Holistic Approach to High Blood Pressure

Concerned about blood pressure - ©Mark Adams/123RF.com

High blood pressure (BP) can be alarming when found during a medical visit or at any other time.

High blood pressure readings may be a wake-up call to take affirmative steps for your health. Natural holistic approaches, and integrative treatments, whether you are on medications or not, can help lower BP and bring benefits to important areas of your life, health, and wellbeing. Unnecessary medication use can carry the risk of falls, hip fractures, and drug-related mental and physical side effects; and more frequent visits to doctors’ offices and hospitals. A significant proportion of the U.S. national health care expense goes to treating high blood pressure. Inaccurate blood pressure measurements lead to overdiagnosis of hypertension, treatment, and use of unnecessary medications.¹,²,³,⁴

A holistic integrative approach to BP would be to learn

• The meaning of blood pressure;

• BP proper measurement;

• How to distinguish white coat syndrome and psychogenic hypertension from actual hypertension;

• What is considered a problem: as moderate to severe hypertension can pose a significant risk;

• When treatment is needed or not;

• What are holistic natural alternatives and best integrative approaches vs medication choices;

• When blood pressure elevations point to serious issues that need attention;

• What are the psycho-spiritual, psychophysiological, and communications aspects of blood pressure?

My Personal Experience

I was inspired to do this article after being frightened by several high systolic blood pressure readings. There is a process of decision-making that has a reliance on advice, obtaining reliable well-sourced information, and the input from our developed inner wisdom or what I call the inner guiding narrative. The inner guide of course needs our attention and awareness. It is influenced by experience and develops in each of us throughout our life.

I took the BP readings with a manual sphygmomanometer and stethoscope I had at home when not feeling well. My blood pressure was elevated. I was worried to the point, that I made an appointment to see a physician with training in internal medicine and cardiology. At the large clinic where I visited, my blood pressure was taken once on each arm, in rapid succession. I was nervous and talking a “mile a minute,” while my BP was being taken. My systolic pressure was way above normal, and my diastolic was quite normal. I am normal weight, athletic, with no risk factors for heart or vascular disease.

I told the physician that my home readings showed systolic pressures in the 150 to 160 range. A recommendation was made that I do home readings with an automatic BP cuff as the Omron that I also had at home. He felt that taking my own BP with an automatic monitor would be a more accurate reading of my BP. It was felt that using a manual method might create more stress and an increase in the systolic pressure reading. I was instructed to take three readings about a minute apart when relaxed and to record the third reading. The physician then wrote a medication prescription for an ACE inhibitor (angiotensin-receptor blocker) BP medication. He told me to come back several weeks after taking the medication, for the nurse to recheck my pressure.

I filled the medication prescription but didn’t take the medication, as I wanted to do proper home blood pressure readings, in a calm setting. I found out that my Omron automatic BP monitor was 10-20 points lower than my more accurate manual BP monitoring. I ordered a more accurate but expensive, Welch Allyn automatic BP monitor which turned out to be precise. Doing a more consistent exercise program, proper nutrition, and relaxation program with yoga and meditation brought improvement. My blood pressure improved with a slightly higher systolic pressure occurring when stressed and not relaxed. I came to the reality that I needed more consistency with my program and follow-up discussions with my trusted healthcare provider with my progress.

My experience and research support my belief that lifestyle change is the first course of action before medication is considered. This is especially true when heart disease or other risk factors are not present, and BP readings remain in a range, felt safe and acceptable, by your healthcare practitioner. I also realized that I had not fully worked through some related earlier life trauma. I had a medical diagnosis of polio and was hospitalized when I was about ten years old. My reactivity with BP taking, I believe, along with probably other related trauma, led to what is called “White Coat Syndrome” or “psychogenic high blood pressure.”  The “good side” of these early traumas and medical experiences, was that it all led to my interest and career in medicine. I hope that the following article will be helpful in understanding blood pressure and holistic approaches to health issues or concerns.

Blood Pressure Measurement

Blood pressure is reported in terms of two measurements: the upper systolic pressure and the lower diastolic pressure. BP reported as 120/80 (all numbers refer to mm Hg, or, millimeters of mercury). Systolic pressure measures the pressure inside of the artery when the heart is contracting to pump blood. The diastolic pressure is the pressure inside the artery when the heart is resting between heartbeats. The elastic elements in blood vessels will maintain the pressure at the lower measurements after the heart has relaxed. With aging when elasticity has been lost in blood vessels, there is a larger spread (pulse-pressure) between the higher and lower readings - as systolic pressures go higher with heart contraction and stress. An increase in the pulse pressure and isolated high systolic pressure can lead to greater difficulties in assessing the risk in aging individuals.⁵,⁶

Higher numbers of diastolic or systolic measurements can trigger concern that you may be at increased risk:

for stroke; heart enlargement from the heart muscle (working against a too high pressure); heart attack; heart failure; kidney failure; an aneurysm (weakening or bulging of blood vessel walls); damaged blood vessels in the eyes; and vascular dementia (a leading cause of memory loss).

