High Blood Pressure Linked to Increased Risk of Dementia

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Story at-a-glance -

  • In the U.S., an estimated 1 in 3 have high blood pressure, and another 1 in 3 have prehypertension
  • Elevated systolic pressure is a major risk factor for cardiovascular disease and stroke. Recent research suggests hypertension, especially elevated systolic pressure, may also raise your risk of dementia
  • Several valsartan-containing blood pressure medications have been recalled due to the presence of N-nitrosodimethylamine, an impurity classified as a probable human carcinogen
  • Several factors can play into the accuracy of your blood pressure reading, including cuff size and placement, body position, machine calibration, stress, smoking and consumption of caffeine or alcohol just prior to the reading
  • Drug-free strategies that can help you regulate your blood pressure include a low-sugar diet, exercise, boosting nitric oxide production using nitrate-rich foods and exercise, intermittent fasting, essential oils, stress reduction and more

By Dr. Mercola

Blood pressure is the force needed to push blood through your arteries coming from your heart to deliver oxygen-rich blood to your body. When your blood pressure is measured, you get a high value (systolic) and a low value (diastolic). The high number is the highest pressure that occurs in your blood vessels while your heart is contracting. The low value is pressure in your arteries between heartbeats when your heart is relaxed.

A blood pressure reading of 120/80 millimeters of mercury (mmHg) is considered healthy. High blood pressure (hypertension) is typically considered anything over 140/90 mmHg, although updated guidelines1 from the American Heart Association now have 130/80 mmHg as the cutoff for a diagnosis of hypertension. Having an elevation in just one of the two values may also be enough for a hypertension diagnosis.

In the U.S., an estimated 1 in 3 have high blood pressure, and another 1 in 3 have prehypertension.2 Typically, your systolic pressure offers the most information about how stiff your arteries are and how much pressure is needed to push blood around your body. Elevated systolic pressure is a major risk factor for cardiovascular disease and stroke.

Recent research suggests hypertension, especially elevated systolic pressure, may also raise your risk of dementia.3 Previous studies have already shown that stroke victims, even if it's a minor stroke, are at increased risk of Alzheimer's, and this adds further weight to recommendations to get your blood pressure under control in order to protect your cognitive health.

High Blood Pressure Linked to Increased Alzheimer's Risk

The study4 in question found that, in older adults, having an elevated average systolic blood pressure puts you at greater risk for brain lesions and tangles associated with Alzheimer's disease. The average blood pressure of the seniors enrolled in the study was 134/71 mmHg, and 87 percent of them were taking medications for high blood pressure. The participants were followed until death, or for an average of eight years. The average age at death was 89. As reported in the press release:5

"Researchers found that the risk of brain lesions was higher in people with higher average systolic blood pressure across the years. For a person with one standard deviation above the average systolic blood pressure, for example 147 mmHg versus 134 mmHg, there was a 46 percent increased risk of having one or more brain lesions, specifically infarcts … the equivalent of nine years of brain aging.

Those with one standard deviation above the average systolic blood pressure also had a 46 percent greater chance of having large lesions and a 36 percent greater risk of very small lesions …

[H]igher average diastolic blood pressure was also related to brain infarct lesions. People who had an increase of one standard deviation from an average diastolic blood pressure, for example from 71 mmHg to 79 mmHg, had a 28 percent greater risk of one or more brain lesions."

Blood Pressure Medication Linked to Sevenfold Risk for Skin Cancer

While drugs are typically the first-line treatment for hypertension, these drugs may have a number of problematic side effects. For example, research6 published in 2017 found hydrochlorothiazide — one of the most popular drugs used worldwide to treat high blood pressure — raises the risk of skin cancer sevenfold. Lead author Anton Pottegard, Ph.D., associate professor from the University of Southern Denmark, commented on the results, saying:

"We knew that hydrochlorothiazide made the skin more vulnerable to damage from the sun's UV rays, but what is new and also surprising is that long-term use of this blood pressure medicine leads to such a significant increase in the risk of skin cancer."

