Hypertension

Diet and Heart Disease – Not as Simple as We Thought

We have all been told for years that the main dietary risk factor for heart disease and stroke is how much saturated fat we eat. We have also been told that eating foods high in cholesterol also increases risk of heart disease and stroke. Evidence is accumulating that consumption of saturated fat increases risk of heart disease and stroke little if at all. Since your body makes cholesterol itself, eating cholesterol rich foods has almost no effect on serum cholesterol. Other aspects of diet have a much greater effect on increasing the risk of heart disease and stroke. In this post I will summarize the evidence and spend some time discussing things we eat and drink that do substantially increase the risk of heart disease, stroke and other chronic diseases.

The Seven Country Study

The most famous study that led to the saturated fat hypothesis was carried out by Ancel Keys. The study started in 1956 and was published in 1978. He looked at the dietary patterns of 7 different countries. The countries included Finland, Greece, US, Italy, Yugoslavia, Netherlands and Japan. He found that saturated fat intake was correlated with increased risk of heart attack and stroke. The country with the lowest saturated fat intake was Crete in Italy, which also had the lowest incidence of heart disease and stroke of the 7 countries. The diet of Crete is the basis for the famous Mediterranean Diet.

Diets of free living humans are notoriously difficult to measure. Keys did his best to accurately determine diet. He had a subset of his subjects in each country weigh their food for a number of days, which is considered the gold standard for dietary studies. The problem with any population study like this is that populations in different countries differ in lots of other ways besides diet. Also diets are complex, so some other factor or factors in diet could account for the low heart disease incidence in Crete. Another problem was that diet was measured in Crete during Lent, when most people did not eat meat. All Keys could really say was that saturated fat intake was associated with heart disease, but he could not say that saturated fat caused heart disease.

People who adhered to the Mediterranean Diet did reduce their population risk of heart disease, but there is a lot more to the Mediterranean Diet than reduced saturated fats. It also includes little added sugar, lots of vegetables and fruit and mostly unprocessed foods. It is not clear that reduction in saturated fat is responsible for the health benefits of the Mediterranean Diet.

The Framingham Study

The next big population study was the Framingham Study. A large group of people in Framingham Massachusetts was followed over many years with surveys about diet, activity, smoking and laboratory measurements of total cholesterol, LDL, HDL and triglyerides among other measurements. Heart attacks, strokes, death from either of these things and death from any cause were recorded in the study group. This was the first large study that implicated cigarette smoking as a cause of cardiovascular disease and cancer. It was also found that the higher the total cholesterol and especially the higher the LDL (low density lipoprotein) the higher the risk of cardiovascular disease. It was also one of the first studies that showed that the higher the blood pressure, the greater the risk of cardiovascular disease. This was a tremendously important and well done study.

The Diet-Heart Hypothesis

The diet-heart hypothesis is that saturated fat is the main dietary cause of cardiovascular disease. It has been very influential over 60 years and is still promoted by the American Heart Association and many cardiologists. Here is the train of thought. The 7 country study implicated saturated fat as associated with cardiovascular disease. It has been found through multiple studies that saturated fat intake raises LDL (so called bad cholesterol). The Framingham study showed that increased LDL was a major risk factor for cardiovascular disease. Since saturated fat raises LDL, therefore saturated fat must cause cardiovascular disease.

That makes perfect sense, so many randomized trials were carried out to nail down the diet-heart hypothesis. Unfortunately, as is often the case with beautiful theories, further randomized trials did not consistently show the expected increase in heart disease from eating saturated fat. The other part of the hypothesis was that eating polyunsaturated fats would decrease the population risk of heart disease. That was based on the observation that consuming polyunsaturated fats decreased LDL levels. Randomized trials have generally failed to consistently show that eating polyunsaturated fats reduces the risk of cardiovascular disease.

Reduced Risk of Cardiovascular Disease in US

Heart disease was epidemic in the US, peaking in the 60’s. Since then, the incidence of heart disease in the US and most other developed countries has decreased by 60%! Scientists debate the cause for this decline. Although saturated fat consumption decreased some, Americans still eat much more saturated fat than the 5% of fat recommended by the American Heart Association. So the fact that we eat somewhat less saturated fat does not explain the remarkable decline in heart disease over the last 60 years. What else changed?

Cigarette Smoking

In the 1940’s half of all Americans said they smoked cigarettes. Smoking began to decline in the US in the 60’s and today only 11.5% of Americans smoke tobacco! This has to be a major factor in the decline of cardiovascular disease (and lung cancer).

