LIKE MOST THINGS, HYPERTENSION IS ALSO NOT FOREVER!
By RENATO U. PARAGAS, M.D.
In my office, patients with these two diseases frequently visit me-hypertension and diabetes. There is not a single day that I do not see them. They comprise around 60 percent of my patients. I am not a cardiologist nor an endocrinologist. To surprise you, my field of specialty is General Pediatrics. Why will older people, especially aged 50 to 80 years, seek medical advice from a Pediatrician? I am surprised as well! Despite my specialty, I am very grateful that I make them cease their “addiction” to pharmaceutical products they have been taking for years, and sometimes, for decades.
Today, I shall talk of high blood pressure or hypertension. Hypertension is a condition in which the pressure within the blood vessels is consistently high. Although the American Hypertension Association had lowered the acceptable high blood pressure to 130/80 mmHg few years ago, the hypertension association of the Philippines still considers 140/90 mmHg as the blood pressure of hypertension. Personally, after 30 years of medical practice, I observed no problem with sticking to 140/90 mmHg as the highest acceptable normal blood pressure for adults especially for those past the age of 40 years.
High blood pressure usually do not manifest symptoms. It is noted only when a person submits for its measurement during visits to the doctor. Because of this, hypertension is often tagged as the “silent killer.” Symptoms usually manifest when complications set in such as ischemic heart disease, stroke, peripheral vascular disease, cardiomegaly (enlarged heart), heart failure, aneurysm, chronic renal disease, cognitive impairment, dementia, hypertensive retinopathy and nephropathy, and even death. When these develop, hypertension will be more difficult to manage due to the presence of some organ involvement.
Individuals who become aware of their high blood pressure are advised by most medical professionals to utilize various forms of medications. These are classified as diuretics, beta-blockers, ACE inhibitors, angiotensin II receptor blockers, calcium channel blockers, vasodilators and their combinations.
Diuretics help the body get rid of excess sodium (salt) and water and help control blood pressure. Examples are hydrochlorothiazide, spironolactone, and furosemide.
Beta blockers reduce the heart rate, its workload and its blood output thus lowers blood pressure. Examples are acebutolol, atenolol, bisoprolol, metoprolol, nadolol, propranolol, and timolol.
Angiotensin is a chemical that causes the arteries to constrict especially in the kidneys. ACE stands for Angiotensin Converting Enzyme. ACE inhibitors help the body produce less angiotensin thus helps relax and dilate the blood vessels and lowers blood pressure. Examples are benazepril, captopril, enalapril, lisinopril, quinapril, and ramipril.
Angiotensin II receptor blockers block the receptors so the angiotensin fails to constrict the blood vessel. Angiotensin is the chemical that narrows the arteries and it needs a receptor - like a chemical slot to fit into or bind with in order to constrict the blood vessel. Failure of the angiotensin to bind with the receptor keeps the blood vessels to remain dilated and thus, lowers blood pressure. Examples are candesartan, eprosartan, irbesartan, losartan, telmisartan and vasartan.
Calcium channel blockers prevent calcium from entering the smooth muscle cells of the heart and arteries. Calcium causes a stronger and harder contraction, thus, by decreasing the calcium, the heart does not contract forcefully. Moreover, the blood vessels relax and open up and reduce heart rate and lower blood pressure. Examples are amlodipine, diltiazem, felodipine, isradipine, nicardipine, nifedipine, and verapamil. It is for this reason that I personally do NOT endorse or advise elders to drink milk or supplement them with calcium. Milk was created by God to be drank by infants only.
Vasodilators or blood vessel dilators relaxes the smooth muscles in the walls of blood vessels most especially those of the arterioles (smallest arteries) thus, allowing the blood vessel to widen to allow better blood flow. Examples are hydralazine and minoxidil.
The Department of Health strictly recommends that any of the above aforementioned medications be taken on a regular daily basis and should not be withheld. If money is an issue to have them available always, the Department informs the public that medications are given for free in barangay health centers. Other measures recommended include lifestyle modification, cessation of smoking and other vices, reduction of salt intake and increase of potassium consumption, regular exercise and adequate sleep.
The best way to manage any problem is to determine the primary cause first. Several references indicate that about 95 percent of all hypertension are classified as primary hypertension or essential hypertension. This means that their true cause is unknown. This sounds so dangerous that most people suffering from this ailment are left hanging in the air searching for a solution that correctly fits the problem. How can one solve something when the real cause is UNKNOWN? Only five percent of those suffering from high blood pressure is the cause truly identified so, proper management can be administered. Common causes are chronic kidney disease (most common), diabetes, pheochromocytoma, Cushing Syndrome, congenital adrenal hyperplasia, hyperthyroidism, hyperparathyroidism, pregnancy and obesity. Through proper identification of the cause, only five percent of all those with high blood pressure can be managed adequately.
So, what happens to the remaining majority? Will they just keep guessing what medication best suits them? Will they just keep on shopping for the doctor who will hit the nail’s head right on target? What if I inform you that the true cause of the hypertension of the majority is merely the lack of water intake especially for those who are past the age of 40 years? Surprised or shocked?
According to Dr. Fereydoon Batmanghelidj, author of the book Your Body’s Many Cries For Water, the thirst sensation of individuals reaching the age of 40 years wanes and is replaced with the sensation of hunger. Thus, at this age, people tend to eat more and drink less. This poor drinking habit will result to a state known as unintentional chronic dehydration (UCD). Aside from poor drinking habit, people today prefer drinking other beverages that the body does not recognize. Worse, most of them contain caffeine that further dehydrate instead of rehydrate the body. Most commercial beverages people cater to are soft drinks, tea, coffee, milk, juices, sports drinks, energy drinks, alcoholic beverages and others. Most of these contain caffeine that acts as a diuretic. Inadequate intake of water plus the intake of beverages that force the kidneys to eliminate more water out of the body will surely lead to dehydration.
