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THe second biggest risk to our heart health, how can we control it?

High blood pressure is brutal. It kills 7.5 million people a year (1), the second leading risk factor in the world after a poor diet (2), and affects approximately 1 billion adults worldwide (3). That's 15 times the population of the UK. It's not all bleak as trials have shown that treatment of high blood pressure (HBP) reduces the risk of cardiovascular disease (CVD) outcomes, including stroke (by 35 to 40%), heart attack (by 15 to 25%), and heart failure (by up to 64%) (4, 5, 6).

 

Considering CVD is the biggest killer of men and women worldwide (7) and the majority of HBP is lifestyle driven, what can we do to help protect our hearts and those of our loved ones? 

High blood pressure (HBP) and diet are the leading risk factors for heart and blood vessel disease (8, 9). As it is well known that diet directly impacts HBP it seems like a golden opportunity to hit two birds with one stone and sort out what we put on our plates to protect our heart from the worlds biggest killer of men and women. 

The scary thing about this destructive risk factor is that there often aren’t any symptoms (10), so it could be wrecking our blood vessels without us even knowing. So the 10 million people in the UK already with HBP (11) may be the minority. Imagine if your home central heating was operating at much too high a pressure, just like HBP, you may not know until it’s too late when your pipe bursts and you have an expensive leak.

 

The savage thing is, with HBP it doesn’t just cause some water damage, it causes strokes, heart attacks and heart failure. This is an expense on our health no one can afford, so knowing your numbers is vital and prevention is the key!

 

To start with, it’s crucial we all know where we stand with interpreting blood pressure numbers. There are two of them - top and bottom. The top (systolic) is the amount of pressure put on your blood vessels when your heart is pumping and the bottom (diastolic) is the pressure in between pumps.

 

Both numbers independently predict negative health outcomes when raised, but the top systolic number conveys a slightly higher risk. (12). Also, we are talking about primary HBP (no specific cause) in this page and not secondary which is where HBP has a known underlying cause (13). 

According to the lovely people at the NHS ‘ideal blood pressure is usually considered to be between 90/60mmHg and 120/80mmHg (14)’ with high being considered over 140/90mmHg. The optimal number being around 115/75 (15) and lowering systolic blood pressure to a target goal of less than 120 mm Hg, as compared with the standard goal of less than 140 mm Hg, can result in lower rates of fatal and nonfatal cardiovascular events and death from any cause (16). So the closer we get to the optimal numbers, the better.
 

So what can we do to protect ourselves and the NHS, as it's estimated that high blood pressure creates a monumental £2.1 billion bill for the NHS (17). Maybe it's time we take responsibility for our own health rather than relying on the fantastic, but overworked, doctors and nurses to pick up the pieces of our poor choices.

 

Diet has a potent impact on our blood pressure numbers. As we found out in more detail here, fruits and veggies come as a packaged deal with fibre, polyphenols, and phytonutrients whilst avoiding trans fats, cholesterol and sodium.

 

The fantastic thing about focusing our eating around fruits and veggies is that adding more of them generally benefits us. Consequently, if we add specific fruits and veggies to our diet that help maintains optimal blood pressure, these other elements may double down the benefits. 

 

As always, keep your GP updated with your lifestyle changes as these options aren’t for everyone, but we hope to arm you with up to date knowledge. What you choose to do with this information is entirely down to you, but our goal is to empower you so you are able to make informed decisions about the most important element of your life, your health. 

At the very least you can then decide that the Chinese takeaway you love is totally worth the health impact because it brings you such joy. It is a balancing act, but until we are aware of all the players involved we may fall foul without even knowing why. 
 

Our overall diets are the cornerstone of optimal blood pressure maintenance, as we discussed here, DASH and Mediterranean diets have shown potent heart-protective qualities (18, 19). These diets are ‘rich in vegetables, fruits and low-fat dairy products and poor in saturated fatty acids and cholesterol’, the reason why focusing more on whole plant foods is heart-healthy is explored here.

