Diastolic Blood Pressure --- Much Ado
About Nothing?
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June 26, 2015

By Susan Callahan, Health Editor and Featured Columnist

[Health and fitness articles are reviewed by our team of Registered
Nurses, Certified fitness trainers and other members of our Editorial
Board.]





While you have been diligently watching your diet and
exercising to lower your blood pressure, a debate in the
scientific community has been raging on.  That debate, on
the importance of diastolic blood pressure --the bottom
number of your blood pressure reading --started several
decades ago and shows no signs of letting up.

What is Diastolic Blood Pressure?

Diastolic blood pressure measures the blood pressure when
your heart is at rest between beats. Systolic blood pressure
measures the pressure levels in your blood vessels when
your heart beats.

The American Heart Association recommends a target of
120/80. Your systolic blood pressure should not exceed
120 and your diastolic blood pressure should not exceed
80. If either your top or your bottom number exceeds its
target, you are considered "pre-hypertensive", meaning
you are at risk for developing high blood pressure. If your
blood pressure exceeds 140/90, you officially have high
blood pressure.


The CDC  concurs with the American Heart Association,
giving the following guideline for Blood Pressure Levels:

Normal:                                                 <120/<80
At risk (prehypertension):                    120-139/80-89
High:                                                      >140/>90


First things first. No one is questioning that blood pressure
matters. It matters a great deal. High blood pressure, over
time, thickens your heart muscle and puts you at increased
risk for heart attack, chronic heart disease, stroke and early
death.


The risk for hypertension-related stroke is particularly
acute. The American Heart Association estimates that every
40 seconds, someone in the US has a stroke and every 4
minutes, someone dies from stroke. According to the
American Stroke Association, more than 75% of people
who have strokes have high blood pressure.


So, no one is questioning that diastolic blood pressure also
matters. It matters plenty. But
how much it matters  
depends on your age.


The Magic Number is 50


























In 2011, an important study was conducted by the
Department of Veteran Affairs, Center for Chronic Disease
Outcomes Research in Minnesota. That landmark study, led
by Dr. Brett Taylor and Dr. Timothy Wilt, discovered that
"normal blood pressure" is a more complicated and
nuanced concept than anyone previously suspected.

Looking at data on 13,792 adults, the researchers plotted a
graph of blood pressure readings versus causes of death.
The data was adjusted for age, sex, smoking status, body
mass index (BMI), cholesterol, education and income.

What they discovered was that up to age 50, your diastolic
blood pressure is the most important predictor of your risk
for dying.

But after age 50, the situation is reversed. Mortality
increases in a stepwise fashion with every increase in
systolic blood pressure above 140.


As the study observed: "For individuals over age 50, the
mortality rate began to significantly increase at a [systolic
blood pressure greater than or equal to 140], independent
of DBP [diastolic blood pressure]."


The VA Minnesota study looked at death from all causes.
But other studies have looked at how your diastolic blood
pressure changes your risk for death from specific causes,
such as coronary heart disease.

For example, in 1985 a study led by Dr. Michael J.
Lichtenstein and Dr. M.J. Shipley of the University of Texas
Health Science Center at San Antonio, looked at 18,403
male civil servants, aged 40 to 64.

They discovered that men with systolic blood pressure in
the highest 20% of the participants had 5% more deaths
from coronary events than men with diastolic blood
pressure in the top 20%. Again, the researchers concluded
that "clinicians should pay more attention to systolic levels
as a criterion for making diagnostic and therapeutic
decisions".

What should we take from all this? Should you disregard
your diastolic blood pressure number if you are over 50?
Certainly not. Your diastolic number still matters as a guide
for how hard your heart is working. You should still watch
that number and, if it is above 80,  make lifestyle changes
to bring it down.


What can you do? Here are the Top 5 changes you should
make, based on medical studies:


1.
Keep Your Salt Levels Very Low

Salt and blood pressure are powerfully connected.
Scientists led by Dr. W.J. Oliver of the University of
Michigan had a unique opportunity to test this hypothesis
when they encountered a remote tribe of Brazilian
Yanomano Indians in 1967.  Before that first contact in, the
Yanomano had not been contacted by outsiders since the
beginning of civilization.  

