prehypertension

[solfish]

I've on SS for ~2 months after a year or so of aimlessly dicking around at the gym:

Age: 29
HT: 5'8''
WT: 169

Squat (3x5)- 240
DL(1x5)- 295
BP(3x5)- 175
Press(3x5)- 115
PC(5x3)- 155

Not impressive, but it in order to keep up LP I've given up on accessories and cardio except for 10 miles/day of relaxed cycling. Had the yearly checkup last week and the BP measured 138/85. Not high enough for a statin scrip, but enough to get the diet&exercise speech. I've checked my BP myself over the past couple days and it doesn't appear to be just white coat syndrome. I smoked for 10 years and have a family history of heart disease. I think I know your opinion on saturated fat and cholesterol so I won't ask about that, but I do want to add some significant cardio and would like to do it without torpedoing my progress. I'm thinking of either dropping "The Original Novice Program" down to twice a week and adding 2 days/week of rowing and BB complex's or doing one big lift + cardio 4 times a week. Thoughts?

[Mark Rippetoe]

You're doing 10 miles/day of what you consider to be relaxed cycling? Every day? Perhaps you're overtrained a little. At 5'8" and 169, you're skinny. And why do you think more "cardio" will lower your blood pressure? And why is this critical at 29?

[jillingworth]

For what it's worth, I was diagnosed as hypertensive about 5 years ago. I don't remember the exact numbers off the top of my head, but my blood pressure would have powered a hydraulic jack. I could literally feel the pressure regularly. I started off with a diuretic, an ACE inhibitor, and a beta blocker a couple times a day. With diet change and kettlebells, I was able to get to the point that I was only using a beta blocker twice a day to control it. After starting LP (no kettlebells, no aerobic - just barbells), within a couple of months, I was able to go off all the pills provided that I also kept my salt and booze intake in check. I don't know if this is normal (in any sense of the term) but for me heavy lifting did wonders for blood pressure.

[solfish]

My understanding is that consistently elevating your heart rate via aerobic exercise will lead to a higher oxygen capacity and lower resting heart rate, which are both good things in terms of cardiopulmonary fitness. I take it your advice is to DTF and not worry about cardio until I have actual hypertension or a 3 plate squat?

[johnst_nhb]

Here is some food for thought:

Salt has nothing to do with high blood pressure except in a very, very small fraction of the population.

However, alcohol, weight and genetics do.

At 138/85 if you got the "talk", then you need a new doctor. Does your doc know that the general accepted norm for BP has risen a bit over the years anyway?

That being said, true high blood pressure really is worth getting under control. However, stay the hell away from statins unless you are [genetically] borderline near explosion.

[Carlos Daniel]

For what it's worth, I was diagnosed as hypertensive about 5 years ago. I don't remember the exact numbers off the top of my head, but my blood pressure would have powered a hydraulic jack. I could literally feel the pressure regularly. I started off with a diuretic, an ACE inhibitor, and a beta blocker a couple times a day. With diet change and kettlebells, I was able to get to the point that I was only using a beta blocker twice a day to control it. After starting LP (no kettlebells, no aerobic - just barbells), within a couple of months, I was able to go off all the pills provided that I also kept my salt and booze intake in check. I don't know if this is normal (in any sense of the term) but for me heavy lifting did wonders for blood pressure.

It's not normal because average hypertension joe doesn't start a quest to squat 300 lbs and beyond as a treatment for hypertension. Good to know you got better, hypertension is serious stuff.

[Subsistence]

I'm a pharmacy student from up in Canadia and I feel people are a little too lax here. I'd like to see the source on salt only being relevant in a very small portion of the population. Similarly I'd be interested in the source for the increased BP recommendations.

High blood pressure increases the strain on the heart. Even if you are only 29, making the heart work harder 24/7 is still not a good thing. Sure it won't kill you now, but you may grow to regret it down the road. Chronically high blood pressure can lead to heart failure amongst other things. Despite what some would have you believe, doctors don't just warn against these things do make the drug companies happy. I also think there is a little misunderstanding here as statins don't act to lower blood pressure, but to lower cholesterol. A first line therapy for blood pressure would likely be either a thiazide diuretic, a beta-blocker, an ace inhibitor, an arb inhibitor, a Ca-channel blocker, or more recently a renin blocker.

