The endothelium is the single cell lining of the blood vessels in our bodies. It strategically controls blood vessel permeability, blood vessel contraction and coagulation. The endothelium maintains vascular health by keeping blood vessels dilated so blood supply to organs is abundant, it inhibits growth of smooth muscle and plaque, it is anti-inflammatory and contains antioxidants. When there is endothelial dysfunction and these cells are disrupted by oxidation, inflammation and autoimmune phenomenon, blood vessel constriction, growth promotion and blood clots/plaque result. Hypertension and cardiac disease, stroke and heart attack are the manifestations of this endothelial dysfunction. The levels of two major biochemical substances in the blood determine the fate of the endothelium. These are Angiotensin II and Nitric Oxide. Angiotensin II is hypertensive and proatherogenic (clot and plaque). Nitric Oxide is anti-hypertensive and anti-atherogenic. Oxidative stress and inflammation favor the formation of Angiotensin II and endothelial dysfunction, while anti-inflammatory states favor Nitric Oxide production and vascular health. Are you beginning to realize hoe lifestyle and diet plan a role here? We know that any food we ingest will have either an anti-inflammatory or pro-inflammatory effect at the cellular level, including the endothelium. This is a MAJOR contributing factor to endothelial health. As a matter of fact, cardiovascular disease including hypertension is more and more being viewed as an inflammatory post-prandial (after eating) phenomenon especially in diets high in refined carbohydrates and saturated fats.
Toxins, including PCB (polychlorinated biphenyls), Mercury, Lead, Cadmium and Iron produce higher plasma oxidative stress and inflammation which is directly correlated with hypertension. A study of hypertension and oxidative stress using a combination of antioxidants illustrated this point. A combination of Vitamins C, E, beta carotene and Zinc were given to hypertensive patients and patients without high blood pressure. The hypertensive patients saw a reduction in their systolic pressure of 9mm, while the patients without hypertension saw no change in blood pressure. The antioxidant therapy neutralized the oxidative stress and decreased the hypertension in the affected patients! The patients with normal blood pressure had no oxidative stress and their pressure were unaffected.
This is leading to a new treatment approach for hypertension. Hypertension is a disease of the blood vessels in which vascular biology is altered. So we as physicians must treat the blood vessels. non-pharmacologic therapeutic options include nutrition, nutraceuticals,antioxidants, weight loss and exercise. Pharmacologic options include ACE inhibitors, Calcium Channel Blockers, Angiotensin II Receptor Blockers (ARB) and to a lesser extent, beta blockers and diuretics.
One of the most effective means to reduce blood pressure is weight loss. A loss of 8-12 pounds reduces systolic and diastolic blood pressure by 7/5 in obese and non obese individuals. It also reduces inflammation and oxidative stress. Obese patients usually have insulin resistance, type 2 diabetes, sleep apnea and inflammation which all have a direct relation to hypertension. Weight loss is key for this constellation of symptoms. Blood pressure will drop! Regular aerobic exercise lowers blood pressure significantly and reduces cardiovascular heart disease. Blood pressure reduction may be as great as 10-15/5-10! Studies have shown that aerobic exercise in hypertensive patients, 5 days a week at 60 minutes per day will reduce blood pressure and increase lean body mass while reducing body fat percentage. Exercise also prevents type 2 diabetes, insulin resistance and Alzheimer’s Disease. So let’s all get moving…..
Thanks for taking the time to read and educate yourselves!