February is “Heart Month,” and my two blogs for this month will focus on helping you understand some of the basis of heart disease and actions that you can take to help reduce your risk of developing cardiac problems.
The information in this blog is not intended to substitute for medical advice from your practitioner.
This is important. Heart disease is the number one killer of both men and women in the U.S., causing more than 600,000 deaths per year. Myocardial infarction (heart attack) from coronary artery disease is the primary cause of heart disease deaths.
Two major factors contribute to the development of heart disease. One is high blood pressure (“hypertension”). The other contributing to plaque development in blood vessels is the elevation of lipids (fats) in the blood, evaluated by blood tests for total cholesterol, high and low-density cholesterol, and triglycerides. This blog will deal with the hypertension factor, and the second blog this month will discuss the elevation of lipids.
Measuring for Hypertension
Hypertension is evaluated by measuring a person’s blood pressure. Blood pressure is measured by placing a cuff, usually on your arm, which is inflated with air, compressing the artery in the arm. A stethoscope is placed over the artery in the arm as the air is slowly released from the cuff. The sound of the blood coming through the artery can be heard through the stethoscope. The first sound represents the systolic blood pressure, the maximum pressure that the heart uses to push blood through the arteries. Arteries are muscular blood vessels that carry oxygenated blood to the body. The last sound that is heard represents the diastolic blood pressure which is the lowest pressure just before the heart beats again.
The categories of blood pressure are:
- Normal – systolic pressure less than 120/diastolic pressure less than 80
- Pre-hypertension – 120-129/less than 80
- Stage 1 hypertension – 130-139/80-89
- Stage 2 hypertension – systolic greater or equal to 140/diastolic greater or equal to 90
What happens when someone has hypertension?
This is a little complicated. I will try to make it understandable. Chronically elevated pressure against blood vessel walls damages the inner lining of arteries called the endo (meaning within/ inner/internal) thelium (meaning cellular layer). The endothelium is only one-cell layer thick. Yet, it plays a major role in regulating normal blood vessel function and structure. It secretes chemicals that cause the blood vessels to dilate (relax) and constrict (tighten). It is also considered the largest endocrine organ in the body; its total area is equal to 6 tennis courts and full length equal to 2 1/2 times distance around the globe!
Injury to the endothelium is the initial event in the development of atherogenesis, the development of fatty material in the walls of arteries that form “plaque.” Plaque narrows the lumen of the artery and can lead to the formation of clots which cause heart attacks, strokes, and other vascular events. There is a balance of chemicals in healthy bodies that cause proper relaxation and constriction of arteries. When the endothelium is injured, it causes inflammation in the artery walls and disrupts this normal balance of relaxation and constriction. The artery then develops a decreased response to the main chemical that causes relaxation of artery walls (nitric oxide).
The plaques, or atheroma, on the wall of the arteries have a fatty core, rich in inflammatory cells, and a fibrous cap covering them. If the fibrous cap is thin, it is vulnerable to rupture, causing bleeding and clot formation. When it occurs, it can occlude the blood vessel or become loosened and travel until it blocks a vessel, causing a heart attack if in a heart vessel, or a stroke if in a vessel in the brain, etc.
Uncontrolled, long-standing hypertension also causes a strain on the heart, especially the left ventricle, which is the part of the heart that pumps oxygenated blood out to the body. The heart develops left ventricular hypertrophy (enlargement and thickening of the muscle) from all its hard work pumping. This, in turn, causes the risk of congestive heart failure, a serious and life-threatening condition.
Preventing Hypertension
So what can be done to help prevent or control hypertension and the damage it can cause?
There are some risk factors to the development of hypertension that a person cannot control. These are family history and genetic make-up, ethnicity, and age. However, most risk factors can be modified. These are diabetes, obesity, sedentary lifestyle, sleep apnea, vitamin D deficiency, smoking, alcohol intake, type A personality, and eating the standard American diet (often called the “SAD” diet) high in sodium, refined starches, and saturated fats.
The first important thing to be done is to reduce sodium intake. Salt is sodium chloride (NaCl), and studies over many decades have consistently shown that sodium intake is associated with the development of hypertension. It is thought that our hunter-gatherer ancestors (our physiologic make-up has not changed much since then) might have had a sodium intake as low as 20 milligrams a day. In contrast, the average American has a daily intake of about 3,300 – 3,400 milligrams per day !!!
