Category Archives: High Blood Pressure

Insane Medicine – Ways to help adjust your blood pressure

Control your Blood Pressure for long term health:

  • Eat a better diet and reduce salt intake
  • Be physically active
  • Take your prescribed medications as you and your doctor agree upon
  • Limit alcohol intake
  • Cope with stress more effectively
  • Maintain a healthy weight

According to the latest recommendations, hypertension is now considered to need intervention if it is 150/90 at the age of 60 or older, unless you are diabetic in which blood pressure above 140/90 needs intervention. Pre-hypertension is considered to be 120-139 systolic and 80-89 diastolic (the lower number).

Remember that blood pressure, when untreated, increases your risk of stroke, heart attacks, and peripheral artery disease.

Here are a few details to consider:

  1. Salt substitutes (potassium chloride and magnesium sulfate blended with normal salt) decrease blood pressure per some studies (American Journal of Clinical Nutrition) by ~4.9/1.5 mm of Hg lower. In the United States, most of our added salt comes from processed and packaged foods (80%) and less from the salt shaker. Salt substitutes have less of an impact on blood pressure reduction unless you add extra salt on your food yourself!
  2. Exercise for life: Per a recent article in JACC (Journal of the American College of Cardiology), those who maintain regular exercise throughout their lifespan and maintain fitness will delay the age at which hypertension affects your body. Men who exercise little typically reached a systolic blood pressure of 120 mm of Hg by age 46, whereas the fit individuals reached that number by age 54!
  3. Higher protein intake has been linked to lower average systolic and diastolic blood pressure per a recent study in the American journal of Hypertension. Over an 11 year period, those in the top third of a group consuming a lot of protein were 40 % less likely to develop hypertension than individuals who consumed the least amount of protein. The amount of protein they consumed was 102 grams, more than double the daily value normally recommended. Combining high protein diets with high fiber intake reduces hypertensive development by 59%. the source of protein does not appear to matter, whether it is animal or plant protein. Just eat healthy! The mechanism by which protein intake decreases blood pressure may be a result of amino acids which dilate blood vessels in addition to an overall healthier diet.
  4. Flaxseed is another food product that can be helpful in decreasing blood pressure. Flaxseed works best when it is used to substitute for other food products such as refined grains. Flaxseed has 55 calories per tablespoon, so it does add calories. It also has a lot of omega-3 alpha-linolenic acids in it, in addition to lignans, a fiber-like polyphenol. The amount of fiber and antioxidants in flaxseeds are excellent. In a recent article in the journal Hypertension, 30 grams of milled flaxseed in foods such as bagels, buns, muffins, and pasta resulted in blood pressure reductions of 10/7 mm of Hg. This was as effective as blood pressure medications!


Insane Medicine – Lowering Dementia Risk


Research is demonstrating that treating multiple risk factors for dementia results in better outcomes than treating each factor individually. Risk factors include:

  1. Poor nutrition
  2. obesity’smoking
  3. physical inactivity
  4. cardiovascular risks
  5. depression
  6. social isolation
  7. lack of mental stimulation

Strategies to help deal with these risks have been shown to help improve cognitive performance. Just treating single variables such as high blood pressure or lack of exercise has less effect than hitting multiple factors at once. A study in Lancet Neurology (August 2014) revealed that one-third of Alzheimer’s Disease (AD) cases are attributable to modifiable factors and thus AD may be reduced in prevalence by improved education , treatment of depression, and management of vascular risk factors such as physical inactivity, smoking, hypertension, obesity, and diabetes.

