The Analyst™

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  Increased Risk of Hypertension  
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Signs, symptoms and indicators | Conditions that suggest it | Contributing risk factors | Other conditions that may be present | Recommendations


Being at risk of hypertension means that although your BP is generally normal, you seem to be at risk for developing it in the future. Watching for changes and taking action to prevent its development is advised. At least two BP determinations should be taken on each of 3 days before a patient is diagnosed as hypertensive. More BP determinations are desirable for patients in the low hypertension range and especially for patients with fluctuating BP. Normal BP is much lower for infants and children. Sporadic higher levels in patients who have been resting for greater than 5 minutes suggest an unusual lability of BP that may precede sustained hypertension. For example, office or white coat hypertension refers to BP that is consistently elevated in the physician's office but normal when measured at home or by ambulatory BP monitoring.

A hypertensive is a person defined as having systolic blood pressure of at least 140mm Hg and/or diastolic of at least 90mm Hg, or taking antihypertensive medication.


Signs, symptoms & indicators of Increased Risk of Hypertension:
Lab Values - Common  High systolic blood pressure

  Normal/low systolic blood pressure

Symptoms - Reproductive - Female Cycle

  Hot flashes
 Women who get hot flashes have higher blood pressure than those who don't, according to a new study led by Weill Cornell Medical College.

High blood pressure is a major risk factor for heart disease -- the latter being responsible for half of all deaths among American women 50 and older.

"One-third of the women we studied reported having had hot flashes within the past two weeks. Among these women, systolic blood pressure was significantly higher -- even after adjusting for whether they were pre-menopausal, menopausal or post-menopausal," says Dr. Linda Gerber, the study's senior author, professor of public health and medicine and director of the biostatistics and research methodology core at Weill Cornell Medical College. "Future research will help us better understand the mechanisms underlying this relationship and may help to identify potential interventions that would reduce the impact of hot flashes on blood pressure."

While previous research has linked menopause to high blood pressure, the new Weill Cornell study, published in the March/April, 2007 issue of Menopause: The Journal of the North American Menopause Society, may be the first to link hot flashes to high blood pressure.

Conditions that suggest Increased Risk of Hypertension:


  Sleep Apnea
 A study from the University of Wisconsin School of Medicine suggests that sleep apnea is a risk factor for chronic hypertension and heart disease. [New England Journal of Medicine, May 2000]

Risk factors for Increased Risk of Hypertension:
Childhood  Being overweight as child
 Increasing cases of juvenile obesity were linked to an increasing number of cases of children suffering from high blood pressure. [Yahoo! News April 28, 2004]


  Salt Sensitivity
 Researchers estimate that 26% of Americans with normal blood pressure and about 58% of those with high blood pressure may be salt sensitive. [Feb. 16, 2001 supplemental issue of Hypertension]

Family History

  Hypertension in parents
 Heredity is a predisposing factor, but the exact mechanism is unclear. Environmental factors such as dietary sodium, obesity and stress seem to act only in genetically susceptible persons.

Lab Values - Common

  Having very/having low systolic BP or haivng normal systolic BP


  Absence of aerobic exercise or exercising aerobically somewhat


  Problem Caused By Being Overweight
 Being overweight is a significant risk factor for the development of hypertension. The prevalence of hypertension in the U.S. is greatly increased by the fact that one quarter to one half of all adults (results differ by study) are overweight. Although the association between higher body fat and blood pressure has been recognized for years, recent studies have discovered a 50 to 300% higher incidence of hypertension among adults who consider themselves overweight compared to those classified as normal weight. Similar findings are revealed from studies involving children and young adults, in which the connection between weight and blood pressure has been observed to be very strong.

Two proposed mechanisms underlying this correlation are the stimulation of sodium retention and increased catecholamine release, which are results of increased sodium sensitivity and hyperinsulinemia. Age, gender, and race are also part of the equation and so should be considered when studying preventive interventions. Hypertension and obesity treatment are necessary to avoid potential morbidity and mortality from coronary heart disease or stroke.


  EFA (Essential Fatty Acid) Type 3 Requirement
 One study found that high dose fish oil can produce a small but significant reduction in blood pressure in men with essential hypertension. [NEJM, April 20, 1989;320: pp.1037-1043.]

  Vitamin D Requirement
 An Alabama researcher found that lack of enough sunshine exposure may increase risk of hypertension in blacks and other dark-skinned people. Those with greater amounts of pigment in the skin require six times the amount of ultraviolet B (UVB) light to produce the same amount of vitamin D3 found in lighter-skinned people.