A healthy, active adult probably needs only 200 – 500 milligrams per day.
Even if you stopped using the salt shaker, the majority of your sodium intake would come from processed/manufactured foods such as bread and pastry products, cheese, processed meats (ham, hot dogs, bologna, bacon, etc.), snack foods, packaged (canned, cardboard, plastic) and freezer prepared foods, and condiments like soy sauce, ketchup, dips, mustard, etc.
Eating restaurant food is also a source, as you don’t know exactly how the food has been prepared, and it usually contains excessive salt and saturated fat. You can reduce your sodium intake by:
- Cleaning out your cupboards and eliminating high sodium packaged foods.
- Increasing fruit and vegetable intake. Fruits and vegetables contain potassium which can off-set sodium intake as well as being high in fiber, which can help decrease cholesterol levels. Six to eight servings of fruits and vegetables a day are recommended. That is a lot – so think about two servings with each meal. I try to have two fruits with breakfast to get the day off to a good start.
- Have home-cooked meals. You have exact control of what goes on your plate and into your stomach.
- Substitute herbs and spices for the salt shaker as much as possible. Food can be tasty without being high in sodium.
- If using canned beans, buy the low sodium kind and rinse them well. If using canned tomatoes, buy the low sodium kind and watch the frequency with which you use them. Avoid canned soups and stay away from “sports drinks” – only the real athletes need them.
Staying Healthy
You should know your numbers, including your blood pressure and cholesterol levels, and follow them, especially if they are abnormal and you want to improve them. Dietary management is beginning to receive attention as the first line of therapy in managing cardiovascular disease.
Dr. Dean Ornish, a cardiologist, has studied the effects of diet and lifestyle on heart function for 37 years. At the 5-year follow-up visit, one of his studies revealed that patients who made lifestyle modifications, including a change to a whole-food plant-based diet, exercise, and stress reduction, experienced a 7.9% reduction in the narrowing of heart blood vessels (called coronary artery stenosis). By contrast, patients who did not make lifestyle modifications experienced a 27.7% increase in coronary artery stenosis.
Another well-known physician, Dr. Caldwell Esselstyn, Director of the Cardiovascular Disease Prevention and Reversal Program at the Cleveland Clinic Wellness Institute, has studied the effects of a plant-based diet on patients with such bad heart disease that they were no longer candidates for surgical procedures. His results have been as astounding as those of Dr. Ornish. Both Dr. Ornish and Dr. Esselstyn have interesting YouTube videos available to watch. The film, “Forks Over Knives,” although a little long, is very informative. It includes interviews with Dr. Esselstyn about his clinical research and with T. Collin Campbell, PhD., about his nutritional research.
Experts believe that the positive impact of a whole-food, plant-based diet is due to the high fiber and phytonutrients they contain. These two elements help the body to reduce overall inflammation. Studies have shown that whole-food plant-based dietary intervention with strict avoidance of processed food and animal products can actually improve vascular endothelial dysfunction. This type of dietary intervention also helps with weight loss, decreases the risk of developing type II diabetes, and decreases the incidence of sleep apnea because of the weight loss.
Other lifestyle interventions that will prevent or reverse hypertension include stopping smoking, discontinuing alcohol intake, and increasing exercise. There is a lot of controversy over alcohol intake. You have all heard of the good that red wine can do, but one would have to drink a whole lot of wine to really have a significant effect on cardiovascular function. In actuality, alcohol intake can harm the heart and is also a risk factor for breast cancer. Increasing exercise does not necessarily entail joining a gym. Walking, for example, is very good exercise, convenient, and does not require any special equipment. Turning off the television is a way to increase exercise! Imagine that if the TV were off. A person wouldn’t just sit and look at an empty wall, but would probably do some other activity like working in the yard, doing housework, building things in the basement or barn, playing with the children or grandchildren and so forth.
I hope this blog has helped you understand some of the basis of hypertension and its potential effects on your general cardiovascular health. If you already have hypertension, consider making lifestyle changes. You will be helping yourself and your health care provider manage your condition better.
I wish you good heart health this month and in the future.
Happy Valentine’s Day!
