They are like two sides of the same coin: If you have high blood pressure, you’re very likely also to have high blood sugar—and vice versa. This is because they are both evidence of the same underlying metabolic imbalance. Correct this imbalance and both will likely improve.
BLOOD PRESSURE BASICS
Let’s start by taking a look at what blood pressure is and why it matters. Your blood pressure is a measure of the force your bloodstream exerts against the walls of your arteries as your heart beats and rests. It’s measured in two numbers: the systolic pressure, when your heart contracts and pumps the blood, and the diastolic pressure, when your heart relaxes between beats. When discussing blood pressure, the systolic number is always given first, followed by the diastolic number, as in 127 over 84 (usually written as 127/84).
When those numbers are too high, you have high blood pressure, also known as hypertension. Hypertension is linked to increased risk for heart attack, congestive heart failure, stroke, and kidney damage. Today about 50 million Americans—one in four adults—have high blood pressure.1 Hypertension is sometimes called the silent killer, because it doesn’t really have any symptoms. Many people who have it don’t know it.
HYPERTENSION GUIDELINES
In the United States,the official guidelines for diagnosing hypertension are set by the National High Blood Pressure Education Program,part of the National Heart, Lung, and Blood Institute. The guidelines were updated in 2003.Here’s how your blood pressure measures up according to the new guidelines:
- Normal: below 120 systolic and below 80 diastolic
- Prehypertension: 120–139 systolic and 80–89 diastolic
- Hypertension Stage 1: 140–159 systolic and 90–99 diastolic
- Hypertension Stage 2: 160 and above systolic and 100 and above diastolic2
Under the old guidelines, which date back to 1997, what’s now de- fined as prehypertension was called high normal. With this change in the guidelines (published in 2003), about 22 percent of American adults, or about 45 million people, are now classified as having prehypertension.3 The new guidelines are based on evidence that damage to the arteries occurs at blood pressure levels that physicians previously deemed acceptable. These studies have also shown that prehypertension is very likely to progress to hypertension as well as to additional health problems, unless changes are taken to correct the underlying cause.Controlling insulin levels and weight with the ABSCP addresses the underlying causes of high blood pressure.4, 5
Just as conventional medicine has recently begun to understand the importance of screening for glucose abnormalities by defining prediabetes, it is recategorizing blood pressure values to allow for earlier identification and treatment of this potentially devastating disease. The root of the blood pressure problem in some people is the same metabolic imbalance we have discussed in previous chapters: high-carbohydrate intake, leading to excessive fat storage, leading to inflammation at the cellular level. You may recall the discussion in Chapter 4 regarding endothelial dysfunction and its relationship to insulin/blood sugar abnormalities. Because endothelial cells line all blood vessels, all blood vessels are at risk for damage. This is why we are committed to helping you identify where you are on the blood sugar imbalance continuum—and to halting its progression.
At first glance the new guidelines seem like a good thing. No one was more of an advocate of early identification of health risks and intervention than Dr. Atkins. If these revisions led to lifestyle changes, in the form of exercise and dietary recommendations that could impact the underlying cause, we would be well on our way to truly addressing the epidemics of obesity and diabetes. Our fear is that, instead, these new guidelines and recommendations could lead millions of Americans not to better health but to the pharmacy—and to the “Band-Aid” solution of pharmaceuticals that are both expensive and potentially dangerous.(See Appendix 6,Drugs for Hypertension,on page 475.)
In this sense, the new guidelines are a bonanza for the companies that make blood pressure drugs.Most people with high blood pressure need at least two and often three drugs to bring it down,and they must take the drugs indefinitely.7, 8 Moreover, assuaged by a false sense of security,people on these drugs may not realize that,although their blood pressure may improve,the underlying condition silently progresses.
GETTING AN ACCURATE BLOOD PRESSURE READING
Your blood pressure normally varies quite a bit—as much as 20 points or more—over the course of a day.A single reading showing high blood pressure doesn’t necessarily mean you have hypertension. If your doctor suspects hypertension,your blood pressure reading may be repeated during the course of the office visit to be sure the stress of the visit itself isn’t raising your pressure. You may be asked to monitor your blood pressure yourself at home for a few days or to return to the office for another reading. On occasion, you may be asked to wear a monitor that records your blood pressure over 24 hours.
