How to understand high blood pressure

By Dr Ross Walker

Hypertension, or high blood pressure, is a prevalent condition that can lead to serious health complications if left untreated. High blood pressure affects one in three adults. While medications remain the cornerstone of hypertension management, various non-pharmacological medical procedures have emerged as effective alternatives or adjuncts to traditional therapy.

Hypertension co-morbidities

It is my opinion that hypertension always needs to be treated regardless of vascular history. This is due to its potential contribution to cerebral haemorrhage, stroke, atrial fibrillation, heart failure and chronic kidney impairment. A recent trial of 9000 people followed for 3 years known as the SPRINT study targeted half the patients to a blood pressure level of 140/90 and the other half to 120/80. This study clearly showed that lowering the blood pressure to 120/80 reduced the risk for heart attack, stroke, sudden death and heart failure by around 30%.

A further sub-study from the same trial published in the Journal of the American Medical Association reviewed blood pressure control in midlife and the relationship to risk for cognitive impairment and potentially dementia later on. It collected 450 brain scans from people with an average age of 50, examining the white-matter lesions (the connecting neurones within the brain). This study found that those people who were targeted to a blood pressure of 140/90 compared to those targeted to 120/80 had a significant increase in white-matter lesions. Another study indicated aggressive management of blood pressure led to reduced cognitive impairment.

Lifestyle factors that reduce blood pressure levels & risk

1. Get rid of that abdominal fat. A healthy waist circumference is < 95 cms for a male and < 80 cms for a female. (Sorry ladies, I don’t make the rules.)
2. 3-5 hours of moderate exercise on a weekly basis
3. Minimise sugar and salt intake
4. Reduce alcohol consumption to less than 3 standard glasses/day
5. Cultivate happiness in your life & try (as much as any of us can) to reduce stress.

There are three natural substances with an evidence base for blood pressure management

1. Kyolic aged garlic extract
2. Bergamot polyphenols-BJE 100
3. 2 small pieces of dark chocolate daily, greater than 70% cocoa

Sleep apnoea and high blood pressure

The final major factor related to the generation of high blood pressure is sleep apnoea. If you are waking unrefreshed and feeling tired throughout the day, you should consider an evaluation for this condition and have this treated.

Despite addressing all of the above issues, many people need pharmaceutical treatment. The pharmaceutical management for hypertension, in my view, has been one of the major advances in medicine over the past century with a very strong evidence base and safety profile. I have a number of patients in my practice who for some reason are against using pharmaceutical therapies, but this is one area where the medical science is absolutely solid and irrefutable.

Secondary causes

Finally, around 5-10% of people have a secondary cause for hypertension. If your blood pressure remains high, despite lifestyle changes, natural therapies, sleep apnoea management & pills, you may need a thorough work up with a specialist hunting for one of these less common causes.

Treating hypertension

Renal denervation

There is increasing interest in medical procedures to treat hypertension. One notable procedure is renal denervation, a minimally invasive technique that targets the renal sympathetic nerves responsible for regulating blood pressure. In this procedure, catheters are used to deliver radiofrequency energy to disrupt these nerves, leading to reduced sympathetic nervous system activity and, ultimately, lower blood pressure. Studies have shown promising results, particularly in patients with resistant hypertension, although long-term outcomes continue to be investigated.

Baroreceptor activation therapy

Baroreceptor activation therapy is another innovative approach. This technique involves implanting a device that stimulates the baroreceptors in the carotid artery. The activated baroreceptors send signals to the brain to reduce sympathetic outflow, leading to decreased heart rate and lower blood pressure. Early studies have indicated significant reductions in blood pressure, with sustained effects over time.

Minimally invasive treatment

A recent study published in the Lancet from the University of London examined the effectiveness of minimally invasive treatment to offer a quick cure for a common cause of high blood pressure.

Targeted Thermal Therapy (Triple T)

The researchers have developed a minimally invasive procedure called Targeted Thermal Therapy (Triple T) for treating a common cause of high blood pressure.

This breakthrough treatment has the potential to address a condition that affects many individuals worldwide who are currently undiagnosed and untreated. The condition known as Primary Aldosteronism accounts for one in twenty cases of hypertension. However, fewer than 1% of affected individuals are diagnosed. This condition results from benign nodules in the adrenal glands producing excess aldosterone, a hormone that contributes to increased blood pressure. Standard blood pressure medications often fail to work for these patients, leading to higher risks of serious cardiovascular events.

The only definitive treatment until now has been surgical removal of the adrenal glands, which requires general anaesthesia, hospitalisation, and a lengthy recovery process, causing many patients to remain untreated. Removing the adrenals also means the patient may need adrenal supportive therapy.

Triple T provides a quicker and safer alternative to traditional surgery by selectively destroying the adrenal nodules while leaving the gland intact.

Minimally invasive

This minimally invasive procedure takes only about 20 minutes and utilises advanced imaging techniques with molecular dyes to accurately identify the nodules for targeted treatment. This minimally invasive procedure takes only about 20 minutes and utilises advanced imaging techniques with molecular dyes to accurately identify the nodules for targeted treatment.

An endoscopic approach allows access through the stomach, directly targeting the adrenal nodules while minimizing harm to surrounding tissues. The study titled FABULAS, the name being an acronym for Feasibility study of radiofrequency endoscopic ablation, with ultrasound guidance, as a non-surgical, Adrenal Sparing treatment for aldosterone-producing adenomas.

FABULAS used Triple T in 28 patients with primary aldosteronism, whose molecular scan had pinpointed a hormone-producing nodule in the left adrenal gland. The new procedure was found to be safe and effective, with most patients having normal hormone levels six months later. Many participants were able to stop all blood pressure medications, with no recurrence of the condition.

Is hypertension treatable?

Some experts believe that 10–20% of all hypertension may be due to curable nodules in one or both glands.

One of the trial participants, Michelina Alfieri, related her story: “Before the study, I suffered from debilitating headaches for years despite multiple GP visits. As a full-time worker and single parent, my daily life was severely affected. This non-invasive treatment provided an immediate recovery—I was back to my normal routine straight away. I’m incredibly grateful to the team for giving me this choice.”

The success of FABULAS has led to a larger randomized trial called “WAVE,” which is comparing Triple T with traditional adrenal surgery. The results are expected in 2027.

The breakthrough was made possible thanks to the collaborative development of novel PET tracer molecules, which enable non-invasive diagnosis by allowing us to precisely locate and treat adrenal nodules for the first time.”

If successfully tested further, Triple T could revolutionize the management of primary aldosteronism, providing a viable treatment option for millions who are currently overlooked in high blood pressure management.

Other options

Procedures like weight loss surgeries (bariatric surgery) have demonstrated significant effectiveness in reducing blood pressure among obese individuals.

Lastly, improving dietary habits through interventions such as the DASH (Dietary Approaches to Stop Hypertension) diet can also have profound impacts on blood pressure levels.

In summary, while medication remains vital in treating hypertension, these alternative and complementary procedures offer exciting avenues for managing the condition, particularly for individuals who may not respond adequately to pharmacological therapies. Ongoing research is essential to establish the long-term safety and efficacy of these methods in diverse patient populations.

As hypertension is the major cardiovascular risk factor worldwide, proper management would see the rates of all forms of vascular disease plummet. Keep the pressure down.