 

Part of this is explained by their ability to lower blood pressure (20, 21) which is known to increase strokes and heart attacks when raised, all part of heart and blood vessel disease known as cardiovascular disease (CVD). So even without changing specifics, a diet focused around whole plant foods will provide a framework for outstanding health. 

 

Within that framework, there are areas that can be improved to make it even better. It’s a bit like getting a sports car for a race, it’s going to do the job pretty well, but making some tweaks like a turbo or spoiler gives it an extra edge. 

To put the below info into perspective, an analysis of blood pressure-lowering treatments showed the impact that a 10 mmHg decrease in systolic blood pressure (SBP) and a 5 mmHg decrease in diastolic blood pressure (DBP) has. This reduces the risks of major cardiovascular events by approximately 20%, stroke by 30–40%, coronary artery disease by approximately 20%, heart failure by approximately 40% and total death by 10–15% [22-24]. 

 

So small reductions towards that NHS's healthy range of  90/60mmHg to 120/80mmHg can have major impacts and may help you or your loved ones prevent such horrific disease events.

 
Image by Brooke Lark

check out our

Breakfast bar recipe

How to make a no-bake snack bar which promotes optimal blood pressures, giving you the inside scoop of how this happens.

Diet vs heart disease?

How much control do we have over our heart health and what tools can we use to give ourselves the best chance of living a life free of this brutal disease ?

Foods that harm

 

 

Sodium, which makes up just under half of salt, is the 'big dog' when it comes to raising our blood pressure. We found here that lowering our salt with just two other simple dietary changes could save 5 million lives caused by CVD. Around 50% of HBP cases are related to salt, which as we know is directly related to various deadly complications (25). 

 

It has been documented since the 80s that increasing salt directly increases blood pressure (26), consequently, the NHS recommends a max of 6g per day. Lowering sodium intake has a slightly bigger (16 vs 15 point reduction) impact on HBP (27) than a single blood pressure-lowering medication (28). The only difference is with the dietary change you're improving your health by potentially tackling the cause of the problem.

Processed meats and other foods such as sauces, pizzas and crisps are all high in salt either added for taste or to make them last longer on the shelf. Other foods that cause harm on the diagram above is alcohol, by lowering our intake down to the government's recommendations for at least 7 days can lower systolic and diastolic pressure by 5.5 and 4.0 mmHg, respectively (29). Additionally, caffeine from substances like coffee and energy drinks raises blood pressure in the very short term, potentially rasing systolic pressures by 8.1 mmHg and diastolic BP by 5.7 mmHg (30).

foods that help

The horrible thing is, these elements will be secretly raising our blood pressures but due to the lack of symptoms, we often won't know it's an issue until it's too late. Focusing on foods that help is key and a great start is potassium. Ensuring you have optimal potassium levels through potassium-rich foods like dried apricots, lentils and potatoes can lead to a significant reduction of 4.25/2.53 mmHg on average (31). It has been found to be best when eating 3,500mcg a day (32), a goal supported by the World Health Organisation (33). 

30g of flaxseed has the capacity to drop blood pressure by up to 15 points of systolic and 7 diastolic in people with HBP. Adding some blue or blackberries to your breakkie 3 times a week with a cup of hibiscus tea have also been associated with a reduction in blood pressure (34-36) as the antioxidants regulate the blood vessel function (37). 

Image by am JD

The fantastic thing about adding whole plant foods to our diet is that even if the impact on our blood pressure is small, they will be improving our overall health due to their health-promoting package. So there really is nothing to lose. It's not all about food however, increasing exercise, losing weight, cutting out smoking and stress all play important roles in their own right. 

Exercise lowers blood pressure (38, 39), so chilling on the sofa and munching your favourite processed food will create a double whammy of blood pressure boosting. Regular Exercise over 3 months can lower systolic blood pressure by 9 -11 points (40, 41).

Obesity (BMI over 29.9) can cause HBP (42-49). Every 1kg lost has the capacity to create a 1.1mmHg drop in systolic and 0.9mmHg drop in diastolic (50, 51). This demonstrates the powerful link between the two factors and the importance of maintaining a healthy weight.