High Blood Pressure

High blood pressure is a major risk factor for heart disease. The number of people with high blood pressure successfully controlled on medicine has more than doubled since 1960. This is clearly another major factor in the decline of cardiovascular disease

Trans Fats

The rise of trans fat consumption was an unintended consequence of the heart-diet hypothesis. Because animal fat (mostly saturated fat) was postulated to cause heart disease, the food industry started figuring out how to use vegetable oil to replace lard and butter, which were high in saturated fats. They needed something that would be solid, not liquid at room temperature. They discovered that if they partially hydrogenated vegetable oil, then it would be solid at room temperature and could substitute for lard and butter. They marketed these products as healthier because they were only partially saturated fats, not saturated fats. The medical establishment bought this story and recommended margarine as a substitute for butter and Crisco (the most successfully marketed shortening substitute) as healthier alternatives. I have been unable to find statistics on trans fat consumption in the US, but it was very large.

It turns out that consumption of trans fats markedly increased the risk of cardiovascular disease. For every 2% increase in the consumption of trans fats, heart disease increased by 23%. This is a shocking number! The consumption of trans fats certainly contributed to the epidemic of heart disease in the 50’s and 60’s. The FDA essentially banned the addition of trans fats to food in June of 1978. The elimination of trans fats is almost certainly another major factor in the decline of heart disease.

Interesterification

Since trans fats have been banned, food companies have come up with a new way to make vegetable oil solid and spreadable. It is called interesterification. It is complicated, but the simplest explanation is that it involves changing the arrangement of fatty acids on a glycerol backbone. These are fully hydrogenated fats, so are not trans fats. We know very little about how these new industrial fats affect human health, but the information we do have suggests that these new products may be just as bad for you as trans fats. You would do best to avoid them until we know more. More about how to do this later in this post.

Do we need to limit red meat consumption?

The main risk of consumption of any food is eating too much of it. It is total calorie intake that makes us fat, and being fat increases the risk of cardiovascular disease, diabetes and some cancers. Eating red meat by itself is very unlikely to increase your risk of heart disease as long as your total calorie intake is equal to the calories you burn up. So there is very little health risk to you in eating red meat, but there is a big risk to the environment. Cattle raising worldwide contributes about 16% of greenhouse gas emissions. Here is a link to a balanced discussion of greenhouse gas emissions from cattle raising: Livestock Don’t Contribute 14.5% of Global Greenhouse Gas Emissions.

The other thing to think about when consuming any meat product, including chicken is that almost all the meat you buy in the grocery store comes from giant factory farms, where animals are treated very inhumanely. That in itself is bad enough, but raising all those animals together increases risk of spreading disease to the people who eat them. Antibiotics are used in many factory farms to keep animals from getting sick. This contributes to the evolution of bacteria that are resistant to most antibiotics.

If you are not willing to give up eating meat entirely, try to find locally raised beef, pork and poultry. Farmer’s Markets are a good place to find meat from locally raised animals. It may be a little more expensive, but likely a lot safer.

What about eating fish?

If you are at high risk of cardiovascular disease or have cardiovascular disease then eating oily fish (salmon, sardines, anchovies, herring, mackerel, tuna, swordfish) twice a week reduces your risk of a heart attack by 50%. If you are at average risk, these fish don’t have unusual health benefits but if you like them, it’s fine to eat them. Because most of these fish contain some mercury they should probably be avoided by pregnant women and children. If you get canned tuna, get Pacific Island Tuna at Walmart. It is sustainably caught. Here is a link to an article from the Nature Conservancy about it: The Nature Conservancy. By the way taking fish oil is not nearly as good for you as eating fish.

Highly Processed Foods

There are convincing data that consumption of lots of highly processed foods leads to health concerns ranging from increased risk of obesity, high blood pressure, breast and colorectal cancer, to dying prematurely from all causes.These foods all also contain additives whose health effects have never been adequately tested. How do you recognize them? Just look at the label where the ingredients are listed. If there are more than two things you don’t recognize, put it back on the shelf. Here is an example of an ingredients list from a loaf of bread!

This is not bread you would want to eat! If you mostly stay out of the central aisles of the grocery store you will avoid most highly processed foods. Just be sure to look at the ingredients label before you buy anything.

It is all well and good for me to make these recommendations, but highly processed foods and factory farmed meat are cheap. People who are poor cannot afford to buy anything else. This is only one of the things that have led to the major health inequities that are present in this richest country in the world.

