Hypertension (also known as high blood pressure) is diagnosed when a person has a sustained elevated blood pressure of 140mmhg (Systolic) over 90mmhg (diastolic) or higher. There are 2 main forms of hypertension:
Essential (primary) hypertension is an elevated blood pressure that has no known or specific cause. Essential hypertension is the most common form of high blood pressure, and one of the most common symptoms of cardiovascular and cardiometabolic disease.
Secondary hypertension is when there is a known cause for the blood pressure to be elevated. Often this is associated with kidney disease, adrenal disease, thyroid dysfunctions or obstructive sleep apnoea, or it can be a side effect of some medications.
More than one third of Australians over the age of 18 have high blood pressure. Unfortunately most people who develop hypertension will have no overt signs and symptoms of high blood pressure, and elevated blood pressure is only discovered by chance when blood pressure is checked. This is why it’s vitally important to have your blood pressure checked regularly especially if you are/have:
Indigenous persons or those of African heritage also have a hereditary predisposition to developing hypertension and cardiovascular disease, so should be proactive in having their blood pressure checked regularly.
In some cases, people may experience some general or non-specific symptoms that may indicate a need to have their blood pressure checked. These may include:
In men, erectile dysfunction has also been linked to hypertension and cardiovascular disease.
If significant symptoms such as breathlessness, loss of body functions, severe headaches, heart palpitations or reduced urine output occur, you should immediately seek the advice of your doctor, as these signs and symptoms may indicate a rare but serious condition known as hypertensive crisis.
The gold standard for diagnosing hypertension is by 24hr ambulatory blood pressure monitoring, where an automatic digital blood pressure machine is fitted and worn by the person for 24hrs, during which time the machine measures blood pressure twice per hour during waking hours, and at least once per hour during the night. The mean wake and sleep blood pressures, along with a number of other blood pressure values are calculated to determine hypertension.
There are 2 parts to a blood pressure reading:
Systolic blood pressure is the highest number shown on a blood pressure reading, and reflects the maximum pressure created when the heart contracts. Systolic blood pressure is what is felt through the pulse.
Diastolic blood pressure is the minimum pressure in the arteries when the heart is at rest in between beats.
A healthy blood pressure is around 120/80mmhg +/- ~20mmhg. The lower the diastolic blood pressure is, the better, as long as it does not become too low as to become symptomatic of hypotension.
The body uses 3 main, complex physiological mechanisms to control blood pressure:
Myocardial contractile force is the strength of the heart's muscle contraction when the heart beats. The higher the force the more blood is ejected from the heart into the arteries, with each beat resulting in a short term rise in blood pressure. The body will generally use this to adjust to sudden changes in posture such as moving from a lying to standing position.
The second way the body can adjust blood pressure is by dilating and contracting the blood vessels, known as vasodilation and vasoconstriction. When blood vessels dilate there is more space for the total blood volume resulting in a drop in blood pressure. When the blood vessels contract, there is less room for blood, and therefore a rise in blood pressure. The body will use this mechanism to adjust to sudden or short term changes in blood pressure, as well as to regulate blood pressure through longer periods of rest or physical activity.
Thirdly, the body controls blood pressure over a longer period of time by regulating total blood volume, by increasing or decreasing the fluid (water) component of blood. If a higher blood pressure needs to be sustained for a period of time, the body will reabsorb fluid from the kidneys and other parts of the body to increase blood volume. When blood pressure needs to reduce, the body will filter water out of the circulating blood volume via the kidneys, or by sending fluids to other parts of the body.
These three mechanisms don’t work independently, but collectively to regulate blood pressure within normal parameters.
Primary hypertension occurs when there is an interruption or dysregulation to the neuro-endocrine and other structural and physiological processes underlying these complex mechanisms.
Research has found people with the ‘atopic triad’ have a defective barrier of the skin and upper and lower respiratory tracts.
These genetic alterations cause a loss of function of filaggrin (filament aggregating protein), which is a protein in the skin that normally breaks down to create natural moisturisation and protect the skin from penetration by pathogens and allergens.
Filaggrin mutations are found in approximately 30 percent of people with atopic dermatitis, and also predispose people to asthma, allergic rhinitis (hayfever), keratosis pilaris (dry rough patches and bumps on the skin), and ichthyosis vulgaris (a chronic condition which causes thick, dry, scaly skin.)If one parent carries this genetic alteration, there is a 50 percent chance their child will develop atopic symptoms. And that risk increases to 80 percent if both parents are affected.
The connection between the gut microbiome and skin health is complex, however, research has found the microbiota contributes to the development, persistence, and severity of atopic dermatitis through immunologic, metabolic and neuroendocrine pathways.
Deficiency of Omega-6 essential fatty acids (EFA) has been linked with the increased incidence of atopic dermatitis, along with the inability for the body to efficiently metabolise EFA’s to gamma linoleic acids (GLA) and arachidonic acids (AA).
Changing weather conditions can certainly aggravate eczema symptoms, but the triggers are subject to change among individuals.
Mould exposure and susceptibility to mould can cause Chronic Inflammatory Response Syndrome (CIRS), of which dermatitis is a manifestation.
A common misconception about hypertension is that it is a chronic disease. Instead, hypertension should be viewed as a sign of disruption and dysregulation of a number of complex neuro-endocrine and immuno-inflammatory pathways in the body.
