Part I:
DO YOU REALLY HAVE HYPERTENSION
AND DO YOU NEED MEDICATION?
By Bill Sardi
properly? A slight shift in your arm position could
Preface: Blood pressure is the amount
produce false readings and you might be needlessly
of mercury (Hg) displaced in a column,
placed on medication.
measured in millimeters. There are
two numbers for blood pressure. The
You may be surprised to find that the aggregate
first number (systolic) measures
care of hypertension provided by physicians and
the pressure when the heart pumps,
pharmaceutical companies is in a shocking state of
and the second number (diastolic)
disarray. Anti-hypertensive drugs don t work and may
measures the pressure when the heart
increase the risk of sudden death. Patients themselves
is momentarily at rest. Treatment for
are not compliant with dietary recommendations and
hypertension may begin if your blood
are justifiably even less compliant with onerous drug
pressure rises above 140/90. For
regimens. After a careful review of the scientific
simplicity, this report refers to blood
literature it can only be concluded that the modern care
pressure in points and refers to
of hypertension is itself a hazard to your health.
the first and second numbers so
readers do not get confused.
There is an urgent need for simpler, less problematic,
less costly technologies to control hypertension. Some
Introduction
promising simple technologies exist, but are being
overlooked by modern medicine.
pressure. It s meant to have the opposite effect.
Here are the details:
Americans are living longer and that means 9 out of
Arm position
10 will face the diagnosis of hypertension during their
lifetime. [J American Medical Assn 287: 1002-1010,
Improper arm position when measuring blood
2002] Every American family is likely to have a loved
pressure with a cuff is often likely to over-diagnose
one treated for high blood pressure, or be diagnosed
hypertension and cause
with hypertension themselves. At least this is what
Measure of blood
inappropriate treatment.
we are told by health authorities. But do millions of
pressure is probably
The arm should be held
Americans really have hypertension? Do they need
the most frequently
horizontally, and at
life-long medications? Do blood-pressure lowering
performed medical act,
the height of the heart,
medications really prevent strokes and heart attacks? .
and the least reliable.
[Rev Med Liege 57: 250-52, 2002]
during blood pressure
measurement. Failure to perform blood pressure
When you go to the doctor you see the needle bounce
measurements in the proper arm position can cause
on the blood pressure dial and you can see that your
a pressure of 155/85 to increase by 25/11, or read as
pressure is high. But was your blood pressure taken
Report: Part 1 - Hypertension © Bill Sardi | June2004 | www.askbillsardi.com | Page 1
180/96. According to one study, less than 8 percent of " One of the problems with blood pressure measurement
nurses and doctors measure blood pressure utilizing the in the doctor s office is that pressure may be charted
proper arm position. during a sick visit. Blood pressure may be elevated
when you are ill. A well visit to the doctor s office
A relatively small downward arm movement in a pa- may give you a more accurate reading.
tient s with high normal blood pressure could influence
the diagnosis and treatment of hypertension. Errors " Another discrete factor may artificially raise your
in blood pressure measurement are so widespread blood pressure. Doctors often utilize a bright-light
that this casts doubt upon estimates of the preva- ophthalmoscope to examine the back of the eyes during
lence of hypertension in the population at large and a physical examination. Bright light has been shown
uncertainty regarding the effectiveness of many to raise blood pressure in normally health adults.
medicines used to treat hypertension. [Internal [Archives Environmental Health 42: 37-43, 1987]
Medicine Journal 34: 290-91, 2004]
" Another problem in monitoring blood pressure is
In another study, blood pressure was measured in that in an attempt to remove mercury-filled blood
the proper horizontal position and then the arm was pressure gauges from hospitals and doctor s offices
dropped to the side and another measure was obtained. for environmental reasons, news devices are not as
For adults with normal blood pressure, their numbers accurate. Accurate blood pressure measurement may
rose by 8/7. Among hypertensive patients the number not be possible using non-mercury instruments. [New
rose by 23/10. [J Human Hypertension 17: 389-95, York Times June 16, 2002]
2003] Another study showed that the difference in
arm position results in a 11/12 point difference among For all of these reasons, some authorities believe
hypertensive patients. [Br Med J 288: 1574-75, 1984] one third to one half of the blood pressure readings
Whenever blood pressure is measured the arm position performed in clinics and doctor s offices are wrong.
should be documented. [J Clin Hypertension 3: 624- [New York Times August 1, 2000]
30, 1987]
White coat hypertension
Many patients experience anxiety in a doctor s office.
It s enough to raise blood pressure. Just the sight of the
doctor s white coat can trigger a rise in blood pressure.
This has been termed white coat hypertension.
In one study 20 percent of males and 54 percent of
females had a white coat response when their blood
pressure was measured.