  Manganese Requirement

Personal Background

  African ethnicity
 Hypertension occurs more often in black adults (32%) than in white (23%) or Mexican American (23%) adults, and morbidity and mortality are greater in blacks.

New research shows that higher levels of uric acid are strongly associated with high blood pressure in blacks, suggesting that a simple blood test could predict risk and that treatments to lower uric acid may be a novel way to reduce hypertension-related complications in this population.

Uric acid levels are influenced by dietary factors, such as high levels of protein, and by the breakdown of the body's cells. Most uric acid is eliminated in urine. However, if excess uric acid is being produced or if the kidneys cannot remove enough of it, levels build up in the blood.

Very high levels of uric acid cause gout, but recent animal and human studies suggest that modest elevations of uric acid are one cause of hypertension. Currently, studies are under way to evaluate whether lowering uric acid prevents hypertension.

"If these studies show that lowering uric acid is an effective treatment, our research suggests that it may be especially appropriate for blacks," said Mellen.

Uric acid can be lowered by medications such as allopurinol and newer agents under development. [Hypertension Nov 7, 2006]

Supplements and Medications

  Current birth control pill use
 Statistics now show that the wide use of the Pill has given rise to health hazards such as breast cancer, high blood pressure and cardiovascular disease on a scale previously unknown in medicine.

  Blood pressure-lowering drug use

Symptoms - Food - Beverages

  (High) coffee consumption
 Caffeine raises the production of the adrenal hormone cortisol, a stress hormone. Cortisol causes the blood vessels to constrict and the heart to pump harder, which leads to high blood pressure. Studies have shown that coffee seems to worsen the symptoms of persons with high blood pressure, and can nullify the effect of high blood pressure medications, making expensive drugs useless.

Symptoms - Food - Intake

  Moderate/high fruit/vegetable consumption
  Eating sizable chocolate portions
 Foods rich in cocoa appear to reduce blood pressure but drinking tea may not, according to an analysis of previously published research in the April 9, 2007 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Current guidelines advise individuals with hypertension (high blood pressure) to eat more fruits and vegetables, according to background information in the article. Compounds known as polyphenols or flavonoids in fruits and vegetables are thought to contribute to their beneficial effects on blood pressure and cardiovascular risk. "Tea and cocoa products account for the major proportion of total polyphenol intake in Western countries," the authors write. "However, cocoa and tea are currently not implemented in cardioprotective or anti-hypertensive dietary advice, although both have been associated with lower incidences of cardiovascular events."

Dirk Taubert, M.D., Ph.D., and colleagues at the University Hospital of Cologne, Germany, conducted a meta-analysis of 10 previously published trials, five of cocoa's effects on blood pressure and five involving tea. All results were published between 1966 and 2006, involved at least 10 adults and lasted a minimum of seven days. The studies were either randomized trials, in which some participants were randomly assigned to cocoa or tea groups and some to control groups, or used a crossover design, in which participants' blood pressure was assessed before and after consuming cocoa products or tea.

The five cocoa studies involved 173 participants, including 87 assigned to consume cocoa and 86 controls, 34 percent of whom had hypertension (high blood pressure). They were followed for a median (middle) duration of two weeks. Four of the five trials reported a reduction in both systolic (the top number, when the heart contracts) and diastolic (the bottom number, when the heart relaxes) blood pressure. Compared with those who were not consuming cocoa, systolic blood pressure was an average of 4.7 millimeters of mercury lower and diastolic blood pressure was an average of 2.8 millimeters of mercury lower.

The effects are comparable to those achieved with blood pressure-lowering medications, the authors note. "At the population level, a reduction of 4 to 5 millimeters of mercury in systolic blood pressure and 2 to 3 millimeters of mercury in diastolic blood pressure would be expected to substantially reduce the risk of stroke (by about 20 percent), coronary heart disease (by 10 percent) and all-cause mortality (by 8 percent)," they write.

Of the 343 individuals in the five tea studies, 171 drank tea and 172 served as controls, for a median duration of four weeks. Drinking tea was not associated with a reduction in blood pressure in any of the trials.

Tea and cocoa are both rich in polyphenols, but while black and green tea contain more compounds known as flavan-3-ols, cocoa contains more of another type of polyphenol, procyanids. "This suggests that the different plant phenols must be differentiated with respect to their blood pressure-lowering potential and thus cardiovascular disease prevention, supposing that the tea phenols are less active than cocoa phenols," the authors write.

