Suggested Citation: Garko, Michael (2018, October). High blood pressure: A lethal cardiovascular killer. Retrieved from www.letstaknutrition.com.
High Blood Pressure: A Lethal Cardiovascular Silent Killer
Dr. Michael Garko, Ph.D.
Host & Producer of Let’s Talk Nutrition
“Life is not living, but living in health” (Marcus Valerius Martialis, 1st century Roman poet) (McDonald, 2004, p. 65). Living in health can be elusive. It requires initiative and insight. The grim morbidity and mortality statistics surrounding high blood pressure (HBP) (also called hypertension) reveals how elusive living in health can be, even though HBP is preventable.
HBP has earned the reputation of being a “silent killer” and for good reason. HBP being “silent” refers to people being unaware of suffering from it because often there are no warning signs in the early stage of its development to alert them and consequently they go undiagnosed (Centers for Disease Control and Prevention, 2018b; World Health Organization, 2013). HBP being a “killer” refers to the 32,200 deaths annually in the United States attributed to it (Sherry et al., 2017). This silent killer is even more of a threat when it is a primary or contributing cause of death, accounting for nearly 1,000 deaths daily (Centers for Disease Control, 2018b; Mozzafarian, 2015). Approximately 7 out of 10 first-time heart attack victims and 8 out of 10 first-time stroke victims are diagnosed with HBP (Benjamin et al., 2017; Centers for Disease Control, 2018; Mozzafarian, 2015).
Prevalence of High Blood Pressure
Prevalence in the United States
About 30% of U.S. adults suffer from HBP (Centers for Disease Control and Prevention, 2018; Charles et al., 2017; Merai et al., 2016). The American Heart Association has the prevalence of HBP slightly higher at 34%, equating to an estimated 85.7 million adults in the U.S. 20 years of age and older (Benjamin, et al., 2017). Of those suffering from HBP, only 54% are reported to have it under control (i.e., having blood pressure at SBP/DBP < 140/90 mm Hg) or otherwise managed successfully.
As people age, the likelihood of developing HBP increases. Hence, 65%-67% of individuals 60 years of age and older suffer from HBP (Benjamin et al., 2017; Charles et al., 2017; Heidenreich et al., 2011). The estimated annual treatment cost for HBP in America is $47.5 billion (Charles et al., 2017).
Among children and adolescents in the U.S., 11% between the ages of 8-17 are reported to suffer from HBP or have borderline HBP (Benjamin, et al., 2017).
HBP is just as notorious and deadly in other countries as it is in the United States. It is estimated that globally the prevalence of HBP is from 1 billion to 1.39 billion people (Bloch, 2016; World Health Organization, 2013). Worldwide, cardiovascular disease is responsible for approximately 17 million deaths annually, 9.4 million of which are attributed to HBP (Lim et al., 2012; World Health Organization, 2013).
Burden on Health, Wellness and Wellbeing and Diminished Quality of Life
In its Global Brief on Hypertension, the World Health Organization (WHO) described the burden of HBP stating, “Premature death, disability, personal and family disruption, loss of income, and healthcare expenditure due to hypertension, take a toll on families, communities and national finances” (World Health Organization, 2013, p. 14). Specifically, HBP is a confirmed major risk factor for cardiovascular disease (CVD) in its various forms and stroke (Benjamin et al., 2017). It increases the risk for coronary heart disease (CHD) and stroke, the first and fifth leading causes of death in the United States, respectively (American Heart Association, 2018; Jackson, et al., 2018). If left untreated HBP, increases the risk for a diminished quality of life and a lifetime burden on health, wellness and wellbeing associated with myocardial infarction, peripheral artery disease, angina, congestive heart failure, aneurysm, kidney failure, metabolic syndrome, obesity, along with premature death and disability (Hamrahian et al., 2018; Mulè, 2014; Narkiewicz, 2006; Rapsomaniki, et al., 2014; World Health Organization, 2013).
Definition of Blood Pressure and Hypertension
Blood pressure is the amount of pressure or force of the blood pushing up against the walls of the arteries created by the heart muscle contracting (Centers for Disease Control and Prevention, 2018a; World Health Organization, 2013). Blood pressure is measured in millimeters of mercury (mm Hg) using two numbers expressed as a fraction. The top number is the systolic blood pressure (SBP) measuring pressure in the arteries when the heart contracts. The bottom number is the diastolic blood pressure (DBP) measuring pressure in the arteries in-between contractions (National Institutes of Health, 2003).
