7.3 HYPERTENSION

7.3 HYPERTENSION

The Human body has over 70,000 miles of blood vessels. The inner lining of these blood vessels is made of a single layer of cells called Endothelial cells. The total surface area of these inner linings is equivalent to 6-8 tennis courts and together this constitutes the the largest organ in the body called Endothelium.

When a baby is weaned off mother’s milk his Endothelium is absolutely clean. As a baby starts to consume foods that are inflammatory to the body the Endothelium starts getting damaged. The body’s self-healing mechanism deposits a localized coating of cholesterol to heal the damage to Endothelium. As we grow older, more of our Endothelium gets spotty deposits of cholesterol. This process is called Atherosclerosis. During growth years from 2 to 16, the size of Endothelium also increases. However, after the age of 16-18 this growth comes to an end.

The result of continuing deposits of Cholesterol is that the effective inside opening of our blood vessels reduces. Also, the surface resistance to blood flow increases. Endothelial cells have a unique ability to release Nitric Oxide gas which makes blood flow smoother. The area affected by cholesterol deposits cannot release Nitric Oxide.

Now, if we apply the simple scientific principle, to achieve the same flow rate the pressure difference between two ends of a tube has to increase when (a) the friction inside is increased and (b) the effective opening is reduced. This is how our body adapts and increases blood pressure (BP). The second principle at play here is that our blood vessels are malleable, and they inflate (ever so slightly) when heart pumps blood. With age and calcification, this capacity also diminishes. This process is known as Arteriosclerosis. Those parts of the blood vessels which have narrowed openings normally would expand allowing the blood to go through. However, after blood vessels are hardened, the body can’t do that anymore and blood pressure has to be increased further to pass the same amount of blood. This is what happens to our bodies as we age into our 60’s and 70’s. High blood pressure is actually a healthy sign that our body is functioning as it should.

Factors affecting the blood pressure are blood volume and resistance. The resistance is a function of the flexibility of the artery wall, artery diameter and blood viscosity.

One leading cause of the problem is the inflammatory foods that we eat. Unfortunately, the medical science’s total focus is on treating the symptom and they find different mechanisms to lower the BP. Starting with Diuretics to Antihypertensive drugs to ACE Inhibitors to Beta Blockers to Calcium Channel Blocker to Vasodilators. Nobody tells you to stop eating inflammatory foods. Your wife tells you not to get angry and not to stress out, but she doesn’t realize the problem is in the food she is cooking. You both go out for dinner to calm you down and have a nice evening out, not realizing that the food that restaurant is serving is causing more harm.

When you change the food to plant based whole food (PBWF) the body begins to heal. The green leafy vegetables are rich in nitrates which release nitric oxide gas. This makes the blood flow smoother by reducing the friction. It also helps remove the clogging of blood vessels which causes heart attack.

This process of recovery is a function of the changes in diet and lifestyle that you are making. The drastic the change the faster the recovery. In Dr. McDougall’s 10-day program here in the suburb of Santa Rosa a drop in BP of 17/11 points is achieved and 90% participants get off or reduce their medication within 10 days. Some other points to note are:

1. Average blood pressure in a newborn child is 64/41. When child is one month old the pressure increases to an average of 95/58 and stays around that till the child is weaned at age of say 2 or so.

2. As child grows and starts eating inflammatory foods the blood pressure increases and by the time he reaches the age of 10 his average BP reaches 110/70. A normal range being 102-120 over 61-80.

3. By the age of 16-18 the average is 120/80 and the normal range is 110-131 over 64-83.

4. After this age of 18, the guidelines for normal, do not change. (Why? We will discuss this separately)

5. Blood pressure goes up with excitement, physical activity (like weightlifting or running) and pain.

6. Blood pressure goes up when we add volume to our blood supply which happens with consumption of salt and water.

7. But the main reason for increase in BP is Atherosclerosis and Arteriosclerosis as described earlier.

8. Dr. Kempner in 1950s successfully treated his patients with rice diet. Blood pressure in patients with BP as high as 240/120 came down to normal.

9. Many people on BP medication feel elated when their BP goes significantly below 140/90. This is a flawed thinking. The goal of all BP medications should be 140/90 and not much lower. For people over 60 it should be 150/90. If you are taking BP medications and your BP is significantly lower than 140/90 or 150/90 depending upon your age, you should reduce medications.

10. When you start doing aggressive BP control, what happens is that you develop many side effects including increased risk of dying of heart disease. This is called J. Phenomenon mortality.

