high blood pressure and hypertension

Diagnosis: High Blood Pressure. Now What?

What is blood pressure and why is hypertension a problem? Here’s what you need to know about this important health metric.

What is blood pressure?

Blood pressure is a measurement of the amount of force the heart has to exert to pump blood around the body. High blood pressure, aka hypertension, indicates that the heart is working harder than it should, and this wear and tear on the body’s engine of life is what can lead to serious health problems and a shortened lifespan.

How is blood pressure measured?

Blood pressure measurements have two readings: Systolic and diastolic. These are measured in mmHG; the amount of pressure exerted to make mercury rise (in millimeters).

The top number is the systolic reading and it represents the pressure exerted on artery walls as the heart contracts. In other words, this is the pressure of blood coming out of the heart with each beat. An ideal systolic measurement is under 120 mmHg.

The bottom number is the diastolic reading and it represents the amount of pressure on artery walls while the heart’s tissue is relaxing between beats. An ideal diastolic measurement is under 80 mmHg.

Why is blood pressure an important health metric?

Blood pressure is a great predictor of future heart disease because it gives us information about the integrity of our blood vessels. If systolic blood pressure is higher than 120, we know that arteries are either stiffer or narrower than ‘normal’, and that the heart is working overtime trying to push blood through these obstructed blood vessels.

While arteries will stiffen and narrow progressively as we age, daily habits and lifestyle factors play a key role in either fast-tracking these decrements, or in promoting a healthy heart and vascular system. In fact, hypertension is the most common preventable risk factor for cardiovascular disease (CVD), chronic kidney disease and cognitive impairment. It is also the leading single contributor to all-cause death and disability worldwide.

Did you know? If tests reveal that you have plaque in your arteries, do not panic. Plaque formation starts *for everyone* in childhood. Being alive causes plaque formation, particularly at “bends” in your arteries known as bifurcations. What you need to know is how much plaque there is and if you’re actually at an elevated risk relative to what would be considered a normal amount of plaque for your age.

Can blood pressure be too low?

While lower blood pressure is generally an indication of a healthier heart, if blood pressure drops too low too quickly, it is generally a sign that something is wrong (loss of blood, severe dehydration, blood pooling, etc.). This is partly why a cool down from exercise is always advised so that blood pressure can gradually return to resting levels versus experience a sudden drop.

There are, however, some people who live with extremely low blood pressure (<90/60) as a result of autonomic dysfunction, which can be both inherited or acquired. This needs to be managed to avoid dizziness or fainting episodes, but is not inherently dangerous for the cardiovascular system. Certain life factors such as high heat or humidity, quick level changes (standing up too quickly for the body), or alcohol can cause symptoms of fainting or dizziness in this population.

As with most things regarding human health, there is a sweet spot for everything. For blood pressure you can rest assured that there is no undue stress on your heart with a resting BP of 120/80 or less.

What classifies as “High” blood pressure?

Source: American Heart Association

Simply put:

  • If your systolic BP is over 120, you’re at risk of developing hypertension
  • If your systolic BP is over 130 or your diastolic BP is over 80, you have hypertension
  • The higher blood pressure rises from here, the more at risk you are for developing CVD

Causes of hypertension

While it is normal for blood pressure to rise and fall throughout the day, the wrong circumstances can cause baseline levels to become chronically high. Hypertension can be caused by primary factors, or be the result of another existing condition (referred to as secondary hypertension). Primary causes include:

  • Smoking
  • Physical inactivity
  • Chronic stress
  • Habitual alcohol intake
  • Excessive sodium consumption (combined with inadequate potassium consumption)

The common thread among these causes is that they are all highly inflammatory inputs to the human body. If you are exposed to one or more of these stimuli for an extended period of time, blood pressure will become more and more elevated over time.

Conditions that can lead to secondary hypertension:

Addressing these root cause conditions will often lead to a reduction in blood pressure.

Is hypertension genetic?

As with many diseases, some people will be more predisposed to hypertension than others. This genetic predisposition however, must meet specific environmental conditions in order to lead to a hypertensive condition. Rising rates of hypertension demonstrate that our current way of living is putting many of us at risk for this genetic predisposition, as many hypertensive risk factors as now commonplace: high salt intake, poor sleep quality/sleep apnea, excess alcohol intake, high mental stress, etc.

