
The curious case of high blood pressure around the world - known
http://www.economist.com/blogs/graphicdetail/2017/01/daily-chart-12
======
reasonattlm
This piece is a great example of entirely the wrong way to think about this
issue.

The procession of mechanisms is as follows, starting with layer 1:

\- calcification

\- cross-linking

\- vascular smooth muscle dysfunction

Which gives you layer 2:

\- vascular stiffness

Which then, entirely and all by itself (
[http://dx.doi.org/10.1371/journal.pcbi.1003634](http://dx.doi.org/10.1371/journal.pcbi.1003634)
), causes layer 3 by messing with the feedback mechanisms for blood pressure
control:

\- hypertension, raised blood pressure

Which then causes layer 4:

\- microvascular damage, such as stroke, kidney issues

\- major vascular damage and sudden death when combined with atherosclerosis

\- cardiac hypertrophy, which is a maladjustment to hypertension

Calcification may be secondary to cellular senescence and other inflammatory
mechanisms. Persistent cross-linking may be made worse by dietary sugars, or
may not - the better studied forms of sugary by-product are not all that
relevant to persistent cross-linking that stiffens tissue. You can read up on
glucosepane to learn more about that. The vascular smooth muscle dysfunction
is probably caused by a combination of inflammatory mechanisms and everything
else that changes with age and poor health, such as metabolic syndrome.

So if thinking about fixing hypertension, you want to be watching people
building cross-link breakers, such as the Spiegel team at Yale, funded by the
SENS Research Foundation, or people clearing out senescent cells, such as the
current brace of senolytic therapy companies, one of which was seed funded by
the SENS Research Foundation. Watching the groups looking into smooth muscle
may or may not go anywhere; it is very hard to say at this stage whether there
is any one target that might help enough for the usual pharmaceutical
development approach to work well enough to care about in the near term.

~~~
YeGoblynQueenne

      The procession of mechanisms is as follows, starting with layer 1:
    
      - calcification
    
      - cross-linking
    
      - vascular smooth muscle dysfunction
    

Could you please throw some links behind that? I've never heard of cross-
linking before and I'd never made the connection with calcification and high
blood pressure, but it sounds interesting to look into.

------
grwthckrmstr
My dad got diagnosed with high blood pressure when he was 30.

For the past 26 years, our family has maintained a low-salt, low-oil diet.
There is regular exercise and walking. Low consumption of alcohol and also
junk/saturated fatty food, meditation and breathing exercises.

I'm damn proud of my dad and the way he's maintained his blood pressure
problem throughout his life. As a by product, the entire family is health
conscious. Props to my mom for making sure we always eat well and healthy. It
wouldn't be possible without her constant effort.

As a result of growing up in this household, I'm extremely sensitive to salty,
oily,and junk food. In the sense that, it doesn't cause a reaction or
anything, but I can TASTE the HIGH amount of salt and oils in All the food
that's served around me, and I see people gobbling it up without even
realising.

Lifestyle diseases.

~~~
beagle3
The lifestyle diseases are apparently not related to oils, and for 80% of the
population, salt either (someone posted links earlier).

The culprit appears to be the combination of carbs and fat; there are cultures
who have lived on mostly carbs which are healthy, and some who have lived on
mostly fat that are; but the combination is lethal.

Also, salt is often demonized unfairly (though in your case, it might be right
- sodium sensitivity is mostly genetic). Too little sodium is more dangerous
than too much for most people. Keto flu is a flu-like condition often
accompanied by rash that is a result of dropping carbs without increasing
sodium+potassium+magnesium intake, with salt likely playing the largest part.

I am now increasing my salt intake gradually, after having essentially no salt
for the last 40 years (grew up in a salty household but didn’t like the
taste). It is hard but I am sleeping better, having less muscle cramps, and
losing more weight than with the same diet before increasing salt. YMMV.

~~~
YeGoblynQueenne
I have a relative who's a kidney patient and who only recently realised her
blood pressure was getting too high- it was up to 194/112 back in February
this year. She only realised when she mentioned having strong headaches during
a doctor's appointment.

My relative is in a scientific discipline and she likes collecting data, I
guess, so she's been tracking her blood pressure meticulously since then. I
helped her to plot it out in R. You can see the resulting diagram below:

[http://www.goblinopera.com/hn/dec_17_anon.png](http://www.goblinopera.com/hn/dec_17_anon.png)

I think anyone who sees this chart cannot fail to notice the big dip in BP in
October: from an average of 140/90 from February to September, to 120/75 after
October. So far, this has lasted (with a bit of a recent spike, possibly
brought on by the inevitable Christmas Binge™).

This dip follows from her decision to control her salt intake, starting around
October. She no longer cooks with salt, or salt her food, she eats very little
cheese and generally stays away from food she hasn't prepared herself and
can't control the salt content of.

So this is the message I keep from this chart: salt intake can really affect
blood pressure.

Obviously, that's a single case and it's hard to generalise- but on the other
hand it's impossible to deny that a specific intervention (controlling salt
intake) was taken in the hopes of having a desired effect (lowering BP) and
that the expected effect directly followed the intervention.

There were confounding factors, to be sure. I've marked various medication
milestones in the chart (anonymised, to protect her privacy). My relative was
suspicious that "Drug 1" was affecting her blood pressure and the chart has
helped convince her doctors that she should stop taking it (see the big spike
after "Drug 1" is taken at the end of May). She is now taking an alternative
("Drug 3"). My relative also lost some weight between February and September
and that definitely contributed.

However, the fact remains that she was able to lower her blood pressure to the
levels considered safe for kidney patients (those are lower than in the
general population) only when she started controlling her salt intake.

