The only way high blood pressure won’t expedite your death is if cancer gets you first.

Implement & Out

High blood pressure? 

1. Normalize uric acid (bodyweight, diet, sleep, exercise).

2. Uric acid still above 5 after lifestyle changes?

3. Talk to your doctor about a uric acid normalizing medication such as allopurinol. Do not target the blood pressure directly until uric acid is below 5. 

4. Consider medical treatment if you still have hypertension. This is called essential hypertension. You’re doing everything right, so the cause cannot be determined, but still have high blood pressure.

Regularly test your blood pressure throughout this process to measure changes.

High Blood Pressure Increases Your Risk of Disease

Excluding cancer, high blood pressure (hypertension) hastens the onset of every major deadly disease, the most influenced of which are stroke, heart failure, and kidney disease. The higher the pressure, the greater the risk. 

What is High Blood Pressure?

Historically, high blood pressure was defined as greater than 140/90 until the standard was recently updated to 130/80 (refresher on systolic vs. diastolic blood pressure). If systolic blood pressure continues to rise, there is a substantial increase in risk for these diseases at the 160 to 180 mark. 

Your doctor will shoo you out the door if you’re hovering around the safety standard. But our goal of reaching centenarian status requires more than living in the safe zone. We must seek to optimize. 

Dr. Richard Johnson, professor of nephrology (kidney disease and function), believes that there is minimal risk associated with a blood pressure of 135/85. This may be the case, but it’s not good enough for us.

Multi-year studies that analyzed patterns of disease proved a blood pressure of 120/80 was superior to 135/85. Risk of stroke and heart failure has also been proven to decrease linearly until you hit a blood pressure of 120/80.

Your doctor’s job is to ensure you’re below the rubber-stamped safety mark of 130/80. Your job is to go from safe to optimal.

One more thing…

“... the answer is we would prefer blood pressure of 120/80, but if it’s 135/85, to put someone on a medication that they’ll have to take for the next 60 years, I’m not sure that that’s the best way to go. I think that doing nutritional and exercise related maneuvers when you’re at 135/85 should be the way to go.” – Richard Johnson, MD 

I’m not a doctor, nor do I play one on the internet. Whether you decide to take an antihypertensive (blood pressure lowering medication) should be a decision made after consulting with your doctor and gaining a second opinion if possible. 

However, Dr. Richard Johnson¹ suggests that if you have a blood pressure of 135/85 it’s best to lower it through dietary intervention and exercise before medication. If you reach 140/90 and are unable to lower it through lifestyle changes, medication is likely to provide protection over time.

Let’s get to work.

Navigating Blood Pressure Health

Step 1: Measure Your Blood Pressure 

To obtain more data points and avoid white coat syndrome, buy a blood pressure device (Omron is very accurate). Alternatively, visit a pharmacy or gym that has a stationary blood pressure monitor. 

During this initial testing phase, take one reading in the morning and one at night for two weeks. Record at least two measurements per sitting separated by two minutes and obey the same preceding routine. Closely follow the instructions and pre-measurement protocol in your device’s manual to ensure you obtain accurate results. 

If your blood pressure is consistently below 130/80, you do not have hypertension. Be proactive by taking readings every few months as blood pressure often rises with age. 

Remember, there is a difference between safe and optimal. If your systolic blood pressure (the top number) is hovering between 120 and 130, you may be at risk of developing high blood pressure (prehypertension). Driving that number down now will pay off over the next 20 years.

If your blood pressure is consistently greater than 130/80, it’s time to bring that number down. 

Step 2: Test Your Uric Acid

Everyone with high blood pressure has reduced blood flow to their kidneys which causes inflammation.

Anything that constricts the kidney arteries, vasoconstrictive drugs such as cocaine for example, decreases blood flow which causes inflammation. High levels of uric acid also cause kidney inflammation.

There are a number of factors driving elevated uric acid, some of which you can control. I struggled to find a reliable at-home test kit, and suggest two paths forward instead. 

Tell your doctor you’ve been testing your blood pressure at home for a couple of weeks and the results indicate that you have hypertension (> 130/80) or prehypertension (systolic > 120 to 130). Show them the data you collected.

Ask for a uric acid test to determine if elevated uric acid is the cause behind your elevated blood pressure (reference this study or this podcast for your reasoning).

If your uric acid levels are above 5 mg/dL, try to lower your blood pressure through the means in step three before medically correcting it with an antihypertensive drug. 

Your second option is to forgo the uric acid test and beeline it to the lifestyle changes outlined below. Although you’ll be flying blind without data to support suspicions of elevated uric acid, making healthy lifestyle changes will only benefit you. Continue to stringently monitor your blood pressure. 

Step 3: Treat Uric Acid

Uric acid levels are impacted by lifestyle choices as well as gender and genetics. Men and post-menopausal women tend to have higher levels of uric acid due to estrogen’s suppressing effect. Our focus will be on the variables we can control.

Diet

Lower your intake of salt, fructose (“fruit sugar”), meat, and alcohol. 

Focus on vegetables, lean meats such as fish and poultry, whole-grain foods, nuts, seeds, and fibre rich foods like legumes. Take note of how much protein you consume each day and consider tapering down in an attempt to reduce blood pressure. Although a controversial topic in nutrition, steer clear of saturated fats, opting for monounsaturated options instead like olive oil.

Not everyone is sensitive to salt, particularly young people who can often eat large amounts and get away with it. However, those with high blood pressure have kidney inflammation which puts the kidney in a state where it cannot efficiently dispose of salt. 

Lowering salt intake can play an important role in lowering blood pressure. If you do consume a salty meal, pair it with water to prevent a rise in blood pressure. 

Fasting has also been shown to correct blood pressure after a few days making it another tool worth testing. Experiment with water-only fasts and low-calorie fasting protocols (Buchinger Method, Fast Mimicking Diet) to see how your blood pressure responds during and post-fast.

Exercise

Aim for three strength training sessions and three hours of Zone 2 aerobic training per week.

Sleep

A proper sleep routine is crucial to every aspect of our health. Aim for a consistent schedule of seven to eight hours per night. 

An underlying objective of these lifestyle changes is to achieve a healthy body weight. Excess body fat drives high blood pressure and the reverse is also correct. Dropping extra pounds if you’re overweight will lower your blood pressure. 

If your blood pressure hasn’t dropped and tests confirm your uric acid is still above 5 after making lifestyle changes, genetics could be holding you back. Do not go after blood pressure directly yet.

Ask your doctor about uric acid lowering medications such as allopurinol. If your blood pressure remains unchanged and uric acid is below 5, consider medical treatment. 

Step 4: Consider Medical Treatment

If all else fails, treating blood pressure medically may provide you with the most protection. There are various classes of drugs to treat blood pressure and the best one for you can only be determined through discussions with your doctor. There are good and bad doctors so always seek multiple opinions. 

Chat next week,

Jack

And, as always, please give me feedback on Twitter. 

Story of The Week

Of the many great qualities that come from writing online, one of my favourites is the like-minded people you meet along the way. I’ve been in Vancouver for the last week, across the country from my hometown of Toronto, and had the chance to go on a hike with a reader. We chatted about sleep, diet, exercise, remembering loved ones, and finding purpose in life through the façade of outward success.

Experiences like these are, among many other reasons, what drives me!