11. A very large study was published in Jan. 2018 by the name “The J Curve between Diastolic BP and risk of all-cause and cardiovascular deaths”. This showed that reducing diastolic BP to very low levels had higher all-cause mortality than those who had diastolic BP of 70-80.

12. A financial conflict exists between study investigators and pharmaceutical companies. From Pharma company’s point of view an aggressive intervention is more profitable, as a result, lobbyists apply subtle pressures on investigators. Lead investigators have been found to receive large consulting fees from Pharma companies.

13. The guidelines for Hypertension are issued by the “Joint National Committee (JNC) on Detection, Evaluation and Treatment of High Blood Pressure”. JNC was first constituted in 1976 and there have been 8 task forces constituted since then. It is quite revealing to study their recommendations.

In 1997 JNC-6 recommended that HT cut off should be 140/90.
In 2004 JNC-7 recommended that anything above 120/80 and up to 140/90 is to be considered Pre HT and therefore watched.

In 2014 caving in to demands by a group of experts who had maintained all along that aggressive treatment of HT by medications is harmful and leads to increased all-cause mortality, the guidelines were relaxed as following: for adults under age 60 cutoff point is 140/90 and for adults over age 60 cutoff is 150/90 (unless they are suffering from CKD or Diabetes in which case it remains 140/90).

As a result of 2014 guidelines the drug industry and Doctors suffered as their incomes dropped. The American College of Cardiologists (ACC) in collaboration with American Heart Association (AHA) decided to issue their own guidelines in 2017 conflicting the JNC-8 guidelines. They reduced the HT thresh hold to 130/80. Hopefully you can see the conflict of interest here. ACC and AHA serve the interest of their members, public’s health is not their priority.

For people over 60 our goal should be to maintain a BP of 150/90 without any medication.

The doctors I follow in the Plant Based Whole Food movement have always maintained that aggressive treatment by drugs causes more harm than good and that is my position also.

You as a consumer will have to make your own call.

So far we have discussed what causes Hypertension and how changing to a plant based whole food diet cures it. Let us now talk about what is normal blood pressure and what is the cutoff point for Hypertension.

HISTORY

First some historical perspective. The blood pressure was first measured in 1733 and the term essential hypertension was first coined in 1911 to describe elevated blood pressure for which no cause could be identified. For few decades BP was categorized as malignant (severe over 210/100) or benign.

Let me repeat this message “till 1911 it was believed by the doctors that a BP level up to 210/110 was not harmful”.

John Hay, Professor of Medicine at Liverpool University, wrote that "while there is some truth in the saying that the greatest danger to a man with a high blood pressure lies in its discovery, because then some fool is certain to try and reduce it".

This view was echoed by the eminent US cardiologist Paul Dudley White in 1937, who suggested that "hypertension may be an important compensatory mechanism which should not be tampered with, even if we were certain that we could control it".
Charles Friedberg's 1949 classic textbook "Diseases of the Heart" stated that "people with 'mild benign' hypertension ... [defined as blood pressures up to levels of 210/100 mm Hg] ... need not be treated".

So as you can see, there has always been a debate, whether to treat high BP with medications or not. Mahatma Gandhi’s BP was 200/100. His doctors were more worried than he.

Over the next decade evidence accumulated from actuarial reports and longitudinal studies, such as the Farmingham Heart Study that "benign" hypertension increased death and cardiovascular disease. This was in spite of the fact that both those studies only pointed to association and not the causation.

POLITICS OF HYPERTENSION

As drugs became available in 1960s and 70s more and more doctors started prescribing drugs. (I have already discussed, how, many patients feel cheated if not prescribed with drugs after visiting a doctor.) The debate however continued. In 1976 a joint national committee was established in the US by the National Institute of Health (NIH) called “Joint National Committee (JNC) on the prevention, detection, evaluation, and treatment of high blood pressure” to come up with the guidelines for treating Hypertension. This became the foremost American regulatory bodies on the management of hypertension. The first JNC report was released in 1977 and since, 7 more JNCs have been constituted and the most recent JNC-8 released its guidelines in June of 2014.

The members of JNC come from various disciplines like, health care, health education, Pharma, Food, Government and consumer advocates. While the consumer advocate’s interest is to serve us by providing the most current and honest research findings, the same cannot be said about others. Pharma and Health Care industries have too much money riding on the outcome of these committees. The government should bat for us, but politicians need donations for re-election and bureaucrats are hoping for a cushy job after retirement (revolving door mechanism). As a result, the decision-making process is quite convoluted.