  • Get regular exercise: this reduces stress, improves blood flow to the brain, strengthens connection of neurons in the brain, improves medical health and balance, thus reducing falls. The goal is 30 minutes of aerobic activity five times a week (walking, dancing, biking as examples) and strength training twice a week.
  • Challenge your brain: Demanding brain activities utilizing different aspects of your intellect help protect against cognitive decline, making your mind more efficient and able to focus. So expose yourself to new ideas and challenges mentally, so that you can maintain your memory skills and concentration abilities. Things like cross-word puzzles, checkers or cards help build up your brain as do math problems. Research shows that staying intellectually engaged may prevent AD. These types of brain challenges add to your cognitive reserve. Social interaction also plays a role in preventing cognitive decline. It has been found that those who play more games or puzzles were more likely to perform better on test of memory, learning, and information processing. They also have greater brain volume in areas associated with memory. Mental workouts enhance brain blood flow and promote cell growth, stronger neuron connections, and keep the brain efficient. It makes the brain less sensitive to trauma such as drugs, stroke, or disease. The internet has resources to help:  or  or  or  or   So consider crossword puzzles, jigsaw puzzles, word searches, math problems, an brainteasers to exercise your mind!
  • Treat mental illness, especially depression: Sadness, hopelessness, and lack of energy may signal depression. Depression is associated with a high risk of cognitive decline. See your doctor to help get treatment.
  • Eat a healthy diet: Eat complex carbohydrates such as whole grains, legumes, fruits, and vegetables. Avoid sodas, sweets, and excess sugars. Protein is essential for growth and cell maintenance, so consider lean meats, fish, poultry, eggs, low fat dairy,  nuts, and beans. Chose healthy fats such as omega-3 fatty acids found in flaxseed oil, fish, and nuts. Monounsaturated fats are also healthful and is present in olive and canola oils. Polyunsaturated fats from corn, safflower, and sunflower seeds are fine as well. Avoid trans-fats. Remember to include your micronutrients and phytochemicals (found in plant sources).
  • Treat cardiovascular risks: Stop smoking, lose weight, be physically active, treat high blood pressure and diabetes, take your prescribed medications.

Avoid Trans-fats in your diet. It is found in many junk foods, especially fast foods, processed foods, baked goods, margarine, and other sources. These products and trans-fats perform about 10% worse on cognitive tests than those who consumed minimal amounts. Trans-fats promote oxidative stress and damage the memory center of the brain, the hippocampus.

Magnesium is essential for brain functioning. It is found in green leafy vegetables, whole grains, nuts, legumes, and hard water. Magnesium helps in energy production, needed especially in the brain. It helps in the formation and release of neurotransmitters as well as functioning of connections in the brain (synapses) to process new information. Studies in Molecular Brain (September 2014) demonstrated that magnesium L-threonate (MgT) supplementation prevented memory decline and prevented synapse loss in mice prone to AD. It also reduced the deposition of beta-amyloid protein in the brain (a cause of AD) Risk factors for magnesium depletion include chronic alcoholism, diabetes, excessive coffee intake, inflammatory bowel disease such as Chrone’s disease, diuretic intake, liver and kidney disease,  and excessive soda and salt intake.The RDA is 400 mg a day –  This link points to sources of magnesium for your diet. Foods included are Almonds, spinach, cashews, peanuts, shredded wheat cereal, soy milk, black beans, whole wheat bread, avocado, baked potato, brown rice, plain yogurt, and others.

This sounds dumb but avoid head injury – it has been shown that older adults who have a head injury are at higher risk of dementia, especially over the age of 65. The main reason for these injuries are falls, many of which are preventable and may be due to deconditioning and weakness from lack of exercise. Remember that exercise increases strength and balance.

Remember to not be anxious over your health – don’t become a hypochondriac. Maintain your health through proper eating, exercise, risk management of cardiovascular problems (high blood pressure, high cholesterol, smoking cessation), taking your prescribed medications, and regular physician check-ups will maximize your health. Don’t get preoccupied with health matters and fears of disease such that they interfere with your daily activities and enjoyments in life. Keep yourself busy and distracted by learning new tasks and volunteering. Consider meditation, relaxing your body and mind, concentrating on the present moment. Exercise your body to reduce stress and reduce your anxiety. This will build your physical strength and increase your feelings of well-being. Keep your head up with positive feeling and be grateful for the good things in your life and those things you can control. Don’t stress out!!




Insane Medicine – Blood pressure can be affected by your medications.

