Ratha (papertygre) wrote,

High blood pressure

For years my blood pressure was borderline, but I always thought it was just driven a little high by birth control estrogen, and I always observed that it would go to normal whenever I discontinued the BC. So I wasn't worried.

Well, in my recent medical adventure getting an arterial stent put in (to fix an injury), they were measuring pretty high blood pressure. Like, as high as 150/90 and occasionally higher. I spent about 2 weeks in the hospital (and discontinued BC a few days after I arrived) so there was plenty of time to track this. Whenever it was really high, the nurses usually didn't believe it, got out a manual cuff to try again, and came up with a lower reading (and when they did this, I got the feeling they were fudging it to conform to their beliefs). I think I look younger than my 36 years, and I believe there is a bias against someone who looks young and healthy having something like hypertension. Plus there is the well known "white coat hypertension" syndrome, and also my dad insists that my BP is likely just "labile" meaning if I could relax more, it would go down. Maybe.

Now that I've got all this hardware, I figure I should be extra careful with my health. I've already been trying to follow a low-fat, whole food diet with moderate salt. For a few years I've been avoiding getting a primary care doc but I should get one soon, and I'm pretty sure when I do, they are going to (a) take my birth control away (I love the convenience of the Ring, which has no progesterone-only alternative), and then they will (b) insist I go on BP medication, which I am very disinclined to do. So I have set about trying to solve the blood pressure issue on my own.

I have become extremely disappointed with the apparent state of knowledge regarding hypertension. Witness: "the precise pathophysiological mechanisms of hypertension and its complications are still poorly understood" [some expert writing on the AHA site]. When you search around, pretty much all the information says: "if you have primary hypertension you will be asked to reduce salt and get more exercise, but you can safely assume that won't help enough, so get ready to take some drugs." Why? Because high blood pressure increases the risk of heart attack and stroke, that's why. But will the hypertension drugs reduce the risk of heart attack or stroke, or just bring the numbers down and inflict side effects? In other words is the high blood pressure a contributing factor to heart attack and stroke, or merely a separate effect with a common cause? These questions are ignored.

In Japan, they consume prodigious amounts of salt, like 10+ grams a day in some places, and they have had pretty high incidence of hemorrhagic stroke, which is the kind where blood vessels in the brain burst under the load. Apparently in the 1950s there was a public health campaign to reduce sodium intake in Japan, and this had the effect of reducing stroke mortality by 80%! [ref]. So clearly high blood pressure from excessive sodium consumption leads to hemorrhagic stroke. But when they talk about hypertension being a risk factor for heart attacks and stroke, they are talking about ischemic stroke, caused by blood clots. Heart attacks are caused by clots near the heart, and ischemic strokes are caused by clots in the brain; actually, they now know that it's usually a sudden rupture of plaque on the wall of the artery that causes the clot leading to the heart attack or stroke event. But OK, so what is the connection between hypertension and arterial plaque? My best inference from a bunch of reading is that they are not directly related. For starters, they actually don't know what causes hypertension. It's not caused by stiff artery walls, which would be the obvious explanation because maybe lots of plaque in the arteries makes them stiff. But even if stiff arteries did cause high blood pressure, then ostensibly high blood pressure would only be dangerous because it's a warning sign that you have lots of plaque (at least, up to the point at which the pressure is high enough to become "malignant" and start directly causing organ damage). Another possible explanation is that sodium intake has some effect on cardiovascular disease directly, and also happens to raise blood pressure. Either way, to me it would be incredibly irresponsible to administer drugs aimed solely at lowering blood pressure -- there are several kinds of drugs, but I'm particularly thinking of the diuretic kind which lowers blood volume which causes blood pressure to lower -- because this makes the numbers go down, but does nothing whatever to affect the root causes that lead to heart attack or stroke, does it?

The jury seems to be out on this -- Dr. Fuhrman says that treating blood pressure has not lowered heart disease mortality, consistent with my conjecture, but this fellow claims that death rates have fallen, in part due to the treatment of hypertension. I was not able to trace any references for either claim.

Furthermore, "overtreating" hypertension actually increases the risk of heart attack. This paper recommends not trying to lower diastolic below 84. This makes sense because if your blood vessels are partially occluded, then during the diastole (time between beats) when most of the blood flow to the heart muscle itself occurs, if the pressure is too low then the heart muscle could be inadequately nourished. Again the problem is the occlusion, not the blood pressure itself. Right?

Now, I probably do want to get my blood pressure lower if I can, anyway, even if my arteries are squeaky clean, because I don't want to put more strain on my medical devices and their endothelial lining than necessary. Also I would rather not have to quibble with my doctor over medication. Better if it's just not an issue.

Considering the work of Esselstyn etc. on eliminating atherosclerosis with a whole food plant based diet, I am committed to that path, so the thing I have yet to try is completely cutting out salt. I could also consume more potassium in the form of greens and sweet potatoes since I have been relatively lazy about vegetables. It is kind of rough not being able to eat out at restaurants (I mean I don't mind it, but it puts a damper on social activities) but I'll have to make it work. Searches for info on how long to expect it to take for sodium exclusion to bring blood pressure down have not been very productive, but I have seen reports of a few days to a few weeks, so I guess I should plan to do it for a few weeks. I can also finally get the discipline together to exercise regularly. I went on a 5 mile hike today, it's a start. I'd rather slam dunk it, then dial back to the minimum required.


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