Increase risk would be present in people with

1. Smoking histories;

2. Diabetes or pre-diabetes;

3. Over-weight or obesity;

4. Family histories of heart disease;

5. Stiffer blood vessels related to aging;

6. Sedentary lifestyles;

7. High cholesterol (especially if LDL-cholesterol particles are predominantly small and dense which can triple the risk of coronary heart disease).

The American Heart Association (AHA) considers blood pressures in adults to be in the high blood pressure stage 1 - if systolic (upper number) readings are in the 130 to 139 range or diastolic (lower number) in 80 to 89 range; to be in the high blood pressure stage 2 - if systolic readings are 140 or higher or diastolic are 90 or higher, and to be a hypertensive crisis (needs immediate evaluation) - if systolic readings are higher than 180 or diastolic readings are higher than 120. According to these standards, it would be estimated that about half of all US citizens would be considered to have high blood pressure. Many people who have elevated BP stage one, are often treated with medication: even if they don’t have existing cardiovascular disease or risk factors for developing heart disease as diabetes or kidney disease. For people with stage 1 hypertension who don’t have cardiovascular disease and are at a less than 10% risk of having an event within 10 years, lifestyle changes are recommended first, before medication use.⁷,

If your systolic blood pressures go up with emotional stress, anxiety or with visits to healthcare practitioners, it may be “White Coat” or psychogenic high blood pressure (BP).

White Coat syndrome more specifically refers to elevated BP reading in a medical setting, i.e., where white coats are often worn. BP, especially systolic blood pressure, can become elevated when anxious or emotionally aroused in any setting. In a relaxed non-stressful setting, as a home or in a more natural environment - BP is more apt to be in a normal range. It has been estimated that at least thirty percent of medical office blood pressures will be elevated because of emotional or psychological responses (anxiety or fear) to being in a medical setting.⁸⁹

The proper taking of BP measurement is critical.

It is recommended that several blood pressure readings be taken: when not talking, in a quiet setting, and after resting quietly for several minutes. Individual readings should be spaced apart by one to several minutes. You can purchase a home blood pressure

device that is relatively easy to use. Write down your readings during different times of day: again doing several readings in one sitting – as three, spaced apart. You can also get readings at a pharmacy or from a friend trained to take BP readings. These can be shared with your healthcare provider. Specialized facilities also have ambulatory, 24 to 48 hours, blood pressure monitors which may be used when indicated.

If you purchase a home blood pressure device, make certain that you receive one of good quality with proper cuff size - as recommended by your healthcare provider or pharmacist. Have your healthcare provider check the accuracy of your automatic cuff readings - by comparing BP readings taken at the same time manually by auscultation. Auscultation is the listening for systolic and diastolic sounds with a stethoscope - after a cuff of a sphygmomanometer is placed on the upper arm and inflated to the point of hearing no sounds. BP pressure reading is viewed on an aneroid monitor, or mercury column - as the cuff is deflated and the first sound of systolic BP is heard and continued until the last diastolic BP sound is heard. Automatic home blood pressure devices can give an incorrect reading that can be higher than 10 to 20 points. Also, lower BP pressure readings can also be inaccurate when compared to manual readings as done in a physician's office. So make sure the instrument you buy is checked and compared with an accurate BP measurement instrument.

Before taking your own BP on an approved and validated device, get instructions on the proper procedures and techniques. Practice relaxation, walking outside in nature, yoga, stretching, peaceful breathing, or meditation. Many of these activities or practices can be enjoyable, brief, interwoven into your day, and especially helpful before taking your BP readings. If you have a mobile device or smartphone, there are some great apps you can try - to learn relaxation, calming techniques, or meditation. Check out these apps: as Calm or 10% Happy - in a format for Android phones or in the Apple App Store. ¹⁰

Relax with one of your learned techniques, as sitting quietly and slowly breathing in and out, while visualizing a peaceful scene. If at home, pick a quiet space without distractions. For taking blood pressure readings - avoid smoking, drinking, or exercising 30 minutes before taking measurements. Sit comfortably with feet on the floor and back straight. After sitting quietly for several minutes - take your first reading, follow with two more readings spaced apart, and record your third reading. If you can learn the proper technique for taking manual blood pressure, you can then use an inflatable cuff with an aneroid monitor, which is known as a sphygmomanometer and a stethoscope like the ones used in healthcare settings. As noted above, doing a manual measurement is more dependable and accurate. It is difficult doing this on your own unless someone can assist you who is experienced in using this method. But for most, an automatic cuff works the best and is the easiest (6).