Smoking can cause HBP (52, 53), as can passive smoke (52). Finally, stress can play a significant role in promoting HBP (54), which makes management techniques crucial. 

Our overall diet has a potent impact on HBP, but knowing what elements have the biggest effect is also helpful. As we know from our article here and just common sense, eating more fruits and vegetables promotes health. Consequently, making whole plant foods the centre of your diet may optimise your blood pressures and has led to the biggest overall change of an 18 point reduction (55). Diets focused around plants are naturally low in sodium (56) and increased plant proteins have been associated with lower blood pressure whereas animal proteins have not (57).

 

Blood pressure is a destructive risk factor which often has no symptoms and the deadliest of consequences. If you don't know already, find out what your numbers are, the downsides of not doing so are simply not worth considering. Now you are aware of some of the research surrounding this brutal risk factor, it's time we take a stand against chronic disease for ourselves, our loved ones and the NHS. We all have the power to take back control of our health to some extent and changing what we put on our plates can have a potent impact on the second biggest risk factor to health: blood pressure.

 

In no way is this information meant to replace the advice given by your doctor, always follow the advice of your health professional. Always discuss any lifestyle changes with your doctor.

As always, don't just take our word for it, have a read through some of the evidence we use which is all referenced below. 

Evidence
  1. Forouzanfar, M.H., Afshin, A., Alexander, L.T., Anderson, H.R., Bhutta, Z.A., Biryukov, S., Brauer, M., Burnett, R., Cercy, K., Charlson, F.J. and Cohen, A.J., 2016. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. The lancet, 388(10053), pp.1659-1724.

  2. Afshin, A., Sur, P.J., Fay, K.A., Cornaby, L., Ferrara, G., Salama, J.S., Mullany, E.C., Abate, K.H., Abbafati, C., Abebe, Z. and Afarideh, M., 2019. Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet, 393(10184), pp.1958-1972.

  3. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet 2005;365:217-223

  4. Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 Report. JAMA 2003;289:2560-2572

  5. Neal B, MacMahon S, Chapman N. Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials. Lancet 2000;356:1955-1964

  6. Psaty BM, Smith NL, Siscovick DS, et al. Health outcomes associated with antihypertensive therapies used as first-line agents: a systematic review and meta-analysis. JAMA 1997;277:739-745

  7. Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2017 (GBD 2017) Results. Seattle, United States: Institute for Health Metrics and Evaluation (IHME), 2018

  8. Vasan, R.S., Larson, M.G., Leip, E.P., Evans, J.C., O'Donnell, C.J., Kannel, W.B. and Levy, D., 2001. Impact of high-normal blood pressure on the risk of cardiovascular disease. New England journal of medicine, 345(18), pp.1291-1297.

  9. British Heart Foundation, 2017. BHF CVD statistics compendium 2017

  10. Magriplis, E., Panagiotakos, D., Kyrou, I., Tsioufis, C., Mitsopoulou, A.V., Karageorgou, D., Dimakopoulos, I., Bakogianni, I., Chourdakis, M., Micha, R. and Michas, G., 2020. Presence of hypertension is reduced by Mediterranean diet adherence in all individuals with a more pronounced effect in the obese: the Hellenic National Nutrition and Health Survey (HNNHS). Nutrients, 12(3), p.853.

  11. BHF analysis of UK surveys (NHS Digital/ Scottish Government/StatsWales/DH Northern Ireland) and ONS UK population estimates

  12. Flint, A.C., Conell, C., Ren, X., Banki, N.M., Chan, S.L., Rao, V.A., Melles, R.B. and Bhatt, D.L., 2019. Effect of systolic and diastolic blood pressure on cardiovascular outcomes. New England Journal of Medicine, 381(3), pp.243-251.

  13. Umemura, S., Arima, H., Arima, S., Asayama, K., Dohi, Y., Hirooka, Y., Horio, T., Hoshide, S., Ikeda, S., Ishimitsu, T. and Ito, M., 2019. The Japanese Society of Hypertension guidelines for the management of hypertension (JSH 2019). Hypertension Research, 42(9), pp.1235-1481.