HBP is typically defined as the manifestation of a chronic or sustained elevation of systemic arterial pressure exceeding a particular established threshold value, requiring the heart to work harder than it would otherwise to circulate blood throughout the network of arterial vessels (Giles, 2009). While there are various surveillance definitions cited in the literature, the American Heart Association’s definition of HBP is most often referenced and is as follows: “SBP ≥140 mm Hg or DBP ≥90 mm Hg or self-reported antihypertensive medicine use, or having been told previously, at least twice, by a physician or other health professional that one has HBP” (Benjamin et al., 2017, pp. 139-140).
Classification of Blood Pressure
The classification of blood pressure (BP) represents the “staging” of the disease process of HBP, and, thereby, is an appraisal of the degree to which the disease has progressed (Giles et al., 2009). As such, classifying HBP or otherwise identifying its stages of disease development serves as a “snapshot” of the pathophysiological process associated with HBP at a particular point in time (Giles, et al., 2009).
The following classification is from the Joint National Committee of the Institutes of Health (National Institutes of Health (2003):
BP Classification Systolic Blood Pressure Diastolic Blood Pressure
Normal <120 mm Hg and 80 mm Hg
Prehypertension 120-139 mm Hg or 80-89 mm Hg
Stage I Hypertension 140-159 mm Hg or 90-99 mm Hg
Stage 2 Hypertension > or – 160 mm Hg or > or – 100 mm Hg
Source: Institutes of Health (2003)
Etiology & Pathogenesis of Hypertension
The etiology of HBP is discussed typically within the context of primary and secondary hypertension (e.g., see Barkis, 2018; Charles et al., 2017).
Primary hypertension (also called essential hypertension) is the most common form of HBP (≈90% of hypertensive patients) but is idiopathic with no discernable cause (Hamrahian, 2017). That being said, there is widespread agreement that the pathogenesis of primary hypertension is most likely multifactorial (e.g., genetics, excess sodium intake, hyperinsulinemia, increased levels of angiotensin II & obesity), disrupting the regulation of arterial pressure and fluid volume and involving multiple organ systems (i.e., cardiovascular system, endocrine system, renal system, respiratory system, nervous system) (see Cain & Kahlil, 2002; Foex et al., 2004; Hamrahian, 2017; Koop, 2005; Pizzornor & Murray, 2013).
In contrast to primary hypertension, secondary hypertension is less common (≈10% of hypertensive patients) (Viera & Neutze, 2010). With respect to the causes responsible for secondary hypertension, Viera & Neutze (2010) contend that the etiologies for secondary hypertension are different for children compared to adults and, thus, they recommend an age-based approach to identifying possible conditions or diseases causing the secondary hypertension (i.e., differential diagnosis) based upon the patient’s reported symptoms, medical history and physical examination.
Children & adolescents. Renal parenchymal disease associated with glomerulonephritis, congenital abnormalities and reflux nephropathy is the most common etiology for secondary hypertension in children and adolescents, (birth-18 years of age), with narrowing of the aorta (i.e., coarctation) as the second most common cause (Arar et al., 1994; Viera & Neutze, 2010).
Young adults. Thyroid dysfunction, fibromuscular dyplasia and renal parenchymal disease are the most common etiologies of secondary hypertension in young adults (19-39 years of age) (Viera & Neutze, 2010).
Middle-aged adults. Aldosteronism, thyroid dysfunction, obstructive sleep apnea, Cushing syndrome, and pheochromocytoma are the most common underlying causes of secondary hypertension in middle-aged adults (40-64 years of age) (Viera & Neutze, 2010).
Older adults. Atherosclerotic renal artery stenosis, renal failure and hypothryroidism are the most common causes of secondary hypertension in older adults (65 years of age & older) (Viera & Neutze, 2010).
Modifiable and Nonmodifiable Risk Factors Associated with High Blood Pressure
It is not as if the risk factors associated with HBP are unknown. The science of cardiovascular disease has identified a constellation of modifiable and unmodifiable risk factors. Yet, HBP is still one of the usual suspects found in the lineup for cardiovascular disease (CVD).
