Finding Serendipity in a Hypertension Crash Course

Can I share a brutal fact with you?

One in every five adults has hypertension! This number is even lower if you live in a poor(er) country. Unbelievable? Here is the evidence! The stark reality is hypertension affects all your vital organs. It is a leading cause of premature deaths globally.

Think about this for a moment…between you and four of the people you know, one has hypertension and will probably suffer its complications. At least ONE person! This is concerning, isn’t it? I know that’s hard to take in. If you are not the ONE, that isn’t much of a relief…someone you know, a beloved ONE is.

I have had my fair share of a downer

When I was growing up, my maternal grandmother lived with us. Like me, my mother was an only daughter. 

Why is this relevant to anything?

My grandma had hypertension, and so did my mum! FYI familial history is a risk factor for developing hypertension.

My inaugural exposure to hypertension was of my grandma’s and subsequently of my mom.  Grandma’s illness was not managed with regular medications. Frequently she would become ill and mom would take her to the “clinic”. They would combine her prescribed meds with some homemade concoctions. She would get well for some time, then ill again.

Eventually, she lost her sight. I saw her declining steadily. From the woman who did our laundry, cooked delicacies, walked us to school, to one who required assistance to walk across the road because she was losing her sight and was too afraid to step out alone. 

Her symptoms and deterioration were down to poorly managed hypertension. This I know now!

There is more

Mom also complained about her hypertension, she knew when her blood pressure was high by her eye colour. They turned red(der). She was(still is) a worrier, a mother hen! Nonetheless, she too did not take any regular antihypertensives.

Today, her blood pressure is better controlled by modifying her diet and taking medications (when she remembers to take it).

The good thing about their predicaments, for me, was I resolved to sever that line of succession, to break that trans-generational transmission. Not that I knew how to at that time. I suppose heaven aligned with my determination! 

I have learned some incredible things that would hugely interest you

Route to high blood pressure

Every person exists by the autonomic circulation of blood throughout their body. This blood essentially carries nutrients, water, hormones and air  (oxygen) to cells.

Now this is important

Blood travels in a vessel, along with and against gravity, exerting pressure against the walls of the vessels. The health of the vessels directly influences that of the cardiovascular system.

Here is why that is important

The outer layer of the blood vessels (tunica adventitia) is made of connective tissues and functions to give shape, support and protection. The middle layer (tunica media) is made up of muscles and elastin that gives elasticity to regulate dilation and constriction, and the inner layer (tunica intima) is made up of smooth endothelial cells that provide frictionless movement of blood. 

Do you see where this is going?

When the endothelial layer is damaged, for example, resistance to blood flow occurs. Stiff, inelastic tunica media reduces the diameter through which blood flows and increases the force against which blood must flow.

Impairments in the functioning of any of these layers cause high pressure within the blood vessels.

Note that blood vessels refers to arteries, veins and capillaries that carry blood from the heart to the rest of the body and vice versa.

To bring it home; you get hypertension when there is sustained high pressure within your vessels as blood flows. The first reading of your blood pressure measurement is the pressure in your arteries when your heart beats to pump blood and the second reading is that of when your heart rests between beats- that is the level of resistance in your smaller vessels.

Some level of pressure is essential to enable adequate perfusion of all cells. For example, blood needs to travel at a good pressure against gravity to perfuse your brain. When this pressure is too low, blood flow is inadequate and cells starve, when the pressure is too high the heart must work harder to pump blood to cells.

Higher than normal blood pressure occurs as a result of smoking, diabetes, kidney disease, stress, atherosclerosis (plaques within the vessels), obesity, physical inactivity, poor nutrition, high blood cholesterol, autoimmune diseases such as scleroderma, hormonal imbalances, familial history, obstructive sleep apnoea, use of medications such as steroids and NSAIDs.

Hypertension increases your chances of getting heart failure, heart attack, coronary artery disease, angina, stroke, kidney disease, blindness, aneurysms (weak, bulging blood vessel), neurological impairments, peripheral vascular disease, alopecia, skin ulcers, muscle cramps and sexual dysfunction. The scary thing is, severe damages are caused to your body long before hypertension is detected or doom strikes.  A preventable silent killer! 

Prevention or cure? -two sides of the same coin?!

Advancements in medicine have led to huge improvements in the treatment of illnesses. Irrespective of this you would choose prevention over cure anytime, Wouldn’t you? This holds for hypertension despite its prevalence and the numerous approaches to managing it.

Is prevention a tad late for you? Don’t bang your head against the wall. You CAN salvage the havoc done and prevent deterioration. In essence, if you are already on the high (blood pressure) side, making simple changes to your lifestyle can help reduce insults to your body tissues.

Come along, I shall walk you through proven ways to nip hypertension in the bud.

Angiogenesis – the growth of new blood vessels

Thousands of miles of blood vessels line your body, working to deliver oxygen and nutrients to every cell of your body. The tiniest of these, the capillaries, end the line of vessels and make up the greatest percentage. Because they are the farthest from the heart, any reduction in blood supply makes capillaries the first to starve, causing cell deaths.

