How to reduce hypertension globally

Heart attacks and strokes are the most common causes of death worldwide in developed and developing countries. The strongest predictor of heart attacks and strokes is a high-blood pressure. This year blood pressure control was the theme of World Health Day, and the World Health Organization (WHO) advised that early detection was the key. They urged all adults to know their blood pressure but their advice about what to do with that knowledge could be improved. Quoting from the WHO fact sheet for the Americas, “the risk of hypertension can be reduced by: Ingesting less salt; maintaining a balanced diet; avoiding the harmful use of alcohol; exercising regularly; maintaining a healthy weight and avoiding tobacco use”

That was it; this is like giving advice about controlling influenza without advice to wash hands thoroughly. There was no advice to avoid or limit the foods that directly damage arteries and lead to chronic arterial inflammation, narrowed arteries and blood pressure build-up. There was no mention of stress management, an essential component in the blood pressure reducing triad that includes diet and exercise. The WHO advice about one of the deadliest health threats that the world faces could be improved.

High-blood pressure is usually defined as a blood pressure over 140/90 mm Hg. Hypertension is diagnosed when a high blood pressure is found on at least 3 occasions. High blood pressure is not really a disease; it is a warning sign that there is a mismatch between the volume of blood flowing in your arteries and size of the space inside the arteries.

The most common cause of this mismatch is atherosclerosis, a chronic inflammatory disease of the arteries characterized by pus-filled fatty abscesses called plaques in the artery walls. Think of your arteries as a hose attached to a faucet, if you turn on the water flow and squeeze the hose, the water pressure builds up. The same thing happens when the space inside your arteries is narrowed by atherosclerotic plaques. Narrowed arteries cause the heart to pump harder.

This further increases blood pressure and may lead to enlargement of the heart, heart failure and irregular heartbeats. Arteries are the blood vessels that supply blood with oxygen and nutrients to the body. When blood flow is blocked vital organs get decreased flow and this increases the risk of conditions such as dementia, kidney failure and erectile dysfunction. Atherosclerosis is a preventable disease because we know what starts inflammation in the arteries.

In 1913 Nikolai Anitschkow (aka Anichkov), a Russian pathologist fed purified cholesterol dissolved in sunflower oil to rabbits and produced the same abscesses that were seen on the arteries of humans with atherosclerosis. Rabbits that were not fed cholesterol had no lesions on their arteries. In 2010 researchers at the University of Massachusetts showed that cholesterol from the food we eat forms minute crystals that activate inflammation inside arterial cells. When an artery abscess bursts open, the debris and blood that spill out can form a clot that completely blocks blood flow.

If the blocked artery blood supplies blood to the heart the blockage will cause a heart attack, if the artery supplies blood to the brain, it will cause a stroke. In 1990 Dr. Dean Ornish showed that arteries could be unclogged by comprehensive lifestyle changes that eliminated most animal products. In 2001 Dr. Caldwell Esselstyn had the same results with a plant-based diet that eliminated all animal products and processed fats. Dr. Esselstyn’s research was featured in the 2011 movie Forks over Knives. Avoiding animal products and processed foods is the most useful advice that WHO could give about blood pressure control.

Advice to limit salt is good, but advice to unclog arteries would be better. Salt attracts water and increases blood volume. Increased blood volume flowing through clogged narrowed arteries increases the mismatch and raises blood pressure. Using the hose analogy, eating salt is like squeezing the hose and turning the faucet to maximum flow. The blood pressure raising effect of salt is much less when arteries are not already clogged by atherosclerosis.

In addition to eliminating animal products and processed foods, WHO may also want to advise the people of the world to:

Eat more fruits and vegetables.  Fruits and vegetables are natural sources of minerals such as potassium and magnesium that open arteries and lower blood pressure.

  • Limit heavily caffeinated drinks.  Caffeine constricts arteries and increases blood pressure. The effect of caffeine is worse when arteries are already clogged.
  • Learn and practice effective stress management strategies and relaxation techniques. Stress hormones constrict arteries and increase blood pressure. The combination of chronic stress and chronically clogged inflamed arteries can be deadly.

The global paradox that WHO faces is that while some populations are getting hypertension and dying from eating too many animal products and processed foods, others are dying from starvation. In 2012 the Food and Agricultural Organization reported that over 2.5 million children die of starvation each year. This occurs while food that could nourish them is used to fatten animals that are eaten by people who will get clogged arteries, hypertension, heart attacks and strokes.

This senseless situation could be changed with improved awareness, but as long respected authorities such as WHO fail to give effective evidence-based health advice the people of the world will continue to suffer and die from preventable conditions. Starvation and obesity are complex issues with multifactorial causes but if the WHO began to advise against eating animal products  it would be an important first step towards the cultural changes that must occur if we are to control chronic conditions such as hypertension and also eliminate hunger and starvation. This would be the most significant step towards “health for all.”