Managing Hypertension: A Multifaceted Approach

Discover effective strategies for managing hypertension through lifestyle changes. Learn about diet, exercise, stress management, supplements, and herbal remedies for better blood pressure control.

A 45-year-old female visited the clinic. She was slightly overweight for her height, and on questioning, she was complaining of regular headaches, anxiety, difficulty breathing when stressed, lightheadedness, deteriorating vision and occasional but rare nosebleeds. She had a family history of heart disease and hypertension in both her mother and father, but they were generally well until their 60s and 70s.

Diagnostically, there was the possibility that she had the early stages of high blood pressure — probably related to stress — with the slight family susceptibility.

Hypertension or high blood pressure is defined as systolic pressure higher than 130 and diastolic pressure higher than 80. While she had no major symptoms, taking into consideration her family history symptoms and lifestyle choices these were indicative of mild hypertension, so I checked her blood pressure and found it to be 140/90: too high.

She agreed to purchase a blood pressure monitor and take her blood pressure daily. As blood pressure can fluctuate significantly depending on the circumstances, to be recognised as a problem it needs to be taken at least three times in different circumstances. It is best if it is taken at home over
a period of three or four weeks at three different times a day and recorded. This she did for one week and it averaged 135/80 most days, but rose to 190/120 on very stressful days, so she was back to discuss a program to reduce it.

Multiple factors

She had a very stressful job, exercised only occasionally, walking in the local park occasionally on fine mornings. The minimal level of exercise for health is 30 minutes three times per week to a personal level of fitness. It doesn’t matter what the exercise is, as long as the person enjoys it enough to want to continue.

Food choices are also major issues with increasing blood pressure, so the next item to check was salt levels, or more accurately the sodium to potassium ratio. Her electrolytes showed high sodium and low potassium, although within normal range medically. However, she really liked salt and consumed several teaspoons with her meals. She also had type O blood and was a big meat eater — and not keen on vegetables. She would eat potato, pumpkin, carrots and beans and ate occasional salads in summer with lettuce, tomato and avocado about twice a week. She had a sweet tooth, and while trying to limit this she would often have a small bar of milk chocolate in the afternoons when her energy dropped; she didn’t like dark chocolate, which is cardioprotective. She often didn’t have time for a healthy lunch so would eat fast food. She also liked cheese and would eat several pieces a day as snacks.

She drank three or four strong coffees a day with one sugar and lite milk, and about two glasses of tap water. She also took one multi-B vitamin when she remembered.

She was a light smoker, smoking a couple of cigarettes when out drinking, maybe 10 a week, and liked wine so drank a couple of glasses most evenings with her meals, and more on weekends when socialising.

She had difficulty getting to sleep at nights as she couldn’t stop her brain going into overdrive. She was probably getting about six hours’ sleep most nights so had great difficulty getting up in the mornings and was chronically tired.

While none of these things were major causes in themselves, the accumulation of multiple assaults was a negative factor, and aligning with her family history increased her risk for high blood pressure and cardiovascular problems.

Treatment

She needed to change her diet, reduce salt intake and increase potassium by eating more vegetables daily, so I suggested a large salad with every meal in summer or a bowl of vegetable soup in winter. She needed to drink up to two litres of filtered water per day, organise stress management such as yoga, increase her exercise and stop smoking — vaping is not a viable alternative.

To decrease her meat intake, I suggested swapping three meals a week with wild, not farmed, fish, and having a couple of non-meat meals such as pasta with vegetables each week. I recommended snacks of unsalted nuts and seeds instead of the cheese and chocolate.

I strongly recommended reducing her salt intake. There are various salt-free spice seasonings on the market that she could try to help her wean off the salt. Dried seawater can be useful as it has a broader range of minerals and tastes saltier, so less is needed.

The supplements I recommended were magnesium, which is calming for the nervous system and helps lower blood pressure, and a “glucofactors” formula to regulate blood sugar. This would also help her stop smoking as it is a blood sugar issue as well as a behavioural one. Despite the zinc content of meat she had variations in her tongue surface indicative of a zinc deficiency so I added this also.

Reducing her alcohol consumption was a necessity. Having three alcohol-free nights a week and ensuring she drank extra glasses of filtered water when she did drink were options I suggested to increase rehydration.

I prescribed a herb mix containing herbs that are known to reduce blood pressure: hawthorn, motherwort, mistletoe, dan shen, linden and ginkgo biloba to be taken twice a day.

While she found this program to be very difficult to start with, she took it slowly. Gradually her energy improved, she lost a little weight, her sleeping improved and overall she was feeling much better. She was taking her blood pressure twice daily and over a few weeks, and it was now averaging 110/70, which was a significant improvement, although it went up on stressful days to 125/80.

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