Patients see the
[Canadian Medical Assn doctor s white coat,
Proper arm position for measurement
Journal 161: 265-69, 1999]
of blood pressure
and their blood
pressure rises
Many patients diagnosed with
above normal
drug resistant hypertension [Blood Pressure Monitoring 7:
There are many other reasons why blood pressure
293-300, 2002]
really have white coat
measurement may be inaccurate.
hypertension. Their blood pressure is elevated in the
doctor s office or clinic, over-riding the pressure control
" Doctors and nurses may be using the wrong size blood
of medication. When a doctor records blood pressure
pressure cuff on your arm, which would raise the blood
one study showed this raised blood pressure by 16 to
pressure reading. The size of the cuff needs to match
26 points and when a nurse took the blood pressure it
your arm size.
raised the numbers by 9 to 17 points (systolic pressure).
Report: Part 1 - Hypertension © Bill Sardi | June2004 | www.askbillsardi.com | Page 2
[Reuters Health Dec. 21, 2001; American Journal millions of people may not even need these
Hypertension 14: 1263-69, 2001] medications.
Researchers estimate that 25 percent of hypertensive About 50 million Americans have high blood pressure
patients can postpone drug treatment and 15 percent and about half are being treated. Only about 27 million
can avoid multiple-drug therapy by monitoring their have their blood pressure under control.
blood pressure away from doctors and nurses. [J Am
Medical Assn 278: 1065-72, 1997; 279: 197-98, 1998] According to the prevailing criteria, one third of
American adults are hypertensive and don t know it.
Home blood pressure monitoring appears to be a better [Reuters Health May 19, 2000] While 140/90 is the
alternative, away from the stress-inducing rise in long-standing point where treatment is started,
blood pressure at the now investigators say the desired point for blood
At least a third of
doctor s office (white pressure is now 115/75. The once-healthy 120/80 is
patients who exhibit
coat hypertension). now considered to be
now considered to be pre-hypertension. That means
now considered to be
a high blood pressure
A recent study of another 45 million Americans are in for a surprise on
reading in the doctor s
home blood pressure their next doctor s visit. [The Lancet Dec.14, 2002]
office do not exhibit the
monitoring reveals
same problem when
120/80 used to be considered
more of these patients
their blood pressure is
normal blood pressure.
are likely to abandon
taken by a nurse.
Now it is considered pre-hypertension.
[Am J Hypertension 14: 1263-69, their medications
2001; BMC Cardiovascular Disorders
(25.6%) than patients
4: 2, 2004]
But do you really have high blood pressure? Are you
being monitored at the
really at an increased risk for stroke or a heart attack?
doctor s office (11.3%) and that their blood pressure
According to a shocking study conducted by University
was more likely to be out of control. [February 291:
of California at Los Angeles researchers, millions of
955-64, 2004]
people are taking blood pressure-lowering drugs
for no good reason. Flawed statistics have been
DOES HOME BLOOD PRESSURE
used to decades to prescribe these drugs. Physicians
MONITORING IMPROVE COMPLIANCE?
now consider the first blood pressure number (systolic
Survey of 1452 patients pressure) as the important indicator of a future mortal
Hypertension Research 23: 21-24, 2000
event like a stroke or heart attack. Usually pressure-
Frequency of use of home Occasionally lowering drugs are prescribed when the first pressure
monitoring of blood pressure missed taking
number rises above 140, but revised figures which take
their medications
age into consideration indicate an increased risk of
dying does not start till pressure reaches 148 for males
Every day 6.5%
and 158 for females age 55-64 years. For adults age 65-
Several times a week 10.1%
74, the figures rise to 159 for males and 167 for females.
Several times a month 11.0%
[Lancet 355: 175-80, 2000] This re-analysis of blood
pressure risks has been suppressed. Health authorities
Never checked their blood 14.5%
pressure are in denial that their long-standing numbers used to
determine when treatment should be prescribed are
flatly wrong.
Millions are/aren t hypertensive
The diastolic blood pressure (second number),
More than $16 billion of antihypertensive drugs were
which has been the main criterion used by most
sold in 2000. More than half of the patients on these
physicians to determine effective drug control
medications have borderline or mild hypertension. If
of hypertension, appears to be of little value in
small declines in blood pressure could be achieved,
predicting future adverse health events such as
Report: Part 1 - Hypertension © Bill Sardi | June2004 | www.askbillsardi.com | Page 3
REVISED TOP BLOOD PRESSURE NUMBER WHICH
INDICATES NEED FOR TREATMENT
Age 45-54 Age 55-64 Age 65-74
Top blood pressure Males 141 Males 148 Males 159
number that
Females 142 Females 158 Females 167
indicates increased
risk of dying and
need for medication
Source: Los Angeles Times January 14, 2000
stroke or heart attack. The systolic blood pressure Pharmacotherapy 51: 208-12, 1997] The problem is
(first number) is a good predictor of these events. that these are relative, not hard numbers.
