Blood Pressure -- Experiments and Stategies

[TromboneAl]

I thought I'd pass on some of the things I've learned about blood pressure, and show you the results of the experiments I've been doing.

At age 58, my blood pressure fluctuates around the border between pre-hypertension and stage 1 hypertension, despite my being at an ideal weight, exercising a lot, not smoking, not drinking much, and not consuming caffeine.

I visited my new doctor last week, and it was 144/92 in the office (white coat hypertension). I was very impressed with her, and she was not very concerned about it. She's seen the chart below. Note that this is the second doc to be not very concerned.

She offered to put me on medication if I wanted, but agreed with my strategy (see next post).

First Experiment

Last July I started taking 200 mg of CoQ10 every day, since some studies suggested that that would lower blood pressure. I measured my blood pressure every day just after waking. Here are the results:



Each point on the graph is an average of the last five measurements. As you can see...

Conclusion: CoQ10 did not lower my BP. If anything, it raised it.
One problem with my experiments is that my BP varies widely. I can literally have a systolic measurement of 123 one day, and 157 the next. As a result, it's hard to draw conclusions. Note that I take my measurements in a very consistent manner, always sitting down for 1.5 minutes before taking the measurement.

Another problem is that with only one subject (me), other variables can creep in. For example, I suspect that the general rise in BP from July through January is caused by the fact that the house is colder in the winter. The room is around 60 degrees in the morning, and I can't wear a sweater when making the measurements.

In my next post I'll describe my next experiment and strategy.

[TromboneAl]

In the past, I've tried reducing my sodium intake, and saw no effect on BP. However, HaHa turned me onto this excellent book:

Amazon.com: The High Blood Pressure Solution: A Scientifically Proven Program for Preventing Strokes and Heart Disease (9780892819751): Richard D. Moore M.D. Ph.D.: Books

which makes the point that reducing sodium alone is not as important as both decreasing sodium and increasing potassium.

The book makes the points that

• The evidence is very strong that increasing the ratio of intake of potassium to sodium from around .4 (American average), to greater than 1 (or higher), for at least six weeks, usually causes a significant decrease in BP.
• This evidence has been largely ignored, in part because of medicine's general drug-centered mindset, and in part due to the huge profits that drug companies make from BP drugs.
• Hypertension is a symptom of an underlying cellular problem, and drugs that lower BP are simply treating the symptom, not the root cause. As a result, reducing BP to a normal level with drugs does not reduce cardiovascular problems to a normal level.
• To reduce your blood pressure, you should eat a lot of potassium-rich foods, and reduce your sodium intake. You should take in at least four times as much potassium as sodium. This is not difficult.
• Results can take months or even years to become apparent.
• People who do not have hypertension can benefit from higher potassium consumption, and it may prevent future hypertension.
• Other minerals play an important role as well, most notably magnesium and calcium.
• The author believes that high-fat foods should be avoided, however, in presenting the limited evidence against fat, he admits that "...the decrease in blood pressure in some of these studies might have been due in part to the increase in dietary potassium."

I also read this short book:

Amazon.com: The Magnesium Solution for High Blood Pressure (9780757002557): Jay S. Cohen: Books

which suggests that magnesium is also important, and that one should take chelated magnesium supplements daily.

So, as my next experiment, I have aggressively eliminated sodium from my diet, and drastically increased my consumption of potassium-rich foods.

Restricting Sodium

Restrict both sodium and carbohydrates, and all of a sudden your food choices are dramatically reduced. For example, a diet soda might have 85 mg of sodium in it. All cheese has too much. Most commercial salad dressings have a lot of salt in them. If you eat out at a restaurant, you're going to get a lot of sodium.

So I have replaced table salt with an all potassium version (e.g. "No Salt"). Both of the above books recommend at salt-substitute that has a mixture of NaCl and KCl (KCl = Potassium Chloride) -- I'm not sure why they don't recommend an all-potassium version.

We use zero-sodium baking powder, and I buy soft drinks with no sodium, or make my own (e.g. lemonade).

Since we usually prepare our own food, it's not too hard to reduce or eliminate sodium.

Increasing Potassium

Many of the foods with high potassium are also high-carb. But it's not hard to find low-carb versions. The top foods for me are almonds, spinach, avocados, and meats. Many of these foods are also rich in magnesium.

Bananas have good PR, but one banana has only 451 mg of potassium whereas 4 oz of chicken has 458 mg. A cup of cooked spinach has over 1000 mg.

Note that OTC potassium supplements are limited to 3% of the RDA, so are not very useful.

So, for my next experiment I am measuring to see whether my radical increase in potassium consumption, decrease in sodium, and magnesium supplementation (400 mg Mg-citrate 2x per day) will decrease my BP.