Different blood pressure cuffs should be used for children and people of various sizes. The standard blood pressure cuff may be too small for people with large arms, for instance, giving an inaccurate reading.6
THE BLOOD PRESSURE–BLOOD SUGAR CONNECTION
High blood pressure often goes hand in hand with obesity, high blood sugar, the metabolic syndrome, prediabetes, and diabetes because in many cases they share the same metabolic root cause. If you have any one of those conditions, there’s a good chance you’re hypertensive, too. People with hypertension are almost 2.5 times more likely to develop diabetes than those with normal blood pressure.9 In a study of almost 70,000 individuals, 30 percent of men over 40 years of age with a systolic blood pressure of between 140 and 159 mm/Hg had impaired fasting glucose, or prediabetes.10
Although very common, the combination of high blood pressure and high blood sugar is quite dangerous. If you have both, you are at much greater risk for blood vessel injury, leading to stroke, heart attack, kidney failure, blindness, and amputations. But don’t get discouraged.Research has shown that even small improvements in blood pressure and blood sugar—along with weight loss—can improve your chances of avoiding those dire outcomes.11 It’s worth noting that none of these studies restricted carbohydrates.We see much better results in patients using the Atkins program.
The increased risks in people with diabetes begin at blood pressure readings of 120/70 and above—in other words, as soon as you reach the prehypertension level. That’s why most experts agree that people with blood sugar abnormalities should aim for a target blood pressure of less than 130/80—and preferably lower.12 Let us remind you that the Atkins Blood Sugar Control Program is designed to address the underlying metabolic abnormalities that are largely responsible for high blood pressure. Once patients have been following the program for a few months, it is not unusual to find blood pressure readings that reflect optimal health—that is, 120/70 or lower—often without medication. This is no Band-Aid!
When 71-year-old Dorothy W. came in for her annual physical, she was five feet tall and weighed 151 pounds. She had been taking three medications to control her blood pressure, but it was still 196/84, meaning she would need yet another drug. She would also need a medication for her lipids, as her lab results showed the following: fasting blood sugar: 122; glycated hemoglobin (A1C): 5.8; total cholesterol: 282; triglycerides: 485; HDL: 38. Her LDL cholesterol could not be evaluated due to her extremely high triglycerides.
Dorothy was interested in decreasing her medications, so under my supervision, she began the Atkins Nutritional Approach, with frequent follow-up visits. After three months, during which I tapered her medications, Dorothy’s triglycerides had dropped to 86; her total cholesterol was now 209, with HDL of 86 and LDL of 57. Seven months later, she was able to eliminate one of her blood pressure medications. She is now down to 123 pounds, takes a very small dose of one medication, and her blood pressure is 120/70. Her fasting blood sugar is 112; c-peptide:2.3; A1C: 5.1; total cholesterol: 197; triglycerides: 39; HDL: 74; and LDL: 115. —MARY VERNON
THE NONDRUG APPROACH TO HYPERTENSION
What can you do to lower your blood pressure without drugs? You’ve probably already guessed the single most important step you can take: Control carbs! When you control both the quantity and quality of the carbs you eat, you directly address the metabolic abnormality that drives blood vessel damage—damage that is the basis for the long list of complications we’ve just discussed. When you control carbs, fat is no longer stored. Rather, the proper level of carb intake allows the body to burn excess body fat for energy.
Other very important lifestyle steps to lower your blood pressure include:
- Be more physically active. Lack of exercise, especially in combination with obesity,makes you more likely to develop high blood pressure. Adding exercise brings your blood pressure down— and helps your blood sugar levels and insulin resistance as well, which in turn helps bring your blood pressure down even further. Before starting an exercise program, read Chapter 22 and check with your physician.
- Limit alcoholic beverages. If your blood pressure is elevated and you drink alcohol, stop drinking altogether and observe the impact on your blood pressure. If your blood sugar is abnormal and/or you are overweight, you probably should not be consuming alcohol at all. (We’ll discuss this more in Chapter 19.)