Dr William Li, founder of The Angiogenesis Foundation defines angiogenesis as the body’s mechanism for growing and maintaining blood vessels. Remarkably, when faced with blocked vessels, collateral vessels form as a natural bypass for blood flow. He asserts that certain foods stimulate angiogenesis.

Stick with me to discover more

Exercise

Exercise is a primary approach to prevent hypertension or its advancement. Aerobic (cardio) exercises are particularly beneficial. They are those activities that increase your heart and respiratory rate. They strengthen the heart muscles to pump more blood with minimal effort. Brisk walking, jumping, lawn mowing, cycling, walking up the stairs, swimming, running and dancing all count. And guess what? You don’t need a gym to reap the benefits.

Let me elaborate

To benefit from exercise you need to be consistent in moderate physical activity for at least 30 minutes daily. Benefits that accrue include reduced inflammatory markers, dilated blood vessels diameter, increased activity of central nitric oxide synthase, decreased thickness of your heart wall, stimulation of enzymes involved in the transport of LDLs to the liver and decreased adrenaline production.

I’m not stopping there now

Resistance exercises such as weight lifting and squats are also proven to reduce blood pressure. Include this in your regime to build strength, burn more fat and improve flexibility. Regular high intensity exercises for example create an oxygen deficit in the working muscles. The demand for oxygen stimulates (through complex processes) capillaries to form so as to supply more oxygen(angiogenesis!).

Consult your doctor before starting any rigorous exercise regime if you have advanced stage hypertension or any chronic illness. 

Cholesterol

Cholesterol is a type of fat in your blood. It is primarily made by your liver, however, it can be found in some animal foods. You may know it as a “bad” thing. Honestly, the guy gets bad press for lack of better understanding. Guess what! It is an essential component of your cell walls; moreover, your body needs it to make hormones such as estrogen, testosterone, progesterone and also to make vitamins. For example, when your skin is exposed to sunlight, the cholesterol under your skin is converted into cholecalciferol known as vitamin D3.

do you know that Fat is insoluble in blood?

Therefore a substance called lipoprotein binds cholesterol on to protein molecules so that cholesterol can transported in blood.

There are different types of cholesterol. The composition and density of lipoprotein determine the type. And how much of the various types of cholesterol determine your risk of disease.

So you see, you cannot outrightly vilify cholesterol without first identifying its various aspects.

Triglycerides

When you eat high fat (saturated fat) and calorie-dense (eg sugar and carbohydrates) foods over that which your body needs, the rest is stored up as triglycerides in your fat cells to provide energy between meals as needed. Triglycerides are a type of fat carried in your blood.

LDLs (Low Density Lipoproteins)

This is a part of cholesterol that carries triglycerides from the intestines and liver to be stored as body fat (adipose tissue) underneath your skin, between muscles, within the bone marrow, around the buttocks, breast and internal organs. You need it for insulation, cushioning and energy. Adipose tissue plays vital roles such as in the production of leptin the hunger suppressing hormone and adiponectin which increases the body’s sensitivity to insulin.

Too many LDLs in circulation is the genesis of plaque formation within the walls of your blood vessels. This happens through a complex process of inflammation called atherosclerosis. Stable plaques cause angina. that is chest pain on exertion. Unstable plaques can break off and cause stroke or heart attack. Plaques reduce blood vessel diameter and elasticity. This resists the flow of blood and increases blood pressure.

The rule of thumb is not to completely avoid fats, but minimise intake of saturated fats, simple carbohydrates and sugar.

HDLs

This is the type of cholesterol that is beneficial. HDLs carry cholesterol from your peripheral to your liver to be recycled and excreted by your bile. In action, it roams your body mopping up excess cholesterol. HDL particles are beneficial for health because they carry enzymes and proteins that are proven to reduce oxidation, inflammation and blood clots. HDLs support your innate immunity by binding to endotoxins and nullifying their effects. It affects many other biological processes such as the transport of hormones, RNA, and vitamins.

Higher levels of LDLs in your circulation is beneficial for your health.

With this in mind your cholesterol level should account for ratios between triglycerides, LDLs and HDLs. A higher HDL to LDL ratio is ideal.

Nitric Oxide (NO) – the “Miracle Molecule”

NO is a gaseous molecule whose important functions are found in industrial chemistry, plants and humans. In the body, it works as an enzyme (synthase) to stimulate many biological processes. It is popularly known for its actions as a blood vessel dilator. This occurs via two pathways 1) from amino acid L-arginine acted upon by NO synthase and 2) enzymes in salivary glands acting on dietary nitrates and nitrites into NO.

Present in your body are three forms of enzymes that stimulate nitric oxide production. Namely: endothelial nitric oxide synthase (eNOS), inducible (iNOS) and neural (nNOS). All three are involved in regulating your blood pressure. However eNOS plays the chief role.

eNOS in your vascular smooth muscles acts on the amino acid L-arginine (derived from food and nutritional supplements), to convert it to nitric oxide gas. This gas travels across your vessel membranes causing a cascade of reactions (beyond the remit of this post) that eventually relax the vessels, reducing pressure within them. As if that is not enough, this process prevents platelets from sticking together to become clots and also inhibits the adhesion of plaques on to the inner walls of blood vessels.

