Hypertension – Modifiable Risk Factors
Our habits are key factors in determining cardiovascular risk. In fact, we may be able to bring our blood pressure readings back into the normal range (depending on which category we fall into) simply by making lifestyle changes, such as quitting smoking and losing weight.
Smoking
Smoking contributes to heart disease, but for a long time, smoking did not appear to be directly linked to high blood pressure. However, previous observations and clinical studies were conducted in medical offices, where smoking is prohibited.
When researchers studied hypertension in smokers, they found that within 5 minutes, systolic blood pressure rose by more than 20 mmHg on average, while it gradually returned to its initial levels over the next 30 minutes. This means that the blood pressure of the typical smoker rises several times a day. Like people with fluctuating hypertension (in which blood pressure can change frequently), smokers may develop hypertension. For example, smokers with upper-normal blood pressure (130–139/85–89 mmHg) may actually have stage 1 hypertension every time they light a cigarette.
This increase occurs because nicotine constricts the small blood vessels, forcing the heart to work harder to pump blood. As a result, the heart rate increases and blood pressure rises. Nicotine also interacts with certain antihypertensive medications, particularly beta-blockers. The chemicals in cigarette smoke increase the risk of heart disease in other ways as well. They can reduce the body’s oxygen supply, lower levels of HDL (good) cholesterol, and affect platelet aggregation, increasing the likelihood of blood clots that can cause ischemia.
The Use of Salt
Researchers first observed a link between high blood pressure and salt in the early 1900s. A massive effort began in the 1960s to educate the public about reducing cardiovascular risk, with recommendations to reduce salt intake to prevent high blood pressure. Of course, the average amount of salt consumed (by the U.S. population) has increased over the past 20 years, a fact that likely reflects our growing reliance on salt-rich processed and ready-to-eat foods.
Every day, the average American consumes about 1½ teaspoons (8,500 mg) of salt, which translates to about 3,400 mg of sodium. The guidelines of the European Society of Cardiology — ESC—recommend a salt intake of 5 mg for all individuals aged 40 and older or those with borderline high blood pressure, heart disease, kidney problems, or diabetes.
About one-quarter of people with normal blood pressure and nearly 50% of people with hypertension are salt-sensitive, meaning they consume too much sodium from their diet, which raises their blood pressure. Research over the past two decades shows clear benefits from reducing salt intake—not only in lowering blood pressure, but also in reducing the risk of stroke and cardiovascular problems. High salt intake also affects the effectiveness of antihypertensive medications.
Obesity
Excess weight and high blood pressure often go hand in hand, because even a few extra kilograms force the heart to work harder. People who are overweight or obese are also more likely to develop diabetes, cardiovascular disease, arthritis, gallstones, sleep apnea, gout, and certain forms of cancer.
Excess body weight increases the risk of developing high blood pressure by 3 to 5 times. The risk continues to increase as the body mass index (BMI) moves toward the obese range. A BMI of 25–29 indicates that a person is overweight, while a BMI of 30 or higher indicates obesity.
Another factor to keep in mind is that while weight itself is a risk factor, its distribution is also very important. People with excess fat in the abdominal area (see figure) are at greater risk not only for high blood pressure, but also for high cholesterol and diabetes. So, if your BMI is 25—and especially if you’ve accumulated abdominal fat—you need to make an even greater effort to lose weight.
Classic mercury sphygmomanometer (analog)
Sedentary lifestyle
When it comes to physical activity, people who lead a sedentary lifestyle are very likely to develop high blood pressure and cardiovascular events. Like any muscle, the heart gets stronger with exercise. A stronger heart pumps more blood more efficiently—with less effort—throughout the body. Other cardiovascular benefits of exercise include weight loss and an increase in levels of “good” HDL cholesterol.
Alcohol Consumption
Excessive alcohol consumption (three or more drinks per day) is a risk factor for developing hypertension. It also affects the effectiveness of antihypertensive medications, increases the risk of stroke, and, in advanced cases, can lead to heart failure.
While moderate alcohol consumption (no more than one drink per day for women and two drinks per day for men) significantly reduces the risk of cardiovascular disease and has little effect on blood pressure, increased alcohol consumption has the opposite effect. How alcohol raises blood pressure is still being investigated, but there appears to be a correlation with the amount of alcohol consumed: the more you drink, the higher your blood pressure. This effect becomes more pronounced with age and occurs regardless of the type of alcohol you drink.
Stress and Blood Pressure
When we experience stress, the body activates the autonomic nervous system’s response to prepare us to take action. The release of hormones speeds up the heart rate and breathing, and extra blood is supplied to the muscles and organs. The stress response provides a burst of energy but also causes a temporary increase in blood pressure. Exposure to any type of stressor can repeatedly trigger this process, leading to more frequent so-called “hypertensive spikes.” Even simply thinking about stressful events or anticipating future stressful situations can trigger this physiological response.
Social relationships play an important role in the body’s response to stress. Family members and friends often provide emotional support and can help alleviate stressful situations. Of course, stressful events are often beyond your control. However, developing effective coping mechanisms can help.