Article: What is your blood pressure?

[Nancy LC]

Another great posting by Dr. Kendrick:
http://drmalcolmkendrick.org/2013/09/09/what-is-your-blood-pressure-bp/
Now to introduce another thread to this discussion. Which is the fact that, if you choose to look at the clinical trials on blood pressure lowering with an objective eye, there is almost no correlation between the amount the blood pressure is lowered (at the arm) – and any clinical outcomes. By which I mean that the rate of heart attacks and strokes do not relate to the degree of blood pressure lowering.

[RawNut]

Interesting you posted this as I was just reading a post yesterday on pulse wave velocity for measuring central arterial blood pressure and arterial stiffness by Peter.

http://high-fat-nutrition.blogspot.in/2010/01/who-pays-piper-for-arterial-stiffness.html

But yeah, lowering blood pressure with drugs is probably only treating the symptom, rather than the cause and where it counts the most.

[M Levac]

Yeah, that's my take as well. As I see it, the belief is that blood pressure is in the middle of the sequence of effects, like so:

Cause -> blood pressure -> heart problems

Hence the belief that treating blood pressure directly will reduce heart problems. When in fact blood pressure sits in parallel to heart problems. Whatever causes heart problems also causes high blood pressure independently, and that's why we see some association between the two. I'm gonna go with carbs on this one. Something like this: Carbs -> high blood sugar -> artery damage; Carbs -> insulin spike -> inhibition of glycogenolysis/lipolysis -> epinephrine compensates -> high blood pressure.

[Rosebud]

I don't know about this...

I have always understood cerebrovascular disease to be more of a problem than cardiovascular disease, when it comes to hypertension. Indeed, one of the reasons I shall continue taking my antihypertensive tablets is because I don't wanna have a stroke. Death, I'm not afraid of, but being alive and possibly being unable to communicate, or being paralysed or whatever, of that I am afraid.

I have seen a lot of evidence over the years that showed hypertension to be very definitely involved with cerebro and cardiovascular disease.

And re the Framingham study, I guess a lot must be open to interpretation.
I just did a really quick google search for a connection between hypertension and cerebrovascular disease, and lo, the first study I came to refers to the Framingham study. Admittedly, it is more about atrial fibrillarion than anything else, but it also clearly shows that people with hypertension were twice as likely to have heart disease as those with normal blood pressure, and three times as likely to have a stroke.
Here (http://stroke.ahajournals.org/content/22/8/983.short) is the link.

Now I know also that Dr Kendrick seems to be saying that lowering "arm" blood pressure doesn't do anything to change outcomes, but again, where's his proof? I haven't seen anything that shows this. In fact I have seen studies (but don't have any at the tip of my fingers) that do indeed show that lowering BP (at the arm) does indeed help.

I guess I'm saying to my fellow blood pressure lowering tablet takers, don't suddenly stop taking your tablets because of one person's interpretation of one study.

[WereBear]

I agree with M Levac's point; the same thing is causing both high blood pressure and vascular disease. Though medicine to reduce the pressure would have some kind of mechanical effect, in taking the pressure off the vascular system.

Most people find their blood pressure going down on low carb, even before they lose enough weight to influence that marker. So I would look elsewhere if low carb isn't lowering it; kidney issues, adrenal, thyroid; there are lots of possible places.

It is dangerous, but it's a symptom, not the disease.

[Pilili]

I am translating an article for you. It appeared a day or five ago in the newspapers in Flanders.
Perhaps what is happening over here in Europe, will also become the new standard in the US.

New standard for high blood pressure (http://www.tijd.be/nieuws/politiek_economie_europa/Nieuwe_norm_voor_hoge_bloeddruk.9395991-3140.art?ckc=1)

The limits for "normal" blood pressure are being adjusted. Blood pressure will as of now be considered too high in the case of 140 mm Hg.

On the annual meeting of European cardiologists in Amsterdam a new standard for the treatment of high blood pressure was presented. The most important change is that blood pressure will be expressed in only one figure anymore: the maximum pressure of 140 mm Hg. This replaces the old and double standard of maximum 140 mm Hg for people with low to moderate risk for CVD and 130 mm Hg for patients with a high risk such as diabetics.

The old minimum standard of 90 max (in the case of low and moderate risk) and 80 mm Hg (high risk) will no longer be used. Only the so-called systolic pressure (measured on the moment the heart contracts and the blood is pumping) will be used. "There was not enough evidence that we were sayving lives by maintaining separate standards", says cardiologist Robert Fagard, under whose direction the new standard was drawn up.

As from now measuring one's blood pressure at home will take a more important place in the treatment of high blood pressure. Usually people's blood pressure is high because they are nervous when visiting their doctor (white-coat hypertension).

---
By the way, I quit taking blood pressure pills a year or three ago, as they threatened to destroy my kidneys. I woke up every night with so much pressure on the bladder that I really needed to go to the toilet (and I drank less then than I do now). My ureum, creatinine and uric acid numbers are perfect now. I also feel confident that no stroke will come.

