The Silent Killer: High Blood Pressure

?? In this Nexus:

?? What is a (high) blood pressure?

?? Blood pressure ≠ heart rate (pulse)

?? Hypertension in scary numbers

?? Hypertension and longevity

? Are you at a higher risk of hypertension?

??♀? Lifestyle changes for blood pressure control

?Extend your healthspan - monitor your blood pressure and take action

Let me start with some question. When was the last time you checked your blood pressure? And don't give excuses that you are only in your 30's or 40's, why would you need to do that. I think that most people have heard that high blood pressure, or a medical term - hypertension, is bad for your health. However, high blood pressure is very frequently disregarded as not that important in the society and it starts to raise concerns only when it have already caused some serious health issues. Therefore, I hope that this Nexus Newsletter edition will serve as a reminder to many and will give some practical tips of how to better take care of yourself, live longer and most importantly healthier life. In this Nexus I will discuss what is defined as a hypertension, what are the scary statistics behind this diagnosis, how it affects your longevity. We will also check if you are at a higher risk of hypertension, what lifestyle changes can significantly decrease your blood pressure and why monitoring it is so important.

What is a (High) Blood Pressure?

Before digging into the risks of having a high blood pressure, let's define the terms - blood pressure, systolic pressure, diastolic pressure:

Blood pressure (BP) is the force exerted by circulating blood on the walls of blood vessels, essential for maintaining blood flow throughout the body. It is measured in millimetres of mercury (mmHg) and presented as two numbers: systolic over diastolic pressure.

Systolic pressure, the higher number, represents the pressure in the arteries when the heart contracts and pumps blood.

Diastolic pressure, the lower number, measures the pressure in the arteries when the heart is at rest between beats.

Together, these values of systolic and diastolic pressure indicate the overall health of the cardiovascular system and can signal potential health issues if they fall outside the normal range.

Widely spread diseases or conditions as hypertension, usually have global clinical practice guidelines for physicians, in order to provide best practices and evidence, which are scientifically proven by extensive clinical research. Such guidelines are constantly revised and updated to include the most recent knowledge about a certain disease. According to the 2020 International Society of Hypertension Global Hypertension Practice Guidelines, normal blood pressure is anything below 130/85. Anything of 140/90 and above is considered as hypertension, which is divided into Grade 1 and Grade 2 hypertension, as shown in the table below (1). If you already have hypertension, these guidelines are worth the read.

It is important to mention that blood pressure may vary from person to person and it is very individual. For example, my mom her whole life had quite low blood pressure, and I inherited this from her. Thus, for her (and myself), high blood pressure might be even within a widely recognized normal range. This is just one of the reasons why you should track your blood pressure throughout your lifetime and know precisely what is normal (or not normal) for you specifically.

Blood pressure ≠ Heart Rate (Pulse)

Those who have smart wearable devices might argue that why do I need to measure my blood pressure, when I instantly measure my heart rate. No, blood pressure and heart rate (also known as pulse) are not the same. As mentioned, blood pressure refers to the force exerted by circulating blood on the walls of the arteries, while heart rate, is the number of times the heart beats per minute, measured in beats per minute. Even though they are related and can influence each other, they are distinct physiological measurements.

A person with hypertension can have a low heart rate. Blood pressure and heart rate are controlled by different mechanisms in the body and can be affected by different factors. For example, an individual might have hypertension (high blood pressure) due to factors like arterial stiffness or hormonal imbalances, while simultaneously having a low heart rate (bradycardia) due to high levels of physical fitness, medication effects, or certain medical conditions.

Hypertension in Scary Numbers

I love facts, precision and numbers, especially, when I need to prove something. Therefore, I want to share some statistics from the World Health Organization , that I hope will shake your head a bit (2):

1.28 billion people worldwide have hypertension

It is estimated 1.28 billion adults aged 30–79 years worldwide have hypertension. Two-thirds of them are living in low- and middle-income countries, but it still leaves over 420 million of people living in a high income countries with this condition. So you cannot disregard it, as it is happening to someone else!

46% of adults don't know they have hypertension

An estimated 46% of adults with hypertension are unaware that they have the condition. And this is due to the reason that our organism manage to compensate the consequences of high blood pressure for quite some time. Hypertension usually has no noticeable symptoms, earning the nickname of "the silent killer". Hypertension develops gradually, and its effects on the body, such as damage to the heart and blood vessels, can go unnoticed until more severe health issues, like heart attacks or strokes, occur. This lack of early warning signs makes regular monitoring crucial for early detection and management. Without regular blood pressure checks, individuals may remain unaware of their condition.

Only 1 in 5 adults control hypertension

Approximately only 1 in 5 adults (21%) with hypertension have it under control. Therefore, hypertension is a major cause of premature death worldwide. People often don't control hypertension due to lack of awareness, as it typically has no symptoms and goes undiagnosed without regular check-ups. Additionally, lifestyle factors like poor diet and lack of exercise, along with challenges in adhering to medication regimens, contribute to poor management. Insufficient understanding of the long-term risks also prevent effective control of hypertension.

What Does Science Say?

Hypertension and Longevity

Hypertension and longevity doesn't go well in one sentence. In one of my previous Nexus editions I have discussed how high blood pressure is a risk factor for 6 out of 10 deadliest diseases in the Western world. These include ischemic heart disease (3,4), Alzheimer disease and other dementias (5), stroke (6), kidney disease (7,8), hypertensive heart disease (9) and type II diabetes (10,11).