  14. NHS 2020. Overview: High blood pressure (Hypertension). https://www.nhs.uk/conditions/high-blood-pressure-hypertension/ [accessed: 16.09.2020].

  15. Lewington S, et al. Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903–13. PMID: 12493255

  16. SPRINT Research Group, 2015. A randomized trial of intensive versus standard blood-pressure control. New England Journal of Medicine, 373(22), pp.2103-2116.

  17. Public Health England, 2017. Health Matters: cost to the NHS. Available: https://www.gov.uk/government/publications/health-matters-combating-high-blood-pressure/health-matters-combating-high-blood-pressure [accessed 20.09.2020].

  18. Sacks, F.M., Svetkey, L.P., Vollmer, W.M., Appel, L.J., Bray, G.A., Harsha, D., Obarzanek, E., Conlin, P.R., Miller, E.R., Simons-Morton, D.G. and Karanja, N., 2001. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. New England journal of medicine, 344(1), pp.3-10.

  19. Estruch, R., Ros, E., Salas-Salvadó, J., Covas, M.I., Corella, D., Arós, F., Gómez-Gracia, E., Ruiz-Gutiérrez, V., Fiol, M., Lapetra, J. and Lamuela-Raventos, R.M., 2013. Primary prevention of cardiovascular disease with a Mediterranean diet. New England Journal of Medicine, 368(14), pp.1279-1290.

  20. Ndanuko RN, et al. Dietary Patterns and Blood Pressure in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Adv Nutr. 2016;7:76–89. PMID: 26773016

  21. Appel LJ, et al. DASH Collaborative Research Group. A clinical trial of the effects of dietary patterns on blood pressure. N Engl J Med. 1997;336:1117–24. PMID: 9099655

  22. Law MR, et al. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ. 2009;338:b1665. PMID: 19454737

  23. Thomopoulos C, et al. Effects of blood pressure lowering on outcome incidence in hypertension. 1. Overview, meta-analyses, and meta-regression analyses of randomized trials. J Hypertens. 2014;32:2285–95. PMID: 25255397

  24. Ettehad D, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016;387:957–67. PMID: 26724178

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  27. Macgregor GA, Markandu ND, Sagnella GA, Singer DR, Cappuccio FP. Double-blind study of three sodium intakes and long-term effects of sodium restriction in essential hypertension. Lancet. 1989;2(8674):1244-7

  28. Wu J, Kraja AT, Oberman A, et al. A summary of the effects of antihypertensive medications on measured blood pressure. Am J Hypertens. 2005;18(7):935-42.

  29.  M. Roerecke, J. Kaczorowski, S.W. Tobe, G. Gmel, O.S.M. Hasan, et al., The effect of a reduction in alcohol consumption on blood pressure: a systematic review and meta-analysis, Lancet Publ. Health 2 (2017) e108ee120, https://doi.org/10.1016/S2468-2667(17)30003-8.

  30. A.E. Mesas, L.M. Leon-Munoz, F. Rodriguez-Artalejo, E. Lopez-Garcia, The effect of coffee on blood pressure and cardiovascular disease in hypertensive individuals: a systematic review and meta-analysis, Am. J. Clin. Nutr. 94 (2011) 1113e1126, https://doi.org/10.3945/ajcn.111.016667.

  31. Poorolajal J, et al. Oral potassium supplementation for management of essential hypertension: A meta-analysis of randomized controlled trials. PLoS One. 2017;12:e0174967. PMID: 28419159

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  55. Wu J, Kraja AT, Oberman A, et al. A summary of the effects of antihypertensive medications on measured blood pressure. Am J Hypertens. 2005;18(7):935-42.

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  57. Altorf–van der Kuil, W., Engberink, M.F., Brink, E.J., van Baak, M.A., Bakker, S.J., Navis, G., van't Veer, P. and Geleijnse, J.M., 2010. Dietary protein and blood pressure: a systematic review. PloS one, 5(8), p.e12102.