So you want to improve your blood pressure?

The ultimate guide to managing your blood pressure and cholesterol from Dr Norman Swan, author of So You Want To Live Younger Longer?

GET THAT HIGH BLOOD PRESSURE DOWN

Biological ageing is speeded up by high blood pressure, which in turn sets up a cascade of events which can lead to an earlier grave than you might have planned. It’s such a powerful risk factor for premature ageing that, arguably, you want to know what your blood pressure is from your 20s onwards and check it every few years. Raised blood pressure creeps up on you and can start when you’re reasonably young, which is why every so often you should measure it at home or get your GP to check it during a visit. Measuring at home is often more accurate.

Here’s the cascade

When your blood pressure is up, the pulse wave that comes out of your heart each time it beats physically batters your arteries, prematurely ageing and stiffening them. Stiffened arteries then increase your blood pressure even more because they resist the pressure wave coming out of your heart each time it contracts. High blood pressure also often goes along with carrying too much weight around your abdomen, which triggers your immune system, which then means the battering is accompanied by inflammation in your artery walls, which then means that whatever bad cholesterol (LDL) is circulating in your blood can more easily enter the now fragile internal walls of your arteries, causing scarring and a proneness to clotting. Stiff and narrowed arteries mean that vital organs receive less blood supply.

This is a slow-moving cluster-f… which gathers speed if you don’t put the brakes on and try getting into reverse. It’s an insidious combination which makes your heart and brain ancient before their time, and makes you prone to heart attacks, heart failure, strokes, kidney damage, glaucoma and dementia.

‘Hypertension’ is the technical term for high blood pressure but it’s misleading and can make you think that stress is the cause. While chronic stress is linked to high blood pressure, it’s far from the only factor. Others include family history, smoking, overweight, high salt intake, too much alcohol and kidney damage, which is commoner than you think. Coming back to chronic stress (see Does the Mind Matter?), it could be from, say, having a job where your boss orders you around and doesn’t give you much chance to decide how to do the job or set your own priorities, or from poverty and social dislocation. That kind of pressure does raise the level of stress hormones – adrenaline and noradrenaline – and fires up the sympathetic nervous system, the network of nerves that prepares the body for emergencies by, among other things, constricting arteries and raising blood pressure. So psychological stresses are not to be ignored but solely focusing on them is a mistake because there’s a lot more going on.

Arterial stiffness is another measure of biological ageing. The stiffer your vessels, the older you are internally. A measure of this is a larger than average gap between the systolic and diastolic blood pressures (top and bottom numbers). For example, you might have a blood pressure of 165/85 mmHg. This is called a raised pulse pressure. Moderate intensity exercise on most days of the week helps to keep your arteries nice and elastic.

So what’s the blood pressure level that helps keep you young?

Well, that depends on what else is going on in your body. If you’re healthy with no other problems, the official level is 120/80. But that’s almost certainly not the blood pressure we evolved to live with. Hunter-gatherers often have lower blood pressures because of exercise and low salt intake and

some studies suggest that increased risk starts when the top figure rises above 115. If you’ve had heart disease, a stroke or diabetes, then the evidence is that you should aim to get your blood pressure a bit lower than what they call normal.

Get cuffed: Now, while measuring your blood pressure might seem straightforward, it’s not. You shouldn’t have taken any caffeinated drinks or smoked for a couple of hours beforehand. You need to have been relaxed and settled for a while and your blood pressure should be measured twice in the same arm with a cuff that’s big enough for the size of your arm. If the pressure’s high at your doctor’s, there’s about a 30 per cent chance it’ll be significantly lower at home. If you do take readings at home, it’s increasingly thought that a blood pressure which is up at night is a sign of hypertension.

What can be done?

If your blood pressure is up, you need to see your doctor and get it sorted out. There are quite a few things you can do to avoid it rising as you age and help get it down if it’s up:

Lose weight: 10 per cent weight loss can be the equivalent of a blood pressure pill.

Exercise at moderate intensity most days of the week: This can also achieve a similar blood pressure reduction to a medication.

Cut your alcohol intake: This can produce a significant lowering if your blood pressure is high.

Reduce your salt intake (see Cut the Salt): This can have an immediate effect and also helps avoid a rise in blood pressure as you get older.

Chronic stress reduction: Not always an easy thing to do.