Coauthor of the study, Dr. Armand B. Cognetta Jr., from Florida State University, has found similar results in patients he treats in Florida, where "the only risk factor, apart from exposure to the sunlight, seems to be hydrochlorothiazide."7

Diuretics, also commonly prescribed for high blood pressure, have the side effect of leaching both sodium and potassium out of your body, and maintaining a healthy sodium-to-potassium ratio is really important for the normalization of your blood pressure.8

Potassium is also needed for proper muscle movement, including the contractions of your heart, and if your level gets depleted it can trigger muscle cramps and heart problems.

Blood Pressure Medication Recalled for Carcinogenic Impurity

Recent news also warns that several valsartan-containing blood pressure medications have been recalled9,10 due to the presence of N-nitrosodimethylamine, which is classified as a probable human carcinogen.

The impurity is believed to be the result of changes in how the active ingredient was being manufactured. The recall has been issued in 22 other countries besides the U.S. The good news is there are many ways to lower your blood pressure naturally, which I'll review below.

If your blood pressure is high, then you may need short-term medication to avoid an acute problem, but it would be in your best interest to address your lifestyle as well. Keep monitoring your blood pressure while implementing the recommendations below, and ask your doctor to cut down or eliminate the medication once your pressure normalizes.

By using natural options to address hypertension and any underlying medical condition, you may realistically be able to reduce your dependence on medication.

How Your Blood Pressure Is Taken May Affect the Measurement

Several factors can play into the accuracy of your blood pressure reading.11 To ensure your reading is as accurate as possible, keep the following factors in mind:

Cuff size

The size of the cuff may change the blood pressure reading significantly. The blood pressure cuff will have an arm circumference range printed on the cuff. Using a cuff that is too small may artificially increase the systolic measurement between 10 mmHg and 40 mmHg.

Cuff placement

The cuff must be placed on a bare arm, not over clothing, with the edges of the cuff aligned and positioned at heart level, approximately 1 inch above the bend in your elbow. The sleeve of your shirt should be off and not rolled up.

Body position

Your body position has a great deal to do with how accurate a peripheral blood pressure measurement will be. The proper position is to have your feet flat on the floor, back supported in a chair, legs uncrossed for at least five minutes and your arm supported while sitting.

Activity

Talking to the person taking your blood pressure during the reading may increase your systolic pressure by 10 mmHg and a full bladder may increase your systolic reading by 10 mmHg. Prior to taking your blood pressure, it is important that you sit quietly for three to five minutes and do not exercise for at least 30 minutes prior to the reading.

Nicotine, caffeine or alcohol

All should be eliminated in the 30 minutes prior to having your pressure measured.

Stress

If your blood pressure consistently measures greater than 140/90 mmHg or above at the doctor's office, while being consistently lower when measured at home, you may have white coat hypertension.

For some people, seeing the doctor is an inherently stressful experience that may temporarily raise your blood pressure. An estimated 15 percent to 30 percent of people with documented high blood pressure have white coat hypertension.12

To decrease your risk of being falsely diagnosed with hypertension in this situation, take a moment to calm down (be sure to arrive for your appointment ahead of time so you can unwind), then breathe deeply and relax when you're getting your blood pressure taken.

Machine calibration

Home machines and automated machines must be accurately calibrated to ensure a proper reading. One study13 demonstrated some home pressure machines were off in up to 15 percent of patients. Readings from these machines may impact treatment recommendations.

Hearing ability when using a stethoscope

Many of the machines used today in hospitals and some clinics to take blood pressure are automated and don't require someone to manually listen for Korotkoff sounds in your brachial artery.

However, there remain a large number of blood pressure measurements taken by an individual listening for the change in sounds in the brachial artery. Individuals who have some hearing loss may record an abnormal reading when they don't hear the change in sounds correctly.

Common Causes of High Blood Pressure

According to medical physiology textbooks, as much as 95 percent of hypertension is called essential hypertension, meaning the underlying cause is unknown. From my perspective, this simply isn't true. A number of factors have been identified as contributing to high blood pressure, including but not limited to:

Insulin and leptin resistance. This is at the core of the problem for most, but certainly not all people with hypertension. It will be vital to make sure you are burning fat as your primary fuel and following a CYCLICAL ketogenic diet as I describe in my most recent book Fat for Fuel.

