Hypertension Basics

by Iva Lloyd, ND

Hypertension, or high blood pressure, affects about 25% of Canadian adults under fifty and over 50% of those over the age of sixty. It also accounts for about 20% of deaths in Canada. Hypertension is considered a lifestyle disorder as it is strongly affected by diet, exercise, stress, smoking and other factors.

Whether you choose to treat your hypertension with prescription medication or natural therapies it is important to be aware of the impact that caffeine and salt have on your blood pressure.

There is a lot of debate as to the long-term risk and/or benefits of consuming caffeine on cardiovascular health, but what is known for sure is that for many individuals with hypertension there can be a significant short-term (roughly 3 hours) spike in blood pressure after drinking a coffee or having a caffeine drink (cola). The spike in blood pressure generally affects both the systolic and the diastolic aspects of blood pressure.

Consuming too much salt can not only spike blood pressure but it can put additional strain on the heart, arteries, kidneys and the brain. The impact of a high-salt meal on your blood pressure can last for hours or even a day or more.

Measuring The Impact of Caffeine on Blood Pressure

To measure the impact of caffeine on your blood pressure follow these steps:

1. Either first thing in the morning (ideally) or three hours after a meal (without caffeine) take your blood pressure.
2. Have your cup of coffee or other caffeine drink (cola).
3. Thirty (30) minutes later take your blood pressure again.

If your blood pressure increases more than 10 points you may have caffeine-induced hypertension.  If you have been diagnosed with hypertension and if your blood pressure rises with caffeine you may want to reduce your caffeine consumption. The more profound the spike in blood pressure the more cautious you need to be with your total caffeine consumption.

Measuring The Impact of Salt on Blood Pressure

To determine the impact of salt on your blood pressure follow these steps:

1. Ensure that you have at least two days with minimal salt and no caffeine in your diet.
2. First thing in the morning take your blood pressure.
3. Have a meal with added salt.
4. Thirty (30) minutes later take your blood pressure again.
5. Continue taking your blood pressure twice a day to determine how long it takes for your blood pressure to return to normal.  

If your blood pressure increases more than 10 points you may have salt-induced hypertension. If you have been diagnosed with hypertension and if your blood pressure rises with salt you may want to reduce your salt consumption.

Because both salt and caffeine are known to spike blood pressure it is helpful if you test them separately.  When determining the impact of caffeine, avoid salt.  When determining the impact of salt, avoid caffeine.  Generally you only have to do the test once. A person's response to salt and caffeine is fairly consistent.  If your blood pressure rises due to consumption of either one, it will generally always rise when you consume them.

The Perfect Storm

Most heart attacks and strokes occur due to a sharp rise in blood pressure over a short period of time due to multiple factors that have a cumulative effect. The more that you are aware of the factors that increase your blood pressure, the more control you will have over your blood pressure.

It is not always advisable or feasible to take your blood pressure multiple times a day, or even frequently during a week, but if you have been diagnosed with hypertension it is important to know your typical blood pressure and what affects you. Unless advised otherwise by your doctor, monitoring your blood pressure means taking your readings once or twice a month under the same conditions - i.e., same time of day.  Whenever you change medication or change a treatment plan for hypertension it is important to monitor more frequently (often daily or at least a couple times a week) to understand the impact of the new treatment on your blood pressure. 

To really understand what affects your hypertension, I recommend that you take a couple of weeks and do the following:

• Monitor the impact of caffeine and salt on your blood pressure.
• If you work out, take your blood pressure before and after a normal workout.  A "good" work-out will decrease your blood pressure as you are improving the circulation of blood throughout the body.  If your exercise regimen is too intensive, too focused on weights versus cardio or if you are dehydrated after your workout you may find that your workout is actually increasing your blood pressure. 
• Stress can have a significant impact on blood pressure. During an acute stressful situation take your blood pressure so that you know the impact that it is having on your readings.
• Being dehydrated will generally increase your blood pressure. If you have a day that you know was more dehydrating -- lack of drinking water, higher stress, diet that was dehydrating, a busy day, etc - take your blood pressure at the end of the day and monitor the impact.
• Whenever you feel lightheaded, have a strange headache or feel weak, take your blood pressure and see if there is any correlation.  If you suffer with any of these symptoms frequently, you are best to talk to your naturopathic doctor.

