The 120/80 Standard

Ever wondered how we came to measure something as invisible yet vital as blood pressure? The measurement of blood pressure traces its roots back to the 17th century, when scientist Stephen Hales first experimented with a simple U-tube manometer. It wasn’t until the 19th century, that a more accurate and practical device—the mercury sphygmomanometer—was developed by Samuel Siegfried Karl Ritter von Basch and later refined by Scipione Riva-Rocci.

The Birth Of Systolic And Diastolic Pressure

1. Korotkoff Sounds: In 1905, Nikolai Korotkoff, a Russian physician, introduced a method of auscultating (examining a patient by listening to sounds from the heart, lungs or other organs) blood pressure using a stethoscope. He identified specific sounds—now known as Korotkoff sounds—that corresponded to different phases of the cardiac cycle, particularly the systolic and diastolic phases.

   
   

2. Systolic Pressure: The systolic blood pressure measurement represents the pressure exerted on the arterial walls during the contraction of the heart, or systole. Korotkoff identified the onset of faint tapping sounds as the point where pressure in the cuff equaled the peak pressure in the arteries, marking the systolic reading. Note: It is the higher of the two numbers in a blood pressure reading.

   
   

3. Diastolic Pressure: Korotkoff further observed that the sounds disappeared completely when the pressure in the cuff dropped to a level where blood flow was no longer obstructed. This disappearance of sounds marked the diastolic pressure, corresponding to the relaxation phase of the heart, or diastole. Note: It is the lower of the two numbers in a blood pressure reading.

Thus, the standard blood pressure reading of 120/80 mmHg is the result of a combination of historical research, population studies, and collaborative efforts within the medical community.

Effects Of Insulin Resistance And Inflammation On Blood Pressure

Recent studies have ushered in a new era of understanding regarding the relationship between diet and hypertension. While traditional factors like sodium intake and obesity remain relevant, contemporary research has spotlighted the significant impact of insulin resistance and inflammation on blood pressure regulation.

What Is Insulin Resistance?

Insulin resistance is a condition where cells in the body become less responsive to the effects of insulin. This sets in motion a cascade of events that negatively impact nitric oxide production and endothelial function, which in turn can contribute to the development and progression of hypertension.

1. Role of Insulin in Nitric Oxide Production: Insulin plays a crucial role in the regulation of nitric oxide (NO) production. NO is a signaling molecule that acts as a vasodilator, meaning it relaxes and widens blood vessels. This vasodilation is essential for maintaining healthy blood pressure levels. When insulin functions properly, it promotes the release of NO from endothelial cells lining the blood vessels.

   In individuals with insulin resistance, the release of nitric oxide are disrupted. As a consequence, blood vessels may experience diminished relaxation, contributing to vasoconstriction and an increase in blood pressure.

2. Oxidative Stress: Insulin resistance is often associated with oxidative stress and chronic inflammation. These conditions further exacerbate the impairment of nitric oxide production. Oxidative stress leads to the production of reactive oxygen species (ROS), which can scavenge and degrade nitric oxide, reducing its availability for blood vessel relaxation.

3. Endothelial Dysfunction: Endothelial cells, which line the inner surface of blood vessels, play a pivotal role in regulating vascular tone and blood flow. Insulin resistance can lead to endothelial dysfunction, characterized by a decrease in the bioavailability of nitric oxide. This dysfunction contributes to a pro-inflammatory and vasoconstrictive environment within blood vessels.

4. Sympathetic Nervous System Activation: IR is also linked to an overactive sympathetic nervous system, which regulates the body's "fight or flight" response. Increased sympathetic activity can further impair nitric oxide production. This heightened sympathetic tone contributes to vasoconstriction and elevated blood pressure.

What Is Inflammation?

Inflammation is a natural and essential part of the body's immune response, serving to protect against harmful stimuli such as pathogens, damaged cells, or irritants. The process involves a cascade of biochemical reactions, immune cell activation, and the release of signaling molecules called cytokines.

The two kinds of inflammation....