[Archives Internal Medicine 162: 577-81, 2002] The
National Heart, Lung and Blood Institute now says the Statistics tell doctors whether blood pressure therapy
first blood pressure number is more important than the works, but it doesn t tell them who will benefit.
second and that it should be kept below 140, regardless Research shows that to prevent 1 death, 11 patients
of age. [CNN May 4, 2000] For decades physicians with hypertension have to lower their blood pressure
had been gauging the severity of blood pressure by by about 12 points over a 10-year period. [Drug Topics
the wrong number. Jan. 26, 2004] In other words, 10 of 11 patients taking
anti-hypertensive drugs will not experience a health
ARE YOUNG ADULTS REALLY AT
benefit. The anti-hypertensive drugs are proven to be
RISK FOR HYPERTENSION?
more effective than not in large populations, but many
millions take these drugs with no health benefit so a few
High blood pressure may often be misdiagnosed
will be spared of a mortal health event.
in young adults. In a study of more than 13,000
individuals whose blood pressure had been measured
Medical treatment of hypertension may reduce
annually for three years, of 36 men age 16 to 34 to
strokes but have no effect upon lowering the rate of
who had been classified as needing treatment, only
heart attacks. [J Hypertension 18: S3-7, 2000]
11 really needed treatment. Only 5 of 19 women
actually needed treatment. [BBC News April
In France, a study showed that drug therapy did not
15, 2004; British Medical Journal, April, 2004]
control elevated blood pressure among 85 percent of
The numbers used to determine the point when
4714 men. [Archives Internal Medicine 162: 577-81,
treatment should be prescribed may not apply to
2002]
young adults. The absolute risk of experiencing a
major cardiovascular event over a 10-year period
Other studies show as little as 6 in 100 hypertensive
amounts to only 1% for hypertensive young
patients are able to control their blood pressure to
adults, age 25-34 years. But this figure is said to rise
below the target number of 140/90. [J Hypertension
to 30 percent among older adults, age 65-74 years.
16: 747-52, 1998]
[Biomed & Pharmacotherapy 51: 208-12, 1997]
A study in Germany found that on an average
day over 700,000 patients are seen by physicians
Does drug therapy work?
with high blood pressure and only 132,000 of these
patients have well-controlled pressure. Better than 8
The quoted figures are that drug therapy may reduce
out of 10 of these patients were taking blood pressure
mortality rates by 12 percent, coronary heart disease
medications. [J Hypertension 22: 479-86, 2004]
by 20 percent and stroke by 36 percent. [Biomed &
Report: Part 1 - Hypertension © Bill Sardi | June2004 | www.askbillsardi.com | Page 4
Single anti-hypertensive drugs generally are not difficult for patients to connect a side effect with a
effective. Most of the time more than one drug is drug. In one study conducted in Norway with 2,586
required to bring pressure under control. patients taking blood pressure-lowering drugs, the
1 drug: 50-60% under control spontaneous reported side effects were only 16%. But
2 drugs 80% under control upon general inquiry 24% reported side effects and
3 drugs: better than =80% under control when specific questions regarding common side effects
Two or three anti-hypertensive medications are by no were asked 62% reported drug-induced symptoms.
means the end of the drug list prescribed by physicians. [Blood Pressure 8: 94-101, 1999]
Low-dose aspirin therapy to prevent blood clots and
statin drugs for cholesterol are often prescribed in A survey published in 1999 revealed that about 3 in
addition to the pressure-lowering drugs. An anti- 10 patients taking blood pressure medications report
diabetic medication may also be needed for individuals side effects that altered their lives. The most common
with blood sugar issues. [J Human Hypertension 18: side effects are fatigue, potassium loss and dizziness.
139-85, 2004] Now you have polypharmacy a patient Nearly 4 of every 10 patients had considered ending
being overwhelmed by too many medications and their medication treatments due to adverse side effects.
