Chronic Hypertension

Grape juice, like red wine, can help prevent blood clots and improve blood circulation.  Resveratrol, commonly found in grapes and other plants, is being studied for its antioxidant properties and its ability to minimize cardiovascular problems.  The “Dr. Sinatra recommended dosage” of Resveratrol is 2–5 mg daily.

Secondly, drinking flavonoid-rich green tea is an easy way to avoid cardiovascular problems and encourage resistance against chronic degenerative diseases, including chronic hypertension, heart attack and stroke.

While plain green tea itself has a delicate flavor, try it in one of the many formulas combining it with lemongrass and other herbs. Add a little honey and lemon, and I think you will find that this healthy heart nutrition tip really is quite delicious. If you can break your coffee habit in the process, you’ll be doubly rewarded, as you’ll also be reducing the amount of caffeine you ingest.

For years now, I’ve been telling my readers and patients to avoid acetaminophen—especially the extra-strength variety—because of the potential for liver problems. I’ve also said to avoid NSAIDs because of the potential for gastrointestinal bleeding, liver damage, and kidney dysfunction.

My advice is clearly supported by a report from the Harvard School of Medicine’s ongoing Nurses' Health Study that suggests that the use of painkillers can make it difficult for women to control high blood pressure. 

The report, published in the September 2005 issue of Hypertension, concluded that women are at increased risk for high blood pressure if they take daily doses of non-aspirin painkillers—such as extra-strength acetaminophen (Tylenol) and ibuprofen (Advil and Motrin).

This observation is especially troubling for pain-ridden patients looking for alternatives after learning a few years ago that prescription NSAID painkillers (such as Vioxx) are associated with higher risk for cardiovascular problems. 

The Harvard study involved 5,123 women age 34 to 77, none of whom had high blood pressure at the onset. Here are the results:

• For women not taking painkillers, the risk of developing high blood pressure levels was about 1 to 3 percent a year.
• Women who were taking an average daily dose of more than 500 mg of acetaminophen (one extra-strength tablet) had a 93 to 99 percent increased risk of developing high blood pressure (and, most likely, a more difficult time maintaining healthy blood pressure) within three years, compared to women taking less than 500 mg.
• Women who were taking more than 400 mg a day of over-the-counter NSAIDS (the equivalent of two ibuprofen) had a 60 to 78 percent increased risk of developing high blood pressure levels, compared to women taking less than 400 mg.
• The widespread use of acetaminophen and over-the-counter NSAIDs may contribute to the high prevalence of chronic hypertension in the United States.

Please take this information to heart. If you take painkillers regularly, please inform your doctor. He or she may have some safer recommendations. Here are a few of mine:

• White willow bark (180 mg twice a day); or
• Low-dose aspirin (325–650 mg a day as tolerated, but discontinue if you experience abdominal discomfort); or
• SAM-e (200–400 mg, once or twice a day as needed).

Remember, there are always safer alternatives to “the business-as-usual” drugs we’re being marketed in the media.

As a cardiologist and a holistic health practitioner, I take blood pressure levels of every patient who comes into my office. And sadly enough, oftentimes, I find that that their blood pressure levels are too high. As you probably know, high blood pressure levels are often a precursor to serious cardiovascular problems, including heart attack and stroke, so this is a situation that I take very seriously.

Some of these patients, however, tell me that they are doing all they can to control high blood pressure and that when they go home and measure it themselves, their blood pressure levels are normal. Occasionally they’ll ask if the instruments in my office are off, or if my staff misread the result.

The actual problem, however, is a common condition called white-coat hypertension (WCH). It’s used to describe people who become anxious over a visit to a physician, dentist, or medical facility. The visit evokes a fight-or-flight response, and their blood pressure levels go up.

Research has shown that abnormally high blood pressure readings in a medical setting could be more than just a benign byproduct of anxiety.  Although the condition is poorly understood, WCH could be a precursor to high blood pressure levels, poor blood circulation, and other cardiovascular problems.