Increased Risk of Hypertension suggests the following may be present:
Diet  Salt Sensitivity
 Researchers estimate that 26% of Americans with normal blood pressure and about 58% of those with high blood pressure may be salt sensitive. [Feb. 16, 2001 supplemental issue of Hypertension]

Recommendations for Increased Risk of Hypertension:
Animal-based  Fish Byproducts
 Vasotensin is the proprietary name of a product from Metagenics. It supports healthy vascular function for optimal blood flow and healthy blood pressure levels by supplying bioactive peptides from bonito fish. It helps prevent the formation of angiotensin II a potent vasoconstrictor through their interaction of bonito peptides with angiotensin converting enzyme.

Fast-acting formula that provides a clinically effective dose in just 2 tablets twice daily. No rebound effect observed in human clinical trials when supplementation is discontinued. Excellent safety profile no adverse effects associated with bonito peptides have been reported.

May be used as a complement to other heart support programs including prescription drugs.


  Green / Oolong / BlackTea (Camellia sinensis)
 Regular and substantial consumption of green tea may provide protective effect against hypertension.


  Fructose Avoidance/reduction
 Increased fructose consumption results in kidney damage and hypertension, as well as other health problems.

Analyzing data from over 4500 participants in the National Health and Nutrition Examination Survey (NHANES), Jalal and her colleagues found that consuming as little as 74 grams of fructose – about 2 ½ 12-ounce cans of non-diet soda – was associated with a blood pressure of at least 135/85. According to guidelines established in 1997, a blood pressure reading of 130/85 signifies hypertension in diabetic persons; 140/90 signifies hypertension in the remainder of the population.

Furthermore, as fructose consumption increased, so did systolic blood pressures among NHANES participants. In quantifying the risk for hypertension imposed by ingesting fructose, Jalal and her associates noted that daily consumption of 74 grams or more was associated with a 28% higher risk for a blood pressure of 135/85 or higher, a 36% higher risk for a blood pressure of 140/90 or higher, and an 87% higher risk for a blood pressure of 160/100 or higher. In other words, the higher a person’s blood pressure was, the more likely they were to be consuming more than 74 grams of fructose daily.

Notably, NHANES participants reported no previous histories of hypertension. Therefore, regular consumption of fructose can drive one’s blood pressure upward, even if it is usually normal. [Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure: The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure [JNC VI]. Arch Int Med 157:2413-2446]

  Vegetarian/Vegan Diet
 The prevalence of hypertension among vegetarians is about one-third to one-half that of non-vegetarians.[1-3] A study of Caucasian Seventh-day Adventists found hypertension in 22% of omnivores, but only 7% of vegetarians. Among African Americans, the prevalence was 44% of omnivores and 18% of vegetarians.[3] Adopting a vegetarian diet significantly lowers blood pressure in both normal and hypertensive individuals.[4-8]
  1. Ophir O, Peer G, Gilad J, Blum M, Aviram A. Low blood pressure in vegetarians: the possible role of potassium. Am J Clin Nutr 1983;37:755-62
  2. Melby CL, Hyner GC, Zoog B. blood pressure in vegetarians and non-vegetarians: a cross-sectional analysis. Nutr Res 1985;5:1077-82
  3. Melby CL, Goldflies DG, Hyner GC, Lyle RM. Relation between vegetarian/nonvegetarian diets and blood pressure in black and white adults. Am J Publ Health 1989;79:1283-8
  4. Rouse IL, Armstrong BK, Beilin LJ, Vandongen R. Blood-pressure-lowering effect of a vegetarian diet: controlled trial in normotensive subjects. Lancet 1983;1:5-10
  5. Rouse IL, Belin LJ, Mahoney DP, et al. Nutrient intake, blood pressure, serum and urinary prostaglandins and serum thromboxane B2 in a controlled trial with a lacto-ovo-vegetarian diet. J Hypertension 1986;4:241-50
  6. Margetts BM, Beilin LJ, Armstrong BK, Vandongen R. A randomized controlled trial of a vegetarian diet in the treatment of mild hypertension. Clin Exp Pharmacol Physiol 1985:12:263-6
  7. Margetts BM, Beilin LJ, Vandongen R, Armstrong BK. Vegetarian diet in mild hypertension: a randomized controlled trial. Br Med J 1986;293:1468-71
  8. Lindahl O, Lindwall L, Spangberg A, Stenram A, Ockerman PA. A vegan regimen with reduced medication in the treatment of hypertension. Br J Nutr 1984;52:11-20

  Caffeine/Coffee Avoidance
 Caffeine raises the production of the adrenal hormone cortisol, which causes the blood vessels to constrict and the heart to pump harder, which leads to high blood pressure. Studies have shown that coffee seems to worsen the symptoms of persons with high blood pressure, and can nullify the effect of high blood pressure medications, making expensive drugs useless.