Find an app for your cell phone: as “Blood pressure Log – myDiary” for androids in the Play Store, or find a similar iPhone app. Apps can make it easy to record blood pressure readings, location, relationship to meals, other activities, and comments. Your record can then be sent or taken to your healthcare provider for review. You can also purchase a small notebook and make a blood pressure log. A free blood pressure log can be downloaded from the American Heart Association (AHA). An automatic home instrument that is fairly accurate, especially with the systolic pressure that I tested, is the Welch Allyn Home, Blood pressure monitor with SureBP technology. This also has an online app for your mobile phone where you can record your measurements and send them to your healthcare provider. I tried other automatic cuffs, which tended to give inaccurate values when compared with manual readings.¹¹,¹²,¹³

When to be concerned about elevated systolic blood pressure

is dependent on many factors, including the presence of other risks for heart disease and stroke, or the amount of time the systolic and diastolic blood pressure is in an excessive range during a 24-hour period. Sometimes, a 24/48-hour ambulatory monitor will be helpful. However, if you can do multiple readings during the day, this may also give an indication of risk. Doing measurements, combined with techniques to lower stress and increase relaxation, may help correct the high BP readings and improve overall health. Lower BP reading and health improvement also come with

• Maintaining and doing more consistent exercise;

• Weight loss;

• Stress reduction;

• Improved nutrition with reduced dietary salt, caffeine, and alcohol;

• Quit smoking;

• Guidance program from your healthcare provider or health educator.

There can be brief or prolonged periods of elevated BP readings due to different factors or stressors. Some of the triggers for elevated blood pressure could be

1. Intense work or athletic performances;

2. Demanding activities or situations when there is a perceived threat or the feeling of vulnerability;

3. Anxiety-provoking situation – especially when where there is a prior history of trauma;

4. Stimulant drugs as decongestants, cold medication, amphetamines as Adderall, and drugs of abuse as methamphetamine and cocaine;

5. Poor diets that are high in salt (sodium), or stimulant as caffeine.

BP that remains elevated, after stressors have been removed, can be a warning that hypertension may exist and the need for further evaluation.

BP that remains elevated for a significant amount of time, during a 24-hour period, would lead to increased risk of heart muscle strain, heart enlargement, or higher risk for stroke. A healthcare professional, who knows you, can best assess with you the meaning of BP readings. Compounding risk factors to be considered would include

• Smoking;

• Overweight, elevated BMI, and belly circumference;

• Diabetic or prediabetic;

• LDL-cholesterol elevation;

• Excessive dietary salt, sugar, refined carbohydrates, processed foods, or alcohol;

• Sedentary lifestyle;

• Kidney disease, etc.

With discussions with a trusted medical adviser, consider what your risk may be and if there is indicated treatment.

Natural alternative treatment maybe

• Weight loss;

• Nutritional supplements;

• Change in lifestyle with a consistent exercise program;

• Stress reduction as with mindful meditation or a yoga program;

• Smoking cessation;

• Dietary improvement with reduced salt; sugar; alcohol; and processed, low fiber carbohydrates - increased healthy fats and moderate protein – as the Keto-Paleo or Mediterranean diet.¹⁴,¹⁵

If your risk is high because of elevated BP, prescribed medication may be the choice for you.  Commonly prescribed conventional blood pressure medications: are diuretics, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin II receptor blockers. There is a risk of taking these medications if not entirely indicated - as possible episodes of too low blood pressure can lead to fainting, falls, fatigue, or possible other long-term risks.

Making interventions to lower systolic blood pressures, especially if other risk factors or significant health problems are present,

can possibly reduce future risk of stroke, heart or

cardiovascular problems, memory problems, and dementia. Intervention may include what has been noted above - as lifestyle change with nutritional improvement, lowering stress, or possibly medications.