Modifiable Risk Factors
The increased risk for HBP is associated with certain metabolic conditions (e.g., prehypertension, obesity, in particular abdominal obesity, elevated triglycerides, reduced high-density lipoprotein cholesterol, glucose intolerance, insulin resistance & hyperuricemia), behavioral risk factors (e.g., unhealthy diet – diet low in whole plant-based foods and one high in salt, sugar and fat typically associated with nutrient-deficient in processed foods, sedentary life style/physical inactivity, sleep apnea, smoking and tobacco use, exposure to toxic chemicals such as Bisphenol A & unmanaged stress) and socio-environmental factors (e.g., education and socioeconomic status) (see American Heart Association, 2018a, 2018b, 2013; Benjamin et al., 2017; Centers for Disease Control and Prevention, 2014a; National Institutes of Health, 2003; World Health Organization, 2013). Of all the mentioned risk factors, diet is of special importance because of its inextricable connection to metabolic risk factors for HBP. The consumption of sugar-sweetened beverages is illustrative of how impactful diet can be on HBP. Jayalath et al. (2015) in a systematic review and meta-analysis found that sugar-sweetened beverages was correlated with a risk ratio for HBP of 1.12, equating to a 8.2% increased risk for HBP for each consumed added sugar-sweetened beverage per day.
Nonmodifiable Risk Factors
Nonmodifiable risk factors include genetics, family history, gender, race/ethnicity and age (see American Heart Association, 2018a, 2018b, 2013; Benjamin et al., 2017; Centers for Disease Control and Prevention, 2014a; National Institutes of Health, 2003; World Health Organization, 2013). The risk for HBP when associated with nonmodifiable risk factors is enhanced even further when occurring in combination with modifiable risk factors (Centers for Disease Control and Prevention, 2014c; Go et al., 2014; Mozzafarian et al. 2015). All of the nonmodifiable risk factors are important but the race/ethnicity statistics associated with African-Americans are stunning. For example:
- African-Americans in the U.S. have the highest prevalence of HBP globally.
- The prevalence of HBP is substantially higher among African Americans compared to Caucasians, Asians and Hispanics.
- African-Americans develop HBP earlier in life than do whites.
- African-Americans are more likely to go from prehypertension to HBP than whites.
- A higher SBP accounts for about 50% of excess stroke risk for African-Americans than whites (Benjamin et al., 2017).
Clinical Assessment of Blood Pressure
Blood pressure assessment is the most commonly performed diagnostic test and is a critical part of clinical practice (Handler, 2009; Ramnarine, 2018). The most relatively reliable and expedient way to measure blood pressure is a sphygmomanometer (pressure cuff). While using a pressure cuff is highly confirmatory for HBP, a urinalysis and spot urine albumin:creatinine ratio test, electrocardiogram, stress test and blood test (creatinine, potassium, fasting plasma glucose, sodium, calcium, uric acid, lipid panel, thyroid stimulating hormone) can be ordered to achieve a more comprehensive diagnostic assessment of the patient (Barkis, 2018; El-Hashemy, 2007).
From a functional medicine perspective, a number of additional laboratory tests can be performed (although some are part of allopathic medicine as well).
- Comprehensive Metabolic Panel (CMP) – Evaluate for glucose level, electrolyteand fluid balance, kidney and liver function and evidence of renal insufficiency, hypokalemia, or hyperglycemia.
- Gamma-Glutamyl Transferase test (GGT) – Evaluate for increase in GGT, a predictor for onset of metabolic syndrome and cardiovascular disease
- Complete Blood Count (CBC) – Evaluate overall health & detection of disorders such as anemia, infection and leukemia. Measures features of blood such as RBC & WBC, hemoglobin, hematocrit, platelets. Check for increased levels in RDW, MCV, MCH, and MCHC.
- Peripheral Blood Smear – Evaluate for red blood cell fragments present in microangiopathic hemolytic anemia caused by HBP.
- Vertical Auto Profile Cholesterol Test (VAP) – Provides results on 15 components of blood cholesterol.