Insulin helps your body to store magnesium, which helps relax your muscles. If your cells have grown resistant to insulin, you won't be able to store magnesium, which leads to blood vessel constriction and rising blood pressure. So, as your insulin and leptin levels rise, it causes your blood pressure to increase.14,15

To determine whether insulin/leptin resistance is at play, be sure to check your fasting insulin level. Aim for a fasting insulin level of 2 to 3 microU per mL (mcU/mL). If it's 5 mcU/mL or above, you definitely need to lower your insulin level to reduce your risk of high blood pressure and other cardiovascular health problems. If your hypertension is the result of elevated insulin levels, dietary intervention will be key.

Elevated uric acid levels are also significantly associated with hypertension, so any program adopted to address high blood pressure needs to normalize your uric acid level as well

Poor nutrition in childhood has been shown to raise the risk of high blood pressure in adulthood16

Lead exposure. For information about how to detox lead, see "The Three Pillars of Heavy Metal Detoxification"

Air and sound pollution. Air pollution affects blood pressure by causing inflammation while noise pollution asserts an effect via your nervous and hormonal systems. Living in an area plagued by constant noise pollution (busy city streets with night time traffic) has been shown to increase the risk of hypertension by 6 percent, compared to living in an area where noise levels are at least 20 percent lower.17

To address these factors, avoid smoking, consider using ear plugs during sleep if you live in a noisy neighborhood and take steps to improve your indoor air quality.

Diet Influences Your Blood Pressure

One of the most important dietary changes needed to improve high blood pressure is to eliminate or dramatically reduce sugar, especially processed fructose, in your diet.

One 2010 study18 discovered that those who consumed 74 grams or more per day of fructose (the equivalent of about 2.5 sugary drinks) had a 77 percent greater risk of having blood pressure levels of 160/100 mmHg (stage 2 hypertension). Consuming 74 grams or more of fructose per day also increased the risk of a 135/85 blood pressure reading by 26 percent, and a reading of 140/90 by 30 percent.

Another dietary culprit is trans fat, which is responsible for atherosclerosis (hardening of your arteries). This is another trigger for hypertension, so avoid all trans fats or hydrogenated fats such as margarines, vegetable oils, butter-like spreads and baked goods.

The easiest way to cut both sugar and unhealthy fats from your diet is to replace processed foods with real, whole foods. This will address not only insulin and leptin resistance but also elevated uric acid levels. To learn more about healthy eating, please see my optimal nutrition plan, which will guide you through the necessary changes step-by-step.

A type of fat you may need more of is animal-based omega-3 fats. Research has shown those with the highest serum levels of omega-3 also have the lowest blood pressure readings. On average, their systolic pressure was 4 mmHg lower and their diastolic pressure was 2 mmHg lower compared to those with the lowest omega-3 blood levels.19

I recommend getting your omega-3 index tested at least once a year. Ideally, your index should be above 8 percent. The best way to boost your omega-3 is to eat plenty of oily fish that are low in mercury and other pollutants. Good options include wild caught Alaskan salmon, sardines and anchovies. Alternatively, take a high-quality krill oil supplement.

Beets May Help Lower Blood Pressure

Another food that has been found to have a beneficial effect on blood pressure is beets.20 In one small placebo-controlled trial, one glass (250 milliliters or 8.5 ounces) of beetroot juice per day for one month reduced blood pressure in those diagnosed with hypertension by an average of 8 mmHg systolic and 4 mmHg diastolic pressure.21

This 8/4 mmHg reduction is very close to that provided by blood pressure mediations, which typically can reduce blood pressure by about 9/5 mmHg, and for many it was enough to bring their blood pressure down to normal levels. The treatment group also saw a 20 percent improvement in blood vessel dilation capacity and a 10 percent reduction in arterial stiffness.

The beneficial effects are related to the nitrate found in beetroot juice. Your body converts the nitrate into bioactive nitrite followed by nitric oxide (NO), the latter of which helps relax and dilate your blood vessels, and helps prevent blood clots.

Other vegetables high in nitrates include arugula, butter leaf lettuce and spring greens. The absolute richest source of nitrate is fermented beets, which contain 2,000 to 3,000 mg of nitrates per 100 grams. For comparison, arugula, which contains the highest amount of any vegetable, has just 480 mg of nitrates per 100 grams.