What made the study important is that the Yanomano are a
"no salt" culture.  Literally, the diet of the Yanomano did
not include added salt.  Their diet consisted of cooked
banana, musa paradisica, and occasional fish, insects and
wild vegetables.

Taking the blood pressure readings of young and old
Yanamano revealed shockingly low numbers.  Young
Yanomano under the age of 9 had average blood pressure
readings of 93.2/58.6.  Fair enough --they are young after
all. But the readings of the Yanamano men over age 50
averaged 100/63.7!  And the women over age 50 averaged
105.7/64.

So the answer to the question of "how low can you go"
when it comes to salt in your diet is "Yanomano low".

Or is it? As with many recommendations, this one is subject
to debate. The current recommendation of the American
Heart Association is that Americans should consume no
more than 1500 mg of salt per day, about half a teaspoon.

That's lower than the recommendation of the Institute of
Medicine which stated in a 2013 report that it finds no
medical benefit to reducing daily sodium intakes below
2300 mg per day.

Either way, these recommendations are far lower than
3500 mg of salt the average American eats daily.

To start to climb down the salt levels in your diet, start with
eliminating ordinary table salt. You should also monitor
your intake of processed meat or fish (that includes so-
called "healthy" proteins such as smoked salmon) and
instead opt for whole, cooked proteins. Bake or grill your
whole meats. Processed meats include sausages, bacon,
luncheon meats such as bologna, hot dogs, pepperoni and
beef jerky.


Also avoid crunchy snacks --- Cheetos anyone? --- as these
are often laden with added salt.



2.
Practice Transcendental Meditation

Transcendental Meditation is a meditative technique for
releasing distracting thoughts in order to promote a state
of relaxation and awareness. The practice involves sitting
for 15-20 minutes with your eyes closed while repeating a
mantra. The mantra can be anything but experts suggest
that it be a word with no meaning to you, perhaps "om".

A 2008 study by Dr JW Anderson et al., at the University of
Kentucky found that practicing transcendental meditation
techniques decreased systolic blood pressure by 4.7 mmHg
and diastolic blood pressure by 3.2 mmHg. Incorporating
meditation has been to shown to lower stress and
depression and improve mental clarity, focus, and well-
being.

3.
Volunteer

A 2013 study by Dr. RS Sneed at Carnegie Mellon University
discovered an unexpected source of blood pressure
reduction. The researchers found that people who had
volunteered at least 200 hours over the last year were
40% less likely to develop high blood pressure. The
researchers noted that volunteering caused increases in
psychological well-being and physical activity, in addition to
socialization and perhaps a little bit of perspective:
“Volunteer activities provide opportunities to make healthy
social connections, and they can also give you perspective
about your problems. Yours might seem less disastrous.”

Volunteering may also have another benefit, which we
cover next.

3.
Increase Your Physical Activity

Increasing the amount you move around each day helps to
lower your blood pressure.

Being physically active and maintaining your physical
fitness helps to reduce your risk for high blood pressure by
32%, according to a mega-study conducted by a team of
doctors from Canada (lead researcher, Dr. Darren
Warburton of the University of British Columbia).


4.
Watch Your Weight

In a 1981 study from Stanford University School of
Medicine of 14,998 male Harvard graduates, scientists
discovered that Men who are 20% or more over their ideal
weight-for-height are at 78% greater risk for hypertension
than lighter men.  If you have gained more than 25 lbs (
11.5 kg) since age 18, you are at 60% greater risk for
developing high blood pressure.

5.
Follow the DASH Diet

A diet that emphasizes fruits, vegetables, low-fat dairy and
low levels of salt ( the "Dietary Approaches to Stpop
Hypertension" or "DASH" diet) has been linked to lower
blood pressure. The Nurses Health Study involves an on-
going evaluation of health risk factors and outcomes for
116,671 female registered nurses.

From this large pool, the health data from a sub-pool of
83,882 participants were selected for an examination of
how their diets affected their health by doctors at the
Brigham an Women's Hospital and Harvard Medical School
in 1991. The study, led by Dr. John Forman, found that
following a DASH diet, in combination with maintaining an
ideal body weight and staying physically active can lower
your risk for hypertension by 46%.


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