- Ferritin, Fibrinogen, C-Reactive Protein (HS) – Evaluate for chronic inflammation
- Homocysteine – Marker for coronary heart disease
- Urinalysis – Evaluate for proteinuria, hematuria, microalbumin and red cell/granular casts for evidence of a secondary cause or hypertensive nephropathy
- Heavy Metal Toxicity – Evaluate for cadmium, lead, mercury, which are associated HBP
- Nutritional Deficiencies – Evaluate for deficiencies in magnesium, potassium, calcium, vitamin D, vitamin C, vitamin K, B1, B6, B7/biotin, B12, B9/folate, choline, CoQ10, omega 3 fatty acids (see Sodano & Grisanti, 2010)
Western & Functional Medicine Interventions for High Blood Pressure
The primary standard of care for HBP in Western/traditional medicine is pharmacotherapy with the admonition to avoid over consuming salts. There is an array of drugs with different mechanisms of action intended to lower blood pressure. The primary classes of blood pressure medications designed to lower blood pressure are:
- Diuretics – Remove excess water & sodium
- Beta-blockers – Reduces heart rate, heart’s workload & blood output
- ACE/Angiotensin-converting enzyme inhibitors (ACEI) – Reduces angiotensin, allowing blood vessels to relax & expand, thereby, lowering blood pressure.
- Angiotensin II receptor blockers – Block angiotensin receptors, prohibiting constriction of blood vessels
- Calcium channel blockers (CCB)– Decrease amount of calcium in cells, relax & expand blood vessels & reduce heart rate
- Alpha blockers – Reduce arteries’ resistance, creating a more relaxed muscle tone of vessels’ walls.
- Alpha-2 Receptor Agonists – Decrease adrenaline by moderating SNS
- Combined alpha and beta-blockers – Administered by IV drip for hypertensive crises
- Central agonists – Decrease blood vessels from tensing up or contracting
- Peripheral adrenergic inhibitors – Block neurotransmitters in the brain that prevents smooth muscles from constricting
- Vasodilators – Helps muscle in walls of blood vessels (especially arterioles) to relax, causing vessel to dilate (American Heart Association, 2018c)
From a functional medicine perspective, perhaps one of the most effective strategies is to replace blood pressure medications with natural compounds derived from food and dietary supplements mimicking the mechanisms of action of HBP drugs. Specifically, natural compounds that would behave like diuretics, calcium-channel blockers, beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, alpha agonists and vasodilators. Alexander (2014) contends that it is time to replace drugs with nutrition and nutraceuticals. For example, he proposes replacing diuretics with Vitamin B6, taurine, and magnesium in combination together, central alpha agonists with taurine and vitamin B6, followed by potassium, vasodilators: with omega-3 fatty acids, magnesium CoQ10), CCB with alpha-lipoic acid, magnesium, and omega-3s EPA & DHA) and ACEIs with dried bonito fish, pycnogenol, omega-3s and hydrolyzed whey protein. Alexander (2014) provides a comprehensive list of natural compounds possessing antihypertensive qualities found In Table 1 at the end of the essay.
Another proven functional nutrition therapy to lower and manage HBP is the DASH diet (Dietary Approaches to Stop Hypertension). The National Heart, Lung, and Blood Institute (NHLBI) funded several clinical trials to determine the effectiveness of dietary approaches to treat HBP. The DASH diet is made-up of vegetables, fruit, grains and grain products, low fat and non-fat dairy foods and generally foods, meats, including poultry and fish, nuts, seeds and legumes (see National Heart, Lung, and Blood Institute, 2018).
Perhaps Marcus Valerius Martialis’ notion of living in health should be modified to read, “Life is not living, but living in health by taking personal responsibility.” HBP is preventable. If it is to be prevented, then individuals need to assume personal responsibility and create a personal prevention program. One step in that direction is to learn about the risk factors for HBP. This can assist in (1) assessing (with the help of a healthcare professional) the likelihood of developing HBP and (2) eliminating or at least reducing the impact of modifiable metabolic, behavioral and socio-environment risk factors, along with the nonmodifiable risk factors of genetics, family history, gender, race/ethnicity and age. Prevention begins with health consumers knowing about the nature of HBP risk factors.