- Stop smoking or using other forms of nicotine.
DIET AND BLOOD PRESSURE
As soon as you start the Atkins Blood Sugar Control Program (ABSCP) and eliminate worthless carbs from your diet, you start to normalize your metabolism. This helps to lower your blood pressure in two ways. First, because your primary source of carbohydrates is now leafy green vegetables and other low-glycemic vegetables (those that have a limited effect on blood sugar), you’re naturally getting a lot more potassium, magnesium, and calcium. These minerals have been found to be effective for lowering your blood pressure.13
Second, controlling your carbs will stop the abnormal salt and water retention caused by your former high-carb way of eating—fluid retention that can raise blood pressure.You may assume this has something to do with the salt content of foods. Although in salt-sensitive people, salt in the diet does lead to fluid retention, by no means is everyone with high blood pressure salt sensitive. In Dr.Atkins’ experience, and according to some research, a high-carbohydrate diet and high insulin levels are more likely to cause fluid retention than salt does.14 We find that on the ABSCP, salt restriction is rarely needed. Some people may actually need some supplemental salt (a cup of bouillon will do the trick) to prevent nausea or weakness when they burn fat rapidly. When you control your carbs, your body soon self- regulates to a more normal salt and water balance. Others who have studied this type of dietary approach concur with this advice.15 Also, on the ABSCP, you will probably find that your taste buds become much more sensitive to the taste of salt (and to sugar). So, instead of salting your food before tasting it,let your newly sensitive taste buds be your guide.
EXERCISE AND BLOOD PRESSURE
Exercise is an integral part of the ABSCP and crucial for lowering blood pressure and blood sugar. In fact, a recent meta-analysis of 54 major studies on the value of exercise for high blood pressure showed without question that regular exercise can lower your systolic blood pressure by nearly 4 points and your diastolic pressure by nearly 3 points. Best of all, you get the benefit no matter how old you are, how much you weigh, or how high your blood pressure is.16 Understand that exercise alone will not fix all the problems caused by excessive carbohydrate intake. It must be done in concert with controlled-carb nutrition to get the full benefit. (See Chapters 22 and 23 for more information on the value of exercise.)
STRESS AND BLOOD PRESSURE
The word hypertension sounds as if it should have something to do with stress. It is true that any stressful situation will make your blood pressure go up. However, that rise is normally temporary. Blood pressure usually returns to normal when the situation is over,even if it takes days or weeks. Whenever you’re under stress, your body produces extra batches of the stress hormones, such as cortisol and epinephrine. These “fight-or-flight” hormones ready your body for action by raising your blood pressure, blood sugar, and heart rate; by making you more alert; and by stimulating your body to draw energy from stored fat and muscle.These hormones raise your blood sugar—so that there will be plenty of glucose available for immediate energy needs during the crisis. The aftermath of this hormonal outpouring? Carbohydrate cravings. Ever found yourself finishing off a giant bag of chips when you’re on a deadline for work or school?17, 18
Under normal circumstances, when the crisis is over, a complex series of feedback loops tells your body to turn off the stress hormones. But when stress is continual—as it often is in modern life—the stress switch gets stuck in the “on”position.When hormone levels remain elevated,the body is in a state of chronic biochemical stress,resulting in insulin resistance,increased hunger,cravings for carbohydrates and other comfort foods, elevated blood pressure, and weight gain. This stress- related weight gain, which usually ends up around your waist, is linked with the metabolic syndrome.19, 20
The solution? Find healthy ways to cope with stress.They include:
- Stabilize your insulin/blood sugar metabolism by implementing the ABSCP.
- Start or step up your exercise regimen,according to the guidelines in Chapters 22 and 23.
- Establish a regular schedule for eating, exercising, and sleeping.
- Implement relaxation techniques such as meditation and yoga.
- Reach out to friends and family for support.
- Avoid sleep deprivation. When you’re short on sleep, you produce more stress hormones; getting more sleep can help flip off the switch.21, 22
DRAWBACKS OF DRUGS
Current guidelines recommend starting drug treatment for people with diabetes as soon as their blood pressure reaches the prehypertension level of 130/90.23 If a patient’s systolic blood pressure is in the 130–139 range,or diastolic blood pressure is in the 80–89 range,and if after a maximum of three months lifestyle changes have not improved the blood pressure, then medication(s) should be prescribed. This usually means taking two and sometimes three different drugs in combination. (For a list of pharmaceuticals used for hypertension, as well as other conditions, see pages 94–96.)
