Hypertension: How does high blood pressure influence the healthspan and lifespan?

Highlights:

• Hypertension is a condition affecting over 1.2 billion people worldwide
• Hypertension management guidelines stage the disease by adopting one of two approaches. The first is defining the threshold for treatment, while the second is identifying the blood pressure above which health events risk increases
• Hypertension is a disease of old age, but when developed earlier in life, it negatively influences longevity
• Diet, exercise, smoking, stress, and obesity are among the factors that modulate the risk of developing hypertension

‍

Introduction

Hypertension (HTN), or elevated blood pressure, is one of the leading causes of premature death worldwide, dubbed as the silent killer. Blood pressure is determined based on the values of systolic blood pressure (SBP) and diastolic blood pressure (DBP). According to the World Health Organization (WHO), about 1.28 billion individuals aged 30-79 years worldwide have HTN, with almost one in 2 unaware of it. Of those who are aware and receive treatment, only one in 5 has HTN under control. In the US, nearly one in every two adults has HTN or takes medications for the condition.

‍

‍

Hypertension staging

International guidelines continuously update HTN treatment algorithms to ensure maximized patient benefit and to remain updated with newly introduced treatments and medications. In addition to discussing treatments, guidelines usually classify hypertension to better understand and manage the condition (1). In this context, guidelines define HTN stages by adopting one of two approaches, either defining a threshold for treatment or identifying the blood pressure above which events risk increases.

The US guidelines define HTN based on the association between blood pressure elevation and the risk of developing cardiovascular diseases (1). In this regard, the American College of Cardiology defines blood pressure under four categories, including (2):

Other guidelines, like the UK, European, and Canadian guidelines, adopt a cut-off point of blood pressure above which treatment benefits exceed the harms associated with it, as observed in interventional clinical trials (1). As such, this approach defines HTN cut-off point at 140/90 mmHg using standard measurement techniques. To differentiate between both sets of guidelines, the US one only identifies two stages and does not distinguish risks at levels above 140 mmHg, which is not the case with the other abovementioned guidelines.

‍

Hypertension, aging, and longevity: Establishing a connection

Aging is a continuous progressive process driven by decreased physiological functioning of various organs and systems. These changes cause an increase in the risk of developing disease and subsequent morbidity and mortality (3). Studies indicate that compared to young adults between the ages of 25-44, older adults have a 100-fold higher mortality risk from a stroke or chronic lung disease, ~90-fold from cardiac conditions, pneumonia, and influenza, and > 40-fold from cancer. This means that under normal aging conditions, HTN risk increases in old age. However, uncontrolled HTN shortens longevity and increases all-cause and cardiovascular disease-specific mortality risk, regardless of gender, age group, or race (4). The latter findings were based on a large US-based study that included about 14,000 subjects that were followed for over 19 years.  

The research highlighted chronic, low-grade inflammation and increased oxidative stress as major contributors to vascular endothelial (cells lining blood vessels) dysfunction and vice versa, creating a vicious cycle (3). Moreover, aging and lifestyle have been shown to play a significant role in immunosenescence and redox dysregulation. The factors involved in the latter have been suggested to fuel oxidative stress and inflammation, affecting endothelial health and promoting the abovementioned vicious cycle (3).

It is essential to understand that oxidative stress and chronic low-grade inflammation are hallmarks of aging (5). When the effects of these factors, among others, are potentiated from a younger age, they accelerate the biological age. This process contributes to the faster development of age-related disorders like HTN. Therefore, preserving oxidative balance, maintaining homeostasis, and adequate stress response, among others, help negate the adverse effects of the mentioned aging hallmarks, earning these features the title "hallmarks of health” (6).

Other factors contributing to endothelial dysfunction include reduced nitric oxide (NO) bioavailability, which plays an important role in modulating vasoconstricting and vasodilating activities (7). Under normal circumstances, NO capacity decreases with aging. In the event  of oxidative stress, NO depletion is accelerated, resulting in adverse effects eventually leading to HTN and other related disorders (8, 9).

It is important to understand that the effects of HTN extend beyond blood vessels. The literature has indicated that HTN causes arterial stiffness (precursor to  coronary artery disease), affects the brain (could cause cognitive decline or dementia), influences muscles (can cause sarcopenia), and could precipitate osteoporosis (3). It is important to understand that HTN affects the entire body and organ systems.