facing drugs that don t work well with each other, and The survey participants were taking 3 anti-hypertensive
that induce nutrient deficiencies as well. Various reports drugs, on average. [Medical Tribune, November 12,
admit to the problem of juggling so many drugs while 1999]
still attempting to avoid side effects. [Cardiovascular
Drugs & Therapy 12: 186-98, 1998]
MOST COMMON SIDE EFFECTS OF BLOOD
PRESSURE DRUGS
A recent study attempted to determine if simpler
Source: Doctor s Guide Nov. 10, 1999
dosage regimens, such as one pill a day, would increase
Beta blockers Fatigue 34%
adherence to treatment. Reduction in the number
Diuretics (water pills) Mineral imbalance 30%
of daily doses appears to increase compliance in
Calcium channel Swelling (edema) 26%
some studies. [Cochrane Database System Review
blockers
CD004804: 2004]
ACE inhibitors Cough 21%
Alpha blockers Cramping 7%
People who take acetaminophen (Tylenol) or
ibuprofen (Motrin) may double their risk for
While physicians and pharmaceutical companies
hypertension. These drugs may raise blood
continue to claim the drawbacks of their drugs are far
pressure by blocking the production of hor-
outweighed by their benefits, the Agency for Health
mone-like substances that widen blood vessels
Care Policy and Research states that the potential
and can also increase sodium retention.
benefits of
benefits of
benefits of these drugs may not outweigh their
[Curhan G, Archives Internal Medicine, October 2002;
New York Times Oct. 28, 2002]
negative effects on quality of life. Stomach aches,
fatigue, nausea, impotence, headaches, urinary tract
Despite the fact there are four major classes of blood
problems, and many other side effects are common. [J
pressure lowering drugs and over 100 varieties of these
Clinical Epidemiology 49:1239-45, 1996; Agency for
drugs available, less than 50% of patients who begin
Health Care Policy Research report No. 201, 1997]
treatment continue taking any of these drugs six
months after initial use. [Canadian J Cardiology 15:
Anti-hypertensive drugs are intended to reduce the
39-41F, 1999]
risk for cardiovascular disease, but ACE inhibitors, a
common type of drug used to control blood pressure,
Side effects with drug therapy
may raise homocysteine levels by as much as 16
percent. [Metabolism 52: 261-63, 2003] Homocysteine
Far more side effects occur from anti-hypertensive
is an undesirable blood protein linked with blood vessel
medications than are reported. Sometimes it is
disease. The reduced risk for cardiovascular disease
Report: Part 1 - Hypertension © Bill Sardi | June2004 | www.askbillsardi.com | Page 5
via blood pressure control is offset by elevated blood pressure levels. [Am J Cardiovascular Drugs 2:
homocysteine which raises the risk of hypertension 77-89, 2002] In other words, the drugs work, so why
and cardiovascular disease. bother with dietary approaches to hypertension?
It s no wonder males do not take a liking to anti- The British Antihypertensive Society says advice on
hypertensive drugs. One study shows that 4 out of 10 life-style modifications should be provided people
males link of the onset of their use of blood pressure with high blood pressure. But their guidelines also
lowering drugs with impotence. [Am J Hypertension state that every patient
How do drugs
12: 271-75, 1999] with a sustained systolic
overcome
blood pressure above
hypertension in
There is also such a thing as too low blood pressure. 160 should be started on
a patient who
When the second number (diastolic) goes below 65 drug therapy outright.
continually consumes
there is actually an increased risk of stroke, the very Furthermore, diabetics
excessive sugar,
adverse health event drugs are intended to prevent. with hypertension are at
salt and alcohol and
[Hypertension 34: 1179-85, 1999] Some hypertensive increased risk should be
smokes?
patients experience an abnormally low blood pressure started on medications if
during sleep and awaken to find the vision in one eye is their sustained blood pressure exceeds 140/90. Among
gone because of a lack of oxygen supply. people whose systolic blood pressure is 140-159 and
diastolic pressure 90-99, physicians should make an
For a long time physicians prescribed calcium assessment of cardiovascular disease risk, say British
blockers for hypertension without knowing the guidelines. A disease risk greater than 20 percent over
drug increased the risk of a heart attack. In 1995 a 10-year period is considered reason to prescribe
the pharmaceutical companies had to perform a U-turn medications. The British guidelines concede that
and convert patients to slower-acting calcium channel most patients will require at least two blood-pressure
blockers after it was found that the fast-acting versions lowering drugs. It s easy to see how diet and lifestyle
of this drug actually increased the risk of heart attacks changes get pushed aside for the drugs.
by 60 percent. Six million Americans were taking these
calcium blockers at the time. [Associated Press, March But can the drugs overcome a poor diet? Inside
11, 1995] How many patients died prematurely before the stroke belt, the southeastern U.S., anti-
these drugs were removed from use is unknown. hypertensive drugs are far less effective than
in other parts of the country. [Archives Internal
Beta blockers are another class of antihypertensive Medicine 160: 825-31, 2000] Surveys reveal people
drugs. Since beta blockers increase insulin living in the southern stroke belt consume the most
resistance, they have been shown to increase the risk salt and lower amounts of potassium, magnesium and
of diabetes. [New England J Med 342: 905-12, 2000] other nutrients. [Journal Nutrition 133: 211-14, 2003]
Diabetes then hastens the onset of hypertension. It s a The lesson here is that drugs can t always overcome
self-perpetuating disease. the deleterious effects of a poor diet. But doctors keep
prescribing the drugs.