Foods that decrease risk of cardiovascular disease

Fiber

Increased dietary fiber has been shown to decrease risk of cardiovascular disease. This may well have to do with promoting a healthy microbiome in the intestine. Sources of fiber that promote growth of healthy gut bacteria are ones that contain inulin. The highest sources of inulin are leeks, asparagus, onions, wheat, garlic, chicory, oats, soybeans, and Jerusalem artichoke. Sourdough bread (no added sugar, honey, or high fructose corn syrup) is also a good source of fiber. Whole grains, fruits, nuts and vegetables are also good sources of fiber.

Fresh Fruits

Fresh fruits are a good source of fiber and also contain many beneficial nutrients including vitamins and antioxidants. Data from multiple studies show that eating fresh fruit daily reduces risk of cardiovascular disease.

Nuts

Eating a handful of nuts per day reduces your risk of heart disease by 20%. Peanuts are technically of legume, not a nut, but legumes reduce the risk of cardiovascular disease as well. Unsalted nuts are better for you than salted.

Whole grains

Whole grains are also a good source of fiber and other beneficial nutrients. Eating whole grains most days is associated with decreased obesity, diabetes and heart disease. Examples of whole grains are

  • Barley.
  • Bulgur, also called cracked wheat.
  • Farro.
  • Millet.
  • Quinoa.
  • Black rice.
  • Brown rice.
  • Red rice.
  • Wild rice.
  • Oatmeal.
  • Popcorn.
  • Whole-wheat flour.
  • Whole-grain breakfast cereals.
  • Whole-wheat bread, pasta or crackers.

Make sure to read the ingredients label for cereals and crackers. Don’t buy anything that has more than two ingredients you don’t recognize.

Fresh Vegetables

Fresh vegetables are also a good source of fiber. Sorry folks, but potato chips and french fries do not count as fresh vegetables! Once again eating fresh vegetables daily significantly lowers your risk of cardiovascular disease.

Bottom Line

Eating red meat and saturated fats does very little to increase your risk of heart disease, but it also does not reduce your risk. Raising livestock on factory farms causes significant harm to the environment and puts people at risk of infectious disease. Eating meat from locally raised animals is safer.

Eating high fiber foods, whole grains, nuts, fruits and vegetable does substantially reduce your risk of cardiovascular disease as well as cancer.

Eating highly processed foods, and this includes the new industrial fats made by interesterfication increases your risk of cardiovascular disease and cancer. The biggest risk of these is probably because they encourage people to eat more calories than they need and have almost certainly led to the epidemic of obesity.

The most concise recommendation for a healthy diet comes from author Michael Poulin: “Eat food (food is anything your grandmother would have recognized as food), mostly plants, not too much.”

Chronic Stress Response: It Can Make You Sick or Kill You

All mammals, including humans have an innate response to perceived threat or stress. The more common name for it is the “flight or fight” response. Our remote ancestors faced many real threats. Let’s say for example one encountered a saber tooth tiger. As soon as he (or she) saw the tiger, several things happened. Epinephrine and norepinephrine were released, speeding up the heart rate in preparation for running away. A surge of cortisol was also released, which increased glucose in the bloodstream for fuel for muscles and the brain. Cortisol also increases mental alertness. Inflammatory molecules were released to promote wound healing should that be needed.

This kind of acute stress response is a good thing. People or animals with this kind of response were more likely to survive and reproduce. Once the acute threat was over, all the hormones and neurotransmitters quickly returned to their baseline levels.

In today’s world, threats from predators are not a problem for the vast majority of people. The threats we perceive are things like poor work conditions; experiencing discrimination, hate, or abuse; poverty; homelessness; divorce or other family discord; having little control over outcomes; feeling overwhelmed.

These are all things that produce the stress response, but unlike our remote ancestors, these threats are chronic. They are either lifelong or at least last a long time. Instead of returning to normal, the stress hormones and neurotransmitters stay elevated for long periods of time. A chronic stress response is definitely not a good thing!

Allostatic Load

The medical term for the acute stress response is called allostasis. Here is the definition of allostasis from Wikipedia: “Allostasis is the efficient regulation required to prepare the body to satisfy its needs before they arise by budgeting those needed resources such as oxygen, insulin etc., as opposed to homeostasis, in which the goal is a steady state.” Allostasis is an adaptive response to acute stress. Allostatic load on the other hand is the long-term result of failed allostasis, resulting in dysregulation (abnormal function) of multiple systems including the neuroendocrine, cardiovascular, immune, and metabolic systems.