~~~
jschwartzi
Given that kidneys are responsible for filtering excess electrolytes out of
the bloodstream it makes sense to me. A person with compromised kidney
function may need to limit intake to a level that the kidneys can handle. This
doesn't necessarily mean that a person with healthy kidneys needs to limit
intake.

~~~
YeGoblynQueenne
Of course. But high blood pressure can damage the kidneys, which can in turn
raise blood pressure further- so if blood pressure is high then it's probably
a good idea to start lowering one's salt intake, anyway.

My relative has been complaining that she was not made aware of the
detrimental effect that high blood pressure has on the kidneys, and how salt
affects this, even after multiple visits to a nephrologist. She could probably
have avoided those crazy high values at the start of the graph if she was
aware.

I was not aware of the connection either and I believe many people are also
oblivious to it, so it's probably a good idea overall to highlight it.

------
esaym
>"diets that include too much salt"

Hasn't that been debunked I thought I read? I certainly hope so.

I had the pleasure of visiting with my Grandma's sister who was down for the
holidays with us. She did not eat much of our cooking as she stated that her
doctor had her on a "low sodium diet". She said she couldn't eat alot of
things she liked, but it wasn't so bad as there was no restriction on sugar
intake so she "gets to eat all the sweets" she wants.

And that was demonstrated several times at the dessert table and by the
several bags of candy she brought with her from back home. I was quite
dumbfounded.

~~~
pkaye
What I've read is that only about 20% of the population has salt induced
hypertension. Regarding low salt diet which I am on due to kidney disease, our
tastes actually adapt the lower salt contents if you do it long enough however
you still need enough to bring out the flavor in many things. My solution is
to pick things that have other stronger tastes like sweet, sour, spicy, etc.

~~~
ianai
Vinegar or lemon juice also help perk flavors up.

~~~
OtterCoder
Don't forget lime juice!

------
robg
Amazing to me that the most basic biological system for survival - stress - is
no where mentioned. And we've known for 40 years that relaxation techniques
are as effective at treating hypertension as prescription medications.

~~~
tremendulo
It's a weakness of empiricism that scientists remain reluctant to consider the
role of (unmeasurable) psychological states, such as pleasure or stress, in
the context of a (measurable) physiological response, such as raised blood
pressure.

My guess is that, together with stress, it is visceral pleasures (arising from
our relationship to food, sex, drugs, alcohol, or other substances/habits)
that are responsible for high blood pressure. Eating food with salt is just
one of the ways it can be made more tasty, and thus more pleasurable, since
salt heightens the response of our taste buds.

~~~
naasking
Because it's difficult to objectively measure stress and pleasure between
people.

~~~
jschwartzi
So we continue to look for our keys under the streetlight rather than in the
bushes where we dropped them.

~~~
naasking
Except we don't actually know where the keys were dropped, so might as well
start under the streetlight.

~~~
tremendulo
Science starts with problems, not observations.

If excessive pleasure is unhealthy or bad, why do people seek it? We can use
folk psychology as starting point, e.g. consumption of Ben and Jerry's in
response to relationship difficulties.

------
Tharkun
So I recently found out I'm one of those many people with high blood pressure.
This knowledge has been stressing me out (I don't want to die yet).

I'm reasonably active as far as software engineers go: 10k+ steps daily and
exercise 2-3 times/week.

My BMI is 28, which is in the overweight category, but I carry a fair amount
of muscle along with my flab.

My diet is the hardest part to control. I live alone and spend a lot of time
at the office, so I often eat takeout Chinese and other convenience food.

My point is that a lot of us HN-y folks probably lead comparable lifestyles.
The kind that we may think aren't _too_ unhealthy, but for at least some of
us, that assumption is wrong. Please keep an eye on your blood pressure and
your waistline. I wish I had started paying attention to this much sooner. Now
I'm not sure whether I can still reverse the outcome.

~~~
kayoone
I have been diagnosed with borderline high bp (around 140/90, sometimes a bit
lower, sometimes higher) 5 years ago and tried everything to reverse it, as
the Doctor did not want to put me on meds so early. Lost 10kg (BMI 23.5), 60km
of cycling a week, 2x exercise a week, reasonably good diet, no smoking,
little alcohol.

From all those measures my BP did not improve a lot, the systolic is nowadays
mostly okay, but i seem to have a problem with the diastolic bp which is often
in the 90-95 range. Right now i am undergoing more checks again and will
probably resort to meds now, which i wanted to avoid (which otherwise healthy,
fit 35 year old wants to start taking bp meds) but it seems like i can't and i
don't want to damage myself more than i already have.