Lifestyle and health habits
Elderly patients tend to have more fatty tissue and
Physicians appear to give lip service to dietary and this dulls the effect of fat-soluble drugs such as the
lifestyle measures to control blood pressure. Here beta blockers. This is an admission the beta blockers
is what a report in one journal said: Non-drug are far less effective against a primary group that is at
therapeutic options should be implemented in all risk for stroke and hypertension, the obese.
patients. However, since there is overwhelming evidence
to suggest that antihypertensive drugs offer protection There is strong evidence that a number of small
against complications of hypertension, a vast majority alterations in diet and lifestyle can prevent hypertension
will require pharmacological treatment to achieve goal or lower existing high pressure. Researchers at the
Report: Part 1 - Hypertension © Bill Sardi | June2004 | www.askbillsardi.com | Page 6
WHY YOU WILL NEVER GET WELL TAKING
BLOOD PRESSURE DRUGS
Source: Drug Safety: 14: 355-64, 1996
Increases Raises total Raises LDL Raises
insulin cholesterol cholesterol triglycerides
resistance
Diuretics X X X X
Beta blockers X X X X
National Cardiovascular Centre in Osaka, Japan, using need to be more amenable to the patients so they won t
home blood pressure monitoring, report the following stop taking them due to side effects.
factors reduce blood pressure:
Blood pressure lowering drugs
According to public health authorities, a reduction as
small as 2 points in the average American s first blood The first effective blood pressure lowering drug became
pressure number could save more than 70,000 lives a available in the 1950s. There are four major classes of
year. anti-hypertensive drugs.
THE FOUR CLASSES OF
Health practice Pressure reduction
ANTI-HYPERTENSIVE PILLS
(mm mercury)
Diuretics Move water and salt out
Top pressure number
of the body
(systolic)/ bottom pressure
number (diastolic)
Beta blockers Slow the heart rate and thus
reduce blood pressure
Weight reduction
Low calorie diet 10/4 ACE inhibitors Reduces the production of
a chemical (angiotensin II)
Daily walking 2-3/1-2
that narrows the arteries
Low-salt diet 9/4
Calcium channel Block the influx of calcium
Potassium 3-4/1-2
blockers into cells; reduces force of
supplementation
contraction in heart muscle
Calcium 1-2/1
supplementation
Every anti-hypertensive drug depletes the body of
Alcohol restriction 3/2
nutrients. Because of this, there is no way hypertensive
[Blood Pressure Monitoring 7: 51-54, 2002]
patients will ever get well. They will suffer nutrient-
related side effects from the various drugs (see chart on
Poor patient compliance is often blamed for the
following page).
failure to successfully treat high blood pressure in
the population as a whole. It can be said that it may
Which pill should be used first?
be difficult to change simple dietary habits among
hypertensive patients. But half of the patients on
The conflicting reports
drug therapy abandon their medications as well. As
much as 16 to 50 percent of patients stop taking their
Doctors are involved in a
blood pressure drugs within the first year of treatment.
long-standing debate on
Since blood pressure is a silent killer, and the drugs
which drug to use first to
often cause fatigue, dizziness and other side effects,
treat hypertension. See if
the patients often feel better when not taking the drugs.
you can make sense of these conflicting reports:
[Drug Topics Jan. 26, 2004] Physicians concede drugs
Report: Part 1 - Hypertension © Bill Sardi | June2004 | www.askbillsardi.com | Page 7
DRUG CLASS GENERIC (BRAND) NAME NUTRIENT DEPLETED
Calcium blocker Atenolol (Tenormin) Coenzyme Q10
Beta blocker Diltiazem (Cardizem) None reported
Lowers melatonin, a brain
hormone that induces
sleep; drug may cause sleep
disturbance (Eur J Clin Pharm
55: 111-15, 1999]
Beta blockers raise cholesterol;
chromium supplements should
be taken to counter this
problem [Ann Internal Med
115: 917-24, 1991]
Up to 25% of beta blocker
users will develop a need for
antidepressants
ACE inhibitor Captopril (Capoten), Zinc
Benazepril (Lotensin)
Enalapril (Vasotec),
Lisinopril (Prinivil) Quinipril
(Accupril)
Diuretic Hydrochlorothiazide Coenzyme Q10, magnesium*,
phosphorus, sodium, zinc, folic
acid
VasodilatorHydralazine Coenzyme Q10, magnesium,
(Apresoline) potassium, vitamin B6, zinc,
COMPANION DRUGS OFTEN PRESCRIBED TO HYPERTENSIVE PATIENTS
Acetysalicilic acid Aspirin Folic acid, potassium, sodium,
vitamin C, iron
Anti-diabetic Glyburide (Micronase Coenzyme Q10
Metformin (Glucophage) Folic acid, vitamin B12
* Magnesium shortage may
result in sudden-death heart
attack
Report: Part 1 - Hypertension © Bill Sardi | June2004 | www.askbillsardi.com | Page 8
" ACE inhibitors should be preferred to diuretics in
Does weight influence
elderly patients. [Expert Opinion Pharmacotherapy
high blood pressure?
