"What the New Blood Pressure Range Guidelines Mean"
The number one killer in the United States and on the planet Earth
is a bad diet.
That is why I’ve dedicated my life to the study of nutrition.
Killer #2 is high blood pressure.
The reason it’s so deadly is that it increases your risk of dying
from so many different diseases: heart disease and stroke,
to heart and kidney failure.
We’re talking an exponential increase in risk of dying from a stroke
as our pressures go up starting from around 110 over 70,
an exponential increase in the risk of dying from heart disease,
again starting at a blood pressure of about 110/70.
We used to consider a blood pressure as high as 175 to be normal,
normal if you wanted to die from the normal diseases
like heart attack and stroke.
A quote-unquote “normal” of 175 over 110 could put you at over
a thousand percent higher risk of having you croak from a stroke
compared to the ideal— not the normal, but the ideal,
which is down around 110/70.
The definition of high blood pressure, hypertension,
dropped from as high as 190/110, down to 160 over 95,
with treatment thresholds for high risk groups starting at 150/90
down to 140/90, and then, most recently, 130/80.
Now…instead of 1 in 3 Americans having hypertension,
with the new definition, it’s closer to 1 in 2,
or more like two-thirds among those over the age of 45.
Every time the threshold drops, labeling tens of millions more people
as diseased, there’s this backlash.
Same thing every time the cholesterol guidelines
get more and more stringent, but don’t blame the guidelines.
Americans are diseased.
That’s the real problem.
The American way of life is the problem, not the guidelines.
Maybe we should focus on that instead.
After all, the number one killer of men and women is heart disease,
a disease that can be prevented, arrested,
and reversed with a healthy enough diet.
So, even though a cholesterol of 200 may be normal,
maybe we should tell people to strive for under 150.
Even though a BMI of 24.9 is technically not overweight,
an average height woman, for example, would be better off down around
120 pounds than 145.
And, similarly, though a blood pressure of 120/80 may be normal,
110 would be a better top number, and 70 a better lower number;
as even down in that range between 70 to 75, or 75 to 80,
each 5-point increment is associated with a third more stroke
and at least a fifth more heart disease.
So, why are the new guidelines up at 130 over 80?
With an average of three different blood pressure drugs
you can force people’s blood pressures from 140 down to 120,
compared to just giving them two blood pressure drugs,
and high-risk people live longer because of it.
Significantly less death in the intensive treatment group but,
because of the higher doses and drugs, had more side effects;
so, you have to weigh the risks versus benefits…
One to 2% of people on the drugs for 5 years will benefit,
not having a cardiovascular event when they otherwise might have,
and that has to be balanced against the higher risk of adverse side effects.
So, you’ll hear commentators saying things like yeah,
the drugs decreased your risk of “events” by 25%,
but increased your risk of a serious side effects by 88%.
OK, but those events can include things like death,
whereas the side effects are more on the order of fainting.
“These adverse events [do] need to be weighed against the benefits
with respect to cardiovascular events and death
that are associated with intensive control of systolic blood pressure.”
Like, if we use drugs to push high-risk people down
to a top number of 120 we might prevent over 100,000 deaths
and 46,000 cases of heart failure every year,
but could cause “43,000 cases of electrolyte abnormalities
and 88,000 cases of acute kidney injury.”
Not great, but better than dying.
So, you can see the conundrum guidelines committees are in.
On one hand lowering blood pressure is good for your
heart, kidneys, and brain, but at a certain point
the side effects from the drugs could outweigh the benefits.
Ideally, we want to get patients’ blood pressures as low as possible,
but only want to use drugs to do it “when the effects of treatment
are likely to be less destructive than the elevated blood pressure.”
The problem is that most people who die
from heart disease, heart failure, and stroke may be in that
borderline range not sufficiently elevated to warrant drug treatment.
If only there were some way to lower blood pressures
without drugs to get the best of both worlds.
Thankfully, there are.
Regular aerobic exercise, weight loss,
smoking cessation, increased dietary fiber intake,
decreased alcoholic beverage intake, consumption of a more
plant-based diet and cutting down on salt.
The advantage is, first of all, no bad side effects.
Some lifestyle interventions can actually work better than the drugs
because you’re treating the cause,
and actually have instead good side effects.
So, not 1 or 2% benefit over 5 years—everybody benefits.
We’ll explore one drug-free approach—water-only fasting, next.