While drugs for hypertension are effective, they often have unpleasant side effects, such as dry cough, fatigue, and erectile dysfunction. They can also cause orthostatic hypotension—blood pressure that’s too low when you’re standing up—in people with diabetes. That’s bad enough, but if you have blood sugar abnormalities, some blood pressure drugs, particularly beta-blockers (Inderal, Lopressor, Corgard), as well as thiazide diuretics (drugs that make you urinate more), could raise your blood sugar even more and tip you over into diabetes.24, 25 The combination of a beta-blocker and a thiazide diuretic can make you six times more likely to become diabetic. There’s also some evidence suggesting that for people with blood sugar problems, treating hypertension with a thiazide diuretic alone or with a combination of a beta-blocker and a thiazide diuretic may actually increase the risk of having a heart attack.26, 27
We have seen all too many patients who have ended up in worse health as a result of taking drugs for high blood pressure. In the case of Allison C., for instance, her doctor failed to realize that her high blood pressure was a sign of the metabolic syndrome. He didn’t investigate any further, which means he never discovered that Allison already had high blood sugar.Instead,he treated her high blood pressure as an isolated problem and prescribed a thiazide diuretic. Sure enough, the drug raised her blood sugar to the point that she became diabetic. When she came to Dr. Atkins, he put her on the ABSCP and stopped her medications. Her blood pressure came down right along with her blood sugar.
All of that said,there is a place for blood pressure medication.Lowering your blood pressure the natural way through weight loss, exercise, and other lifestyle changes takes time. The risks of uncontrolled high blood pressure are serious. While you should avoid some antihypertensive drugs if you have high blood sugar, others such as ACE inhibitors, calcium channel blockers, and angiotensin receptor blockers (ARBs) don’t negatively impact blood sugar and may be safe for you. Discuss the use of hypertension medications with your doctor and weigh the pros and cons carefully.Remember that your doctor is probably following recommended guidelines that advise beginning treatment with thiazide diuretics.
DRUGS FOR HYPERTENSION
Doctors now have a truly impressive array of pharmaceuticals from which to choose when it comes to treating high blood pressure. Here’s a rundown of the current arsenal. (Note: Every time you combine two drugs,as is often the case when treating hypertension,you increase the risk of side effects and adverse reactions; when you combine even more drugs, the odds of a negative interaction go up considerably.)
Diuretics
The first drug most hypertension patients are prescribed is a diuretic—a drug that makes you excrete more water and salt. Why do these drugs help? If you are eating a high-carb diet, high insulin levels can make you retain both salt and water,which raises your blood pressure.28 Diuretics reverse this, but of course they don’t solve the underlying condition that is causing your hypertension. Diuretics fall into three categories:
- Thiazides. One of the most commonly used drugs, especially when first beginning drug treatment of hypertension, thiazides cause a moderate amount of water, salt, and mineral loss. These drugs can worsen glucose metabolism to the point of causing Type 2 diabetes and/or gout.
- Loop diuretics. Loop diuretics cause greater salt and water loss than thiazides—so much so that these drugs are usually given with a potassium supplement and may cause severe dehydration.
- Spironolactone. This commonly used diuretic is potassium- sparing—you retain more potassium in your body instead of excreting it, which helps prevent dangerous electrolyte imbalance. It must be used cautiously in combination with other drugs to avoid excessive potassium retention.
Beta-Blockers
Another group of medications commonly used to treat high blood pressure are the beta-blockers. These drugs work by blocking a receptor that regulates your heart rate and blood vessel tightness.This keeps your heart from speeding up and relaxes the blood vessels, but there’s a major downside: The very same receptor that’s found in the cells of your heart and blood vessels is also present in fat cells.29 Beta-blockers block your body’s ability to move stored fat out of fat cells. For many patients, this results in weight gain, which only worsens high blood pressure. If you take insulin, you could be at risk for life-threatening problems from beta-blockers, because they prevent your body’s normal response to low blood sugar. The combination of insulin and a beta-blocker can cause dangerously low blood sugar that is very difficult to raise.30–32
Calcium Channel Blockers
Calcium channel blockers (amlodipine, bepridil, and others) are also used to treat hypertension. These drugs relax your blood vessels, but when used alone they may not bring your blood pressure down enough. Constipation is a major side effect.
