On Monday, November 15th, the morning paper brought bad news to more than 15 million Americans. They now had high blood pressure. If you or someone you care about is one of these hypertensive newbies, you might want to read this before filling any prescriptions.
What scientific discovery led to the new diagnostic guidelines?
We’ve known for some time that treating elevated blood pressure reduces the risk of stroke (by 35-40%), heart attack (by 15-25%) and heart failure (by up to 64%). But here’s where it gets a bit tricky. Observational studies have shown a progressive increase in cardiovascular risk as systolic blood pressure (SBP, the first number e.g. 120/80) exceeds 115. However randomized controlled trials (the gold standard for clinical research) have only shown the benefit of lowering SBP below 150 in the general population with hypertension only.
Enter SPRINT, the Systolic Blood Pressure Intervention Trial. The study was designed to test the hypothesis that a lower SBP (e.g. <120) would decrease clinical events more than a standard goal. The results, published in the New England Journal of Medicine in 2015, showed that more aggressive treatment did indeed further decrease cardiovascular events in a high-risk population.
Most of the newly diagnosed hypertensives are not high risk. They have blood pressure elevation of SBP 130-140. The recommended treatment for this group (unless there is preexisting cardiovascular disease or risk >10%) is lifestyle modification, not medication. This includes physical activity, weight control, diet, controlled alcohol consumption and smoking cessation.
Take a moment and calculate your risk with the link in the next section.
How to determine your risk
In order to determine the appropriate treatment it is necessary to define not only your level of hypertension but also your risk category. This can be calculated with a standardized formula provided here.
Treatment Recommendations
If you have elevated blood pressure (120-129/anything), non-medical interventions are advised. These include diets high in fruits and vegetables and low in salt and bad fats, increased physical activity, an exercise regimen, weight loss where indicated, no smoking and limited alcohol consumption (women 1 serving/day, men 2 servings/day).
If you have Stage 1 (130-139/80-89), no cardiovascular disease and are at low risk(<10%), lifestyle modification is the place to begin.
If you have Stage 1 (130-139/80-89) and cardiovascular disease or risk above 10%, medication plus lifestyle modification is recommended.
If you have Stage 2 (>140/90), both medication and lifestyle modification are recommended.
Beets
If your SBP falls between 120 and 140, you have no cardiovascular disease and are at low risk (<10%), you must explore the benefits of beets.
Good research has repeatedly documented the blood pressure lowering effect of beet juice (BJ). One week of this rich red elixir can decrease SBP by 14 mm/Hg. In addition, drinking 2.4 ounces of BJ one hour before exercise has been shown to increase exercise capacity by as much as 24%.
People with high blood pressure have lower levels of nitric oxide, a chemical that relaxes blood vessels. This relaxation opens the vessels (vasodilation) increasing blood flow throughout the body. Without nitric oxide the heart and muscles cannot meet the increased demand of exercise. BJ is rich in nitrate, which the body converts to nitric oxide. By promoting vasodilation, BJ lowers blood pressure, improves exercise capacity and duration, and protects the blood vessels from stiffening (arteriosclerosis).
Archeological records indicate that we have used the leaves and roots of Beta vulgaris for dyes, teas, medicines and eating of course, since the third millennium BC. Many cultures believed they provide more than colorful nourishment.
The Greeks and Romans considered beets an aphrodisiac and a symbol of love and lust. They may have been onto something. Beetroot is rich in boron, an essential ingredient for sex hormone production. Also, the dilation of blood vessels that beetroot juice promotes is similar to the more localized action of drugs like Viagra.
Recent research has continued to uncover medicinal properties locked in beets. These include boosting stamina, decreasing inflammation, helping prevent cancer and promoting detoxification.
So beet it.