Boost Your Nitric Oxide Level

High-intensity exercise will also trigger NO production in your body and, ideally, you'd both eat nitrate-rich veggies and exercise. Without question, that is high on my list of recommendations, right behind reducing insulin resistance. There are two primary strategies: One is to supply your body with a high-quality source of vegetable nitrates, which serve as precursors for nitric oxide. Arugula is the highest source but our fermented beet powder has 500 percent greater concentration of nitrates.

It is great to give your body the raw materials to create nitric oxide, but after it is made it is stored inside vesicles lining your blood vessels and it won't work until you release it. High intensity exercises are great at releasing it and the best one I can recommend is the Nitric Oxide Dump. This exercise, developed by Dr. Zach Bush and demonstrated in the video below, will help lower your blood pressure and improve blood flow.

Other Lifestyle Strategies for Lowering Your Blood Pressure

In addition to what's already been mentioned, here are several additional suggestions that can help lower your blood pressure naturally.

Optimize your vitamin D level

Vitamin D deficiency is associated with both arterial stiffness and hypertension.22 For optimal health, maintain a vitamin D level between 60 and 80 nanograms per milliliter year-round.

Mind your sodium to potassium ratio

According to Dr. Lawrence Appel, lead researcher on the DASH diet and director of the Welch Center for Prevention, Epidemiology and Clinical Research at Johns Hopkins, your diet as a whole is the key to controlling hypertension — not salt reduction alone. He believes a major part of the equation is this balance of minerals — i.e., most people need less sodium and more potassium, calcium and magnesium.

According to Appel:23 "Higher levels of potassium blunt the effects of sodium. If you can't reduce or won't reduce sodium, adding potassium may help. But doing both is better."

Indeed, maintaining a proper potassium to sodium ratio in your diet is very important, and hypertension is but one of many side effects of an imbalance. A processed food diet virtually guarantees you'll have a lopsided ratio of too much sodium to potassium. Making the switch from processed foods to whole foods will automatically improve your ratios.

Consider intermittent fasting

Intermittent fasting is one of the most effective ways I've found to normalize your insulin/leptin sensitivity, which is a root cause of hypertension.

Exercise regularly

A comprehensive fitness program can go a long way toward regaining your insulin sensitivity and normalizing your blood pressure. If you are insulin resistant, you'll also want to include weight training. When you work individual muscle groups, you increase blood flow to those muscles, and good blood flow will increase your insulin sensitivity.

I also recommend training yourself to breathe through your nose when exercising, as mouth breathing during exercise can raise your heart rate and blood pressure, sometimes resulting in fatigue and dizziness. To learn more about this, please refer to my previous article on the Buteyko breathing method.

Walk barefoot

Going barefoot will help you ground to the earth. Experiments show that walking barefoot outside (also referred to as Earthing or grounding) improves blood viscosity and blood flow, which help regulate blood pressure. So, do yourself a favor and ditch your shoes now and then.

Grounding also calms your sympathetic nervous system, which supports your heart rate variability. This in turn promotes homeostatis, or balance, in your autonomic nervous system. In essence, anytime you improve heart rate variability, you're improving your entire body and all of its functions.

Address your stress

The connection between stress and hypertension is well documented, yet still does not receive the emphasis it deserves. In fact, it has been shown that people with heart dis­ease can lower their risk of subsequent cardiac events by over 70 percent simply by learning to manage their stress.

Suppressed negative emotions such as fear, anger and sadness can severely limit your ability to cope with the unavoidable every day stresses of life. It's not the stressful events themselves that are harmful, but your lack of ability to cope.

The good news is, strategies exist to quickly and effectively transform your suppressed, negative emotions, and relieve stress. My preferred method is the Emotional Freedom Techniques (EFT), an easy to learn, easy to use technique for releasing negative emotions. EFT combines visualization with calm, relaxed breathing, while employing gentle tapping to "reprogram" deeply seated emotional patterns.

Essential oils

A number of essential oils can also be helpful, including lavender, ylang-ylang, marjoram, bergamot, rose, frankincense, rosemary, lemon balm and clary sage. In one study,24 scientists found exposure to essential oil for one hour effectively reduced stress as measured by a reduction in the participants' heart rate and blood pressure.

The effect was only temporary, however. In another, similar study,25 inhalation of a blend of lavender, ylang-ylang, neroli and marjoram essential oils was associated with a reduction in blood pressure and cortisol secretion, which is often elevated during stress.