[Nancy LC]

I think his point about the difference in Arm and Central BP was pretty good. Their estimate was that 25% of people on BP meds shouldn't be on them.

Further, the fact that they don't even know if the meds work is a little alarming, especially considering the possible side-effects.

I guess I would want to know my central BP before I would agree to take them, and then I would want to know my central BP after I took them to see if it was working.

[katoman]

I have read, through links from this site, that the BEST ACE inhibitor is....

WATER.

Drink enough and the body will naturally maintain the ACE inhibition cycle on its' own.

[Zei]

I'm gonna go with carbs on this one. Something like this: Carbs -> high blood sugar -> artery damage; Carbs -> insulin spike -> inhibition of glycogenolysis/lipolysis -> epinephrine compensates -> high blood pressure.
I'm voting carbs, too. Doesn't elevated insulin signal the kidneys to retain sodium so less water gets passed out of the system into the sewer? At least I've heard that's why when one starts a low carb diet drinking salty broth or otherwise increasing dietary sodium is a good idea because so much sodium is lost to the sewer when insulin drops.

[Atrsy]

I've heard that if the pressure is 120/80 it isn't as good as 140/60 because the bigger span between the numbers indicates that the arteries are more flexible.

[coachjeff]

I have a very strong genetic predisposition to high blood pressure. It was borderline high even in junior-high. My brother is on BP meds. A "good carb" diet low in salt did basically nothing to help it. LC works like a charm for it though...even when eating a fair amount of sodium.

[M Levac]

I was thinking about a point Dr Kendrick made. Basically, blood pressure measurements are unreliable on their own, especially if you make only one measurement at any one spot. It can be all over the place for all kinds of reasons. I'm gonna say I agree. But I'm also gonna say when you understand all that, it can be a pretty good indicator that something's going on, if you take many measurements over time. If we just take exercise for example. Something is obviously going on, and blood pressure will respond up and down accordingly. Based on this, we can eventually predict where blood pressure will go. And based on that and combined with other parameters, we can then use it to diagnose particular conditions, if not at least determine if there's a condition to diagnose. My guess is that's what docs do already, but my experience says they go about it all wrong. Maybe it's because of the inherent unreliability.

I participated in several clinical studies to test various drugs, and we got tested for all kinds of physical parameters, including blood pressure. Based on the frequent measures, I could expect my BP to be within a pretty tight range at any one point, most particularly at rest. Lo and behold, that's where it would be when measured this time around. To me, I'd call this reliable. In fact, when my BP went up to something around 120/80 at one of the selection exams, I was perplexed. I fully expected it to be right around 90/60. And that's when I started to think something was going on. Heart rate was around 80 when it should have been around 60. Then I got my blood glucose result and it was around 100, when I fully expected it to be right around 67. Now I was thinking real hard about all that. Suffice to say I knew something was going on based on all those parameters (and other parameters I'm not gonna go into right now), including blood pressure.

The point I'm trying to make is that blood pressure can be reliable, if we understand how it works, if we keep a history, if at some time it's not where we expect it to be, independently of where it sits now relative to the official normal BP range.

You see, docs don't compare current BP to previous BP, they only compare it to official normal BP range. It's ironic to me since the official normal BP range was determined from a statistical analysis of a bunch of previous BP measurements. So anyway, if your current BP is within the normal range, even if it's changed significantly since last measurement (like it did in my case), everything's A-OK for the doc, and it literally doesn't matter what you say, nothing will be done based on that. Only if your current BP measurement is out of bounds will the doc do anything about it.

I understand the reason. The doc must rely on his own direct observation to make a diagnosis at the time of consultation, and BP is just not suited for this purpose. He'd have to do direct observations too often, it would be too much of a hassle, and this is why we have a standard official normal BP range the doc can compare to, as a rough indicator he can use any time. This is where the patient comes in. He can make frequent BP measurements as often as he wants. In fact, he can measure several standard parameters just as easily just as often; HR, BG, blood ketones, weight, blood oxygen, and probably many others I can't think of right now, then put it all in a journal and then show that to the doc at the yearly checkup or when something's obviously wrong. But this implies the doc must rely on the patient to make a diagnosis, and that's not about to happen any time soon if my experience is any indication. Still, I believe that's the direction healthcare is going, should be going. In fact, I believe smart docs are those that rely on their patients.

[M Levac]

I forgot to add that when the doc finds BP out of bounds, and he does something about it, he does something about BP directly. Gives us BP meds. Doesn't use BP as indicator of anything else. To him, BP is a problem on its own. That's just absurd, to me anyways.

[WereBear]

I forgot to add that when the doc finds BP out of bounds, and he does something about it, he does something about BP directly. Gives us BP meds. Doesn't use BP as indicator of anything else. To him, BP is a problem on its own. That's just absurd, to me anyways.

True. For instance, I once had a blocked kidney artery, and the only symptom was headaches, which led them to discover I had high blood pressure. If they had simply given me meds to lower the blood pressure, the real condition would have gone undiagnosed... until a disaster.