ACE Inhibitors
Angiotensin-converting enzyme inhibitors (ACE inhibitors) are popular among patients with diabetes because they don’t have any effect on insulin, blood sugar, or weight, and because they have been shown to slow the progression of kidney damage. However, these drugs often cause a persistent dry cough, which means some patients with asthma and other respiratory problems can’t take them.
Angiotensin Receptor Blockers
Closely related to ACE inhibitors is a newer group of drugs called angiotensin receptor blockers, or ARBs. People who can’t take ACE inhibitors can usually take ARBs. Like the ACE inhibitors, ARBs help protect the kidneys in patients with diabetes.If you take either of these types of drugs, you need to have your kidney function monitored regularly, because they can impair kidney function in people with decreased blood flow to the kidneys.33, 34
Before Dr.Atkins even considered prescribing powerful pharmaceuticals,he would ask his patients to follow the ABSCP until he could evaluate their response. The dietary changes alone are often enough to bring blood pressure down significantly. But multivitamin and mineral supplements and exercise are major parts of the program as well, and these, too, play a crucial role in lowering blood pressure. For patients who require more help to bring down their blood pressure, Dr. Atkins would prescribe additional supplements,targeted to their individual needs.
He found that people with high blood pressure usually respond well to a combination of several different supplements, including magnesium, the amino acid taurine, essential fatty acids, and coenzyme Q10.(We’ll discuss these supplements and others for heart health in Chapter 21.)
When a patient’s blood pressure was only mildly elevated or if it had responded well to a controlled-carb approach and exercise, Dr. Atkins would use lower supplement doses.Of course,if a patient’s blood pressure was so high that he or she was already taking drugs,or that it posed an immediate risk, he used medications and larger supplement doses until the ABSCP had taken effect. In many cases, his patients found their blood pressure came down to normal or near normal levels within a few months, if not sooner. For those patients who still needed medication for hypertension, he was able to keep the doses to a minimum and was often able to get them down to just one drug.
Remember, if you’re already taking blood pressure drugs and start following the Atkins approach, you’ll probably need to lower your dosages as the benefits of controlling carbohydrates kick in. Establish in advance with your doctor a plan about which medications to taper as your blood pressure improves.
Jeff T., a university professor, had severe metabolic syndrome and hyper- tension. He took three drugs daily for hypertension alone. He decided to begin the Atkins Nutritional Approach, but because of his demanding schedule, he didn’t wait to come in for an appointment and medication plan. After three days of doing Atkins on his own, he was forced to discontinue all his medications. Unfortunately, this required a hospital stay because his blood pressure dropped so low. He laughed and told me, “Well, Doc, it really works!” It does work but this is a good example of why it is so important to work closely with your doctor to plan a strategy in advance, so medications can be safely tapered. —MARY VERNON
As your blood pressure improves, so will your heart health—but there’s more to improving your cardiac health than blood pressure alone. That’s what we’ll discuss in the next chapter.
WHAT’S YOUR BLOOD PRESSURE IQ?
1. Systolic pressure is the pressure:
- when your heart beats
- when your heart relaxes between beats
- when your heart stops
2. Normal blood pressure is less than 120/80.What are the readings for the stages of hypertension?
- prehypertension
- stage 1 hypertension
- stage 2 hypertension
3. The main symptom of prehypertension is:
- headache
- dizziness
- tiredness
- nausea
- none
4. High blood pressure increases your risk of:
- heart disease
- stroke
- kidney disease
- eye disease
- all of the above
Answers stage 2 hypertension is 160/100 and higher.3.e.4.e. 140/90 to 159/99; stage 1 hypertension is prehypertension is 120/80 to 139/89; 2.1. a.