A Danish study published in the Journal of Human Hypertension found a heightened cardiovascular event risk for patients with WCH over a 10-year period. A Japanese study reported in the journal Hypertension Research suggests that WCH contributes to carotid arteriosclerosis. And in another Japanese medical report, based on eight years of observation, researchers suggest that WCH is a “transitional condition to hypertension” and may carry a “poor cardiovascular prognosis.”

If you experience WCH, I suggest you take the following high blood pressure remedies to get it under control and avoid potential cardiovascular problems:

• Introduce a regular stress-reduction program into your life. That could include activities such as exercise, tai-chi, meditation, or yoga. This is a wonderful way of lowering blood pressure naturally.
• Watch the salt (again). This cardiovascular nutrition tip can’t be stressed enough.
• Start taking blood pressure-friendly supplements on a daily basis—such as fish oil (2,000-3,000 mg), magnesium (400-800 mg), hydrosoluble CoQ10 (50-150 mg), and a garlic supplement high in allicin (500-1,000 mg). You can find these supplements in most health food stores.

For decades I’ve been making spaghetti sauce for family and friends. As I prepare the sauce over the course of a day, I repeatedly taste it to make sure that I get it just right.

Twenty or so years ago, I noticed that the day after the meal I had gained a few pounds—and I was unusually thirsty as well. I was perplexed until I investigated and learned that the canned tomatoes, pastes, and purees I was using were high in salt.

Here I was, a cardiologist, as well as a holistic health practitioner, and I hadn’t made the connection. Excess salt contributes to water retention, and that was my problem. Of course, too much salt also makes it difficult to control high blood pressure and contributes toward a myriad of other heart risk factors.

I quickly changed my ways and my spaghetti sauce recipe. I started avoiding foods high in salt, which meant reading labels on foods in the grocery store. (This one act alone is an excellent way to naturally maintain good blood pressure levels.)  Most people don’t think they eat too much salt because they didn’t use a salt shaker. Unfortunately, that’s simply not the case.

The average adult consumes the equivalent of nearly two teaspoons of salt a day—practically two times the upper limit for good health. And the majority of that excess salt is hidden in processed foods, such as canned spaghetti sauces, soups, and dill pickles.

I’ll never forget a patient of mine who had chronic hypertension and ate his fill of canned ham (packed with salt) on Easter Sunday. The next day he was in the emergency room with a hypertensive crisis and acute heart failure. His heart just couldn’t handle the large amount of salt he had consumed.

His was an extraordinary situation, but it underscores the need to be careful with salt intake. So let his story and mine be lessons for you as well. 

In my last blog post, we talked about the importance of monitoring your blood pressure regularly. But what do you do if your blood pressure levels are high, or borderline high? There are several things you can (and should) do to control high blood pressure as a woman.

1.      To Control High Blood Pressure, Be Careful with Hormone Replacement Therapy (HRT): In 2004, results were published from the Women’s Health Initiative, a study including women taking Premarin. The women taking this pharmaceutical form of estrogen, (made from the urine of pregnant mares), were observed to have “skyrocketing” blood pressure levels. But Premarin is not the only HRT that causes high blood pressure.

Dr. Sinatra has noted that Provera, another HRT mainstay, drove up blood pressure in the women he treated, many of whom were no longer hypertensive once they discontinued the drug.

What we’re learning is that to control high blood pressure, individually tailored bio-identical hormone therapy from more natural plant and synthetic sources are better for women. Combining estradiole, estriol, estrone, testosterone, and progesterone may soften those arterial walls that can stiffen with age, and may even intercept elevating blood pressure.  So please consider this approach if you are on the traditional HRT medications, especially if you’re trying to control high blood pressure.

2.      Watch the Painkillers: A report from the Harvard School of Medicine’s ongoing Nurses Health Study, published in the September 2005 issue of Hypertension, concluded that women are at increased risk for high blood pressure if they take daily doses of non-aspirin painkillers such as extra-strength acetaminophen and ibuprofen.