  • There are a number of medications that can cause your blood pressure to rise, some of which may interact with medications you are already taking. One common mediation is NSAIDs (non-steroidal anti-inflammatory medications such as Motrin/Advil) which cause the kidney to retain sodium.  Use NSAIDs infrequently if possible.
  • Steroid medications such as prednisone or hydrocortisone can cause blood pressure spikes as they cause the body to retain sodium and water which increases your blood pressure.
  • Beware of over the counter medications such as pseudoephedrine which cause blood pressure to rise in some individuals.
  • Suddenly stopping your blood pressure medication can cause a rebound effect, especially with certain classes of medicines such as beta-blockers and clonidine. Blood pressure can go very high quickly. Be certain your doctor is aware that you stopped or ran out of your blood pressure medicines.
  • With some medications that you are prescribed, blood pressure increases frequently occur but you may need the medication either way. For example, cyclosporine and tacrolimus for organ transplants will increase blood pressure but are needed to prevent rejection of your organ transplant. Your doctor can monitor the situation and add new anti-hypertensives for this.
  • Gaining weight can increase your blood pressure, with a five pound gain adding up to a 4mm of Hg increase in your blood pressure. Abdominal weight gain leads to more blood pressure elevation than fat gain elsewhere in the body. A higher body mass index is associated with higher blood pressure, but it is the presence of extra abdominal fat that actually is the culprit in the blood pressure rise  Remember to keep active and cut back on your sodium intake. We lose ~5% of our lean body mass per decade after age 30 and thus need fewer calories as a result. Eat smaller portions, eat slowly, and eat at home when possible to control your intake of calories. Use vegetables and fruits as snack options, avoid processed foods.

Insane Medicine – High Blood pressure and the new Rules

Insane Medicine - Blood pressure cuff
Insane Medicine – Blood pressure cuff
  • Blood pressure is force that is exerted on your arteries with every heart beat, with the systolic pressure (top number) being the peak pressure the moment the hear contracts, while the diastolic number (bottom number) is the pressure when the heart relaxes. There is always residual pressure in the circulatory system when the heart is at rest due to the elastic, expansile ability of veins and arteries in the cardiac cycle that expand and collapse with each heart beat.
  • normal blood pressure is anything less than 120/80
  • When a person develops high blood pressure, that puts stress on the vital organs inside the body, especially the brain, heart, and kidneys. This increases your risk of stroke, heart disease, and kidney failure. Vascular dementia due to damaged vessels and strokes in the brain results in dementia.
  • As people age, high blood pressure becomes more and more common, with ~70% having high blood pressure by the age of 65-74.
  • There have been recent changes in the blood pressure goals per a recent report by JNC-8.  If you are age 60 or older, any blood pressure up to 150/90 mm of Hg is acceptable, unless you have diabetes, in which case 140/90 mm Hg is the acceptable goal. This new goal has not been accepted by all the medical authorities.
  • The American Society on Hypertension (ASH) suggests that patients age 80 and over should be allowed to have a blood pressure up to 150/90, unless they have high risk issues like diabetes or kidney disease, in which the 140/90 upper limit should be used. If the person is less than age 80, then 140/90 is the upper limit of acceptable and probably a goal of 130/80 should be used if they have poor heart function or kidney disease.
  • Which target should you be using? Ask your doctor, but it seems reasonable to be more aggressive with blood pressure treatment if you have diabetes, kidney disease, protein in your urine, or heart disease.
  • Lowering a person’s blood pressure too low may make them dizzy when they stand or even pass out due to low blood pressure. This is something we want to avoid!
  • First line treatment includes lifestyle changes such as dietary modifications such as reducing salt intake and eating more antioxidant-rich fruits and vegetables. Physical activity is a key component as well.
  • Have your doctor check for possible secondary causes of high blood pressure such as ‘white-coat’ hypertension (stress in the doctor’e office that goes away when you measure blood pressure at home). Also medications such as prednisone, or over-the-counter agents for colds and cough can increase blood pressure. Have your doctor review your non-prescribed medicines.
  • Have your doctor consider looking for thyroid disorders, kidney disorders, or sleep apnea that can elevate blood pressure.
  • Keep track of your home blood pressure with a home blood pressure cuff that is properly calibrated and used. This can be more accurate when properly done than a doctor’s office single reading of blood pressure.
  • For those who need medications, doctors will start low and titrate medication upwards slowly. There is more evidence that ACE inhibitors or ARB inhibitors mixed with amlodipine ( a calcium channel blocker) are excellent first line therapies. Beta blockers are not in favor for primary or secondary use unless there is some specific reason to be taking them (such as heart disease). Be prepared to take two or even three medicines to control your blood pressure.
  • Again, the best treatments to start with are lifestyle modifications! Lose weight, take in less salt. Consider following the DASH diet!

The DASH diet to help control high blood pressure: