Among Canadian adults aged 20 to 79, 23% reported they had been diagnosed with hypertension by a health-care professional, were taking anti-hypertensive medication, or had high measured blood pressure equivalent to stage 2 hypertension. This proportion increased significantly with age as 51% of adults aged 60 to 79 had stage 2 hypertension compared to 22% of adults aged 40 to 59.
Hypertension – characterized by chronic high blood pressure – continues to be the leading risk of death and disability, affecting 22.6% of Canadian adults. Although an increase in blood pressure is normal with age, chronic elevation in blood pressure is a major risk factor for coronary artery disease, stroke, kidney failure, atherosclerosis, left ventricular hypertrophy, atrial fibrillation, and congestive heart failure. Just 50 years ago, hypertension was considered an incurable malady. Fortunately, with the development of a wide range of therapeutic options over the past few decades, hypertension has now become one of the most modifiable risk factors for cardiovascular disease
The primary clinical marker for hypertension is a measurement of systolic and diastolic blood pressure, a long-standing protocol in the physician’s toolbox. Current standards set by Health Canada suggest that a systolic blood pressure of 120 mm Hg or below and a diastolic blood pressure of 80 mm Hg or below are optimal levels to limit the risk for hypertension and its associated diseases (2).
Precision tools for monitoring hypertension risk
Due to the variety of predisposing factors for hypertensive diseases, recent research has focused on personalized approaches for diagnosing and managing hypertension. The current scope of clinical hypertension management depends on the use of a wide range of pharmaceutical therapies due to the severity of the disease. The utility of pharmacogenomic (PGx) screening is being explored more commonly in hypertensive patients due to the large array of drug-based therapeutics currently available to manage the condition (3).
PGx can help identify the drugs to which patients are more likely to respond and the most efficacious dose for them. Nevertheless, drug-based interventions still have room for improvement as only 53% of treated individuals achieve a recovery of systolic and diastolic values to a healthy range (4). Fortunately, studies in twins have shown that genetic factors contribute to 40% of blood pressure variation in humans, suggesting that elevated blood pressure can be highly impacted by lifestyle interventions such as diet, exercise, and stress management (5). In fact, management of hypertension is rarely limited to pharmacology alone and is usually accompanied by lifestyle interventions.
For most of human history, the only source of salt for our ancestors was found naturally in food, and salt intake was estimated to be below 0.5g/day (6). The rise in dietary salt consumption aligned with the discovery of its preservative properties, eventually leading to salt being one of the most highly traded commodities in the world today. While we have seen over a 20-fold increase in daily salt consumption during this time, our physiology has not adapted to tolerate this high level of salt intake. High dietary sodium consumption can increase the risk of developing kidney disease, stomach cancer, obesity, and hypertensive diseases. Reducing dietary salt can be as simple as reducing the consumption of processed food in your diet, as over 80% of all dietary salt comes from processed foods (6). One of the easiest ways to reduce dietary salt includes eating more home-cooked meals and prioritizing vegetables and whole foods.
Body weight reduction
Weight reduction can have some of the most dramatic effects on hypertensive patients. A landmark study in the field found that losing just 2 kg (4.4 pounds) over a six-month period reduced systolic blood pressure by 3.7 mmHg and diastolic blood pressure by 2.7 mmHg (7). Virtually every clinical trial in this area has found a strong relationship between weight loss and blood pressure reduction.
Chronic stress can often promote maladaptive behaviors such as smoking, alcohol consumption, inactivity, and poor diet, which can significantly increase the risk for hypertension (8). While some degree of stress is essential, chronic stress can be very detrimental, highlighting the importance of relaxation. Meditation and breathwork can be invaluable tools to give your mind the positive cues to shift into a relaxed state. Giving high priority to sleep hygiene can also provide great benefit as sleep is one of the most critical periods for rest and recovery of the mind and body.
The prevalence of hypertension is becoming a global health crisis and poses one of the greatest threats to public health today. However, with the array of tools available for blood pressure reduction, we all have the potential to reduce our risk for hypertension and its associated diseases. To better understand blood pressure, the Preventous team is here to help you and answer all your questions. Contact your doctor or nurse if you are having problems.
Dr. Rohan Bissoondath,