Diet and nutrition is central to a personal prevention program to prevent, treat and manage hypertension. The DASH eating plan (mentioned above) is proven to be effective when it comes to HBP. However, a whole food plant-based diet no meat, no dairy and no oil (if the person suffers from CHD) has been proven to be effective with patients suffering from CHD. Caldwell Esselstyn, cardiac surgeon at the Cleveland Clinic, has had success in treating CHD patients with the diet (see Esselstyn & Golubic, 2014; Esselstyn, Gendy, Doyle & Golubic, 2014). The diet is challenging but it works and would most likely serve HBP patients well.
Lifestyle factors also need to be included in any personal prevention program. For example, stress management would be an important element of personal prevention program for HBP. There are workshops and online courses in which people can enroll to learn the most effective ways to learn about and manage stress. Physical activity, especially endurance/cardiorespiratory exercise under the guidance of a personal trainer, can go a long way in preventing, treating and managing HBP.
The American Heart Association offers specific lifestyle, and diet recommendations and tips to implement them. They are found at the end of the essay in Tables, 2, 3 and 4.
American Heart Association (2018a). Detailed summary from the 2017 guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults. Retrieved from https://healthmetrics.heart.org/wp-content/uploads/2017/11/Detailed-Summary.pdf.
American Heart Association (2018b). Heart Disease and Stroke Statistics 2018 At-a-Glance. Retrieved from https://www.heart.org/-/media/data-import/downloadables/heart-disease-and-stroke-statistics-2018—at-a-glance-ucm_498848.pdf.
American Heart Association (2017). Know your risk factors for high blood pressure. Retrieved from http://www.heart.org/en/health-topics/high-blood-pressure/why-high-blood-pressure-is-a-silent-killer/know-your-risk-factors-for-high-blood-pressure.
American Heart Association (2018c). Types of blood pressure medications. Retrieved from http://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure/types-of-blood-pressure-medications.
Arar, M.Y., Hogg, R..J, Arant, B.S. & Seikaly, M.G. (1994). Etiology of sustained hypertension in children in the southwestern United States. Pediatric Nephrology, 8(2):186-189.
Barkis, G.L. (2018). Overview of hypertension. Merck Manual. Retrieved from https://www.merckmanuals.com/professional/cardiovascular-disorders/hypertension/overview-of-hypertension
Benjamin, E.J., Blaha, M.J., Chiuve, S.E. et al. (2017). Heart disease and stroke statistics-2017 update. Circulation, 135(10): e146-e603.
Bloch, M. J. (2016). Worldwide prevalence of hypertension exceeds 1.3 billion. Journal of the American Society of Hypertension, 10(10): 753–754
Centers for Disease Control and Prevention (2018). High blood pressure. Retrieved from https://www.cdc.gov/bloodpressure/index.htm.
Centers for Disease Control and Prevention (2018a). About high blood pressure. Retrieved from https://www.cdc.gov/bloodpressure/about.htm.
Centers for Disease Control and Prevention (2014a). Behaviors that increase risk for high blood pressure. Retrieved from https://www.cdc.gov/bloodpressure/behavior.htm.
Centers for Disease Control and Prevention (2014b). Conditions that increase risk for high blood pressure. Retrieved from https://www.cdc.gov/bloodpressure/conditions.htm.
Centers for Disease Control and Prevention (2014c). Family history and other characteristics that increase risk for high blood pressure. Retrieved from https://www.cdc.gov/bloodpressure/family_history.htm.
Centers for Disease Control and Prevention (2018b). High blood pressure facts.
Retrieved from https://www.cdc.gov/bloodpressure/facts.htm.
Charles, L., Triscott, J. & Dobbs, B. (2017, October). Secondary hypertension: Discovering the underlying cause. American Family Physician. 96(7):453-461.
El-Hashemy, S. (2007). Naturopathic standards of primary care. Canadian College of Naturopathic Medicne.
Esselstyn, C. & Golubic, M. (2014). The nutritional reversal of cardiovascular disease – Fact or fiction? Three case reports. Experimental Clinical Cardiology, 20(7): 1901-1908
Esselstyn C.B., Gendy, G., Doyle, J., Golubic, M. Roizen, M.F. (2014) A way to reverse CAD? The Journal of Family Practice. 63(7): 356, 364b.
Giles, T.D., Materson, B.J., Cohn, J. & Kostis, J.B. (2009). Definition and classification of hypertension: An update. The Journal of Clinical Hypertension, 11(11): 611-614.