If systolic blood pressures continually peak at or are above 190 mg Hg, or even at lower pressures, if linked with other symptoms, would indicate the need for urgent medical evaluation: as dizziness, headaches, visual changes, chest pain, shortness of breath, blood in your urine, or stroke symptoms - as loss of muscle control or paralysis in the face or an extremity.

Remember that a single blood pressure reading is only a starting point to evaluate your health and screen for BP problems. Proper assessment of BP readings, as outlined above, is what is recommended. That is why it’s often ideal to have your blood pressure taken in different settings, times of day, and in different situations - which would include BP readings taken in professional healthcare settings at least several times during a year. You may require even more frequent checks if you have elevated readings.

A broader understanding of high blood pressure responses, in the social and interactive situation, comes from famed writer and researcher, James J. Lynch, Ph.D.

BP, for example, can show major increases when a person is talking. There has been the concern of a possible link between these “communicative physiological changes” and future serious health problems. Dr. Lynch calls this, “communicative disease.” Sometimes, even during casual conversations, blood pressure can rise more than it does during maximal physical exertion.

Lynch sees human loneliness as a marker and consequence of dysfunctional communications by which the ability to express and experience connectedness is lost. Blood pressure that increases when we speak to others often falls below baseline levels when we listen to others, relate to pets, or participate in the natural world. Lynch felt that human speech has lost its connection to the “heart” - our ability to be in relational; effective contact; and in open, non-competitive, loving, compassionate communications with others.

Childhood experiences with "toxic talk" from adults' use of language to hurt, control and manipulate rather than to reach out, nurture and listen can contribute to later life dysfunctional communication and the experience of loneliness and isolation. Lynch felt that exercises to improve “communicative health" must be undertaken with the same seriousness and commitment as is done with strenuous physical exercises programs. He developed a type of blood pressure biofeedback monitoring that was used in a therapy session. This was done by a trained therapist to help heal the psychological and physiologic issues and “disconnect” - associated with high blood pressure responses - in the unaware person with problems with “communicative health.”¹⁶

Elevated or spikes in BP - when triggered by stress, social situations, or interpersonal encounters - can be the earmark of untreated emotional or psychological issues

as post-trauma, depression, and anxiety. Successful therapy and treatment may be available from a mental health provider trained to address and treat these issues.

Regular meditation practices can bring improvement in general health and BP.

Integral mindful meditation, as described by Ken Wilbur, can bring both “wake up” and “grow up.” The waking up part can be very useful in, not only achieving states of freedom from mental stress, but also to help progress to an often-needed spiritual transformation and awakening to natural states of peace,

loving compassion, and well-being - that occur with regular meditation practices. The growing-up part of mindfulness meditation practices is for the development of more presence and in-the-moment awareness - to recognize patterns or influences on our behaviors, thinking, and emotions. The “hidden roadmaps” and “filters,” hidden below the level of our usual awareness, can prevent the positive changes needed in our health and emotions.¹⁷

Mindful meditation can be studied and developed with persistence, practice, and guidance. With consistency, growth can occur in the areas where we are often unaware, stuck, or remain in repeated destructive patterns. When this type of awakening and growth begins to permeate into one's 24/7 life, there is the possibility of real transformation and return to communicative and blood pressure health.

Correction of “psychophysiological” issue, as high blood pressure, is possible with the many integrative, holistic resources, and therapies available.

Therapy work is recommended: if there is a significant history of trauma; repetitive patterns of emotional, cognitive, or behavioral problems; unhappiness; depression; anxiety; or any chronic mood disturbance. Integrative holistic-oriented practices, or therapies, can help retrain the brain and neurocircuitry (neuroplasticity) to be more consistent in a relaxed, state of well-being. Some practices or therapies to consider, in working towards a healthy blood pressure and an overall good state of health:

• Cognitive Behavioral Therapy (CBT);

• EMDR or other somatic and trauma-based therapies;¹⁸

• Biofeedback or Neurofeedback;

• Spiritual Emergence therapy and Mindfulness-Based Experiential Therapy;

• BAUD Therapy;¹⁹

• Yoga, Relaxation Training, and Mindfulness Meditation Training;

• Nutrition and Exercise Guidance or Coaching.²⁰

TIPS

1. Safe, more natural, non-medication therapies or practices, whether you are on medications or not, can lower BP and bring benefits to many other areas of your health as well.

2. The BP becomes the wake-up call to take positive health steps for your life. Natural, holistic treatments are a consideration, especially if you are not in the range of blood pressure elevation where medications may be indicated.

3. Always discuss important issues affecting your health with your healthcare practitioner.

By Ron Parks, MD & edited by Shan Parks

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