Until now, no real cause has been found, it could even be some nervous
disorder because of high stress times i had in the past, but nobody knows. I
also have no family history of high bp, so it still puzzles me and freaks me
out to the point i got an underlying anxiety.

If losing weight etc. does not help much, also get your kidneys and thyroid
checked. I have some kidney checks coming up and it freaks me out...

The good thing is that it made me a lot more conscious of what i eat, drink
and do, i just wish i would have monitored it earlier because i don't even
know when it started.

~~~
Tharkun
Something consider: elevated diastolic blood pressure with a systololic blood
pressure of <140 is apparently not correlated to more negative outcomes.
Apparently home blood pressure monitors are prone to overreport the diastolic
reading by about 7mm in those instances. Source: recently read a paper about
this, which looked at multiple large scale studies. Don't have the link on
mobile, sorry.

Bottom line: well done on the lifestyle changes, and don't worry if only the
bottom number is high.

~~~
kayoone
Interesting, I have read quite conflicting information on that though, link
would be appreciated. The problem is not just with home monitors though and I
read while it’s more disregarded in older people it could point to underlying
issues in younger people which is what freaks me out since nobody found
anything yet.

------
nickjj
White coat syndrome cannot be ignored too. This is where your BP can increase
by a lot just by being in a doctor's exam room.

I went in for a checkup a few years ago and they took my BP and it was like
140/93 with an 87 heartbeat (I was 32 and in decent shape), so my doctor was
like, hey I don't want to put you on any medication but your BP looks a little
high, let's chart your BP at home for the next 2 months and see how it goes.

So I grabbed a BP machine and about 3 times a week I took my BP, alternating
arms and doing it at various times in the day. I could see that my BP was a
little high for weeks, but by the end of the 2 months I had a 2 week stretch
where it was about 120/80 steady.

I took the same BP machine I bought and took it to the follow up exam and it
was 138/87\. That's a pretty big spike.

Now I take it myself twice a month or so (just for good measure) and it's
usually 120/80ish with a resting heart beat of 58-62. My dentist likes to take
your BP before doing any type of work and it was 135/88 before a cleaning too.

I don't know about you, but I generally don't like getting my BP taken. It
causes some anxiety.

I wouldn't immediately discount high BP to white coat syndrome, but you should
ask your doctor if you can track your BP at home if you're on the cusp of high
BP.

~~~
vwcx
Can you recommend a particular BP machine? I have $100 in an FSA I need to
spend in the next 16 hours and I've had a similar experience to you with white
coat syndrome.

~~~
nickjj
My doctor recommended this one
[https://www.amazon.com/gp/product/B000NY6JXA](https://www.amazon.com/gp/product/B000NY6JXA)
(it's $42).

Keep in mind, that I'm not a doctor and I don't know if this one will work for
you. I would definitely ask your doctor. Maybe run this one by him/her for a
confirmation.

------
anon1253
I've had high blood pressure since 24. I've had every possible diagnostic
test, tried medication (no avail). I'm not overweight and do walk about 50
minutes a day, eat as healthy as can be expected. And still it averages around
170/90\. I gave up on it. If global disaster doesn't kill me first, it'll
probably be a heart attack around 50. There are worse ways to go. Seriously,
even lifestyle changes for the relatively healthy only seem to make a 10 mmHg
difference, so eh. Whatever.

~~~
vfc1
High blood pressure is a largely diet-related western only disease. It's not
normal that it rises with age either, just something we got used to it.

If you want to cure your blood pressure, watch this video till the end -
[https://nutritionfacts.org/video/how-not-to-die-from-high-
bl...](https://nutritionfacts.org/video/how-not-to-die-from-high-blood-
pressure/)

Then if you want the details, have a look at this playlist -
[https://www.youtube.com/playlist?list=PL5TLzNi5fYd8jLx2M6exR...](https://www.youtube.com/playlist?list=PL5TLzNi5fYd8jLx2M6exRO1DoEP0BAzdy)

------
rskar
I wonder if the world-wide trend on high blood pressure is aligned with that
of vitamin D?:

\-
[https://naldc.nal.usda.gov/download/17956/PDF](https://naldc.nal.usda.gov/download/17956/PDF)

\-
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4396645/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4396645/)

\-
[http://www.journals.uchicago.edu/doi/full/10.1086/691683](http://www.journals.uchicago.edu/doi/full/10.1086/691683)

\-
[http://ajcn.nutrition.org/content/87/4/1080S.full](http://ajcn.nutrition.org/content/87/4/1080S.full)

\-
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5356990/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5356990/)

------
chiefalchemist
I think it's fair and necessary to ask: Are the (negative) effects of high
blood pressure the same for all genders across all gene pools?

Also, what is the breakdown of high blood pressure being a disease? Vs being a
symptom (of another disease)?

We need deeper data.

------
galfarragem
Age factor must be also relevant:

A friend of my father has the same lifestyle and food habits today at 60's as
during his 40's and 50's. He always had normal blood pressure until recently.