Handler, J. (2009). The importance of accurate blood pressure measurement. Permanente Journal, 13(3): 51–54.
Hamrahian, S. & Falkner, M. (2017). Hypertension in chronic kidney disease. Advances in Experimental Medicine and Biology, 956:307-325.
Jackson SL, Zhang Z, Wiltz JL, et al. Hypertension Among Youths — United States, 2001–2016. MMWR Morb Mortal Wkly Rep 2018;67:758–762.
Lichtenstein, A.H, Appel, L.J., & Brands, M. et al. (2006). Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation, 114(1):82-96
Merai R, Siegel C, Rakotz M, Basch P, Wright J, Wong B; DHSc., Thorpe P. CDC Grand Rounds: A Public Health Approach to Detect and Control Hypertension. MMWR Morb Mortal Wkly Rep. 2016 Nov 18;65(45):1261-1264.
Lim, S.S., Vos, T., Flaxman, A.D., Danaei, G., et al. (2012). A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet, 380 (9859): 2224-60.
Go, A.S., Mozaffarian, D., Roger, V.L., Benjamin, E.J. et al. (2014). Heart disease and stroke statistics—2014 update: A report from the American Heart Association. Circulation. 129:e28–e292.
Mozzafarian, D, Benjamin, E.J., Go, A.S., et al. (2015) Heart disease and stroke Statistics-2015 Update: A report from the American Heart Association. Circulation. 2015; e29-322.
Mulè, G., Calcaterra, I., Nardi, E., Cerasola, G. & Cottone, S. (2014, September). Metabolic syndrome in hypertensive patients: An unholy alliance. World Journal of Cardiology, 6(9): 890–907.
Murphy, S.L., Xu, J.,, Kochanek, K.D., Curtin, S.C. & Arias, E. (2017, November) Deaths: Final data for 2015. National Vital Statistics Reports, 66 (6): 1-75. National Center for Health Statistics. Health, United States, 2017: With special feature on mortality. (2018). Hyattsville, MD. Retrieved from https://www.cdc.gov/nchs/data/hus/hus17.pdf
National Center for Health Statistics (2017). Hypertension. Retrieved from https://www.cdc.gov/nchs/fastats/hypertension.htm
Narkiewicz, K. (2006). Obesity and hypertension—the issue is more complex than we thought. Nephrol Dial Transplant, 21: 264–267.
National Institutes of Health (2003). The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK9630/pdf/Bookshelf_NBK9630.pdf.
National Institutes of Health (2010). Fact Sheet – Hypertension (high blood pressure). Retrieved from https://report.nih.gov/nihfactsheets/Pdfs/Hypertension(HighBloodPressure)(NHLBI).pdf.
National Heart, Lung, and Blood Institute (2018). DASH eating plan. Retrieved from https://www.nhlbi.nih.gov/health-topics/dash-eating-plan.
Ramnarine, M. (2018). Blood pressure assessment. Retrieved from https://emedicine.medscape.com/article/1948157-overview.
Rapsomaniki, E., Timmis, A. & George, J. et al. (2014, May). Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1·25 million people. Lancet, 383(9932):1899–1911.
Sodano, W. L. & Grisanti, R. (2010). Cardiovascular disease: A comprehensive approach to evaluation and management. Retrieved from http://www.functionalmedicineuniversity.com/FDMT545ACardioIG.pdf.
Viera, A.J. & Neutze, D.M. (2010). Diagnosis of secondary hypertension: an age-based approach. Am Fam Physician, 82(12): 1471-1478.
Walter, A. (2014, April). Hypertension: Is it time to replace drugs with nutrition and nutraceuticals? Pharmacy and Therapeutics, 39(4): 291–295.
World Health Organization (2013). A global brief on hypertension: Silent killer, global public health crisis. Retrieved from http://apps.who.int/iris/bitstream/handle/10665/79059/WHO_DCO_WHD_2013.2_eng.pdf;jsessionid=01436A04828C192C98D07C3004363172?sequence=1.
Yoon SS, Fryar CD, Carroll MD. Hypertension prevalence and control among adults: United States, 2011-2014. NCHS data brief, no 220. Hyattsville, MD: National Center for Health Statistics (2015).