‍

‍

The impact of diet on hypertension

Research has demonstrated that diet is one of the modalities that could modulate hypertension. In this context, the literature indicates that strategies to prevent hypertension in otherwise healthy individuals include (10):

• Reducing sodium intake: The American Heart Association (AHA) recommends consuming no more than 2,300 mg daily. The ideal limit would be no more than 1,500 mg per day for most adults (11). According to AHA, Americans, on average, consume >3,400 mg of sodium per day. One must be aware that different types of salt have varying  amounts of sodium.
• Limiting alcohol consumption: To prevent high blood pressure, the AHA recommends no more than one drink for females and no more than two for males per day (12). A drink is one 12 oz. beer, four oz. of wine, 1.5 oz. of 80-proof spirits, or one oz. of 100-proof spirits.
• Increasing potassium intake: The WHO recommends an intake of 90 mmol/d (3510 mg/d) for healthy adults (13).

In addition to the above, specific diets have been shown to reduce the risk of HTN significantly. Examples include the DASH (Dietary Approaches to Stop Hypertension) diet or the Mediterranean diet (10). The DASH diet emphasizes consuming fruits, vegetables, and low-fat dairy products (10). In addition, it promotes the reduced intake of saturated and total fats. A typical intake of the DASH looks like the following (14):

‍

‍

You can read more about the DASH diet in an article dedicated to it (How Can the DASH Diet Improve longevity?).

The typical Mediterranean diet is characterized by a high intake of vegetables, legumes, fruits, nuts, grains, seafood, and olive oil (15). Research shows that the Mediterranean diet has been shown to improve blood lipids, reduce inflammatory biomarkers, improve endothelial functions, and have other beneficial effects. The typical intake of a Mediterranean diet consists of (16):

‍

‍

You can read more about the Mediterranean diet in the article dedicated just to it (Mediterranean diet can prevent cardiovascular diseases and type-2 diabetes). Other interesting articles discussing longevity aspects from dietary perspectives can be found here (Do you know the most popular diets that impact longevity?) and here (The 3 rules of the Okinawa diet for longevity).

‍

How can lifestyle influence hypertension?

There is substantial evidence from research that a sedentary lifestyle is among the leading causes of HTN. Physical inactivity drives HTN by altering the cardiac output and total peripheral vascular resistance (17). In addition, it leads to obesity which influences multiple components, like inflammatory biomarkers, contributing to HTN and other diseases. A recent meta-analysis of 14 studies found that a combination of diet and physical activity yields the most benefit and could even revert people in the prehypertensive stage to normal blood pressure (18). In some cases, exercise can be more result-oriented than drugs. To get more insights into this area/field, we suggest further reading of our articles; (How to Add Meaning to The Longevity Exercise Routine), (The effects of exercise on longevity), (Aerobic or resistance training, or both?), (Swimming: exercise with unique life-long benefits) provide an in-depth understanding of the benefits associated with physical activity.

Other lifestyle factors that have been found to influence HTN risk include mental stress, smoking, sleep deprivation, excessive caffeine consumption, and increased intake of drugs, like nonsteroidal anti-inflammatory medications, glucocorticoids, and sympathomimetics (19-22).

‍

‍

Tips to help your clients mitigate their risk of developing hypertension

To help your clients protect themselves from developing hypertension or controlling the disease for those who have it, here are some tips you could offer them.

• Explain to your clients what hypertension is, how frequent it is, and the factors that put a person at risk.
• Highlight to your clients that to prevent the disease, they need to implement several approaches at the same time. For example, fixing the diet while being sedentary might not be sufficient to prevent the disease.
• For healthy clients, recommend not to consume more than 2,300 mg per day. Mention to them that, ideally, they should not consume over 1,500 mg. However, further restrictions could also apply to certain groups, like HTN patients and those susceptible to the disease.
• Unless they have a health condition that interferes with potassium intake, recommend your clients to maintain sufficient intake by consuming food like dried fruits (raisins, apricots), beans, spinach, broccoli, bananas, avocado, and lentils. Also, it is important to avoid or limit alcohol intake.
• Encourage your clients to adopt a habit-based dietary technique that leads to healthy eating patterns, minimizing the risk of developing hypertension.
• Highlight the importance of maintaining an active lifestyle to reduce the risk of HTN.
• Encourage your clients to avoid smoking, as it contributes to HTN and other diseases.
• Mention the importance of having a sufficient amount of sleep, as its deprivation could contribute to cardiovascular diseases, including hypertension.
• Explain to your clients the importance of avoiding self-medicating with some pain relievers and remind them to seek a healthcare professional's advice before use.
• Mention to your clients that they need to limit their caffeine consumption, especially at night.
• Encourage your clients to engage in stress-relieving activities, like meditation, walking, and social engagement.
• Suggest your clients monitor their blood pressure using a sphygmomanometer and write down the results.

