by pure chance I stumbled over Robert E. Kowalski’s The Blood Pressure Cure - 8-Weeks to Lower Blood Pressure Without Prescription Drugs.

The world renowned medical journalist and author of the New York Times best selling 8 Week Cholesterol Cure is the survivor of a heart attack who underwent two coronary bypass surgeries. He has turned his attention to his blood pressure, relating how he lost weight, quit smoking, managed stress, lowered his BP and managed his cholesterol levels, while avoiding medications and their side effects.

Kowalski’s book is crammed with data about the nature of blood pressure, its relationship to cholesterol, triglycerides, diet, exercise and electrolytes (sodium, potassium, calcium and magnesium).

Given my ignorance of hypertension, which is large, I was fascinated to learn that hypertension is one of the three major risk factors for heart disease and strokes. The other risk factors are cholesterol and cigarettes. BP is insidious however, as there are no symptoms of high blood pressure, until it’s too late. One “symptom” is called a stroke. Another is called a heart attack.

Prior to detailing the cure for hypertension, Kowalksi comprehensively relates its nature and its causes. He explains many aspects of hypertension including: the significance of the condition in children (especially in families where there is a history of cardiovascular disease); women’s attitude to hypertension, where he holds that women are generally focused on breast and ovarian cancer and not on heart disease, even though heart disease will claim more female victims than breast cancer; and, in the case of senior citizens, the relationship between elevated blood pressure and dementia.

Throughout the book, Kowalski makes claims for and against foods, minerals and supplements. He follows his claims with citations of research from the United States, Australia, Israel, Taiwan and the Netherlands. And while he urges the reader to exercise, he is a realist, explaining a 30-minute walk (most days) is good enough, and there’s no need for a sweaty work out at the gym. Lucky for me.

While on his soap box, Kowalski reiterates not only that we should eat less, but that we should eat better. And he draws into focus just how easy it is to make healthy food choices. Granted, not quite as easy as making unhealthy ones, but easy enough. He spotlights four electrolytes: sodium, potassium, calcium and magnesium.

Sodium and salt substitutes: cutting back on salt is a good idea assuming you are salt sensitive. Many are not salt sensitive, yet many follow this directive, even when it has no effect on them. He explains that salt and other sodium compounds are involved in a chemical sequence initiated in the kidneys that ends with the production of a substance, angiotensin that raises blood pressure. Some BP medication blocks the action of the angiotensin. The greater one’s sensitivity to sodium, the more angiotensin is made in the kidney, the more sodium stored in the body, and the more water is retained in the body’s tissues. All of this elevates BP.

Should everyone restrict salt and sodium? Yes, if you’re salt sensitive. Bearing in mind that the salt you add from the shaker is paltry compared to what is found in packaged and processed foods, Kowalksi suggests you measure your BP over a few days on your current diet and then stop all salt. Add no salt to your cooking and meals. Desist from processed foods including takeaways, terminate between meal snacks and while he doesn’t say so, I assume stop visiting restaurants. If your BP improves significantly then, congratulations. Keep it up. If you see no improvement, don’t worry. There are other ways of lowering your BP.

He relates the twin benefits of potassium chloride. Not only does it function as a salt substitute, but it packs a whopping amount of potassium. Use it when cooking in place of salt and you won’t even taste it! A Taiwanese study comparing salt (sodium chloride) eaters and salt substitute (potassium chloride) eaters showed that the latter had 40 per cent less chance of dying from cardiovascular disease than the salt eaters. Research suggests the difference was not due to less sodium being consumed by the latter group but rather because of that group’s higher potassium intake.

Potassium: too much sodium in the body signals the kidneys to raise blood pressure. Too little potassium does the same thing.

According to Kowalski, too many Americans (and I wonder … Australians?) consume insufficient potassium. A 1991 study where participants were restricted potassium for 10 days resulted in rises in BP whether the participants had normal or elevated pressure to start with. A 12-year Californian study suggested that a high potassium intake protected against strokes, the worst result of hypertension.

Potassium restriction was also associated with sodium retention and with calcium depletion in various studies. The converse is also true. Potassium causes the body to excrete more sodium in the urine, the very same mode of action achieved with anti-hypertensive drugs called thiazide diuretics.

Calcium: the third electrolyte was proven to be (when consumed in insufficient amounts) at least as important as consuming too much sodium. So how does calcium work its wonders? It lowers the concentration of parathyroid hormone in the blood. This is the hormone that regulates calcium metabolism. In turn, that may reduce calcium concentrations in the body’s cells and slow the calcium from entering the arteries. Calcium in the arteries affects the tone of the vessels, thus potentially leading to higher blood pressure as the arteries stiffen.