An increased risk of developing hypertension was associated with drinking five or more cups of coffee per day in a large study of former white male medical students followed for an average of 33 years. [Arch Intern Med 2002;162(6): pp.657-662]


  Aerobic Exercise
 One study of 6,000 healthy adults found a 52% increased risk for hypertension in sedentary individuals compared to those who were fit, while another study found a 35% increase.


 Magnesium has a mild effect on lowering blood pressure and so is used to treat and prevent hypertension and its effects.



  Vitamin Folic Acid
 Researchers have discovered that women (especially young women) who consume 800mcg or more of folic acid daily reduced their risk of hypertension by 33% over those consuming less than 200mcg of folic acid per day. The study included more than 150,000 women between ages 26 and 70 and although younger women showed the most dramatic benefits, subject women in the highest age brackets also enjoyed a 13% reduction in hypertension risk from consuming adequate
amounts of folate. The study did not examine whether men would be helped or not. [American Heart Association. News release, October 2004]

Weak or unproven link
Strong or generally accepted link
Strongly counter-indicative
Very strongly or absolutely counter-indicative
May do some good
Likely to help
Highly recommended


Apnea:  Cessation of breathing.

Cancer:  Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.

Cardiovascular:  Pertaining to the heart and blood vessels.

Catecholamine:  Any of various amines (as epinephrine, norepinephrine, and dopamine) that function as hormones and/or neurotransmitters.

Chronic:  Usually Chronic illness: Illness extending over a long period of time.

Diastolic:  Pertaining to the relaxation phase of the heartbeat, or period when the heart muscle is resting and filling with blood. When used in blood pressure readings (for example 120/80), it refers to the second/lower number.

Gout:  A disease characterized by an increased blood uric acid level and sudden onset of episodes of acute arthritis.

Hg:  The chemical symbol for mercury, often used to indicate pressure measurements in either inches or millimeters.

Hormones:  Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.

Hypertension:  High blood pressure. Hypertension increases the risk of heart attack, stroke, and kidney failure because it adds to the workload of the heart, causing it to enlarge and, over time, to weaken; in addition, it may damage the walls of the arteries.

Menopause:  The cessation of menstruation (usually not official until 12 months have passed without periods), occurring at the average age of 52. As commonly used, the word denotes the time of a woman's life, usually between the ages of 45 and 54, when periods cease and any symptoms of low estrogen levels persist, including hot flashes, insomnia, anxiety, mood swings, loss of libido and vaginal dryness. When these early menopausal symptoms subside, a woman becomes postmenopausal.

Millimeter:  (mm): A metric unit of length equaling one thousandth of a meter, or one tenth of a centimeter. There are 25.4 millimeters in one inch.

pH:  A measure of an environment's acidity or alkalinity. The more acidic the solution, the lower the pH. For example, a pH of 1 is very acidic; a pH of 7 is neutral; a pH of 14 is very alkaline.

Protein:  Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.

Sodium:  An essential mineral that our bodies regulate and conserve. Excess sodium retention increases the fluid volume (edema) and low sodium leads to less fluid and relative dehydration. The adult body averages a total content of over 100 grams of sodium, of which a surprising one-third is in bone. A small amount of sodium does get into cell interiors, but this represents only about ten percent of the body content. The remaining 57 percent or so of the body sodium content is in the fluid immediately surrounding the cells, where it is the major cation (positive ion). The role of sodium in the extracellular fluid is maintaining osmotic equilibrium (the proper difference in ions dissolved in the fluids inside and outside the cell) and extracellular fluid volume. Sodium is also involved in nerve impulse transmission, muscle tone and nutrient transport. All of these functions are interrelated with potassium.

Stroke:  A sudden loss of brain function caused by a blockage or rupture of a blood vessel that supplies the brain, characterized by loss of muscular control, complete or partial loss of sensation or consciousness, dizziness, slurred speech, or other symptoms that vary with the extent and severity of the damage to the brain. The most common manifestation is some degree of paralysis, but small strokes may occur without symptoms. Usually caused by arteriosclerosis, it often results in brain damage.

Systolic:  Pertaining to the contraction phase of the heartbeat, or the pressure in the arterial system caused by the heart as blood is being pumped out. When used in blood pressure readings (for example 120/80), it refers to the first/upper number.