Allostatic load is measured traditionally by 10 indicators of chronic stress. Primary indicators are the hormones and neurotransmitters released by stress. Secondary outcomes are measurements of the systemic effects of the primary indicators. All of these indicators are associated with the perception of stress. Below is a table showing the 10 indicators, how they are measured, and which body systems are affected. Here is a link to the full article from which this table comes: Allostatic Load: Importance, Markers, and Score Determination in Minority and Disparity Populations

CategoryMarkerFunctional purpose
Primary mediatorsDehydroepiandrosterone sulfate (DHEA), serumSecreted by the adrenal glands. When high with stress it tends to lower cortisol and be protective in the stress response.
Cortisol, urinaryIntegrated measure of 12-hour hypothalamic–pituitary–adrenal axis activity. Secreted by the adrenal glands. Has multiple effects in stress response.
Epinephrine, urinaryIntegrated indices of 12-hour sympathetic nervous system activity. Sympathetic nervous system activation increases heart rate and blood pressure.
Norepinephrine, urinary
Secondary outcomesSystolic blood pressureIndices of cardiovascular activity and major risk factor for vascular disease
Diastolic blood pressure
Waist–hip ratioIndex of long-term levels of metabolism and adipose (fat) tissue deposition. High value means fat around internal organs which increases inflammation and increases LDL (bad cholesterol) and triglycerides.
High-density lipoprotein cholesterolIndex of atherosclerotic risk protection. Low value increases risk of heart disease.
Total cholesterolIndex of long-term atherosclerotic risk
Hemoglobin A1CIntegrated measure of high blood sugar over 2–3 months

Each indicator that is a certain distance out of the normal range counts as one point. The score can range from zero to ten. The higher the score, the greater the risk of illness or death.

Other Indicators

Although the ten indicators were the ones described in the original papers about allostatic load, other indicators have been used as well.

  • Heart rate variability is the normal beat to beat variability in the heart rate. In a healthy heart there is slight variation in the timing of one heartbeat to the next. Chronic stress reduces or even eliminates this beat to beat variation.
  • High sensitivity C-reactive protein (CRP). This is a measure of systemic inflammation that can result from chronic stress.

How is the stress reaction triggered?

The stress reaction begins in the brain. Something in the environment is perceived in a part of the front of the brain called the prefrontal cortex. This is the executive decision maker in the brain. If the prefrontal cortex perceives something in the environment as a threat, then it sends messages to the limbic system (the part of the brain that is involved with emotions). It also sends messages to centers lower in the brain, especially the hypothalamus. The hypothalamus sends messages to the adrenal glands which secrete cortisone, norepinephrine and epinephrine. The hypothalamus secretes DHEA. Messages from the hypothalamus are also sent to the white blood cells which secrete inflammatory chemicals called cytokines. All of this prepares the body to deal with the perceived threat. Different people may perceive different things as a threat. It is the reaction to perceived threats that causes allostatic load. If another person experiences the same thing in the environment as not a threat, then there is no stress reaction.

Diseases associated with high allostatic load (high chronic stress)

A high allostatic load score is not disease in itself, but if chronic stress continues then disease in the cardiac, metabolic, neuroendocrine and immune system can occur. Here is a list of diseases associated with persistent high allostatic load.

  1. Heart disease, primarily progressive blockage of the coronary arteries. This can lead to angina and/or heart attack. Congestive heart failure and arrhythmia like atrial fibrillation can also occur
  2. Peripheral arterial disease. That is blockage in arteries in the legs and sometime fingers.
  3. High blood pressure
  4. Stroke
  5. Autoimmune diseases like rheumatoid arthritis or lupus
  6. Diabetes
  7. Fibromyalgia
  8. Chronic Fatigue Syndrome
  9. Dementia or decreased cognitive function
  10. Depression
  11. PTSD
  12. Cancer, particularly breast and ovarian cancer. The increase in cancer is probably related to decreased immune system function

Allostatic Load and Mortality

Many studies have shown that people with persistently hight allostatic load have about a 25% higher premature death rate than people with low allostatic load.

Disparities in Health Outcomes

The response to chronic stress (allostatic load) may explain some of the disparities we see in health outcomes. We know, for example that Adverse Childhood Events (ACE), which include things like abandonment and abuse, increase the risk of many chronic diseases in adulthood. Studies have shown that adults with a history of ACE have high allostatic load scores.