If you take painkillers regularly and are trying to control high blood pressure, please ask your doctor for safer recommendations. What we use at our house—and it works well for various muscle aches and pains—is Traumeel, a homeopathic remedy you can find in health food stores. Traumeel is available in both a topical cream and a tablet that you place under your tongue.

3.      Control High Blood Pressure with Some Simple Changes to Your Diet: To control high blood pressure and keep your heart healthy, you want to increase your intake complex carbohydrates (like oatmeal); low-glycemic vegetables such as asparagus, broccoli and kale; legumes like chick peas and lentils; fruits; cold-water fish (especially fatty ones); organic eggs; olive oil; and nuts, seeds, and flaxseed.

At the same time, to control high blood pressure you want to decrease your intake of refined white flour and sugar, partially hydrogenated oils, starchy vegetables like corn and peas, processed fruit juices, organ meats, cashews (because they’re high in saturated fat), full-fat dairy products, and omega-6 oils (such as corn, safflower, and sunflower). 

4.      Eat More Garlic:   An Australian review of 11 studies in which hypertensive patients were randomly given a garlic supplement or placebo, found that garlic can lower blood pressure as effectively as some drugs. On average, the mega-analysis turned up blood pressure reductions of 8.4 systolic points, and 7.3 diastolic points. The higher a patient’s blood pressure was at the beginning, the more it was lowered by taking garlic.

To control high blood pressure, I recommend four cloves of raw garlic (about four grams) daily to achieve a noticeable blood pressure lowering effect. You could also toss crushed garlic into food for the last few minutes of cooking, but anything more than lightly warming it will destroy its medicinal properties to control high blood pressure.

5.      Control High Blood Pressure with Exercise:  Regular exercise is a sure way to help control high blood pressure. Physical activity also lowers levels of stress hormones circulating in the blood, which is important since stress tends to constrict arteries and drive up blood pressure. To control high blood pressure, you want to strive to exercise three to four times a week. Try taking a brisk walk, getting on your bicycle, playing noncompetitive golf or tennis, or even dancing —all of which are great for your blood pressure and your stress level. Even simple day-to-day activities like taking the stairs instead of the elevator, parking further back in a parking lot, or a leisurely walk, are helpful to control high blood pressure.

6.      De-Stress—It’s a Surefire Way to Control High Blood Pressure: Stress is a major mitigating factor when it comes to your blood pressure, so be aware of the psychological pressures you’re juggling. Overachieving and time urgency are all-too common “normals” for women. We juggle multiple roles as breadwinner, wife, daughter, mother, and friend that often involve nurturing others at our own expense if we don’t refuel.

Some good ways to de-stress and control high blood pressure include meditation, relaxation, imagery, yoga, prayer, Tai Chi, exercise, reading, listening to calming music, or playing with children and friends into your daily life.  

Also remember that not all venting is “complaining.” Talking with someone you trust about the stresses in your life, benefits your wellbeing—and helps you control high blood pressure.

Lastly, remember to stay positive! No woman is sentenced to a life of high blood pressure because of her DNA. It’s not our destiny! Our blood pressure reading is only a number, and it’s one we can lower with our own conscientious lifestyle changes, and medication if needed.

Watch for more information about women and high blood pressure in Dr. Sinatra’s monthly newsletter, Heart, Health & Nutrition. 

Years ago, high blood pressure was something adults developed as they got older. But given our modern day lifestyles—filled with fast-food based, high fat diets, and sedentary activities—record numbers of children have hypertension. 

As caretakers for our children during their early lives, it’s really up to adults to help our children maintain healthy blood pressure. After all, we’re the ones prepping their meals, supervising their out-of-school hours, and taking them to the pediatricians. And moms, dads and grandparents call all team up together to help the children we love.

So, how can we help our children achieve healthy blood pressure?

Keep Them Active: Studies show that more active kids tend to have healthy blood pressure. So, the best thing we can do is keep our kids physically active. When I raised my children, all we had to monitor was television viewing.  Now we have the internet, cell phones, and electronic games to contend with. So, get the whole family off the couch and go out for a walk, bike ride, or toss the ball around in the yard. 