I started on Jan 26, and so far, while the idea is supported, the results are inconclusive, since I may just be seeing typical random fluctuations.

I will report back. I'll consider this strategy a success if my BP averages below 130/85 after a year.

[Moemg]

You do realize that this is a little nutty ? Try not taking your blood pressure so much maybe it's just anxiety that is causing it to spike .

[TromboneAl]

Quote:

Originally Posted by Moemg You do realize that this is a little nutty ? Try not taking your blood pressure so much maybe it's just anxiety that is causing it to spike .

http://www.early-retirement.org/foru...ml#post1165311

[Rich_by_the_Bay]

Al, it sounds like you are extrapolating extensively here from isolated measurements. To be sure the risks and complexity of BP for cardiac and stroke events is hard to measure and sort out for many of the reasons you cite.

I would consider 24 hour monitoring once or twice (ambulatory BP monitoring) if you or your doctor are unclear about treating. It probably correlates the best with outcomes. But even the most high quality, large and well designed studies all point to some risk for stroke and heart failure after all controls and recognized variable are sorted out. The risks of treatment are less than the risk of stroke, kidney and heart failure.

Whether to start BP meds depends on lots of personal factors, lifestyle, other meds and conditions, and personal values. And remember, unless you are diabetic, have already had a BP complication such as stroke, etc. we are typically talking about treatments with net benefits in the range of fractions of a percent to 3% per year.

[W2R]

Quote:

Originally Posted by TromboneAl I visited my new doctor last week, and it was 144/92 in the office (white coat hypertension). I was very impressed with her, and she was not very concerned about it. She's seen the chart below. Note that this is the second doc to be not very concerned.

Al, unlike you I am on medication for BP and the last time I went in, my BP was almost identical to yours. I was really alarmed! I was sure my doctor would raise the (now minimal) dosage of my BP meds. But like your doctor, he wasn't upset about it at all. I asked him twice directly about it but he seemed to have no problem with it at all.

Well, I don't understand but then I am paying him for his experience and expertise, so if he has it clearly pointed out to him and still says it's OK, then I guess it's OK.

As for ways to lower BP other than meds (which up to now have worked beautifully), losing weight is the most sensible one for me. You don't seem to have an ounce to lose, though. That is so admirable. Weight loss is the toughest goal I have ever tried to tackle and I am still battling it without much success. I'll never give up, though.

[Peter]

Add my new doctor to the list not concerned with 140/85. "Nothing to worry about", he said. "Probably because it's your first visit here."

I want to believe him. Not sure whether I should ... not on BP meds right now.

[kaneohe]

T-Al, thanks for your info/data. Here's another thing to try
Resperate: Can it help reduce blood pressure? - MayoClinic.com

Not necessarily, the machine which costs a few hundred bucks but the
belly breathing it's supposed to be training you to do
Breathing Exercises to Control Blood Pressure | eHow.com

My doc suggested looking into it after I brought up my observation that my
BP often seems unusually low after a day at the beach or river. Since it doesn't happen as often at the lake, my theory is that it is the sound of the water that is the reason and not the exercise (since the gym doesn't seem to do it as well either). Considering getting some CDs w/ the appropriate sound but have not yet.

Also have you considered taking the BP at some other time . My impression is that the BP is often the most unstable immediately after waking so you might reduce the noise in the measurement (and the # of
measurements required) by taking at a more stable time.

[braumeister]

Is it possible that your sodium intake is too low (rather than too high)?

There seems to be a some controversy as to the actual existence of solid evidence that sodium intake correlates with hypertension (or heart disease):
[excerpt from Eades' blog]

Eades also commented:

Quote:

Potassium is linked to sodium. If you lose a lot of sodium through the diuretic effect of the low-carb diet, you’ll ultimately lose a lot of potassium as well. Keeping your sodium intake up as mentioned above will help preserve your potassium as well.

[another excerpt]

Also, low calcium intake also appears to be a likely factor in hypertension.
Diet and Hypertension

My own blood pressure has always been excellent, but it became elevated after I started a low carb lifestyle. After a number of months, my readings closely resembled the chart you posted. I came to the realization that my calcium intake (which had always been very high throughout my life) was drastically reduced, so I made an effort to increase it as much as possible, consistent with a fairly low carb diet. In my case at least, the experiment worked, and my BP is now much closer to normal on a consistent basis.

You might consider examining your own calcium intake to see if this might apply to you.

[TromboneAl]

Quote:

Originally Posted by kaneohe Also have you considered taking the BP at some other time . My impression is that the BP is often the most unstable immediately after waking so you might reduce the noise in the measurement (and the # of measurements required) by taking at a more stable time.