Summary

Hypertension is a silent killer because it can be asymptomatic and remain undetected for years. This condition influences and is influenced by other diseases, like kidney failure. Although a serious disease, its risk could be minimized by implementing certain lifestyle modifications. This means that for the overwhelming majority of people, preventing or controlling the disease is potentially possible. This leads to improved healthspans and lifespans for people.

‍

References

1. Gabb G. What is hypertension? Aust Prescr. 432020. p. 108-9.
2. Iqbal AM, Jamal SF. Essential hypertension. StatPearls [Internet]: StatPearls Publishing; 2022.
3. Buford TW. Hypertension and aging. Ageing Res Rev. 2016;26:96-111.
4. Zhou D, Xi B, Zhao M, Wang L, Veeranki SP. Uncontrolled hypertension increases risk of all-cause and cardiovascular disease mortality in US adults: the NHANES III Linked Mortality Study. Sci Rep. 2018;8(1):9418.
5. López-Otín C, Blasco MA, Partridge L, Serrano M, Kroemer G. The hallmarks of aging. Cell. 2013;153(6):1194-217.
6. López-Otín C, Kroemer G. Hallmarks of Health. Cell. 2021;184(1):33-63.
7. Sun HJ, Wu ZY, Nie XW, Bian JS. Role of Endothelial Dysfunction in Cardiovascular Diseases: The Link Between Inflammation and Hydrogen Sulfide. Front Pharmacol. 2019;10:1568.
8. Förstermann U, Xia N, Li H. Roles of Vascular Oxidative Stress and Nitric Oxide in the Pathogenesis of Atherosclerosis. Circulation Research. 2017;120(4):713-35.
9. Pourbagher-Shahri AM, Farkhondeh T, Talebi M, Kopustinskiene DM, Samarghandian S, Bernatoniene J. An Overview of NO Signaling Pathways in Aging. Molecules. 2021;26(15).
10. Bazzano LA, Green T, Harrison TN, Reynolds K. Dietary approaches to prevent hypertension. Curr Hypertens Rep. 2013;15(6):694-702.
11. How much sodium should I eat per day? Heart.org: American Heart Association; 2022 [updated 01-11-2021; cited 2022 07-10]. Available from: https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sodium/how-much-sodium-should-i-eat-per-day.
12. Limiting Alcohol to Manage High Blood Pressure Heart.org: American Heart Association; 2022 [updated Oct 31, 2016; cited 2022 07-10]. Available from: https://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure/limiting-alcohol-to-manage-high-blood-pressure.
13. Farapti F, Buanasita A, Atmaka DR, Setyaningtyas SW, Adriani M, Rejeki PS, et al. Potassium intake is associated with nutritional quality and actual diet cost: a study at formulating a low sodium high potassium (LSHP) healthy diet. J Nutr Sci. 2022;11:e11.
14. Challa HJ, Ameer MA, Uppaluri KR. DASH diet to stop hypertension. StatPearls [Internet]: StatPearls Publishing; 2021.
15. Schwingshackl L, Morze J, Hoffmann G. Mediterranean diet and health status: Active ingredients and pharmacological mechanisms. Br J Pharmacol. 2020;177(6):1241-57.
16. Rishor-Olney CR, Hinson MR. Mediterranean Diet. StatPearls [Internet]: StatPearls Publishing; 2022.
17. Park JH, Moon JH, Kim HJ, Kong MH, Oh YH. Sedentary Lifestyle: Overview of Updated Evidence of Potential Health Risks. Korean J Fam Med. 2020;41(6):365-73.
18. Krishnamoorthy Y, Nagarajan R, Murali S. Effectiveness of multiple combined lifestyle interventions in reducing blood pressure among patients with prehypertension and hypertension: a network meta-analysis. Journal of Public Health. 2022:fdac027.
19. Aronow WS. Lifestyle measures for treating hypertension. Arch Med Sci. 2017;13(5):1241-3.
20. Spruill TM. Chronic psychosocial stress and hypertension. Curr Hypertens Rep. 2010;12(1):10-6.
21. Jadhav SB, Jatti GM, Jadhav AS, Rajderkar SS, Naik JD, Nandimath VA. Stressing 'mental stress' in hypertension: a rural background study. J Clin Diagn Res. 2014;8(6):Jc04-7.
22. Wang Y, Mei H, Jiang YR, Sun WQ, Song YJ, Liu SJ, et al. Relationship between Duration of Sleep and Hypertension in Adults: A Meta-Analysis. J Clin Sleep Med. 2015;11(9):1047-56.

‍