In another manner, when you eat nitrate-rich foods such as found in the DASH diet, salivary enzymes called nitrate reductase enzymes convert nitrates to nitrites. On reaching the acidic environment in your stomach, nitrite is reduced to nitric oxide. This travels through the body, exerting its effects throughout.

Sounds simple?

It is! However nitric oxide is highly reactive and has a half-life of few seconds… the gas dissipates or becomes inactivated by other substances in the body as it is produced. Guess what potentiates the work of L-arginine? L-citrulline; another amino acid found in foods such as watermelon, garlic, almonds and dark chocolate. Interestingly, about 80% of L citrulline is recycled into L arginine by the kidneys.

Nutrition

When diet is wrong medicine is of no use

When diet is right medicine is of no need

Ayurvedic proverb

The food you eat arguably has the largest impact on your health. Nutrients such as proteins, fat, vitamins and minerals available ( or absent) in your diet influence how your body functions.

Lets delve more into it

To determine the effect of diet on blood pressure, researchers using Dieting Approach to Stopping Hypertension (DASH) found that a diet rich in fruits, vegetables and low in saturated fats significantly lower blood pressure.

Seeds and (whole)grains are high in fibre. Dietary fibre binds to fats from food and passes them out in faeces. This prevents the body from absorbing fats. Beta-glucan, a form of soluble fibre found in grains is known to work in that way. And guess what? This substance also promotes angiogenesis.

Nutrient-dense seeds such as chia seeds and flaxseed seed are cardio-protective. They contain essential fatty acids, fibre, vitamins and minerals. This post details six seeds you should eat. All the seeds mentioned in the post contain lignan, a bioactive compound that prevents inflammation and oxidation- the two major precursors of many diseases.

Pay particular attention to these foods

• Foods containing Ursolic acid such as peppermint, rosemary, thyme, basil, sage, oregano) and fruit skins.
• Foods rich in Flavanoids ( (coloured fruits and vegetables, e.g onions, broccoli, blueberries, tomatoes, chili peppers, green tea, red wine and soy)
• Monounsaturated fats & Omega-3 fatty acids (extra virgin olive oils, avocado, omega 3 fish oil)

Ever noticed how you drink more water when you eat salty food? This is because water goes with salt. The more water in your body, the harder your heart works to push all that volume around your body, and the harder your kidneys work to excrete the salt. Persistent stress on these organs damages them. On top of that, NO production is reduced with high salt intake.

Reduce salt intake. Watch out for excess salt in processed and fast foods.

Medication

If you are already diagnosed with hypertension, you are most likely taking one or more meds from these classes:

Statins work to reduce LDLs in your bloodstream by preventing LDL cholesterol synthesis in the liver. They bind to the enzymes that make cholesterol and block its actions. Lower production of cholesterol allows the liver to mop up LDLs from your blood and make bile. How do you know which of your meds is a statin? The “statin” in their names gives them away e.g Atorvastatin.

Angiotensin Converting Enzyme (ACE) inhibitors as the name suggests is a group of antihypertensives that work to prevent the release of the hormone angiotensin II. This hormone is a vessel constrictor and so by hindering the production, blood vessels relax and open up to allow blood flow. This research shows that they also reduce the volume of blood in circulation by working on the kidneys to reduce the amount of sodium reabsorbed. They generally end in “pril”e.g Ramipril

Angiotensin II Receptor Blockers work by blocking the activation of angiotensin receptors. Know them by “sartan” suffix e.g Valsartan

Beta Blockers work on a specific receptor (beta-adrenergic) to inhibit the effect of the hormone adrenaline. The effect of adrenaline on the body is highlighted in this post. Inhibiting adrenaline leads to weaker heart contractions, beats and pressure in the big vessels. Know them with the “lol” ending e.g. Labetalol.

Calcium Channel Blockers work by preventing calcium from entering your arteries and heart. The thing is, Calcium causes muscles to contract strongly and by so doing increases pressure within the vessels. By blocking its entry, smooth muscles in the arteries relax to accommodate blood flow. Medications in this group tend to have a “pine” ending e.g Amlodipine.

Diuretics are called water pills, these are first-line medications to manage hypertension. They work on the kidneys to excrete more water and salt, thereby reducing the volume of blood.

Bear in mind that these meds, like many others have side effects. Common side effects tend to depend on what body activity is inhibited or given expression.

In essence

You CAN reduce/eliminate your risk of getting hypertension. Here’s how: quit smoking, manage stress well, reduce: salt, saturated fat, refined carbohydrate, alcohol and take up physical activities. It is important to take your medications as prescribed.

More importantly, make your approach sustainable and beneficial by remaining disciplined and consistent. Go Forth and Revolutionise Yourself!

I’m glad you read this far. Did you find anything useful? Disagree with anything? I love to know. Leave a comment to share it.