 

As a mom, and a grandmother of seven, I’d like to address an overlooked—and far too often under-diagnosed—condition that’s happening to kids in record numbers. Its high blood pressure levels…and it’s affecting far more than our children’s hearts.

A new study just came out this summer which showed that not only do record numbers of children have high blood pressure levels—but their minds and bodies are paying an extraordinary price for our ignorance!

Researchers at the University of Rochester followed 201 children ages 10 to 18 that were referred for high blood pressure. Of those children, 100 were diagnosed with hypertension, and the other 101 children either didn’t have hypertension or had “white coat hypertension” (anxiety at the doctor’s office, which falsely registers a high blood pressure reading).

But what’s most startling is the children with high blood pressure levels were four times more likely than children with healthy blood pressure to have learning disabilities and/or ADHD! To me, that’s a frightening statistic. Just think of how many children are either struggling in school, or taking ADHD medications—when their real issue is high blood pressure levels.

Plus, what wasn’t mentioned by the researchers is something Dr. Sinatra would check for if one of our own grandchildren was hypertensive, and/or had ADHD or a learning disability: their lead and heavy metal level. If you are concerned about a child, find yourself a good ND (Naturopathic Doctor like our son, Drew) and check their blood and urine levels of these toxic agents.

Clearly, we need to understand that learning disabilities and ADHD aren’t always just isolated issues. Often, they’re a sign that we need to investigate further and ensure that there is nothing amiss in our children’s core health. 

 
Next time, I’ll be sharing more information about high blood pressure levels in children—and what we can do to turn the issue around.

I’ve written a lot about healthy blood pressure over the past few weeks, and there’s good reason for that. Controlling chronic hypertension is one of the best ways to reduce your risk of heart attack and stroke.

Today I want to go back to the relationship between diet and blood pressure levels, and talk specifically about salt.

Most people think they’re doing a good job cutting down on their salt intake simply by sitting down for a meal and not reaching for the salt shaker. Unfortunately, that’s not the case. What you eat is just as important.

The majority of salt we consume is hidden in the ingredients used to increase the shelf-life of processed and fast foods. Some salty choices, like potato chips, are obvious, but others you may not be aware of.

I’ll never forget a hypertensive patient of mine who ate his fill of canned ham (packed with salt) one Easter Sunday. The next day he was in the emergency room in hypertensive crisis, having an episode of acute congestive heart failure. His heart couldn’t handle the enormous amount of salt he’d eaten.

Now, I’ll admit that was an extraordinary situation, but it happens, and it underscores the need to be careful with salt intake—especially if you have high blood pressure levels, bad circulation, or other cardiovascular problems.

So the next time you reach for something to eat, make sure it’s not full of "hidden salt." I’ve put together a partial list of products that are loaded with it, to help you steer clear of some of the worst offenders:
 

• Canned and dried (packaged) foods, especially soups
• Potato chips, pretzels, saltines
• Salty or smoked meats—bacon, bologna, corned beef, luncheon meats, sausage—canned meats, and pickled meats
• Salty or smoked fish—anchovies, caviar, herring, and sardines
• Pickles and sauerkraut
• Salted nuts
• Olives
• Processed cheese and cheese spreads
• Macaroni and cheese
• Canned vegetables and vegetable juices
• Ketchup and tomato sauce
• Soy sauce
• Frozen pizza

If you’re struggling to control high blood pressure, you might want to consider making an appointment with a chiropractor.

According to a study published in the Journal of Human Hypertension, unresolved high blood pressure may be related to a misalignment in the atlas (C-1) vertebra, which sits at the top of your spinal column. (It’s said to have been named after Atlas in Greek mythology, who was sentenced to hold the heavens on his shoulders.)

To test their idea, researchers divided 50 patients with chronic hypertension into two groups. One group received a single chiropractic manipulation of the atlas vertebra, and the other group received a non-significant adjustment.