Hypertension can significantly shorten life expectancy if left untreated, as it happens in many cases. On average, hypertension alone can reduce life expectancy by 5 to 8 years (12,13). But as any trouble it usually doesn't come alone. The impact of hypertension on overall mortality is attenuated as a function of the age of onset, going from mortality risks 2.5 times higher when hypertension is diagnosed before the age of 45 to excess mortality risk lower than 30% when this diagnosis is made over 65?years (14). This means the earlier in life you become hypertensive, the higher risk of overall mortality. The exact impact depends on factors such as the severity of hypertension, how well it is managed, and the presence of other health conditions. Effective treatment and lifestyle changes can mitigate many of these risks and improve longevity.

An interesting study was performed in Portugal, aiming to identify the prevalence of hypertension in centenarians and to evaluate whether gene polymorphisms encoding key molecules in blood pressure regulation are associated with longevity (15). The study has recruited 253 centenarians (100.26 ± 1.98 years) and 268 control subjects (67.51 ± 3.25 years). The prevalence of hypertension among centenarians was 64.4% and the majority (58.9%) were controlled, which was statistically significantly lower than the control groups, and much better controlled as well. The findings of the study indicated that hypertension is a risk factor for not achieving longevity. Moreover, hypertension, adjusted for gender and diabetes, was independent risk factor of anti-longevity. These findings suggest that the prevalence of hypertension was lower in centenarians than in the elderly, reinforcing the importance of better cardiovascular risk profiles to achieve longevity even in the presence of genetic predisposition.

Are You at a Higher Risk of Hypertension?

High blood pressure is influenced by a number of risk factors, which can be broadly categorized into modifiable (the ones that you can influence) and non-modifiable factors. So lets do a quick check for you:

Non-Modifiable Risk Factors

Age: The risk of hypertension increases as you age, particularly after age 65.

Family History: Having a family history of hypertension increases your risk.

Ethnicity: African Americans, are at higher risk of developing hypertension.

Gender: Men are more likely to develop hypertension before age 55, while women are more likely to develop it after menopause.

Modifiable Risk Factors

Diet: High salt intake, low potassium intake, and diets high in saturated fats and cholesterol can increase blood pressure.

Physical Inactivity: Lack of regular physical activity can lead to weight gain, increasing the risk of hypertension.

Obesity: Being overweight or obese increases the workload on the heart and can raise blood pressure.

Alcohol and Tobacco Use: Excessive alcohol consumption and smoking can both lead to higher blood pressure.

Stress: Chronic stress can contribute to an increase in blood pressure.

Sleep Apnea: This sleep disorder, which causes breathing to repeatedly stop and start, can lead to hypertension.

Other Factors

Chronic Conditions: Conditions such as diabetes, kidney disease, and high cholesterol can increase the risk of developing hypertension.

Medication: Certain medications, such as birth control pills, cold remedies, and decongestants, can increase blood pressure.

Risk factors of high blood pressure are well presented in the picture below (16):

Lifestyle Changes for Blood Pressure Control

According to the 2020 International Society of Hypertension Global Hypertension Practice Guidelines, there are clear actions that you can take in order to reduce your blood pressure without being put on a constant medication use as shown in the table below (1). In short, the most important things to look at is salt reduction, smoking cessation, regular physical activity and healthy diet full of fruits and vegetables, which will also help you reduce weight, smoking cessation and moderate alcohol consumption. These are all under your control and under your will power.

Extend Your Healthspan - Monitor Your Blood Pressure and Take Action

There is no other way of knowing your blood pressure than monitoring it. For adults with normal blood pressure, it should be checked at least once every 1-2 years during routine healthcare visits. Those with prehypertension should measure it every 3-6 months, while individuals with hypertension should monitor it more frequently, possibly daily or weekly, as advised by healthcare provider. People with additional health conditions or on specific medication may also need more frequent monitoring. My advise would be:

1. Buy a blood pressure monitor and always have it at home when needed.
2. To start with - measure your blood pressure once a month for couple of months. You will get to know your patterns.
3. If you see that there are no issues, you can do it once a quarter or once in 6 months.
4. If you see that it is above 130 for systolic and above 85 for diastolic, measure it more frequently to see if such pattern continues. Look into your lifestyle and see where you can make a significant difference.
5. If you see that it is above 140 for systolic and above 90 for diastolic, see your family physician immediately and do not relay on medication only as a quick fix. Your lifestyle changes can help you get back to normal. As for the medication - if they are prescribed, they need to be taken regularly, on daily basis, as prescribed!!! Do not improvise and take it only when you feeling some symptoms, don't make jokes with your health.
6. Monitor your blood pressure when you feel strange symptoms or that something is not right, to be sure it is not related to your blood pressure. These include chest pain, shortness of breath, palpitations (sensation of feeling your own heart beating), claudication (pain or cramping in the legs or arms that occurs during exercise or physical activity), peripheral edema (swelling of tissues, usually in the lower legs or hands), headaches, blurred vision, nocturia (waking up during the night to urinate frequently), hematuria (blood in urine), dizziness.
7. Do it right. Monitoring conditions can highly influence the results. The visual below nicely summarize how you should do the measurement (1).

I have checked a random online pharmacy website for the prices of a blood pressure monitors and no, it is not expensive, so no arguments here please. The price ranged from 24 to 89 EUR. I bought mine for something around 50-60 EUR. And yes, some are more expensive than others, giving a bit more precision, but the most important thing that you measure your blood pressure at least with something. If you don't have any medical training, I recommend you to buy an automatic one, which is put on your arm (not on your wrist as those are less precise and give more variation). On the occasion of this Nexus edition I have checked my blood pressure and it was 113/70 (the proof below), which is on the lower side for my age. If I managed to convince at least one person to check the blood pressure of your own, I am happy!

I hope that if you didn't have a blood pressure monitor to date, you are searching for one online right now. Remember, if you don't feel anything bad (yet), it doesn't mean that your blood pressure is in order. More insights about your health, longevity and prolonging your healthspan is coming in two weeks!