Between 1977 and 2004 under the direction of NIH, various JNCs issued reports. After the 2004 report there was a lot of hue and cry, as many consciousness doctors believed it was wrong and influenced by the greed of Pharma industry. Many senior doctors by that time including PBWF doctors, had already been disillusioned by the aggressive use of drugs to treat diseases of diet and lifestyle.

Despite 5 years in preparation, NIH did not release a JNC-8 report as it had become apparent to them that pendulum had swung to the other direction. They made the decision to withdraw from issuing the guidelines. The responsibility for issuing hypertension related guidelines was transferred to the American Heart Association (AHA) and the American College of Cardiology (ACC). It is like asking the fox to guard the henhouse. Without the endorsement of the AHA or the ACC, JNC-8 committee members decided to publish their guideline report anyway in 2014. The table below summarizes some recent JNC guidelines.

You can see from this table that based on JNC-6 guidelines a blood pressure reading of 120/80 was defined as optimal and 140/90 as Hypertension. These are the numbers etched in the minds of most doctors and patients even today.

There has been a growing debate over past three decades that with increased specialization in the medical field the health of the patients is not improving, and all-cause mortality rates are on the rise. From patients' point of view, he wants to live healthier and longer life; he really doesn’t care what the markers for BP or Blood Sugar or cholesterol are. Some of the senior doctors have come to a realization that medical care has gone haywire and have become vocal. PBWF movement is an outcome of that dissatisfaction with the status quo.

Going back to the JNC table you can see that these consumer advocates finally won out. The JNC-8 guideline recommends that for people over the age of 60 no treatment should be prescribed up to a BP reading of 150/90 and the goal of medication should be to achieve a BP of under 150/90. For younger people the cutoff is 140/90.

When one is not on BP medication, lower BP is sign of good health. But when you are taking BP medications, maintaining a BP way below 150/90 or 140/90 (for under 60) is a mistake. You are unknowingly harming yourself and reducing your life expectancy.

As a result of JNC’s 2014 guidelines the drug industry and Doctors suffered loss of income. The American College of Cardiologists in collaboration with American Heart Association decided to issue their own guidelines in 2017 conflicting the JNC-8 guidelines. They reduced the HT thresh hold to 130/80. You can now understand the politics at play. ACC and AHA represent the interest of their members (doctors) and not the consumers like you and I. ACC/AHA guidelines make 31 million more people subject to hypertension treatment with medications. At 300 dollars a year that is 9 billion dollars a year in doctors' fees and roughly the same for Pharma companies.

I have come across many people in my health groups who were taking BP medications and maintaining BP at levels far below 150/90 and were proud of the fact that their BP was 120/80 or 125/85. Clearly these people were harming themselves and increasing their chances of all-cause mortality.

ERROR IN BP MEASUREMENT

To further complicate the issue of diagnosis of Hypertension is the fact that the doctors and their staff are very poor in measuring BP.
Most common practice is to take measurement at the doctor’s office, but these readings are often taken incorrectly and there is also the anxiety factor known as the white coat effect

In a recent study (Nov. 2017) called Systolic BP Intervention Trial (SPRINT), it was found that the proper measurement (called research grade; 5-minute rest, 3 automated measurements and no other human in the room) was 12.7 mm lower than routine office measurement.

When you measure at home, you are likely to get lower readings.
Ambulatory monitor that gives average of 24 hours, is the best reading.
There are 19 different elements that constitute an accurate BP measurement. Some of these are:

- need to be seated for 5 minutes.
- Back supported and feet on the ground.
- No caffeine, smoking or exercise for for 1/2 hour prior to reading.
- No talking by patient or observer.
- No clothing under the cough.
- Support arm horizontally at the level of heart.
- Cuff should be right size; not too small.
- Repeat measurements with results averaged of lowest two readings. Or take the lowest reading.
- Failure to adhere to these guidelines may lead to higher readings.

A recent study in 20 clinics showed that of all readings that were over 140/90, 36% had normal second measurement.

TO SUMMARIZE

1. The drugs for hypertension have adverse drug reactions and dangerous side effects and should be taken with caution to avoid kidney problems.

2. Most measurements of BP are taken improperly and lead to higher than true readings.

3. There is confusion about BP cutoff guidelines due to vested interests of big Pharma and Health Care Providers.

4. It is best for people over 60 to maintain BP below 150/90 without taking medications.

5. When one changes diet to PBWF, BP goes down within weeks and achieving a target of 150/90 or 140/90 (for under age 60) is the easiest of all health goals.
​
How Atherosclerosis reduces effective opening of our blood vessels thereby increasing the BP.👇