The functional medicine perspective considers primary hypertension as a sign that there is a chronic and progressive interruption and dysregulation of the complex neuro-endocrine physiology that regulates blood pressure, and in most cases, this will be driven by an underlying immuno-inflammatory process affecting the heart and blood vessels.
The root cause of these disrupted processes will in most cases be influenced by modifiable diet and lifestyle factors as well as a number of psycho-social and physiological determinants. These include:
Hypertension or high blood pressure is a serious risk factor for developing a number of complications if it is not properly managed through appropriate diet and lifestyle measures, and in some cases medication.
If left untreated, hypertension increases the risk of:
Early intervention to prevent hypertension or reduce elevated blood pressure is critical for reducing the risk of developing chronic complications.
According to the Australian guidelines for the diagnosis and treatment of hypertension, hypertension (high blood pressure) is defined by a sustained elevated blood pressure of 140mmhg (systolic) over 90mmhg (diastolic).
Once hypertension has been diagnosed, treatment will usually consist of lifestyle advice to address physical activity, weight management, diet, smoking cessation and alcohol intake.
If the above strategies are not sufficient to reduce blood pressure to lower risk levels, then prescription medications are used either selectively or in combination. The types of medications used include:
Up to 3 different medications may be used in combination to help control blood pressure in some people.
Whilst early intervention to reduce blood pressure and risk of adverse events is necessary, these strategies alone do not address the underlying factors that have resulted in hypertension. Addressing the neuro-endocrine and inflammatory dysregulation for effective risk reduction and reversal of hypertension is essential.
Functional medicine practitioner and hypertension specialist Mark Payne provides a more natural treatment for high blood pressure and takes into consideration that hypertension is a sign of dysregulation in the neuro-endocrine system, alongside lifestyle and dietary factors, a person's health history and lab markers to develop a personalised plan to regulate blood pressure and improve cardiovascular health.
Functional testing may be used to assess underlying and contributing factors, such as:
Once a clear picture has been established, a holistic treatment protocol for hypertension will be recommended that may include:
Alongside the clinical advice of your practitioner, in our clinic, your health coach will guide you through implementing your healthcare plan, making your journey back to health more enjoyable, while fast-tracking your path back to good health.
(Alex is a real patient but we’ve changed his name and image to protect his privacy.)
Alex was 40 years old when he came to see us after being recently diagnosed as having hypertension with a blood pressure of 155/105 at rest.
His GP had ordered a 24hr blood pressure monitor as well as an echocardiogram as Alex mentioned he frequently has heart palpitations, particularly when physically active at work. The echocardiogram showed a mild enlargement of the left ventricle of the heart with mild mitral valve regurgitation.
Read Alex's story by hitting the button below
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The most effective strategies to prevent hypertension include:
There are certain populations of people, such as indigenous persons or those with an African heritage, who have a hereditary predisposition to developing hypertension and cardiovascular or cardiometabolic disease. For most people, a family history of hypertension, cardiovascular, or cardiometabolic disease increases their risk for developing these types of conditions, and therefore it is important for these people to lead a health promoting lifestyle including a healthy diet, exercise, effective stress management, and avoiding smoking and excessive alcohol intake.
More rarely there are certain genetic factors that can lead to hypertension. Some of these include genetic factors that affect the renin-angiotensin-aldosterone pathway, Liddle’s syndrome, and certain tumours known as paragangliomas.
The four stages of hypertension are:
Hypertensive urgencies and hypertensive emergencies occur when the systolic pressure rises above 180mmhg and the diastolic pressure rises above 110mmhg. In these cases immediate medical attention is required.
Having an experienced practitioner assess your personal health status and detecting any underlying causes, particularly in the systems that regulate blood pressure alongside inflammation and immune activation.
An alternative treatment to hypertension starts with understanding that the root cause of these disrupted processes will in most cases be influenced by modifiable diet and lifestyle factors as well as a number of psycho-social and physiological determinants.
Prolonged stress, gut health, thyroid disorders, food allergies and sensitivities, heavy metal and environmental toxicities, and autoimmune and inflammatory conditions have all been associated with hypertension.
Headaches caused by hypertension can be resolved by treating the underlying cause of hypertension with a hypertension specialist, which will in turn address the headaches.
Hypertension or high blood pressure means there is an increased hydrostatic pressure within the blood vessels. If this increased pressure continues over a long period of time it can lead to micro-trauma of the delicate cells that line the inside surface of the arteries creating systemic vascular inflammation.
Once this inflammatory process is established within blood vessel tissues, immune cells begin to collect in the tissues, progressively leading to atherosclerotic plaque formation.
The combination of hypertension and dyslipidemia presents a significant risk for atherosclerosis and cardiovascular disease.
Hypertension is a significant risk factor for all forms of cardiovascular and cardio-metabolic diseases. The presence of hypertension, in most cases, is a result of diet, lifestyle and other modifiable risk factors such as smoking, obesity and excessive alcohol intake, all of which are also risk factors for insulin resistance and diabetes.
For many people, hypertension will be the first sign that the cardiovascular and cardio-metabolic systems are not functioning optimally and addressing important diet and lifestyle factors to correct hypertension is critical in reducing the risk for the development of diabetes and serious cardiometabolic disease.
While finding the root cause of a health issue through holistic, personalised assessment is an approach of both naturopathic and functional medicine treatments, functional medicine practitioners are trained to a high standard in the latest scientific evidence and clinical tools like functional pathology tests to address conditions like hypertension. Therefore, the functional medicine approach to hypertension is a more advanced, investigative approach to treating hypertension that typically leads to better health outcomes.
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