This Q&A resource highlights questions I often get in my practice and on my social media channels. I hope you find my tips and guidance on each topic helpful.
- What causes high blood pressure?
Genetics contributes about 40-50%, largely related mostly to kidneys, and to a large extent involving salt sensitivity. Health habits also contribute 40%, (e.g. weight, salt intake, diet, lack of exercise)>. I suspect most of the remaining 10% or so is linked to a mind-body origin.
- What blood pressure level is now considered to be too high and require medication?
If systolic BP is above 140/, almost all should be treated. If usual SBP is above 130, most would treat, although in elderly patients I am cautious.
- Which blood pressure medications are the most effective ones?
ACE inhibitors, angiotensin antagonists (ARBs) diuretics and calcium channel blockers are all equally effective. The art of medicine though is individualizing treatment by identifying which drug or combination is most likely to be effective in a given individual (see my book Hypertension and You).
- How do I correctly check my blood pressure at home?
An arm cuff is better than a wrist cuff. Sit down, put your cuff on, sit quietly for 5 min, then take 3 readings about a minute apart. Most patients and physicians overlook the 5 min wait, resulting in readings that are higher than the resting BP, often leading to overtreatment.
- How can I best advocate for myself when it comes to concerns about the side effects of blood pressure medication?
Don’t get bent out of shape over the long list of side effects that are listed for every drug. If you think you are having side effects, tell your physician. My book, Hypertension and You, carefully discusses the side effects.
- Based on your experience as a physician, what is your view of the mind-body connection?
Decades of mind-body research focused on the day-to-day stress and emotional distress we experience has led to little progress in understanding or treating hypertension, and for that matter, many other conditions as well. I am most focused on our most powerful emotions, often from the past, which ironically, many are completely unaware of by virtue of having repressed those emotions. See my new book IHidden Within Us.
- Are there medical conditions that are linked to a history of abuse or trauma?
There is a very long list of medical conditions concerning which research has shown an association with a history of abuse or trauma. A shortlist includes hypertension, colitis, autoimmune diseases, fibromyalgia, migraine, and many, many others.
- If I have come to realize that I may have repressed emotions related to past trauma and think it might be impacting my body, how can I verify this?
That is an area that medical research has barely explored. A history of trauma, with repression of severe emotions related to it, certainly raises suspicion of a link but is not proof per se of cause and effect. Hidden Within Us explores this.
- What healing options are available in the treatment of medical disorders with a mind-body connection?
Depends. Functional disorders such as tension headaches, irritable bowel and others that are linked to perceived emotional distress, can benefit from relaxation techniques, psychotherapy, and antidepressant medication. Disorders linked to repressed emotions can benefit from gaining awareness, and from medications (see Hidden Within Us).
- What resources are available to help me learn more about medical disorders with a mind-body connection?
There are innumerable books on the mind-body connection as it relates to the emotional distress we are aware of. Those traditional beliefs have not led to a major impact on the understanding or treatment of medical disorders. Few books explore the role of repressed emotions. The books of Dr. John Sarno were pioneering in this regard.
- What are the main risk factors for hypertension?
Genetics (family history), weight, salt intake and genetically determined salt-sensitivity
- How much of an effect will reduction of salt intake have on my blood pressure?
On average 5-10 mm. The effect is greater in salt-sensitive individuals, and less in those whose hypertension is not salt-sensitive. Salt sensitivity is more common in people of color and in older individuals), and less in others.
- If my blood pressure suddenly increases to 180 or more, am I at risk of a stroke if it is not quickly lowered?
Very unlikely. Remember, BP hits 180 routinely during exercise. Elevated resting BP, even if severe, puts you at risk over months or years, not minutes or hours. It also depends on your history. A BP exceeding 200 is of greater immediate concern in someone whose BP was always normal than in someone with a history of chronically elevated BP.
- Can blood pressure medication lower my blood pressure too much? Is it dangerous?
Yes, it can cause weakness, lightheadedness, even fainting. That is why it is best to monitor your BP at home.
- At what point should I see a specialist in hypertension?
If your BP is not well controlled on 3 or more medications, or if your BP is controlled but you are living with medication side effects. Or if you have severe hypertension (e.g. frequently running above 180.)
- What are the most effective exercises for maintaining healthy blood pressure levels?
That’s an easy question: the type of exercise that someone enjoys, or is willing to do on a regular basis, no matter what kind of exercise, is best.
- Do heart palpitations always develop with long-term hypertension, even if fairly well controlled?
Usually they do not.
- Why do I always have high blood pressure readings at doctor’s offices?
About 10-20% of patients with BP elevation at the doctor’s office have normal BP at home (“white coat” hypertension). In some it can happen even without being aware of feeling nervous. That is why it is worthwhile confirming hypertension with home readings.
- Can diuretics cause dehydration?
At a high dose, or in a sensitive patient, yes. Also, I always tell patients: if they are sick and not eating, skip the diuretic.
- Do diuretics lower blood pressure as much as other blood pressure drugs?
At the right dose, yes.
- What is the most common use for diuretics?
Hypertension, heart failure
- In whom is a diuretic most likely to be successful in lowering blood pressure?
In patients with salt-sensitive hypertension. Thus they are preferentially effective in black and in elderly patients.
- If a person struggles with anxiety and has what is considered white coat syndrome, should they always use a beta blocker?
If BP is normal at home, no treatment is necessary. In some patients with anxiety and hypertension, a beta-blocker can be a nice fit in tackling both problems.