Lowering the high bar

May is National High Blood Pressure Education Month, but it seems that the people who need the education most are the ones who are doing the “educating.” This is another chapter in the saga of how misguided “experts” can be reactionary and short-sighted in their recommendations for the treatment and prevention of medical conditions. Today’s focus: hypertension.

I should preface this e-Alert by reminding you that whenever government agencies dispense dietary and medical advice – in this case, from the National Heart, Lung, and Blood Institute (NHLBI) – it should be taken with a grain of salt (even if you have high blood pressure).

 

 

Yellow means yield 

The mainstream media dutifully reported the mainstream medical news last week when the Journal of the American Medical Association provided early publication of a NHLBI report announcing a set of parameters for a new category they call “Prehypertension.”

You’re probably familiar with the standard blood pressure reading, in the form of a fraction; systolic pressure, the top number, represents the pressure of the blood against the artery walls when the heart contracts, while the bottom number represents the diastolic pressure, or the pressure against the artery walls when the heart relaxes between beats.

The threshold for high blood pressure is 140/90. That hasn’t changed. But the new guideline states that a blood pressure reading between 120/80 and 139/89 should be considered prehypertension. Furthermore, the NHLBI reports that prehypertension is more dangerous than previously believed, because anyone with a BP reading within this range may be at twice the risk of dying from heart disease.

In addition to heart disease, hypertension is associated with a high risk for heart failure, stroke, and kidney damage. So establishing this new “danger zone” is a good thing. It’s a yellow caution light letting you know it’s time to apply the breaks to any diet or lifestyle choices that don’t support the health of your heart.

The report calls for several preventive measures that we would all agree with: stop smoking, exercise, maintain a proper body weight, don’t drink too much alcohol, eat fruits and vegetables, don’t eat junk food. You pretty much can’t go wrong following those guidelines.

But, of course, the recommendations don’t end there

 

 

 

 

DASHing for high carbs 

The report goes seriously wrong in two key areas: its recommendations for diet and for drugs.

A few years ago the NHLBI developed a diet called Dietary Approaches to Stop Hypertension (DASH). According to the institute, studies have shown that DASH can significantly lower blood pressure. Sounds great. Just one thing, though. If you follow the DASH diet you may be setting yourself up for type 2 diabetes. And coincidentally, the age group most at risk for developing high blood pressure (50 and older) is the same age group most at risk of developing type 2 diabetes.

It’s not surprising that DASH falls in line with the USDA dietary pyramid in recommending 7-8 servings of grains and grain products per day. Grains are the foundation of the food pyramid that many nutritionists and doctors now believe accounts in large part for the growing problems of obesity and the resulting type 2 diabetes. So say you’re 55 years old, 20 pounds overweight, and your doctor discovers you have high blood pressure. You start following the DASH diet (recipes include pasta, rice and plenty of potatoes), and according to NHLBI studies, your blood pressure will drop. But at 7-8 daily servings, those carbohydrates are going to add up quickly.

So should you move your blood pressure reading out of the prehypertension category at the expense of moving into the prediabetic category? Obviously, that’s not a good trade off.

 

 

 

 

Back up the drug truck 

The new guidelines estimate that as many as 45 million Americans fall within the new prehypertension category. And although the NHLBI doesn’t recommend drug therapy to treat prehypertension, you can be certain that many doctors WILL be recommending a drug, backed up with enthusiastic encouragement from the pharmaceutical companies. Just imagine a brand new potential market of 45 million! And if those millions are not taking drugs for their prehypertesion, they’re at least standing in the doorway of hypertension, ready to step in.

For those that don’t succeed with the DASH diet (and don’t quit smoking, don’t lose weight, don’t curb their drinking, etc.) and step through the doorway to join the ranks of the hypertense, what does the NHLBI recommend? The report’s exact words: “Most patients with hypertension will require 2 or more antihypertensive medications to achieve their BP goals.”

2 or more! Hey, it’s Christmas morning for the drug companies! And the list of suggested pharmaceuticals is impressive: ACE inhibitors, beta-blockers, calcium channel blockers, angiotensin-receptor blockers, and thiazide-type diuretics. In e-Alerts and Members Alerts we’ve told you many times about the adverse side effects and various problems associated with these drugs. And when they’re combined, there’s no telling where that dangerous chemistry experiment might lead.

 

Putting the horse ahead of the cart

In past issues of the HSI Members Alert, we’ve written about natural ways to address blood pressure, like the Chinese “immortality herb” jiaogulan, which has been proven to regulate blood pressure (July 2000), and the Ayurvedic herb arjuna, which has been shown to offer “significant cardioprotection.” (June 2001).

But it’s important to remember that high blood pressure isn’t a disease, in the same way that a high fever isn’t a disease – it’s a sign that something else is wrong. As HSI Panelist Allan Spreen, M.D., told me, “Hypertension can be caused by many diseases, such as kidney disease, iatrogenic disease, heart disease, or even snake bite or other toxins.”

Hypertension, then, is a signal that there’s a problem. If you and your doctor discover and address the problem, in most cases you’ll take care of the hypertension. But adding negative influences to the situation with a misguided diet or a buffet of powerful drugs clearly doesn’t put you on a problem-solving path.

To Your Good Health,

Jenny Thompson
Health Sciences Institute

Sources:
“The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure” Journal of the American Medical Association, 2003;289, Early Release Article, 5/14/03, jama.ama-assn.org


“May is National High Blood Pressure Education Month – NHLBI Issues New High Blood Pressure Clinical Practice Guidelines” FirstGov for Seniors, 5/03, seniors.gov
“New Guidelines Issued for High Blood Pressure” Sally Squires, Washington Post, 5/14/03, washingtonpost.com

“U.S. Changes Guidelines on Blood Pressure” Lauran Neergaard, The Associated Press, 5/14/03

“Your Guide To Lowering High Blood Pressure – Healthier Eating with DASH” National Heart, Lung, and Blood Institute, nhlbi.nih.gov