by Dr. Asela Russell, at the Center for Women’s Health
We’ve heard the promises before: This prescription drug will treat your disease—don’t bother to change your life, just take the drug.
The latest example has been the high blood pressure medications called ARBs (or angiotensin receptor blockers). These nifty compounds modify the kidney’s regulation of the hormones renin and angiotensin, lowering blood pressure. They have been widely used for the last 10 years because they are highly effective. They may even block the decline in kidney function that hit diabetics with hypertension especially hard.
A new comparison study published in Lancet Oncology suggests that the law of unintended consequences still holds. The investigators found a 1.2% increase in cancer including lung, prostate and breast in long-term users of ARBs, that’s a small percentage but concerning for patients who are taking these life-saving medications. The good news: there was no corresponding increase in the risk of cancer deaths. The FDA is studying the issue, of course, and the increased risk is small, thank goodness. The review is ongoing, but the message is the same: there’s no such thing as a free lunch.
In any case, don’t stop your high blood pressure medicines and talk to your doctor. The FDA has advised continuing ARB medications while studies are ongoing because the potential risk of cancer is small and the benefit of antihypertensives is great—we must prevent heart attacks and strokes too!
The recurring theme in my mind, as a result of this new information, is that the cornerstone of managing any disease is to control it or improve it through a healthy lifestyle. Hypertension is a prime example of a disease that is strongly affected by lifestyle. Our ideal blood pressure puts the systolic number at 120 or less—that’s the pressure it takes to pump blood through your vascular system. The diastolic number, the resting pressure in your blood vessels ideally should be less than 80.
Your blood pressure can be affected by BMI or body mass index. Obesity (BMI over 30) increases blood pressure measurably—for every 22 lbs of increased weight, systolic BP rises an average of 3 points. A sedentary lifestyle increases BP by 2-4 points. Sodium or salt intake increases BP in the 50% of hypertensives who are salt-sensitive. Other controllable factors that can raise blood pressure: low calcium, potassium and magnesium intake, high stress, smoking, use of NSAIDs (ibuprofen, etc), excess alcohol—in short, the pitfalls of modern life.
The Lunch plan. That’s what I’m calling my own personal plan for bringing back the reality check.
- DASH diet, a Mediterranean-inspired diet has been shown to lower blood pressure through increased intake of vegetables, fruits, whole grains, fish, low-fat dairy foods. Learn about it www.nhbi.nih.gov/hbp/prevent
- Lower sodium—sodium or salt is an acquired taste. That means the taste for it can be “unacquired” too. Start by lowering your sodium intake gradually. Don’t add salt, don’t eat foods with visible salt (pretzels for example) and avoid salty foods. Next start label surfing your prepared foods—work on getting your total sodium intake under 1500 mg/day.
- Increase calcium intake—increasing dairy, even non-fat dairy, to 3 servings/day has been shown to lower blood pressure. Can’t tolerate dairy? Other great sources of calcium include broccoli, sardines, spinach, and turnip greens.
- Increase your intake of potassium—potassium rich foods like apricots, tomatoes, oranges, beets can help to lower blood pressure.
- Look for and eat a magnesium-rich diet. Black beans, leafy greens, whole grain cereals and peanuts are foods with lots of magnesium. Side benefit: magnesium helps prevent constipation.
- Go to www.nhbi.nih.gov/hbp/prevent/factors for a list of other blood-pressure lowering foods.
Exercise—a moderate level of exercise is recommended to help with lowering blood pressure. Most people don’t need to get medical clearance before starting a moderate exercise program.
- Start small by parking further from the front door or taking the stairs sometimes.
- Increase gradually to an overall goal: at least 150 minutes of walking per week.
- Pray, meditate or take a 10-20 minute quiet break each day.
- Consider biofeedback like the Resperate. Go to www.RESPeRATE.com for more information.
Maintain a healthy body weight
A BMI less than 27 is ideal for the control of hypertension
- BMI Categories:
- Underweight = <18.5
- Normal weight = 18.5–24.9
- Overweight = 25–29.9
- Obesity = BMI of 30 or greater
- Calculate your BMI at www.bmhisupport.com/bmi/
Correct other co-factors
- Limit alcohol to 1 serving/day or less
- Stop smoking!
That’s my lunch plan; now bring me the reality check!
Asela Russell, MD
Dr. Asela Russell, the founder of Center for Women’s Health, is a Board-certified OB/GYN. She has practiced in the Denver Metro area since 1987 and opened the Center for Women’s Health in 2003, after working with The OB/GYN Associates for more than 15 years.
Dr. Russell attended Yale University and Duke Medical School and completed her OB-GYN Residency at the University of California-San Francisco. After completing her residency, she was a US Public Health Service provider working for the Navajo Nation in Arizona.