When a person is in a state of UCD, about 66 percent of water inside the cells is lost, 26 percent of water outside the cells is lost and eight percent of water in the blood is lost. When this occurs, three mechanisms will happen that cause hypertension.
First mechanism. UCD causes the blood to become thicker, more viscous. The resistance of blood flowing against the blood vessel walls is increased. As a result, the heart will require additional force to pump the thicker blood. This extra force required to pump blood will eventually increase the pressure leading to higher blood pressure or hypertension.
If your doctor entertains this mechanism as the cause of your hypertension, he will prescribe beta blockers such as acebutolol, atenolol, bisoprolol, metoprolol, nadolol, propranolol and timolol. Beta blockers reduce the heart rate, its workload and its blood output thus lowers blood pressure.
Second mechanism. UCD causes less water to reach the kidneys. Kidneys are very sensitive to changes in the water and electrolyte levels in the body. When kidneys sense shortage in water supply, it directs the brain to release a hormone vasopressin. The most important action of vasopressin is its anti-diuretic action on the collecting ducts of the kidneys. This leads to a decrease in the renal free water clearance, concentration of urine and a reduction in urine volume. The net effect is the reabsorption of water in the blood along with thirst-generated water intake that leads to normalization of plasma osmolality. However, vasopressin is also a potent vasopressor actions. As the name implies, it also causes elevation of the blood pressure.
If your doctor entertains this mechanism as the cause of your hypertension, he will prescribe vasodilator such as hydralazine or minoxidil or calcium channel blockers such as amlodipine, diltiazem, felodipine, isradipine, nicardipine, nifedipine, and verapamil. Vasodilators relax the smooth muscles in the walls of blood vessels most especially those of the arterioles (smallest arteries) thus, allowing the blood vessel to widen to allow better blood flow. Calcium channel blockers prevent calcium from entering the smooth muscle cells of the heart and arteries. By decreasing the calcium, the heart does not contract forcefully and the blood vessels relax and open up and reduce heart rate and lower blood pressure.
Third mechanism. UCD causes decrease in blood volume thus less blood reaches the kidneys. When this event occurs, the renin-angiotensin system (RAS) will be activated. RAS is a complex multi-organ hormone system involved in the regulation of blood pressure by balancing water and electrolyte levels. It regulates the vascular resistance and tone. It also regulates sodium and water absorption in the kidneys thus has a direct impact on the systemic blood pressure.
When less volume of blood reaches the kidneys, this activates pro-renin to cleave into its active form, renin and released into the bloodstream. In the liver, renin converts angiotensinogen to angiotensin I. In the lungs, angiotensin I is converted to angiotensin II by Angiotensin-Converting Enzyme (ACE). Angiotensin II is a potent vasoconstrictor that increases blood pressure. It also acts on the pituitary gland to stimulate the secretion of vasopressin, also known as antidiuretic hormone, that increases water retention in the kidneys. Angiotensin II also stimulates the secretion of aldosterone that is involved in retention of sodium in the kidneys and other glands. This, together with water retention, leads to increased blood volume and also blood pressure.
If your doctor entertains this mechanism as the cause of your hypertension, he will prescribe ACE Inhibitors that help the body produce less angiotensin thus helps relax and dilate the blood vessels and lowers blood pressure. Examples are benazepril, captopril, enalapril, lisinopril, quinapril, and ramipril. He may also prescribe Angiotensin II receptor blockers that block the receptors so the angiotensin fails to constrict the blood vessel. Failure of the angiotensin to bind with the receptor keeps the blood vessels to remain dilated and thus, lowers blood pressure. Examples are candesartan, eprosartan, irbesartan, losartan, telmisartan and vasartan.
You would note that the three mechanisms associated with high blood pressure is brought about by a single factor - Unintentional Chronic Dehydration (UCD). By merely hydrating the body properly, one will correct the mechanisms contributing to hypertension. It just surprises me that most medical professionals ignore the vital role UCD plays in the causation of hypertension. They prefer utilizing pharmaceutical products over a cheaper, more effective and safer solution, “mineralized water”- purified drinking water supplemented with several drops of Ionique Mineral Drops. Additional health benefits one gets from “mineralized water” is the presence of magnesium. Magnesium is known as a natural anti-hypertensive. It does not only help lower blood pressure but it also works to regulate the amount of total blood cholesterol. It lowers the level of bad cholesterol and yet, increases the level of the good cholesterol. Magnesium is also the most important mineral for heart health since it provides sufficient energy to keep the heart functioning optimally.
So, if you hate high blood pressure to be with you for a lifetime, just hydrate your body adequately. The formula for proper hydration is 50 milliliters per kilogram body weight per day (50 ml/KBW/day). Supplement it with at least 80 drops of Ionique Mineral Drops on a daily basis. Dr. Fereydoon Batmanghelidj, author of the book Your Body’s Many Cries for Water, declared that giving diuretics to people with high blood pressure is a great, unforgivable blunder so avoid it entirely. Mineralized water is not just your best option to conquer hypertension but it is the safest approach to prevent its dreaded complications and the numerous adverse effects of medications as well.
Like most things, hypertension is also NOT forever!
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