After eight weeks, the patients who received the atlas manipulation showed a significant improvement in blood pressure levels. Their systolic readings dropped by an average of 14 points and their diastolic readings dropped by an average of 8 points—an improvement similar to that which can be achieved by taking medication.

The reason for the improvement is related to the atlas vertebra’s unique shape. Unlike other spinal vertebrae, the atlas is relatively flat and depends solely on muscles and ligaments to remain properly aligned. This difference allows the skull to rotate freely but makes the atlas particularly vulnerable to displacement. Misalignment can potentially interfere with nervous tissue pathways in the brain stem and lead to high blood pressure.

Because C-1 misalignment does not typically result in pain, it usually remains undiagnosed and untreated. That’s why I recommend giving this approach a try if your other efforts at lowering blood pressure naturally haven’t had the results you were hoping for. You may simply have a problem that you don’t know about. Once corrected, you’ll be on your way to healthy blood pressure and a healthy heart!

 

Last week was a sad one for the entertainment world. We lost actress Farrah Fawcett, singer Michael Jackson, and pitchman Billy Mays. Fawcett found peace after her anguishing battle with cancer, and Jackson’s cause of death is yet to be determined. But it looks as if Mays most likely fell victim to hypertensive heart disease.

This condition encompasses a number of cardiovascular problems that result from long-standing high blood pressure. Initial autopsy findings showed that Mays had an enlarged left ventricle, an oversized heart weighing more than 500 grams, and plaque buildup in one of his coronary arteries. All are classic side effects of chronic hypertension.

It has not been stated whether Mays knew he had a cardiac problem, or if he was taking steps to address it. But this fact is undeniable: His death is a tragic yet valuable reminder of how important it is to control high blood pressure. Simple changes to your diet, exercise regimen, nutritional supplementation, and stress reduction techniques can often do the trick. They cost very little, don’t require prescription drugs, and are the best way I know to prevent heart attack and cardiovascular disease.

After decades of experience with sudden cardiac death (SCD)—and remember, the grim truth is that 50 percent of the time SCD is the first sign of cardiovascular problems—I would be remiss if I did not also mention that emotional stress may have been a factor. Mays was onboard the U.S. Airways flight that blew out its front tires upon landing in Tampa the day before his death. There have been several firsthand accounts of the terror passengers experienced when this happened. Many understandably feared for their lives.

For someone with chronic hypertension and underlying atherosclerosis, this would have been a dangerous situation. Psychological stress can cause sudden spikes in blood pressure. As blood pressure rises, the amount of "shear force" that blood exerts against arterial walls increases—sometimes to a point where it can disturb areas of plaque buildup and even potentially cleave them off. This in turn can lead to clots, heart attacks, and strokes. I've written about many of my personal experiences with stress-related SCD in my book Heartbreak and Heart Disease.

It is for the families surviving SDC to mindfully put the puzzle pieces together and try to understand what happened to their loved one. But the take-home message for you is that none of us can afford to be casual about high blood pressure.

Take control of yours today.

 

Yesterday I kicked off my four-week challenge to begin lowering your blood pressure, and today I’m going to give you your marching orders for the first week. In short, I want you to make a firm commitment to good cardiovascular nutrition.

Now, I know that a lot of you may have struggled with diets in the past and not realized the results you hoped for. You’re certainly not alone. But I can assure you that making better food choices is one of the most effective ways to control high blood pressure without medication. And I promise you it will work—as long as you’re willing to stick with the plan.

As you review the following recommendations, keep in mind that you don’t have eat all of the foods every day. It’s okay to concentrate on the ones that suit your taste (though I do encourage you to branch out a bit). What’s more important is that you eat these foods consistently, and that they become progressively more prominent in your meal planning. As you get started, try adding one new item each day until you’ve incorporated them all. (Note: Followers of my Pan-Asian Modified Mediterranean eating plan will find that they’re already consuming a lot of these foods as part of their daily meals.)
 

