Doctor’s Tip: High blood pressure (hypertension)

Dr. Greg Feinsinger

Blood pressure consists of two numbers: The upper (systolic) number is the pressure in arteries when the heart contracts; the lower (diastolic) number is the pressure between beats, when the heart muscle is relaxed.

When either the systolic or diastolic pressure is elevated, arteries are damaged. Hypertension is called “the silent killer” because it usually causes no symptoms, but is the leading risk factor for strokes and a major contributor to heart attacks, heart failure, chronic kidney disease, loss of vision, dementia including Alzheimer’s, rupture of the aorta, age-related brain shrinkage, and damage to small blood vessels in the brain.

Based on studies of large populations, the risk of heart attacks and strokes starts to climb when blood pressures are greater than 115/75. In their 2022 book “Healthy Heart, Healthy Brain,” Doctors Bale and Doneen state that to prevent heart attacks and strokes, we doctors should keep patients’ blood pressures less than 120/80, with a few exceptions, such as some frail, elderly patients who do better with slightly higher blood pressures.

Following are some of the factors that can cause hypertension: 1. obesity; 2. genetics; 3. the standard American diet — high in animal products, fat, sugar, salt, processed food, and added oil; 4. sleep apnea; 5. thyroid disease; 6. chronic kidney disease; 7. some prescription medications such as steroids, certain anti-depressants, and estrogen; 8. over-the-counter medications such as naproxen, ibuprofen, and decongestants; 9. a few herbs such as licorice; 10. illicit drugs such as cocaine and amphetamines; 11. alcohol; 12. caffeine in some people; 13. and adrenal gland abnormalities.

The majority of Americans eventually develop hypertension, and many of them go undiagnosed. It’s therefore important to check your blood pressure periodically at different times of the day, either with your own automatic arm (rather than wrist) cuff, or by visiting a blood pressure-checking station, available at Walmart and many pharmacies.

Here’s what we know about lifestyle and hypertension:

1. Early in the 20th century, there were no medications for hypertension, and people, including F.D.R., died from what was called “malignant hypertension” — blood pressures above 220/120 or so. In the 1940s, Dr. Walter Kempner put a group of these people on a strict rice and fruit, salt-free diet which brought blood pressures down to normal.

2. In countries on a Western diet, blood pressures increase with age. However, in societies such as the Blue Zones, where people are on a lifelong plant-based, whole food diet, blood pressures are the same at 90 as at 19.

3. When hypertensives are placed on such a diet, blood pressures often normalize.

4. Blood pressure goes up during exercise, but regular moderate daily exercise helps lower blood pressure.

In his book “How Not to Die,” Dr. Greger mentions the following foods as being particularly effective at lowering blood pressure if consumed daily: whole (unprocessed) grains; ground flaxseed; hibiscus tea; legumes; and watermelon. Also helpful are foods that cause the endothelial organ system that lines our arteries to produce nitric oxide, which causes arteries to dilate, thereby lowering blood pressure: beets, greens, cilantro, basil and rhubarb.

Lifestyle changes are inexpensive and free of side effects. Unfortunately, not everyone is willing to make them, though. There are now multiple medications to treat hypertension, and many have only rare side effects. If your blood pressure is high, it’s important to get it down to 120/80 or less, one way or the other. If you are young, or if your hypertension is difficult to control, your provider should look for factors mentioned in the fourth paragraph that could be contributing.

Dr. Feinsinger is a retired family physician with special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: one-hour consultations, shop-with-a-doc at Carbondale City Market, and cooking classes. Call 970-379-5718 for appointment, or email

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