Control or prevention? Is controlling blood pressure into the normal range adequate? Or would it be better to prevent high blood pressure? Blood pressure control began in the 1950s and has been improving ever since. Thiazide diuretics became widely available and provided the first practical control. Since then, there has been a discovery of multiple other drugs to control blood pressure. These drugs have considerably increased the number of people who can obtain blood pressure control. This has decreased the number of people suffering strokes.
However, no matter how well controlled the pressure, the risk of stroke is not reduced to the same as that of someone with normal blood pressure taking no blood pressure medication. If elevated blood pressure were the cause of stroke, the risk of stroke should be the same when the pressure is the same. A recent study (1) of a large number of participants determined the risk of stroke in patients with blood pressure control – that is, with systolic blood pressure below 140 (the cutoff point for hypertension).
The present study included almost 27,000 participants, all of whom were over 45 years of age. The question the researchers tried to answer was whether lowering blood pressure to the normal range would reduce the risk of stroke to the same as those with normal blood pressure on no medications. The researchers had over six years of follow-up on average. They found that almost half of the participants' systolic blood pressure was brought into the non-hypertensive range.
Then they studied the participants according to the number of medications required to reach the non-hypertensive range. They broke the patients into those requiring 1, 2, or 3 medications to reach a non-hypertensive blood pressure. The findings were not good. The researchers found that all of those with normal blood pressure on medication had a higher risk of stroke than those with normal blood pressure taking no medication.
The Results Of Blood Pressure Control
The risk of stroke for those with one medication was 1.42 times that of a normotensive person. Those patients requiring 3 medications to obtain blood pressure control had a risk of stroke 2.48 times as much as a person with normal blood pressure on no medication.
The researchers had several possible explanations for the increased risk despite a normal blood pressure. They felt that the participants may not have been well controlled continuously, but may have had periods during which they were hypertensive. Another possible explanation was that during the period of hypertension before the pressure was controlled, the increased pressure may have damaged the blood vessels, or led to atherosclerosis, or led to increased vascular aging. Some damage may have become irreversible by the time the pressure was controlled.
The researchers felt that an emphasis on preventing or delaying the onset of hypertension may be a more effective strategy. They mentioned that there were well-documented interventions for prevention, but implementation for the general population was difficult.
Why Prevention Is Better Than Control
Multiple previous posts discuss how hypertension is a sign of a basic underlying cellular disease. The increased blood pressure is not the cause of the health problems, but is the long term result of years of poorly functioning cells in the body.
The disease that causes hypertension affects every cell in the body. Specifically it stems from an improper potassium to sodium ratio in our cells. This improper ratio results in an electric field in the cell that leads to malfunction of multiple proteins in the cell. In turn this leads to cells that do not function the way they should.
The blood pressure rise is from the malfunction of the adrenal and kidney cells that produce hormones affecting blood pressure. But the effect is not just to these cells. Even when the blood pressure is not elevated, the cells in the heart and blood vessels are damaged by the poor ratio, as shown in a series of studies discussed here and here.
How To Prevent Hypertension
Medications do not correct this poor potassium sodium ratio, so the cells still malfunction when you are taking medications that control blood pressure. The key to correcting the potassium sodium ratio in the cell is to get high potassium foods in the diet. These are foods that are high in potassium, low in sodium, and are alkaline. This allows the kidneys to adjust the potassium sodium ratio in the body as discussed here. The adjustment of the ratio provided by the kidney results in a proper ratio in all cells in the body, so that the cells can function properly.
By consulting the multiple tables on this site, you can revise your diet to include enough high potassium foods to provide your body with the proper potassium sodium ratio, and prevent hypertension and strokes.
1. Is blood pressure control for stroke prevention the correct goal? The lost opportunity of preventing hypertension. Howard G, Banach M, Cushman M, Goff DC, Howard VJ, Lackland DT, McVay J, Meschia JF, Muntner P, Oparil S, Rightmyer M, Taylor HA. Stroke. 2015 Jun;46(6):1595-600. doi: 10.1161/STROKEAHA.115.009128. Epub 2015 May 7.