The value of knowing the impact that different lifestyle factors have on your blood pressure is that you can avoid doing multiple things that increase your blood pressure simultaneously.  For example, when under stress you would know whether or not to avoid that extra cup of coffee and the high-salt meal.  You would know whether going to the gym will add to the problem or whether it would be beneficial. 

Knowing the impact that different lifestyle factors have on your blood pressure also allows your naturopathic doctor to tailor a treatment plan specifically for you.  For example, hypertension that is driven more by stress than by dietary factors would benefit from herbs or nutraceuticals focused on stress management.  Treating chronic dehydration (a common cause of hypertension) requires a different treatment approach than if the cause of hypertension if due to a high-salt diet or chronic stress.

Other Resources

To learn more about hypertension check out the following other resources:

• www.ndhealthfacts.org/hypertension
• Blog: Heart Health - A naturopathic perspective
• Blog: Cardiovascular Events - A Perfect Storm

Talk to your naturopathic doctor to learn more about how to manage your hypertension and to receive a treatment plan tailored specifically to you.

Naturopathic Doctors

Medically Trained.  Naturally Focused.

Sugar and Salt -- Foods or Poisons? - Part 2: Sodium-Potassium Balance

In a previous blog we discussed the health impact of sugar.  The other "drug" or "poison" that is associated with many chronic diseases is salt. Salt is both essential to health and toxic. What determines its impact is the amount that is consumed and the balance between sodium and potassium in the body.

Facts on Salt:

• Generally speaking, an adult requires about 1500 to 2000 mg of sodium a day.  Unfortunately the amount in a typical North American diet is between 4000 and 9000 mg. 
• Roughly 80% of salt comes from processed food; 5% is found naturally in food and only about 10 to 15% is added at the table.  It is the salt from processed food that is the major problem! 
• When it comes to the impact of salt on health the type of salt has little impact. Sea salt, kitchen salt, commercial cooking salt, Himalayan, Fleur de Sel or kosher salt is all the same.
• Infants who have been introduced to starchy foods early in life tend to have a greater preference for salty foods and as a result develop a taste for sugar.

Sodium-Potassium Balance
Salt is made up of sodium chloride (NaCl). Sodium (Na) is the primary extracellular electrolyte. The concentration of sodium on the outside of the cell is about 10X greater than inside. The amount of sodium in the body has to balanced with potassium (K). Potassium is the primary intracellular electrolyte. The concentration of potassium inside the cell is about 30X more than it is outside the cell. This delicate balance between sodium and potassium is required to maintain health and to sustain life. It also determines the electrochemical gradient which is critical for nerve impulse transmission, muscle contractions, heart health and for the movement of other essential electrolytes across the cellular membrane.

The main reason for a sodium-potassium imbalance is diet. Other reasons may include vomiting and diarrhea or prescription medications. Talk to your naturopathic doctor about your prescription medications to determine what impact they may be having on your sodium/potassium balance. Medications such as diuretics, corticosteroids, laxatives and many slow-release medications can cause decreased potassium levels.

Symptoms and diseases associated with sodium/potassium imbalance include:

• dehydration
• electrolyte dysregulation
• muscle pain and tension
• hypertension
• cardiovascular disease
• stroke
• diabetes
• osteoporosis
• obesity
• cancer
• multiple sclerosis
• autoimmune disease
• kidney disease
• lung disease
• growth retardation in young children
• cognitive decline, including dementia and Alzheimer's disease

Maintaining a healthy sodium / potassium balance:

• A diet high in whole foods, primarily fruits and vegetables, is the best way to maintain a healthy balance of sodium to potassium. Trust mother nature. Eating food in its natural state is the easiest way to maintain health.
• Eliminate or greatly reduce processed food as that is the primary source of sodium (salt). Most restaurant food is very high in salt.
• If buying any canned, frozen or processed food read the labels and ensure that the sodium level is minimal.
• Increase your consumption of potassium-rich foods such as: 
• dark leafy vegetables such as beet greens, spinach, kale
• vegetables such as potatoes, tomatoes, mushrooms and squash
• legumes such as white beans, pinto beans, kidney beans, lentils
• fish such as salmon, halibut, haddock and sardines
• fruits such as prune juice, papaya, bananas, avocados, plums and oranges

The most accurate way to measure your Na/K balance is a 24-hour urine collection test. To learn more about this talk to your naturopathic or medical doctor.

To read more details on the impact of high sodium - low potassium on health, check out the research article "Salt in Health and Disease - A Delicate Balance" by TA Kotchen, AW Cowley and ED Frohlich.