One study showed that toddlers whose mothers took prenatal calcium supplements had lower blood pressure than those whose mothers did not.

Magnesium: the fourth electrolyte needed by the body. Like calcium and potassium, we consume far too little of this mineral. Magnesium aids in proper nerve function and assists in energy metabolism. It is involved in muscle activity, activates certain enzymes and is used by the body to make cell protein, fats and carbohydrates. Study after study indicates that the more magnesium that is consumed the greater the decline in BP.

Kowalski intones that while good food is crammed with the right minerals, his prescription calls for intakes far greater than found even in the best of diets. Bottom line: get used to popping half a dozen heavy duty vitamin supplements and minerals, daily.

Kowalski preaches way beyond simple lifestyle changes such as weight loss and cigarette cessation. While acknowledging that these are useful steps, they do not bring blood pressure levels to normal. His wish list for the reader is as follows:

1. When next at your GP, get your BP tested, with a cuff inflator on your upper arm. Don’t measure BP on the wrist.
2. Buy a home BP monitoring device. He recommends the German brand OMRON. They’re as accurate as testing in a doctor’s office and will give you a better reading as it will not be subject to “white coat syndrome”, the feeling that overcomes many when in the presence of medicos.
3. Eat better: more fruits and vegetables, whole grains, seafood, poultry, lean meats, nuts, no-fat and low-fat dairy foods, and good oils (e.g. olive and canola).
4. Swap sodium chloride for potassium chloride. Ensure you get enough calcium, magnesium, and potassium to keep your BP in balance.
5. Exercise 30 minutes a day, most days. More, if you can manage it.
6. De-stress three or four times a day, close your eyes breathe deeply. If you have any sleeping disorder, get it checked.
7. Attain and maintain a healthy weight. While Kowalski recites the Body Mass index mantra (being the body weight in kilograms divided by the height squared), thankfully he prefers the more realistic waist guide measurement. He says that women with waist circumference of 35 inches or more and men with 40 inches or more will lower BP by 2 point for every kilogram lost. Subtle message: lose that excess baggage you’re carrying.
8. Quit smoking. A no-brainer.
9. Drink hot cocoa. Enjoy a hot cup of cocoa half an hour before bedtime. Cocoa is rich in polyphenols (a plant substance that has been clinically proven to lower BP). Or eat (in very small quantities) very dark chocolate. Eliminate cola drinks. You can keep drinking coffee. And keep an eagle eye out for the words “hydrogenated” on the packages of foods you buy at the supermarket. This is code for trans-fatty acids which not only raise the bad cholesterol (LDL) but also lower the good cholesterol (HDL). They are added to foods to lengthen their shelf life and improve taste.
10. Take proven supplements including grape seed extract, tomato extract, pycnogenol (a derivative of the French maritime pine tree). These dietary supplements have been clinically proven at major medical research centres to dramatically lower blood pressure, often as much as prescription drugs - but without the side effects. With somewhat less enthusiasm, he recommends ingesting the amino acid, L-arginine.

There is much to hear about hypertension, but unfortunately most of us listen when it’s already too late to act. A GP’s inculcation, such as “take this tablet once a day, and let's check the BP in a month, shall we” is not my idea of sound health management.

Unfortunately, given the low profile BP has, we rarely get timely medical or dietary advice before we get hit with the news of our high BP.

If you’re like me and are new to high BP or if you’ve been “managing” your BP for years with drugs, or better still, if you’re a likely candidate for high BP based on your family’s cardiovascular history or on your poor diet, then this book will open your eyes to another way of management.

As for me, I’ve stopped popping Avapro. I started taking it two months ago, and my BP has improved from a “bad” 164/94 to an “excellent”’ 120/70. My GP is over the moon. But the improvement, may I add, wasn’t free. It came with side effects.

I will give myself 10 weeks on Kowalski’s program to see if it works. When mentioning this to my GP, I was surprised, (and delighted) by her wholly supportive stance. After all, by following Kowalski’s program, if it works, I have nothing to lose, apart from a regimen of Avapro.

But if Kowalski’s cure fails me, then it’s straight back to my Avapro or another BP drug. Or I can risk high BP and what that entails.

But if Kowalski’s prescription does succeed in keeping my BP under control, then I’ll be rid of not only Avapro’s dreaded side effects, but also of my recurring nightmare, where nightly I ask myself: what damage will a drug like Avapro do to me, if I were to take it daily for say the next say 40 years. What damage indeed.