Lifestyle factors in high blood pressure
In my previous life as an acute care Internal Medicine physician, I saw many cases of uncontrolled hypertension or “high blood pressure” admitted to the hospital. After taking a careful history, many of these episodes had clear explanations. Identifying the trigger often made the difference between that person requiring more blood pressure medication, versus addressing the underlying problem. If you have high blood pressure, these are questions you should ask yourself. Many people don’t realize that they are doing something to cause or worsen their high blood pressure.
Life Events and Lifestyle
What have you been eating?
Salt and sugar can raise blood pressure.
Salt
It is well known that salt intake (sodium chloride) correlates with blood pressure levels in population-based research studies.[1] When salt intake is reduced, blood pressure generally improves, so sodium restriction is a fundamental part of lifestyle recommendations for high blood pressure.[2]
Bottom line: Acutely high salt intake (like at a social event – think salted fish, cold cuts, chips) is a common trigger for uncontrolled hypertension leading to hospital admission. A high salt diet, when eaten regularly, leads to higher blood pressure in susceptible people. Salt could have a blood pressure increasing effect on you too.
Sugar
A diet high in sugars and simple carbohydrates can often nudge someone down the road to prediabetes or diabetes. The elevated blood glucose seen in diabetes contributes to further increasing blood pressure in several ways, including impaired blood vessel wall relaxation and kidney damage.
What have you been drinking?
Regular alcohol use raises blood pressure.
Alcohol
If you want to lower or reverse your high blood pressure and you drink alcohol daily, this could be the reason.
Once big caveat: If you believe that you have a problem with alcohol and stopping has been difficult (you have gotten shaky, sweaty or developed a fast heartbeat in the past after not drinking for example), I strongly suggest you speak with your health care practitioner or an addiction medicine professional for assistance – abrupt cessation of alcohol use can trigger seizures and an alcohol withdrawal syndrome. With proper medical supervision and alcohol detox, this is prevented.
Caffeine
Heavy caffeine use (coffee or energy drinks) can also raise blood pressure.
How’s your sleep?
If you snore or have been told that you stop breathing during sleep, consider obstructive sleep apnea as a possible cause and talk with your doctor about getting tested.
Do you smoke or use nicotine products?
Smoking cigarettes and using other sources of nicotine such as chewing tobacco, raises heart rate and can raise blood pressure.
Medications
Over the counter pain relievers
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin/Advil) and naproxen (Aleve) are notorious for doing this. This is a super common scenario in Internal Medicine practices. The typical story goes like this: a patient has a musculoskeletal injury or other reason to start taking a daily NSAID pain reliever. After a few weeks, he/she develops high blood pressure. This is very easy to fix by stopping the medication, as blood pressure generally normalizes within a few days of stopping an NSAID provided there has not been a kidney injury. If pain relief is still needed, acetaminophen (Tylenol) can be substituted in most people and does not have a blood pressure raising effect.[3]
Steroids
- Oral steroids such as prednisone and methylprednisolone have the strongest blood pressure raising effect of all the steroid delivery methods. The longer you take the medication, the more of an effect you will see.
- Nasal steroids such as Flovent or Flonase, or inhaled steroids given for asthma such as beclomethasone or budesonide can also raise blood pressure when used chronically and at high doses.
- Even topical steroids, when used in very high potencies can raise blood pressure, albeit rarely. Since people apply these ointments to the skin, they often forget to list them on a medication list. The doctor managing your high blood pressure may not know that you were given one of these medications from a dermatologist, so it is important to tell them. Examples of high potency topical steroids include clobetasol propionate (Temovate), halobetasol propionate (Ultravate) and diflorasone diacetate (Psorcon).
Unlike the short-lived blood pressure raising effect of NSAIDS, the steroid induced blood pressure effects can often linger for weeks after stopping the drug, sometimes longer depending on how long the drug was taken. If you find yourself in this situation, be patient and ensure that you have medical follow up to check for any new onset prediabetes, diabetes or unresolving high blood pressure.
Other miscellaneous medications
- Hormone Replacement Therapies
- Testosterone, estrogen and other forms of hormone replacement including oral contraceptives.
- Nasal Decongestants and Bronchodilators
- Allergy medications such as pseudoephedrine (Sudafed) commonly causes rapid heart rate and elevated blood pressure.
- Asthma Inhalers (Beta-2 agonists known as bronchodilators) such as albuterol, salmeterol and salbutamol.
- Various Psychiatric Medications
- Stimulant ADD medications including:
– Adderal, Ritalin and Concerta.
– Some antipsychotics such as Abilify and Clozapine.
– Some antidepressants including Effexor and Wellbutrin.
Dietary Supplements
Many dietary supplements are helpful in supporting blood pressure lowering, but the list of blood pressure raising supplements is quite short. The common ones include:
Licorice
Licorice is the most commonly used supplement in my practice with blood pressure raising effects. Used as an adrenal adaptogen to help people adapt to chronic stress, the blood pressure effects are welcome because these people will often have low blood pressures to begin with. If I start someone on a licorice containing adrenal support protocol who has had elevated blood pressure readings in the past, I will always arrange for more frequent blood pressure checks (in office and at home) to be sure they are tolerating the supplement. Licorice can also come as tea and is often found mixed into teas that are “stress relieving.” I even found two of these teas in my office.
Other miscellaneous supplements to avoid if you have high blood pressure include:
- Stimulant supplements such as Ephedra and Guarana, often found in weight loss products.
- Asian (Panax) Ginseng.
- Vitamin D, in an overdose, can cause high blood pressure – aka “hypervitaminosis D.” This is rare.
Take home message
If you have high blood pressure, especially if you already take blood pressure lowering medications, it is important to know that certain lifestyle habits, salt, sugar, certain medications and some dietary supplements can cause your blood pressure to further increase. Be sure to carefully review the product labels of all dietary supplements you take, teas you drink, and especially “powders” from the health food store (think green powders and electrolytes – they can have high sodium content).
Sharon Goldberg is a Santa Fe based Integrative and Functional Medicine Physician who specializes in personalized preventive and wellness focused patient care. She is Board Certified in Internal Medicine since 2000 and has advanced training in Tropical Medicine and Hygiene. She has over two decades of practice experience working with both complex chronic illness and disease prevention. She is a medical educator, peer reviewer and coauthor of integrative and prevention related clinical research.
To schedule an appointment with Dr. Goldberg click here.
References and Endnotes
[1] Institute of Medicine Committee on Strategies to Reduce Sodium Intake. “The national academies collection: reports funded by national institutes of health.” Dietary reference intakes for calcium and vitamin D (2011).
[2] Eckel, Robert H., et al. “2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.” Circulation 129.25_suppl_2 (2014): S76-S99.
[3] Tylenol needs to be used cautiously in anyone with liver cirrhosis and at much lower doses if at all because of the increased risk of liver toxicity from the medication. If you have cirrhosis, discuss this with your doctor before taking acetaminophen. In healthy adults without liver issues, the maximum dose of acetaminophen should never be exceeded (i.e., never take more than 4000mg in a 24-hour period).
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