A SPARKLING ACHIEVEMENT
Barbara Woodruff had the metabolic syndrome, but despite taking several medications for hypertension, she was not able to control her blood pressure. Now that she has dropped 70 pounds, significantly lowered her blood pressure, and felt her energy skyrocket, she can pursue her hobby as a fireworks technician.
People look at me and think I’m just a little gray-haired grandmother who does needlework and has semiretired to Florida. Little do they know that at 62, I am so filled with energy because of my adherence to the Atkins Nutritional Approach that I spend much of my free time shooting off fireworks!
Yes, you read that right. I’m a pyrotechnics expert. I shoot off fireworks both by computers and by hand. I even choreograph shows to music. It’s a hobby I simply love. I wouldn’t be able to do it if it hadn’t been for Dr. Atkins. I adopted the Atkins lifestyle on April 1, 2001, and lost 70 pounds in less than one year. That was great, but even better was that Isignificantly lowered my blood pressure while my energy level skyrocketed. I was working once on a fireworks job with a 23-year-old guy and literally wore him out. He quit at the end of the day!
BEFORE AFTER
NAME: Barbara Woodruff
AGE:62
HEIGHT:5 feet 1½ inches
WEIGHT BEFORE:
216 pounds
WEIGHT AFTER:
145 pounds
If I had not gotten control of my blood pressure (today I take only one blood pressure medication, instead of three), I would not be allowed near the fireworks. If I had a heart attack or a stroke out on the field (the area where fireworks are shot off), who knows what could happen? No one would be able to help me because even firefighters can’t be within a certain boundary around the fireworks.
In my “real job,” I work at Disney World. It’s work that requires me to be on my feet for most of the day, and I would not have had the stamina to keep up if it wasn’t for my Atkins lifestyle. I’m trying to get on the Disney World pyrotechnics team (my dream job), but for now I am working in the shops on Main Street. One of them is the fudge shop. People always ask me, “Don’t you want to eat everything?” I can honestly say, “No, I don’t.” Doing Atkins has permanently taken away my sugar cravings. If a slight urge for something sweet trickles in, I eat an Atkins Endulge bar and that takes care of it.
I can always tell when I’ve slipped up a bit and had too many carbohydrates, usually around the holidays. When I eat something high-carb, my heart starts racing and my face gets flushed.When I’ve gone up to 150 pounds from my normal weight of 145, I can tell because I start huffing and puffing as I walk through the tunnels underneath Disney, which are used by employees to get around quickly. Then I go right back to Induction and in a week, the weight is gone and I feel great again.
As with many women, my weight problem started after I had children. The pounds crept on after each pregnancy. At age 42, I became a single parent, and the stress resulted in my putting on even more weight. Then I had a hysterectomy, began hormone replacement therapy, and ballooned up 20 pounds almost overnight. A few years later, I developed high blood pressure.
When I reached 216 pounds, I said, “That’s it.” In the early 1990s, I had tried doing Atkins and lost 15 pounds. But it was hard to stay on it with people pestering me that it defied the government recommendations in the form of the food guide pyramid. Also, it was difficult to know which foods were high in carbohydrate, because the labeling on products was quite poor back then.
This time around, no one, not even my doctor, was going to stop me. I lost about 12 pounds during the first week. About eight weeks later, I had my blood pressure checked and it had already dropped. By January 1, 2002, I had lost 70 pounds and felt terrific. Now, my blood pressure has gone from 160/90 to 145/85.
It’s so easy to maintain this lifestyle today because there are so many delicious low-carb products in stores. Even restaurants are making it easy by offering low-carb meals. I work out along with a daily exercise program on local television.
I recently studied for, and got, a Florida commercial driver’s license, as well as certification to haul hazardous materials. I love driving an 18- wheeler! I’ve also taken up counted cross-stitching as a hobby. I guess the latter is a more typical “grandmotherly” activity. I bet you’ve never met someone whose grandchildren watch a fireworks show and can say, “My Nana did that!” I’m thrilled to say that mine can.
Note: Your individual results may vary from those reported here. As stated previously, Atkins recommends initial laboratory evaluation and subsequent follow-up in conjunction with your health care provider.