African Americans have higher incidence of many cancers, as well as poorer outcomes from those cancers. They also have worse outcomes from heart disease, high blood pressure and diabetes. While a good portion of these poorer outcomes are related to lack of access to health care, these disparities persist to some degree even in middle class and upper middle class African Americans. Almost all African Americans have experienced or still experience racism on a chronic basis. African Americans of all social classes have higher allostatic load scores than caucasians. Chronic stress and response to it may be the common denominator for these disparities as well as for health outcome disparities in other marginalized populations.

How to reduce allostatic load

There is typically a long time between the presence of indicators of allostatic load and illness and death caused by diseases associated with these indicators. That presents an opportunity to reduce allostatic load before the chronic stress response leads to illness and death. So how do we reduce allostatic load?

Some of the things that cause allostatic load can only be reduced by societal changes. Things like poverty, structural racism and homelessness cannot be decreased by individual effort. Even these causes, though, can respond to the mind body methods discussed below. On the other hand, if you don’t have enough to eat, have no home, or have a job that gives you no control of your life, it is not likely that you will have the energy or the will, or the financial means to do many of the mind body methods discussed below. We should not be distracted from working to decrease the inequities that are responsible for societal causes of chronic stress.

Mind-Body Medicine

Remember that an external threat is first received by the peripheral nervous system and transmitted to the pre-frontal cortex. In order to reduce allostatic load we can either reduce the threat perception in the prefrontal cortex (top down) or reduce the transmission of threat in the peripheral nerves (bottom up).

Top Down Treatments

Top down treatments start with intentional activity in the prefrontal cortex. The idea is to decrease activation of the limbic system and the hypothalamus. This can be accomplished by mindfulness meditation, hypnosis (including self hypnosis), mental imagery and progressive muscle relaxation. All of these techniques when done regularly have been found to decrease allostatic load indicators and to reduce the risk of stress related illnesses.

Bottom Up Treatments

Bottom up treatments decrease the threat transmission to the prefrontal cortex. They include yoga, Tai Chi, massage and biofeedback. These treatments have also been shown to decrease allostatic load and to reduce stress related illness.

Bottom up and top down are somewhat of an oversimplification. All of these treatments have some aspects of both top down and bottom up. Yoga, for example includes aspects of meditation. The same goes for Tai Chi. Biofeedback involves some attention from the prefrontal cortex. Massage also includes progressive muscle relaxation.

Bottom Line

The body’s reaction to a perceived threat includes a complex cascade of messages from the executive center in the prefrontal cortex to multiple body systems including the nervous system, the endocrine system, the cardiovascular system and the immune system. All of these things prepare the body to deal with the threat. As long as the threat is short term the stress response is very useful to the organism.

Perception of chronic stress leads to continuous secretion of all the stress hormones and inflammatory cytokines and this leads to dysfunction of multiple body systems and eventually to illness and death.

Mind body treatments, both top down and bottom up can reduce the allostatic load (chronic stress response) and reduce the risk of stress induced illness and death.

Many causes of chronic stress have to do with the structure of our society, such as poverty, homelessness and structural racism. Individual effort is not likely to ameliorate the effect of these causes of chronic stress. All of us should be working toward societal change to reduce chronic stress response in marginalized populations.

High Blood Pressure: Silent and Deadly

This is the third post in a series on chronic diseases in the US.

Statistics

High blood pressure (hypertension) is the 5th leading cause of death in the US. In 2019 half a million people in the US died with hypertension as the cause or major contributing cause. Two thirds of all strokes and half of all heart attacks are caused by hypertension. The old definition of hypertension was a systolic blood pressure of 140 or greater and/or a diastolic blood pressure of 90 or greater. There is a new definition of hypertension that we will talk about later, but by the old definition, one out of every 4 people in the US have uncontrolled hypertension. By the new definition nearly half of people in the US have hypertension.

Definitions

The medical term for high blood pressure is hypertension. Blood pressure has two components. The systolic pressure is the pressure when the heart beats, forcing blood out of the left ventricle into the arteries of the body. The diastolic pressure is the pressure left in the arteries between beats. Both are equally important, and an increase in either one (or both) increases risk.

It has been known for a long time that there is a continuous increase in risk of cardiovascular disease and stroke as blood pressure rises. The lower your blood pressure the lower your risk. The spot on that blood pressure vs risk curve where we define the disease hypertension is arbitrary. The vast majority of deaths, strokes and heart attacks come from systolic blood pressures of 140 or higher and/or diastolic blood pressures of 90 or higher.

