3 Mistakes Most People Make About High Blood Pressure.
Don't make these common mistakes when it comes to high blood pressure.
High blood pressure is one of the biggest killers on the planet.
As a risk factor, it is responsible for more early deaths than any other risk factor1.
It impacts over 1 billion people.
But here is the real problem.
It is silent.
Most people do not know when they have high blood pressure.
And even when they do, it is usually not managed correctly.
Getting this wrong is costing lives on a global scale.
We need to do better.
The good news is that there are three common mistakes I see people make all of the time that are easy to get right.
Getting The Wrong Data.
Managing blood pressure is about getting good data.
Most people, if they are lucky, have their blood pressure measured in their doctors’ office once a year.
This approach is as close to useless as makes no difference.
I have essentially abandoned measuring blood pressure in my office.
The probability of your blood pressure measured in a doctor’s office being an accurate reflection of your usual blood pressure is low.
As I commonly say, “You are dealing with bad traffic, bad parking and bad coffee. So do you really think this is a good time to measure your blood pressure?”.
Of course, it isn’t.
You need to measure your blood pressure at home over multiple days to get a better idea of what your real blood pressure is.
In the words of the KGB, you must “Trust but verify”.
To do this, you have two options.
You can do a 24 blood pressure monitor at home which is very useful.
Or.
You can measure your own blood pressure with an upper arm-based cuff (Not a wrist-worn cuff).
Every morning at the same time.
While seated, with your arm resting on a table at the same level as your heart.
With your back supported and feet flat on the floor. (No crossed legs).
After you have gone to the toilet.
Take three measurements 1 minute apart. Average the 2nd and 3rd.
That is your blood pressure.
Now, do this for 7 to 10 days in a row.
If you really want to be precise, do it in the afternoon also.
When you average out the figures for each day - That is your blood pressure.
It is only with a reliable method of measuring your blood pressure accurately at home that you can determine if high blood pressure is an issue for you.
And given that about 1 billion people worldwide have high blood pressure, this is a worthwhile exercise.
Not Knowing What High Blood Pressure Really Is.
In simple terms, the higher your blood pressure, the higher the risk of a future heart attack or stroke.
Even systolic (Top number) blood pressures of greater than 90 mmHg increase the risk of future heart disease2.
For systolic blood pressures above 120mmHg, for every 20 mmHg increase in blood pressure, the risk of a fatal heart attack or stroke doubles.
So what constitutes ‘High’ blood pressure?
For the absolute majority of people reading this, it is anything greater than 120 mmHg systolic.
It’s as simple as that.
Now, having a systolic blood pressure of 122 mmHg will only increase your risk very, very marginally.
But having a systolic blood pressure of 150 mmHg is a whole different story.
Ideally most people should aim to maintain a blood pressure below 120 mmHg with lifestyle approaches.
But if this is not possible then medications should be considered.
We have multiple, randomised controlled trials that have shown that even compared to keeping systolic blood pressure in the mid-130s versus the low 120s with medications, there is a 25% difference in the rate of major heart events such as heart attacks and stroke3.
Getting this right in your 50s can mean an almost 3-year life extension4.
Want one of the easiest longevity hacks out there?
This is it.
No fancy procedures. No expensive supplements.
Just good old-fashioned blood pressure control.
Missing Treatable Causes Of High Blood Pressure.
I see this happen all the time.
90% of high blood pressure is typically classified as ‘Unexplained’, but it is amazing what happens when you dig a little deeper.
There are weird and wonderful causes of high blood pressure, including adrenaline-secreting tumours and narrowing of the kidney arteries.
You find these from time to time.
But rarely.
Two things are frequently missed.
Insulin resistance.
Obstructive Sleep Apnea.
When you look at studies of people with ‘unexplained’ high blood pressure, you find they routinely have higher fasting insulin levels and HOMA'-IR scores suggestive of insulin resistance5.
The good news about this finding is that insulin resistance is largely reversible with lifestyle measures, including optimising nutrition and exercise.
The second cause of high blood pressure frequently missed is obstructive sleep apnea, which is characterised by heavy snoring, episodes of stopping breathing during sleep, daytime sleepiness and poor daytime concentration.
It is important to note that not all people who snore have obstructive sleep apnea and to properly diagnose it requires doing a formal overnight sleep study.
The good news is that it can be treated, and with weight loss, its impact can be lessened, particularly its impact on high blood pressure.
We Need To Do A Better Job When It Comes To High Blood Pressure.
If we are going to make a dent in the risk factor that drives the greatest amount of premature mortality worldwide, we need to do a better job of identifying and managing high blood pressure.
For most people, that will simply require modifications to their lifestyle.
But for many it will require medications that will save lives.
The key thing is not to make the three mistakes laid out above.
Know your data - Trust but verify.
Get to target - Low 120s or below.
Don’t miss common reversible causes - Insulin resistance and obstructive sleep apnea.
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The global epidemiology of hypertension. Nat Rev Nephrol. 2020 Apr;16(4):223-237.
Association of Normal Systolic Blood Pressure Level With Cardiovascular Disease in the Absence of Risk Factors. JAMA Cardiol. 2020;5(9):1011–1018.
A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2015 Nov 26;373(22):2103-16.
Assessment of Long-term Benefit of Intensive Blood Pressure Control on Residual Life Span: Secondary Analysis of the Systolic Blood Pressure Intervention Trial (SPRINT). JAMA Cardiol. 2020;5(5):576–581.
Role of insulin resistance in essential hypertension. Cardiovascular Endocrinology 3(4):p 129-133, December 2014.
I'm surprised you didn't mention salt (sodium) intake. About 60% of people are sensitive to salt intake. I'm one of them, but my wife isn't. To get my SBP below 120, I have to keep my salt at <1,000mg/day. My wife and I are both 76. We are not on any meds.
A key challenge is eating out. Restaurant food is loaded with salt.
That was Reagan who said "Trust, but verify".