• Fruits, vegetables, and low-fat dairy foods. These foods are rich in potassium, calcium, and magnesium, all minerals crucial for healthy blood pressure.
   
• Wild Alaska salmon, organic nuts and seeds, free-range meats, sardines, DHA-fortified eggs, and fermented soy. There is a consistent connection between a high intake of healthy protein, particularly non-animal protein, and lower blood pressure.
   
• Oatmeal and whole grains rich in soluble fiber. After eight weeks of eating these foods for breakfast every morning, one study of hypertensive patients found that 70 percent of them were able to reduce their medication dosage by at least half, and 30 percent were able to quit their meds entirely.
   
• Omega-3s and other healthy fats (monounsaturated), such as those in avocados, olive oil, cold-water fish, and organic nuts and seeds. Omega-3s, especially, stimulate the production of nitric oxide, which is produced by the endothelium to keep arteries dilated.
   
• Garlic. Four cloves of garlic every day (about four grams) can lower blood pressure as much as some drugs.
   
• Seaweed. Eating just three grams of dried wakame daily for four weeks can reduce systolic pressure by up to 14 points and diastolic pressure by up to 5 points.
   
• Celery, celery extract, and celery oil. These contain apigenin, which relaxes blood vessels and helps control high blood pressure. Eat four stalks of celery per day, 1,000 mg of celery extract per day, or one-half to one teaspoon of celery oil three times per day.
   
• Lentils, chickpeas, broccoli, natto (the fermented Japanese soy dish), and other low-glycemic carbohydrates. Eat these foods in place of high-glycemic choices—such as soda, candy, and sweets—that stoke inflammation (one of the most dangerous heart risk factors) and damage arteries and cells.

Good luck. For specific meal planning ideas, check out some recipes on my web site.

Earlier this week, a study in the Archives of Internal Medicine reported a link between the amount of sodium and potassium you consume and your risk of developing cardiovascular problems. Even though this isn't big news, I'm glad it was published. It reinforces the importance of keeping minerals in the body properly balanced--especially if you are trying to control high blood pressure.

If you have hypertension, you already know that it's important to limit your sodium intake. Sodium promotes water retention, and excess water in the body drives up blood pressure.

But I've found that many people are unfamiliar with the need to consume extra potassium in this situation. Potassium relaxes arterial walls, which helps bring blood pressure back into a healthy range, as well as helping to prevent heart attacks and strokes. As much as 10 years ago, Harvard researchers found that a diet high in potassium helps protect against stroke-related death in people who have high blood pressure. They studied more than 43,000 men over an eight-year period and found that the men who consumed an average of 4.3 grams of potassium a day had a significant reduction in stroke risk compared to those who consumed an average of only 2.4 grams. The study in this week's Archives of Internal Medicine concluded that for people with blood pressure readings at the high end of the normal range, the risk of heart disease increased by 24 percent for every unit increase in a person's sodium-to-potassium ratio.

For best health, always strive to consume more potassium than sodium, and make 3 grams of potassium a day your minimum goal. You'll have the best odds for success if you follow a cardiovascular nutrition plan like my Pan Asian Modified Mediterranean (PAMM) diet, which features lots of whole grains, fruits, vegetables, nuts, and healthy fats like olive oil. Some foods that are especially high in potassium include raisins, prunes, apricots, papaya, dates, avocados, bananas, cantaloupe, oranges, beets, strawberries, watermelon, greens, spinach, peas, squash, tomatoes, mushrooms, beans, and baked potatoes. (A baked potato alone has about 800 mg of potassium.) Avoid packaged foods like the plague--they're loaded with sodium.

I'm also not a huge fan of potassium supplements because the amount of potassium that products may contain is limited to 99 mg per daily dose, or about the amount in two bites of a banana. You're much better off consuming potassium in foods.

Finally, if you're taking a diuretic to maintain healthy blood pressure, pay special attention to this information. Diuretics are notorious for draining the body of minerals, so you need to be especially careful of your potassium level.