Table 1 – Natural Compounds With Antihypertensive Qualities
Angiotensin-Converting Enzyme Inhibitors
Central Alpha Agonists (Reduced sympathetic nervous system activity)
Table 2 – Lifestyle Recommendations for Cardiovascular Disease Risk Reduction
AHA’s recommended lifestyle goals to reduce the risk of CVD are as follows:
- Consume an overall healthy diet.
- Aim for a healthy body weight.
- Aim for recommended levels of low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides.
- Aim for a normal blood pressure.
- Aim for a normal blood glucose level.
- Be physically active.
- Avoid use of and exposure to tobacco products (Lichtenstein, et al., 2006, p. 83).
Table 3 – Diet Recommendations for Cardiovascular Disease Risk Reduction
AHA’s recommended diet goals to reduce the risk of CVD are as follows:
- Balance calorie intake and physical activity to achieve or maintain a healthy body weight.
- Consume a diet rich in vegetables and fruits.
- Choose whole-grain, high-fiber foods.
- Consume fish, especially oily fish, at least twice a week.
- Limit your intake of saturated fat to <7% of energy, trans fat to <1% of energy, and cholesterol to <300 mg per day by choosing lean meats and vegetable alternatives; selecting fat-free (skim), 1%-fat, and low-fat dairy products; and minimizing intake of partially hydrogenated fats.
- Minimize your intake of beverages and foods with added sugars.
- Choose and prepare foods with little or no salt.
- If you consume alcohol, do so in moderation.
- When you eat food that is prepared outside of the home, follow the AHA Diet and Lifestyle Recommendations(Lichtenstein, et al., 2006, p. 83).
Table 4 – Practical Tips To Implement Diet and Lifestyle Recommendations
AHA’s recommended tips to implement its diet and lifestyle recommendations to reduce the risk of CVD are as follows:
- Know your caloric needs to achieve and maintain a healthy weight.
- Know the calorie content of the foods and beverages you consume.
- Track your weight, physical activity, and calorie intake.
- Prepare and eat smaller portions.
- Track and, when possible, decrease screen time (e.g., watching television, surfing the Web, playing computer games).
- Incorporate physical movement into habitual activities.
- Do not smoke or use tobacco products.
- If you consume alcohol, do so in moderation (equivalent of no more than 1 drink in women or 2 drinks in men per day)(Lichtenstein, et al., 2006, p. 86).
Food Choices and Preparation
- Use the nutrition facts panel and ingredients list when choosing foods to buy.
- Eat fresh, frozen, and canned vegetables and fruits without high-calorie sauces and added salt and sugars.
- Replace high-calorie foods with fruits and vegetables.
- Increase fiber intake by eating beans (legumes), whole-grain products, fruits, and vegetables.
- Use liquid vegetable oils in place of solid fats.
- Limit beverages and foods high in added sugars. Common forms of added sugars are sucrose, glucose, fructose, maltose, dextrose, corn syrups, concentrated fruit juice, and honey.
- Choose foods made with whole grains. Common forms of whole grains are whole wheat, oats/oatmeal, rye, barley, corn, popcorn, brown rice, wild rice, buckwheat, triticale, bulgur (cracked wheat), millet, quinoa, and sorghum.
- Cut back on pastries and high-calorie bakery products (e.g., muffins, doughnuts).
- Select milk and dairy products that are either fat free or low fat.
- Reduce salt intake by comparing the sodium content of similar products (e.g., different brands of tomato sauce) and choosing products with less salt; choosing versions of processed foods, including cereals and baked goods, that are reduced in salt; and limiting condiments (e.g., soy sauce, ketchup).
- Use lean cuts of meat and remove skin from poultry before eating.
- Limit processed meats that are high in saturated fat and sodium.
- Grill, bake, or broil fish, meat, and poultry.
- Incorporate vegetable-based meat substitutes into favorite recipes.
- Encourage the consumption of whole vegetables and fruits in place of juices (Lichtenstein, et al., 2006, p. 86).
 A common misunderstanding is that risk factors are causes of a disease such as HBP. Risk factors are variables that increase the likelihood of disease and linked to it by way of a statistical association or correlation. The stronger the statistical association the stronger the inference that can be made about a particular factor putting people at risk for developing a disease. Risk factors are a necessary condition for the development of a disease, whereas, causes are a sufficient condition. In other words, risk factor contribute to a disease, while cause ensure it.