4: 825-88, 2003]
The literature regarding weight and blood pressure
" Diuretics are considered the first line of treatment for
is conflicting.
elevated blood pressure. [Expert Review Cardiovascular
Therapy 1: 35-41, 2003] An old fashioned diuretic is
A study of overweight individuals over a period of 8
as good, if not better, than some newer more expensive
years did not show that weight reduction lowers el-
medicines for treating high blood pressure, according
evated blood pressure. [Hypertension 36: 20, 2000]
to a government sponsored study. [Associated Press,
Dec. 17, 2002; J Am Med Assn 288: Dec. 18, 2002]
However, another study showed that exercise drops
blood pressure by 2 to 3.5 points, and exercise plus
" The lack of benefit and potential side effects of
weight reduction drops blood pressure by about 6 to
beta blockers are overstated. Some investigators
8 points. [Hypertension, August 2000]
recommend these agents not be used in the management
of hypertension in the elderly. There are numerous
Another report claims an overweight person may
reasons why these recommendations should not be
reduce pressure by about 1 point for every 2 pounds
followed. There is abundant evidence that beta blockers
of weight loss. [Hypertension 42: 878-84, 2003]
are effective therapy. [J Clinical Hypertension 10/08/
2002]
Oddly enough, overweight individuals with high
Most hypertensive patients are placed on more
blood pressure are less likely to die prematurely
than one medication but unless the drug regimen
or have heart attacks or strokes than thinner
includes a diuretic, patients will be at increased risk
people. Fat dulls the heart muscle excitability from
for stroke. [Archives Internal Medicine 161: 37-43,
adrenal stress hormones like adrenaline. In thin
2001]
people these stress hormones can increase the size
of the heart and cause stiff arteries. [J Am Medical
At one time the Joint National Committee on
Assn 285: February 28, 2001]
Detection, Evaluation and Treatment of High Blood
Pressure erroneously recommenced beta blockers as So which drug is the drug physicians should prescribe
first-line treatment in the elderly, but beta blockers first? Beta blockers or diuretics? Both of these drugs
are inappropriate and should no longer be used as increase the risk of sudden death.
initial antihypertensive therapy. This means that
more than 7 million elderly patients with high blood Going off drugs cold turkey
pressure are exposed to the cost, inconvenience and
side effects of beta blockers without any potential Can hypertensive patients go off their drugs cold
for health benefits whatsoever. [Archives Internal turkey? In a British study, 22 percent of patients who
Medicine, July 26, 1999] stopped taking their drugs neither suffered a relapse or
related problems after three years. One in three men
Despite the myriad of side effects, lack of patient and one in six women succeeded at stopping their
acceptance and ineffectiveness of the drugs, Dr. medication. [British Journal General Practice 49: 977-
Donald Lloyd-Jones at Northwestern University 80, 1999, BBC News, January 31, 2000]
says elderly patients with high blood pressure need
to be treated more aggressively, with more drugs.
The majority of patients are being treated with just one
drug, he claims. [American Society Hypertension 19th
Annual Meeting, New York, May, 2004] Dr. Lloyd-
Jones says they need more medications.
Report: Part 1 - Hypertension © Bill Sardi | June2004 | www.askbillsardi.com | Page 9
concentrations it can cause circulatory shock and
The root causes of hypertension
induce cell death.
There are four main root causes of hypertension
A recent report indicates the decline in production of
that never seem to be properly addressed. These are
nitric oxide is a major cause of high blood pressure.
calcification, sugar, salt and nitric oxide.