That's interesting. I chose "upon waking" because that seemed the easiest way to standardize things. For example, if I chose "after lunch" the measurement would be influenced, for example, by whether I did strength training that morning or not, how much I had to eat, etc..

Quote:

Add my new doctor to the list not concerned with 140/85. "Nothing to worry about", he said. "Probably because it's your first visit here."

One theory as to why the doctors don't seem concerned is that published recommendations about BP are overly conservative for liability issues.

Something else is that I've tended to focus on the systolic (top) number, but I've come to understand that the diastolic is, if anything, more important (from the Moore book):

BPCurve.jpg

So, perhaps your doc is giving more weight to the "85" which is at the high end of normal.

Also, when we read that you should be concerned about anything over 120/80, that is a recommendation for all ages. Perhaps if you had 140/85 at age 20, the doc would be worried.

But Moore says "It turns out that 120/80 isn't really normal, or healthy, it's just average for the United States."

[TromboneAl]

Quote:

Originally Posted by braumeister Is it possible that your sodium intake is too low (rather than too high)? There seems to be a some controversy as to the actual existence of solid evidence that sodium intake correlates with hypertension (or heart disease): [excerpt from Eades' blog] Eades also commented: [another excerpt] Also, low calcium intake also appears to be a likely factor in hypertension. Diet and Hypertension My own blood pressure has always been excellent, but it became elevated after I started a low carb lifestyle. After a number of months, my readings closely resembled the chart you posted. I came to the realization that my calcium intake (which had always been very high throughout my life) was drastically reduced, so I made an effort to increase it as much as possible, consistent with a fairly low carb diet. In my case at least, the experiment worked, and my BP is now much closer to normal on a consistent basis. You might consider examining your own calcium intake to see if this might apply to you.

Yes, it sure can get complicated, and perhaps I'm going too far on the sodium. I will look into that.

How did you increase your calcium intake?

[Meadbh]

Easiest way to increase calcium intake is to take a few Tums every day. Exercise is good for lowering BP, but Al gets plenty of exercise!

[TromboneAl]

Quote:

Originally Posted by braumeister Is it possible that your sodium intake is too low (rather than too high)?

Thanks for the heads up. Although I don't think it was too low in the past, I do think, after a little research, that my new strategy of aggressively eliminating all salt, is taking it too far.

Too Little Salt Can Also Be A Problem

So I am modifying my strategy to limit but not eliminate salt, while continuing to eat a lot of potassium-rich food.

[StevenJ]

I have been borderline hypertensive for several years (about 128-132 / 85-92 when relaxed) and have managed to avoid BP meds. On top of that I have white coat hypertension and it’s not uncommon for it to run 150/100 or higher during doctor visits. Cool as a cucumber on the surface but evidently my body’s not convinced. I showed the doc my tracking numbers, all nice and pretty in Excel with charting, but he encouraged me to wear an ABPM overnight to verify. Sure enough I get wound tight as a 10-day clock in doctors’ offices (and other stressful situations) but typically my numbers are as described above.

For me, room temperature has an effect on my BP reading: cooler temperatures raise the reading. I figure the cooler temp restricts the blood vessels a bit – the opposite of vasodilation. Also, I think a cool cuff on my arm effects the reading. I usually warm the cuff before taking a reading – that helps relax me a bit.

I have a Resperate and it definitely lowers my BP short term. I’m able to get some nice low readings when I run the test at the end of a 10-minute breathing session. The jury’s still out on long term benefits. I tend to be a shallow breather, up in my chest – sort of like I’m in fight or flight mode. Resperate helps train to breath more deeply and expand the belly. I’ve done it enough with the device that I can mimic the breathing pattern without it - I do that (when I think to do it) when feeling stressed on the j*b.

Anyone here have any experience with what’s called the chiropractic Atlas procedure to reduce blood pressure? Evidently it’s been around for quite a while but I just recently learned of it. WebMD speaks of it here:

[Tom52]

My BP has normally been close to 120/80. I had not had a physical for about 3 years and I decided to go as I also needed a referrel for a colonoscopy. I have a new female Dr that my wife really likes. I had never been to a female Dr and the idea of a total female stranger checking the prostate, etc. was definitely making me anxious. Then to make matters worse right off the bat she tells me my urine specimen tested for microscopic blood. This is not what I wanted to hear since my Dad had bladder cancer. So it was no surprise to me that BP was 158/88.

I had to return to the Dr about a week later to check the BP again, but I still not been to the urologist to get the cystoscopy. As expected the BP was very high. Of course, the Dr thinks I need to be medicated for high BP and I have to go back in two weeks for another check.