Aerobic exercise for 120-150min/week has been shown to decrease blood pressure by 4.9/3.7. A reduction of sodium intake of 1800mg/day has been shown to elicit a 5.1/2.7 drop in blood pressure. 1.1/0.9 can be expected per kg lost and 3.9/2.4 when cutting out 3.6 alcoholic drinks/day. Lastly, in hypertensive patients the DASH diet of high fibre and complex carbs can cause an 11.4/5.5 drop in hypertensive patients. Reference: Padwal R et al. CMAJ SEPT.27,2005; 173 (7) 749-751.

If you look at those recommendations you can see that you can cause a bigger response than pharmacotherapy often can. I would look at the above factors and made a judgement call. You may want to try to keep the cardio light (brisk walking level) while watching your salt intake, diet, and alcohol, while continuing your linear progression. Brisk walking shouldn't bite into your recovery too badly, and when squats get hard they WILL really get your heart pounding. I'd also be cautious with the weight gain. While you are not very heavy for your height, packing on a bunch of weight is something I would see as contraindicated in a prehypertensive patient. My suggestion would be to control your blood pressure first, then see how it responds to a weight gain- especially if you are hoping to avoid medications. That said, a lot of blood pressure medications aren't particularly unpleasant, but I generally do recommend them as a last resort. If you start them now I wouldn't be shocked to see you on them for life, and you are pretty young for that.

Also, fish oils have shown to be of some use in managing hypertension. Natural standard, an evidence-based resource for natural health products, gives it grade A evidence for helping in hypertension and states:

"Multiple human trials have reported small reductions in blood pressure with intake of omega-3 fatty acids. DHA may have greater benefits than EPA. However, high daily intakes of omega-3 fatty acids may be necessary to obtain clinically relevant effects, and at high dose levels, there is an increased risk of bleeding. Therefore, a qualified healthcare provider should be consulted prior to starting treatment with supplements."

The doses usually used at 3-4g/day. 3g/day is generally considered safe. Note that is 3g combined EPA+DHA, so it will be around 10 1g capsules (with 300g combined EPA+DHA in each).

[grubinski]

My BP was 140/90 for years ... and then I saw 155/95 a few times. I used to think it was the caffeine in my coffee, which I drank all day with 3 teaspoons of sugar in each cup. When I went on a Paleo-ish diet, and cut the sugar basically to zero (coffee black now), my BP came right down to 120/80 or lower and has stayed there.

Just an n=1 data point. For me it was all the sugar.

[Carlos Daniel]

Here is some food for thought:

Salt has nothing to do with high blood pressure except in a very, very small fraction of the population.

However, alcohol, weight and genetics do.

At 138/85 if you got the "talk", then you need a new doctor. Does your doc know that the general accepted norm for BP has risen a bit over the years anyway?

That being said, true high blood pressure really is worth getting under control. However, stay the hell away from statins unless you are [genetically] borderline near explosion.

Allow me to be dickish: do you have medical training, or at least training in another healthcare profession? if not, why do you think you're allowed an opinion (a valid opinion, anyone can have silly opinions) in a subject that requires medical training?

[stef]

I'm a pharmacy student from up in Canadia and I feel people are a little too lax here. I'd like to see the source on salt only being relevant in a very small portion of the population. Similarly I'd be interested in the source for the increased BP recommendations.

This was pretty old news even when I was in undergrad, but you'll have to do the medline search on your own. Fortunately, you're already on line.

The lax attitude you see is because this isn't a panic type situation and this guy can easily test his own responses over time as he solidifies his training habits. His post indicates that he's made the single most important step for CVD risk correction -- stopping smoking -- but he has just started adapting to actually training. Dropping in a bunch of other changes all at the same time tends to be counterproductive for long term success and makes it impossible to distinguish which changes are the important ones (and we're assuming at this point that his short-term testing of blood pressure is indeed reflective of the real current state...I wouldn't go that far were it me, but would monitor longer before even considering changes). Why give up something lovely like salt if a couple more months of adaptation might already do the trick?

When I went on a Paleo-ish diet, and cut the sugar basically to zero (coffee black now), my BP came right down to 120/80 or lower and has stayed there

That's pretty common. Excessive carbs and nasty processed food are good things to ditch. (And in case you're wondering, I'd go there before my trusty little salt shaker, Sub.)

stef