Blood pressure lowering drugs have only shown limited
ability to restore nitric oxide. [Current Pharmacological
Calcification
Des 10: 1695-98, 2004]
When arteries become stiff and inflexible due to
Because nitric oxide is the agent that dilates blood
calcification, hypertension may develop. [Hypertension
vessels and improves circulation as well as blood
Research 27: 47-52, 2004] Women develop
pressure, the last of nitric oxide is associated with
hypertension at an alarming rate after menopause. The
erectile dysfunction in males. About 4 in 10 males with
release of calcium from bones in the post-menopaulsa
erectile dysfunction also have high blood pressure.
period then accumulates in arteries which can result
[Journal Urology 171: 2341-45, 2004]
in hypertension. [Biol Trace Element Research 63:
105-11, 1998] Calcification of arteries in the breast of
In a laboratory researchers demonstrated that
females, visible in mammograms, is also a marker for
magnesium enhances the production of nitric oxide
hypertension. It is interesting to note that arteries in
in the cells that line the inside of arteries. Thus
the breast don t begin to calcify in women until age 40
magnesium plays a role in widening blood vessels,
and rises with advancing age. [Clinical Radiology 59:
preventing hypertension and blood clots. [Biochim
92-95, 2004] But another study indicates age or gender
Biophys Acta 1689: 6-12, 2004]
do not influence calcification. [Radiology 224: 235-42,
2002]
Estrogen is believed to play a role in controlling
hypertension. In animals whose ovaries have been
In one study, coronary artery calcification was found
removed, supplemental estrogen has been shown to
among 62% of men with normal blood pressure and
increase blood serum levels of nitric oxide. [Clin Chim
84% of men with high blood pressure. Coronary artery
Acta 344: 53-57, 2004]
calcification is more often associated with hypertension
in women than men. This is likely due to the loss
The provision of phytoestrogens (plant estrogens) may
of calcium from bones in post-menopause, with the
counter this problem. In an animal study, female mice
calcium being deposited in arteries. In the same study
whose ovaries had been surgically removed to stop
cited above, 23% of women with coronary artery
production of estrogen, a high sodium diet raised their
calcification had normal blood pressure while 62% of
arterial pressure but a normal sodium diet did not. This
the hypertensive women had calcified coronary arteries.
means the loss of estrogen may make females more salt
[Med Sci Monitoring 2002; 8: CR775-81, 2002]
sensitive. The provision of plant estrogens to these
animals on a high sodium diet reduced their arterial
Calcium-blocking drugs stop the influx of calcium into
pressure. [Am J Physiol Regul Integr Comp Physiol
cells, but they don t stop arterial calcifications per se.
281: R1934-39, 2001] An excellent source of plant
Hormones such as estrogen, which sends a signal for
estrogens are lignans found in flaxseed meal.
bones to retain rather than release their calcium, and
vitamin K and magnesium help to retard calcifications.
Natural molecules called polyphenols, found in grapes,
berries, tea leaves and wine can induce nitric oxide
Nitric oxide
formation. [Clin Chim Acta 344: 53-57, 2004]
Nitric oxide is a transient gas that widens (dilates)
Red wine molecules have been shown to enhance the
arteries and controls blood pressure. It is produced
blood-pressure lowering effects of both acetycholine
from the amino acid arginine. At low concentrations
nitric oxide can improve circulation, but at high
Report: Part 1 - Hypertension © Bill Sardi | June2004 | www.askbillsardi.com | Page 10
and nitric oxide. [Clinical Experimental Pharmacology Even occasional drinkers are at a mildly elevated risk to
Physiology 30: 605-15, 2003] develop hypertension. [J Studies Alcohol 65: 184-90,
2004] The risk for hypertension rises with the amount
It is obvious that antihypertensive drugs don t adequately of alcohol consumed. [Alcohol Clin Exp res 26: 1010-
address the issue of nitric oxide but natural molecules 16, 2002]
do. These natural molecules are overlooked.
A paradoxical effect is produced by
Sugar wine separate from beer or alcoholic
spirits. Consumption of red wine with
While excessive salt consumption is widely known to a meal actually lowers blood pressure
elevate blood pressure, high sugar levels go overlooked among obese hypertensive patients
as a major cause of hypertension. Elevated sugar and the effect is lasting (for hours). [J
levels increase the presence of aldehyde, a chemical Alcohol Studies 63: 247-51, 2002] The
that raises blood pressure. Not one of the current anti- consumption of flavonoids, molecules
hypertensive drugs adequately addresses this problem, found in wine, grapes, berries, cherries, cocoa and
though anti-diabetic drugs do. citrus rind, is low among hypertensive individuals.