The new definition of hypertension

Blood pressure categories in the new guideline are:

  • Normal: Less than 120/80 mm Hg;
  • Elevated: Top number (systolic) between 120-129 and bottom number (diastolic) less than 80;
  • Stage 1: Systolic between 130-139 or diastolic between 80-89;
  • Stage 2: Systolic at least 140 or diastolic at least 90 mm Hg

There are no new data on the continuous increase in risk as blood pressure rises. The American Heart Association and other associated groups have simply decided to change the spot on the risk curve where hypertension is defined. They point out that the risk of cardiovascular disease is 3.5 times higher in the Elevated category than in the normal category. That sounds like a lot, but three times a very small risk is still a very small risk.

Measurement of blood pressure

High blood pressure has no symptoms, so you don’t know if you have it unless you measure it. In order to figure out where you are on the blood pressure risk curve, you have to know what your average blood pressure is. Blood pressure should not be measured until you have been sitting quietly for 5 minutes. That clearly does not happen the vast majority of the time when the nurse or medical assistant takes your blood pressure in your doctor’s office. More likely you have rushed to get there, had trouble finding a parking place, walk into the office already agitated and anxious, and the nurse takes your blood pressure as soon as you sit down. That is a recipe for having a falsely elevated blood pressure!

Home blood pressure measurement

The best way to determine your average blood pressure is to measure it at home. There are lots of very reliable reasonably priced home digital blood pressure monitors. Choose one that has a cuff that goes on your upper arm, not your wrist. The wrist blood pressure monitors are not very accurate. Also check that the cuff is the right size for your upper arm. If your upper arm is very large, then you will need a monitor with an extra large cuff. It is a good idea to measure the diameter of your upper arm before you buy a blood pressure monitor. Here is a link to an article by Forbes Health that rates the top ten home digital blood pressure monitors: Best Blood Pressure Monitors of 2022. Note that the highest ranked one is not the most expensive one. Any of the OMRON monitors are good, so if that brand is what is available in your local pharmacy, that brand would be fine.

Measure your blood pressure twice a day for at least two or three weeks. You should sit quietly in a chair for five minutes before you measure your blood pressure. You should not measure your blood pressure right after you have had your morning coffee. Either measure it before coffee (or tea) or about two hours after your last cup. All of the good monitors keep a record of your blood pressures, and some of them will calculate the average for you.

What to do based on your average home blood pressure

Normal (less than 120 systolic and less than 80 diastolic): You don’t need to make any diet or lifestyle changes based on your blood pressure

Elevated (systolic 120-129 and less than 80 diastolic): Although your risk of cardiovascular complications is a little higher than if your systolic pressure was less than 120, it is not much higher. You might want to make some modest diet and lifestyle changes (which I will discuss later). You definitely do not need blood pressure medicine.

Stage 1 (systolic between 130-139 or diastolic between 80-89): This used to be considered normal by the old definition of hypertension. Blood pressure at this level bumps up your risk of stroke or cardiovascular disease by a bit more than the elevated category but it still would be considered moderate risk. You would definitely want to make some diet and lifestyle changes and if you did that you would likely still not need blood pressure medicine.

Stage 2 (systolic 140 or greater or diastolic 90 or greater): The risk of stroke or heart disease is substantially high and gets progressively higher as the blood pressure increases. You still should do diet and lifestyle changes, but you probably will also need blood pressure medicine. If you have stage 2 hypertension, you should definitely see your doctor.

Risk factors for hypertension

Surprise, surprise! The risk factors for hypertension are almost the same ones that increase your risk of type 2 diabetes, heart disease, cancer, and stroke. They are:

  • Heredity (not simple and involving multiple genes each contributing a tiny part)
  • Increased body fat, particularly increased waist circumference
  • Sedentary lifestyle
  • Eating high sugar, high carbohydrate processed foods
  • Eating too much salt

Diet and lifestyle changes to decrease blood pressure

Bottom Line

  • High blood pressure, even very high blood pressure has no symptoms. Because of that everyone should determine their average blood pressure at least once a year.
  • Home blood pressure measurement is the most accurate way to know your average blood pressure.
  • Measure your blood pressure twice a day for at least 2-3 weeks and calculate the average.
  • If your average blood pressure is in the elevated range or higher, then diet and lifestyle changes will help reduce it.
  • If you have stage 1 or 2 hypertension you should see your doctor.