Hypertension is also more prevalent with age, owing to progressive stiffening of arteries caused by slowly developing changes in collagen and increases in atherosclerosis (plaque formation). That said, studies have shown that is not an inevitable consequence of aging and that increases in blood pressure are related to changes in diet, decreased physical activity and increased consumption of alcohol.

As mentioned previously, hypertension is preventable and there are things we can control no matter our genetics or age.

How to lower blood pressure

The most effective ways to manage and lower blood pressure are:

  1. Increased physical activity
  • This is the magic ingredient. Something is better than nothing, and more is better.
  • While aerobic/cardiovascular training has always been the main recommendation for lowering BP, new research shows that any form of activity is effective at lowering blood pressure. It would seem that dosage is what is most important, so if your blood pressure is high, choose any activity that you find the most enjoyable or that’s easiest to work into your daily routine. Start with whatever dosage you can manage, and build this up over time.
  • Aim to achieve the weekly recommended dosages of >150 hours of aerobic activity and >2 sessions of resistance training.

2. Dietary changes (like the Dietary Approaches to Stop Hypertension (DASH) diet)

  • Dietary changes that promote an increase in fruits and vegetables, higher fiber, lower fat and lower sugar.

3. Reduced consumption of alcohol

  • Less than 2 standard drinks/day for men, and less than 1 standard drink/day for women

4. Weight Loss

  • Any amount of weight loss will have a favourable impact on blood pressure. As previously discussed, weight loss is complicated and effectively maintaining body weight is more a symptom of altered daily actions, rather than a daily focus.

5. Reduced sodium (salt) intake

  • Studies have shown that sodium reduction has a dose-response relationship (the more salt you reduce, the lower blood pressure falls) and that this effect is more pronounced in people with higher blood pressure (the higher your baseline blood pressure, the more effective salt reduction will be for lowering levels)
  • Achieving a daily salt intake of 3-6g is ideal. Most people typically consume 9-12g daily, so aiming to cut salt intake in half is a good ballpark strategy.

6. Increased potassium intake

  • Aim to achieve >5g of potassium daily, via increased intake of fruits and vegetables.

If you find you’re not achieving aspects of the above list, focus on whichever one is the most attainable to you. Once you feel you have a handle on one element, add in another layer and you’ll be well on your way to reducing your risk factors for CVD and beyond.

What about medications?

There are many available medications that help lower blood pressure. First-line antihypertensive medications include ACE inhibitors, angiotensin II receptor blockers (aka sartans), calcium channel blockers, thiazide diuretics, and beta-blockers in certain circumstances. Physicians help patients determine which drugs are right for them and prescribe one or a combined medication plan based on individualized circumstances.

Which is better, exercise or medications?

Studies have shown that medications alone and exercise alone are both effective at lowering blood pressure. Adding exercise to a medication regime is beneficial at further lowering blood pressure, but to a degree that is not completely additive. A 2021 meta-analysis showed that exercise alone elicits greater blood pressure reductions than medication alone, contrary to previous research showing the opposite.

Where physical activity surpasses medications, is how it lowers blood pressure: via anti-inflammatory action through the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis. Long story short: Physical activity is the unquestioned king when it comes to human health, and should be the recommended backbone of all disease management.

In Summary

  • High blood pressure, aka hypertension, indicates that the heart is working harder than it should, which can lead to serious health problems and a shortened lifespan.
  • Plaque formation starts in teenage years for everyone and exists in all bodies. Presence of plaque in arteries is not an emergency if levels are appropriate.
  • A healthy blood pressure measurement is anything lower than 120/80.
  • If your systolic BP is over 130 or your diastolic BP is over 80, you have hypertension.
  • Hypertension is caused by behaviours such as smoking, physical inactivity, chronic stress and habitual alcohol intake.
  • Neither genetics nor age lead to an inevitable development of hypertension.
  • Increasing physical activity is the most effective way of lowering blood pressure with the added benefit of improving other health markers.
  • Reducing sodium intake and increasing potassium intake is a simple and effective way to lower blood pressure.
  • Both medications and exercise are effective at reducing blood pressure levels; exercise provides additional health benefits on top of medication.
  • The more strategies applied to reducing blood pressure (salt v. sodium, exercise, reduced alcohol, DASH diet, weight loss) the more you can reduce your risk of hypertension.

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