Since that second test I have gone cold turkey on the diet soda and haven't lifted a salt shaker. I also exercise daily. I picked up a BP monitor at Walgreen's that the pharmacist recommended.

I have been checking my BP twice a day for about a week now. It was checking about 140/85 up until last Tuesday when I finally had my cystoscopy which showed the plumbing to be in perfect health. From that point on my BP checks are back to a normal range for me. The only exception was this evening when it checked 137/79. The BP monitor keeps the readings in memory along with time and date stamp.

My strategy is to continue the exercise and avoid the diet sodas and salt shaker. I am also doing some breathing exercises to reduce stress. I will take the monitor with me on my next visit to the Dr. If the Dr gets a higher BP reading than normal, I will take a test with my monitor for comparison. Hopefully, I can show that normally my BP is not high enough to warrant medication.

[LOL!]

Have you measured your BP after sweating a lot? Say you go running and lose 2 to 3 lbs of weight, what is your BP then?

[Alan]

Quote:

Originally Posted by TromboneAl Thanks for the heads up. Although I don't think it was too low in the past, I do think, after a little research, that my new strategy of aggressively eliminating all salt, is taking it too far. Too Little Salt Can Also Be A Problem So I am modifying my strategy to limit but not eliminate salt, while continuing to eat a lot of potassium-rich food.

Do you have regular check-ups with blood work? If so, where have the sodium levels been? If your levels are well within range every year then you probably are okay.

Reason I ask is that you are thin and very fit, and exercise a lot, so daily salt intake may be different if you routinely sweat a lot. I always like to be able to measure something if I can, rather than impute a value.

[noelm]

Haven't read all other responses but here are my 2 cents.

AFAIK, use of CoQ10 in blood pressure is not really proved. Whatever 'research' is there, its done by the supplement manufacturers, so I take it with a grain of salt. Pls correct me if I am wrong.

Secondly, are you measuring on both the arms or only one? I came across some new findings where it was mentioned that you should take measurement on both the arms and if you can, take lying as well as standing. The article was not very clear on how or what kind of difference does it make to the measurement and any supporting data. You may want to keep separate set of data with this, to see if you see any difference.

Questions -
- You mentioned about use of NaCl+KCl mixture, could you please cite the product? I started using Mrs Dash instead of salt. I was planning to try Miso (low sodium) but it won't go with every preparation.
- You started Magnesium supplements, what salt/compound of magnesium are you using and how much daily? (Do you see any change in your BM pattern?)

I am trying all these BP stuff because I get severe migraines and I am on Verapamil as a prophylactic. Last time I went to my neuro, my BP was 135/90.

[braumeister]

Quote:

Originally Posted by TromboneAl Yes, it sure can get complicated, and perhaps I'm going too far on the sodium. I will look into that. How did you increase your calcium intake?

Quote:

Originally Posted by Meadbh Easiest way to increase calcium intake is to take a few Tums every day. Exercise is good for lowering BP, but Al gets plenty of exercise!

Tums are indeed a very simple and effective calcium supplement.
I use them occasionally.

But mainly, I enjoy whole milk, homemade yogurt, heavy cream in my coffee, plenty of cheese, canned salmon and sardines, etc. Believe it or not, a bowl of Cheerios with milk provides quite a lot of calcium, and I love it

Sure, this means I have merely a low (instead of very low) carbohydrate diet, but since I don't really need to lose any more weight, I find I can maintain myself just fine this way, and indulge myself a bit as well. YMMV.

[MichaelB]

Quote:

Originally Posted by TromboneAl http://www.early-retirement.org/foru...ml#post1165311

I recalled this post this morning when reading The Economist. It addresses efforts and technology in the area of self measurement, with numerous references.

Quote:

The quantified self Counting every moment Technology and health: Measuring your everyday activities can help improve your quality of life, according to aficionados of “self-tracking” The idea of measuring things to chart progress towards a goal is commonplace in large organisations. Governments tot up trade figures, hospital waiting times and exam results; companies measure their turnover, profits and inventory. But the use of metrics by individuals is rather less widespread, with the notable exceptions of people who are trying to lose weight or improve their fitness. Most people do not routinely record their moods, sleeping patterns or activity levels, track how much alcohol or caffeine they drink or chart how often they walk the dog. ./. Self-quantifying is being taken seriously by start-ups, in Silicon Valley and elsewhere, which are launching new devices and software aimed at self-trackers. It may even provide a glimpse of the future of health care, in which a greater emphasis is placed on monitoring, using a variety of gizmos, to prevent disease, prolong lives and reduce medical costs.

The article here The quantified self: Counting every moment | The Economist