[zeph317]

I've heard that if the pressure is 120/80 it isn't as good as 140/60 because the bigger span between the numbers indicates that the arteries are more flexible.

that's actually not true. the pulse pressure (the difference between the numbers) is optimal at 40. higher or lower means there's something wrong. the higher it is, it often signifies a problem with the aorta.

http://www.mayoclinic.com/health/pulse-pressure/AN00968

my son's pulse pressure is usually at least 60, but he has a congenital defect and has had several surgeries and is on meds. his pulse pressure has been over 100 at times.

[Dalesbred]

This is interesting. I have been on BP meds (lisinopril) since my late 20s and as I was slim, non-smoker, good diet, exerciser etc, this was considered unusual enough for exhaustive investigation of my heart, kidneys (angiogram, MRI etc) and nothing was found. My dad had a stroke at age 40 and I've also inherited his poor circulation (had veins stripped). I can only conclude that there is a strong genetic component in many cases of high BP, at least in my own case, and as there's nothing else I can do within my control I'll regretfully have to keep taking the tablets. I have noticed a strong situational component in my own case - at very stressful times my readings go through the roof (160/120 in the weeks before my wedding for instance) even though my resting HR is 45-50. I often wish I could be "bled" with leeches like in the olden days as I think I just have too much blood for my circulatory network, but the NHS won't take my donation now due to the drug I take, hey ho. I'd love to come off the tablets but like the earlier poster I am too scared I'll "survive" a stroke.

[Nancy LC]

Everyone in my family was on BP meds by the time they were in their 40's. I was starting to go high, but as soon as I went on LC my BP dropped a lot.

Dalesbred, some types of BP meds slow heart rate. Beta-blockers, I think.

[Dalesbred]

Yeah, I tried betablockers once, hated them, felt like I was drowning! ACE inhibitors have no (noticeable) side effects for me, plus, I run a lot which is what I hope the low RHR is to do with. I have been LC for ages which is why I can't attribute my high BP to diet, there was no impact at all sadly.

[RobLL]

I often wish I could be "bled" with leeches like in the olden days as I think I just have too much blood for my circulatory network, but the NHS won't take my donation now due to the drug I take

The Puget Sound Blood Bank will do therapeutic blood draws with a doctor's Rx.

Going from very high carb to very low carb made no differences in my blood pressure

About the time I was Dx'ed with diabetes they were recommending that all diabetics should have BP below 120/below 80. My primary care person and Blood Sugars 101 both said better research suggested too many side effects from medications, below 140/90 might be better, now I am reading even below 160/below 100 may be OK

[teaser]

Mine used to be 140 over 90 and getting higher yearly. Now it's usually in the 120s over 70s.

[Fauve]

Very interesting! Thanks.

[katoman]

I often wish I could be "bled" with leeches like in the olden days as I think I just have too much blood for my circulatory network, but the NHS won't take my donation now due to the drug I take, hey ho. I'd love to come off the tablets but like the earlier poster I am too scared I'll "survive" a stroke.You can. Ask your doctor for a prescription to have a therapeutic phlebotomy be performed. I had asked my doctor about it if I had too high serum iron. Turns out it's not necessary as it actually appears that I am, after all these years, and even on low carb, still mildly anemic.

ps: I've recently added more organ meats... trying for once a week.

[Dodger]

Mine was slowly rising over the years and was at 140/90 when I started low-carbing. Now it is at 110/70.

[Dodger]

Pulse pressure doesn't seem to really matte (http://www.ncbi.nlm.nih.gov/pubmed/12020303)r.

Levels of SBP and DBP were more strongly related to cardiovascular disease than pulse pressure

[M Levac]

So I was looking around and I learned that hypertension comes in two ways. Essential (primary) and secondary. Essential is said to be caused by literally nothing. That's right. Nothing causes primary hypertension. And this kind consists of 90-95% of all cases. No wonder doctors go about it all wrong.

Please excuse the shameless plug below. If we used my paradigm as the base logic to diagnose, we'd find a cause to primary hypertension. It's pretty simple. A high-carb diet is disruptive of normal metabolism through its effects on the hormones that regulate metabolism, and other factors could also disrupt metabolism the same way. If we removed the carbs, but are still left with abnormal metabolism, then we can conclude there's another factor at play that acts the same way carbs act. To apply this base logic to hypertension, we must assume that there is always a cause.

My own personal experience tells me there is always a cause. Some of you also said your BP dropped once you went low-carb. The very existence of BP meds tells us there is always a cause. BP meds do stuff to normal metabolism to do their job. Isn't it obvious that hypertension is caused by stuff that acts on the same systems, just in reverse?

The belief right now is that hypertension is a cause for other things. But this gives us serious problems when looking at the relationship between BP and things that affect BP. Take exercise for example. If BP is a cause, then we can logically conclude that high BP causes us to exercise. That's just absurd of course, but that's the logic.

I mean seriously. We're talking about doctors and scientists here. Those are pretty smart people. How much smarter do they have to get to figure out how absurd this is?