Home >  Health News & Articles >  Dr. Bennett's Articles >  Hypertension Is Not Essential
Articles by Dr. Bennett
Hypertension Is Not Essential
Author: Cleaves M. Bennett MD FACP
Monday, January 07, 2008

"Most cases of high blood pressure are known as essential or primary hypertension. This means your doctors aren't sure what the exact cause of your high blood pressure is."
Source: The Mayo Clinic

"In many people with high blood pressure, a single specific cause is not known. This is called essential or primary high blood pressure. Research is ongoing to find the causes of essential high blood pressure."
Source: National Heart, Lung and Blood Institute of the National Institutes of Health

In 90 to 95 percent of high blood pressure cases, the American Heart Association says there's no identifiable cause. This type of high blood pressure, called essential hypertension or primary hypertension, tends to develop gradually over many years."
Source: The Mayo Clinic quoting the AHA.

"The exact causes of hypertension are not known." and "In as many as 95% of reported high blood pressure cases in the U.S., the underlying cause cannot be determined. This type of high blood pressure is called essential hypertension."
Source: WebMD

"Patients with arterial hypertension and no definable cause are said to have primary, essential, or idiopathic hypertension."
Source: Harrison's Textbook of Medicine.

"No single or specific cause is known for most cases of hypertension, and the condition is referred to as primary in preference to essential."
Source: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine

These statements (from 2006-2007) are very misleading and also very troubling. In such a technologically/scientifically advanced society as the USA, if we have a medical condition such as hypertension that affects 90+% of the population and we don't know what is causing it, well then we are in big trouble. But this is what all the young doctors are being taught!! Hypertension is "essential"! Everybody knows that Essential = Necessary! Hypertension is a necessary part of aging? And they are being taught that no one knows what causes it. Like it's God's will or something. We don't know what causes it - so take these pills.

But I beg to differ with these opinions. They certainly are not factual. My take on this? There is absolutely no question any longer that the pandemic of hypertension is related to the combined effects of multiple unhealthy lifestyle factors. (genes may influence when you get hypertension, not whether.) The multiple unhealthy lifestyle factors include:

A diet that is much higher in salt, some 5 to 10 times as much as our primitive ancestors, Paleolithic humans from 10,000 years ago. They had no access to salt for curing or seasoning. On a modern human diet, salt intake is in the range of 8 to 12 grams, This markedly increases our extra-cellular fluid volumes. We notice it when our ankles swell after standing or sitting too long. Cut your salt intake and you'll lose 5-10 lbs in a few days. Keep it low and your blood pressure will come down and you'll be able to start reducing your pills, starting with the diuretic (water) pills. For many people, reducing salt intake is the most important change they can make in order to "control high blood pressure without drugs."

A diet that is much lower in potassium, calcium and magnesium than our primitive ancestors, Paleolithic humans. These minerals all tend to lower high blood pressure.

A diet that is much higher in fat than our primitive ancestors. They hunted and fished for their meat. We go to the grocery store and buy meat that comes from livestock that have been fattened with grain in order to make the meat very tender and thus very, very unhealthy. Meat fat raises blood pressure.

A high fat diet and large doses of high fructose corn syrup and other sweeteners are fueling the pandemic of obesity, particularly in children. Obesity by itself tends to raise blood pressure, in part due to high levels of circulating adrenal hormones such as adrenalin and noradrenalin. (Being obese is very stressful.)

Modern human daily existence is a 1000 fold more complex and demanding than that of our primitive ancestors. The usual term we use for this is "stress". We have a lot of stress. Multitasking is the rule for most of us, and many of us are adrenalin "junkies".

Modern human daily existence is much less physically active than that of our primitive ancestors. Bikes, cars, buses, planes, trains and elevators make it possible for humans to avoid completely the stress reducing benefits of physical exertion.

Excessive intake of alcohol will elevate the blood pressure in virtually all people. Alcohol of course initially relaxes you, but as it wears off, the blood pressure usually rises. The most extreme example of this occurs after the sudden cessation of binge drinking which often results in life-threatening hypertension as part of the "DTs", or delirium tremens which follow.

Various drugs are known to elevate blood pressure (although by themselves without the other unhealthy lifestyle factors this may not lead to established hypertension). Motrin, Celebrex, Naproxen and similar pain meds (NSAIDs) will usually elevate blood pressure. Birth control pills may raise blood pressure, although not in all women. Obviously nasal decongestants (pills or spray) if used excessively can cause a problem as can the broncho-dilator drugs and sprays used for asthma.

Several cups of strong coffee and a cigarette or two will raise your blood pressure and keep it up for hours.

The combination of these diet and lifestyle factors is contributing to the development of hypertension (>140/90) in 90% of Americans before they die. If you add in all the "pre-hypertensives" (120/80 to 140/90), pretty close to 100% of us get higher than optimum blood pressures before we die. The problem is appearing in teens and even pre-teens.

A popular theory recently advanced by Barry Brenner at Harvard suggests that low birth weight and resulting smaller kidneys is an important cause of essential hypertension. The problems with this theory: 1) 90% of people eventually become hypertensive and 2) adults who donate a kidney do not become hypertensive any more commonly than normals.

Last word: "Although the specific mechanisms for most hypertension remain unknown, it is highly likely that the process could be slowed, if not prevented, by the prevention of obesity, moderate reduction in sodium intake, higher levels of physical activity, and avoidance of excessive alcohol consumption. Since hypertension will eventually develop in most people during their life-time the need for much more widespread adoption of these potentially effective and totally safe preventive measures is obvious." Norman Kaplan MD*

Cleaves M. Bennett MD FACP
Clinical Professor of Medicine Emeritus
UCLA Harbor General Hospital
Torrance, CA

*Norm Kaplan is known as "Mr. Hypertension" because his own book, Kaplan's Clinical Hypertension, now in its 9th edition, is the bible for most students, interns and resident doctors in training. There is no one on this planet who knows more about hypertension, its causes and treatment. He more than any other expert has written about lifestyle and diet optimization as preferred treatment (over multiple pills) for this increasingly common complication of aging in America and most of the rest of the developed and developing world.

Additonal Articles
The Polypill
Author: Cleaves M. Bennett MD FACP
Category: Health News & Articles
Listen. I'm not advocating closing down all the drugstores don't get me wrong. I'm just saying that we all, consumers and physicians and pharmacists need to use drugs more judiciously and especially less frequently if eating and living more healthfully will do the job. Read More
The Kiddie Cholesterol Debate
Author: Cleaves M. Bennett MD FACP
Category: Health News & Articles
Making decisions about your health is never easy, and things get even harder when the choices involve children. That's why the latest recommendation from the American Academy of Pediatrics (AAP) to widen cholesterol-testing to include kids as young as 2 is shaking up doctors and parents alike. The academy is also urging doctors to consider treating young patients from families with a history of abnormally high cholesterol levels — a major contributor to heart disease — with medications known as statins. Read More