Treating High Blood Pressure

By Bonnie Jenkins, Advanced Natural Medicine

Last month, the American Heart Association released their new 2007 Guidelines for Preventing Cardiovascular Disease in Women. Unfortunately, while some of the recommendations make sense, the ones your doctor will probably focus on only serve to bring more women into the heart disease industry – including a push towards more medication and heart surgery.

The Low Down

The guideline's recommend that women to keep their LDL “bad” cholesterol below 100 mg/dL (the old guidelines set the normal level at 130 mg/dL). And if you are at high risk of heart disease your LDL should be kept below 70 mg/dL. Since few doctors consider diet and exercise as a first line of defense, most will automatically recommend medication – and that means a big boost in statin drug sales.

While statins will make the overall cholesterol and LDL numbers look better, the real benefits of radically lowering cholesterol – a longer, healthier life without heart disease and stroke – remain unproven. In fact, there has never been a single randomized controlled clinical trial (the gold standard of evidence-based medicine) showing that statins are beneficial for women who don't have heart disease. Just the opposite may be true – clinical trials involving more than 10,000 women show that those taking statin drugs developed heart disease at about the same rate as women who took a placebo!

The Pressure's On

The 2007 guidelines also recommend aggressively treating high blood pressure with drugs when it’s 140/90 mm Hg or above – which is considerably lower than the old guidelines of 160/100 mm Hg. The new guidelines will probably result in doctors prescribing hypertension medication much the same way as they do statin drugs – like candy.

There’s another problem with overtreating hypertension – you can lower blood pressure to dangerous levels. Research over the last 20 years clearly shows overaggressive treatment of blood pressure with drugs can kill. Heart attacks, death, and/or stroke was three times higher for patients with a diastolic blood pressure (the lower number) of 60 mmHg compared to a person with a normal pressure of 80 to 90 mmHg.

Not all Bad

Even with the push towards pharmaceuticals, the 2007 guidelines did contain a few golden nuggets. Unlike past recommendations, the American Heart Association is no longer recommending hormone replacement therapy or selective estrogen receptor modulators (like Evista) to prevent heart disease in women. And, while they don’t mention antioxidants or folic acid, the guidelines do recommend supplemental fish oil. Women with heart disease should take approximately 850 to 1000 mg of EPA and DHA, while those with high triglyceride levels should take 2,000 to 4,000 mg.

The guidelines are also big on exercise, noting that “women should accumulate a minimum of 30 minutes of moderate-intensity physical activity like brisk walking on most, and preferably all, days of the week.” For women who need to lose weight or maintain their weight loss, the amount of time increases to a minimum of 60 to 90 minutes. Going hand-in hand with exercise, the guidelines recommend a diet rich in fruits and vegetables, high-fiber whole grains and fish – especially oily fish like salmon – at least twice a week. The American Hearth Association also advises limiting your intake of saturated fat to less than10 percent – and if possible to less than seven percent. And nix the trans fat. They also include the same recommendations you’ve heard for years: keep dietary cholesterol under 300 mg/d and lower your sodium intake to less than one teaspoon a day.

So what should you make of the new and improved guidelines for women? Although they do represent some progress, it’s clear that the American Heart Association is still heavily influenced by the pharmaceutical industry to boost their profits by making more women sick with their broader definitions of high cholesterol and high blood pressure. My advice – use common sense. Pay attention to the recommendations for supplements, diet and exercise, and, unless you are at high risk for cardiovascular trouble, ignore the rest.

One Last Thing ...

Low-dose aspirin is possibly the most controversial recommendation in the guidelines. Instead of limiting its use to high risk people, they urge all women – regardless of age – to take a baby aspirin, even those who are perfectly healthy. Now I can understand a doctor recommending aspirin to a patient with a history of stroke, heart attack, angioplasty or bypass surgery. But for people without these problems, the risks of taking a daily low-dose aspirin definitely outweigh the benefits. Since aspirin acts like a blood thinner, the primary risk is bleeding. People who take aspirin regularly (even in a buffered or coated form) are twice as likely to develop a perforated ulcer or bleeding in the GI tract – both of which kill more people in the U.S. each year than asthma or cervical cancer. So if you aren’t in a high risk group, forget the aspirin. Even though most of us consider aspirin pretty benign, remember it’s still a drug – and like all drugs, it can have some serious side effects.

This Just In ...

If you feel faint, dizzy or lightheaded after quickly standing up, especially in the morning, you probably have a common condition called orthostatic hypotension. According to British researchers, relief may be as simple as drinking two glasses of water.

Orthostatic hypotension occurs more frequently in older people, particularly those who are frail and sick. But it’s not uncommon in young, healthy people. Orthostatic hypotension is caused by a drop in systolic blood pressure (the top number) of at least 20 points or a drop in diastolic blood pressure (the bottom number) of at least 10 points within three minutes of standing.

The U.K. study included 14 volunteers with blood pressure abnormalities. The researchers first measured volunteers’ blood pressure while seated, then while standing, plus once before and twice after drinking two glasses of water. The results showed a significant increase in standing blood pressure at both 15 minutes and 35 minutes after drinking the water. Moreover, 11 of the 14 volunteers reported an improvement in their symptoms after drinking the water. What’s the take-away message? A bedside pitcher of water may be an effective remedy for those morning moments of dizziness.

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References:

Abramson J, Wright JM. “Are lipid-lowering guidelines evidence-based?” Lancet. 2007 Jan 20;369(9557):168-169.

Messerli FH, Msancia G, Conti CR, et al. “Dogma disputed: can aggressively lowering blood pressure in hypertensive patients with coronary artery disease be dangerous?

Annals of Internal Medicine. 2006;144:884-893.

Mosca L, Banka CL, Benjamin EJ, et al. “Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update.” Circulation. Feb 19, 2007.

Young TM, Mathias CJ. “The effects of water ingestion on orthostatic hypotension in two groups of chronic autonomic failure: multiple system atrophy and pure autonomic failure.” Journal of Neurology, Neurosurgery and Psychiatry. 2004;75:1737-1741.