[Med Hypotheses 55: 306-09, 2000] In an animal study,
Numerous natural molecules available as dietary oral administration of grape skin extract significantly
supplements counter the rise in aldehyde/sugar-related reduces blood pressure. [J Pharm Pharmacology 54:
hypertension. 1515-20, 2002] It is interesting to note that Europeans
have a high incidence of hypertension (1 in 2 people)
" N-acetyl cysteine, a sulfur-based dietary supplement, than in the USA (1 in 4 people). The highest frequency
binds to aldehydes preventing their damaging effects of hypertension in Europe is 55 percent in beer-drinking
upon proteins. [Artery 23: 10-36, 1998] Germany, and the lowest is 38 percent in red-wine
drinking Italy. [Journal American Medical Assn. 289:
" Another sulfur-based dietary supplement, alpha 2363-69, 2003]
lipoic acid, has also been shown to reduce blood
pressure caused by elevated sugar levels. [Nutrition Sodium
Metabolism Cardiovascular Diseases 10: 339-46,
2000; J Hypertension 18: 567-73, 2000; Hypertension High levels of salt consumption may
39: 303-07, 2002] double the risk for stroke. [Stroke,
May 13, 2004] A study published in
" High-dose Vitamin B6 has been shown to have 1995 among 3000 hypertensive adults
powerful effects at countering a sugar-induced rise in showed that reduced intake of dietary
blood pressure. sodium lowers mortality and morbidity
rates. [Hypertension 29: 1144-52,
" Vitamin C also lowers aldehyde levels and may help 1995]
control sugar-induced blood pressure.
One tablespoon of salt contains 2300 mgs of sodium.
Alcohol Americans consume about 2-3 tablespoons of sodium
per day, most of it laced into processed foods. There
A subclass of the sugar problem is alcohol. Alcohol is a has been a cry for food producers to reduce sodium
sugar. Sugar raises blood pressure, at least temporarily content in their foods, but they are competing for the
by its ability to raise aldehyde levels. Upon cessation taste buds of consumers and find it difficult to reduce
of alcohol consumption, elevated blood pressure drops salt content.
into the normal range within days. [Circulation 73:
628-36, 1986] Not only are our foods laced with excessive salt, but
hypertensive individuals have been found to have a
Report: Part 1 - Hypertension © Bill Sardi | June2004 | www.askbillsardi.com | Page 11
diminished sense of taste for salt. [Niger Postgraduate
Peter Sleight MD, Professor Emeritus of
Medical Journal 10: 96-98, 2003] They can eat lots of
Cardiovascular Medicine at the University of
salt without sensing they are consuming too much.
Oxford says relatively small drops (2 to 5
points) in blood pressure in the whole population
More than half of the patients with diagnosed
achieved by modest salt reduction will do more
hypertension are salt sensitive. Salt sensitive means
good than larger changes produced by drugs in
a given amount of sodium in the diet may raise blood
the smaller group of adults with hypertension.
pressure, but not among all individuals, only the salt-
[Medical Tribune August 14, 1997]
sensitive.
Iron
A study in France estimates 5 to 16 percent of healthy
adults exhibit a salt dependent blood pressure.
Iron load (ferritin) is considered a risk factor for
[Journal Hypertension 21: 289-94, 2003]
elevated blood pressure. [Am J Clinical Nutrition 76:
1256-60, 2002] Elevated iron storage is also associated
Older adults can reduce their need for medications to
with high blood sugar levels which in turn raises blood
control blood pressure by 30 percent by either losing
pressure. [Endocrine Research 29: 299-306, 2003]
8 pounds or reducing salt consumption by about 920
Middle-age males have about twice the iron load as
milligrams per day. [Hospital Medicine, October
menstruating females and have a higher prevalence for
1998]
hypertension. [J Hypertension 20: 1513-18, 2002]
One study estimates salt reduction would reduce stroke
Many health practices that help to control blood
deaths by 14 percent and mortal heart attacks by 9
pressure, such as a vegetarian diet, juicing, teas, etc.
percent among hypertensive individuals and strokes by
For example, a water-only fast for 14 days has been
6 percent and mortal heart attacks by 4 percent among
shown to reduce blood pressure to at least 120/80 in
adults with normal blood pressure. [Journal Human
82 percent of 68 patients who had mild hypertension.
Hypertension 16: 761-70, 2002]
The fast produced a drop of about 20/7 points. [J
Alternative Medicine 8: 643-50, 2002] Fasting reduces
A study conducted in Israel showed a low sodium diet
iron consumption.
only reduced blood pressure by 4 points (first number)
among adults with mild hypertension. [J Human
Copyright 2004 Bill Sardi, Knowledge of Health, Inc.
Hypertension 11: 765-66, 1997]
Surprisingly, when government health researchers
reviewed all of the studies on dietary sodium and health,
they could only find evidence for a moderate reduction
in salt intake, certainly less than the current 4000 to
6000 mg per day consumed by many US adults, and
probably about 2400 mg daily intake. [J Am College
Nutrition 16: 192-203, 1997]
Lead
At levels of intake below current US occupational
exposure guidelines, 40 micrograms per day, lead is
associated with elevation of blood pressure and this
is pronounced among postmenopausal women. [J Am
Med Assn 289: 1523-32, 2003].
Report: Part 1 - Hypertension © Bill Sardi | June2004 | www.askbillsardi.com | Page 12
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