Acute inflammation is a temporary and localized response, crucial for healing and defending the body. Example - injury, strenuous workout, etc

Chronic inflammation, however, is a persistent and systemic state that can be detrimental to health. It has been implicated in various chronic diseases, including hypertension.

Several mechanisms illustrate the intricate connection between inflammation and hypertension, but for the sake of brevity, I am covering two of them here:

Immune System Activation:

• Inflammation activates the immune system, resulting in the release of pro-inflammatory cytokines such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha). These cytokines can directly affect blood vessel walls, contributing to vascular inflammation and impaired vasodilation.

Renin-Angiotensin System (RAS) Activation:

• Inflammatory signals can activate the renin-angiotensin system (RAS), a hormonal system that regulates blood pressure and fluid balance. RAS activation can lead to vasoconstriction and increased sodium and water retention, contributing to elevated blood pressure.

What Leads To Inflammation?

1. Unhealthy Diet: Diets high in processed foods, refined sugars, and hydrogenated fats can promote inflammation. Conversely, diets rich in seafood, some vegetables and omega-3 fatty acids have anti-inflammatory effects.

2. Obesity: Adipose tissue, especially visceral fat, produces inflammatory substances. Obesity is associated with chronic low-grade inflammation, creating a pro-inflammatory environment that can contribute to hypertension.

3. Inactivity: Lack of regular physical activity is linked to chronic inflammation. Exercise has anti-inflammatory effects and can contribute to overall cardiovascular health.

4. Smoking: Tobacco smoke contains numerous chemicals that can trigger inflammation. Smoking is a well-established risk factor for hypertension.

5. Chronic Stress: Prolonged stress can activate the immune system and contribute to chronic inflammation. This can also be prolonged periods of inadequate sleep.

   
   

Managing High Blood Pressure

Managing high blood pressure involves a holistic approach that includes lifestyle modifications, dietary changes, regular exercise, adequate sleep, and stress management. Here are actionable steps to lower high blood pressure, considering the association with insulin resistance and chronic inflammation:

Foods To Include:

1. Leafy Greens:

   • Rich in Potassium: Leafy greens such as spinach, kale, and Swiss chard are excellent sources of potassium. Potassium helps balance sodium levels in the body, potentially reducing the risk of high blood pressure. Please note that leafy greens or potassium rich foods might not be appropriate for everyone. They are to be avoided for those with chronic kidney disease or who have a history of kidney stones or oxalate intolerance.

   • Magnesium Content: Magnesium is another mineral found in leafy greens, contributing to muscle and nerve function, as well as blood pressure regulation.

   • Antioxidants: Leafy greens are packed with antioxidants like vitamin C, beta-carotene, and flavonoids, which help combat oxidative stress and inflammation. Good to note here that while cooking leafy greens is recommended, their antioxidant properties are reduced on cooking.

2. Berries:

   • Rich in Antioxidants: Berries, including blueberries, strawberries, and raspberries, are loaded with antioxidants like anthocyanins. These compounds have been associated with lower blood pressure and reduced inflammation.

   • Vitamin C Content: Berries are a good source of vitamin C, an antioxidant that may contribute to overall cardiovascular health.

3. Oats:

   • High in Beta-Glucans: Oats contain beta-glucans, a type of soluble fiber that has been linked to improvements in cholesterol levels, which may in turn impact blood pressure.

4. Fatty Fish:

   • Omega-3 Fatty Acids: Fatty fish such as salmon, mackerel, and trout are rich in omega-3 fatty acids. These essential fats have anti-inflammatory effects and are associated with improved cardiovascular health.

   • DHA and EPA: Omega-3s, particularly DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid), may help reduce blood pressure by promoting vasodilation and improving blood vessel function.

5. Nuts and Seeds:

   • Magnesium-Rich: Nuts and seeds, including almonds, walnuts, and flaxseeds, are excellent sources of magnesium. Magnesium is vital for muscle and nerve function, contributing to proper blood pressure regulation.

   • Healthy Fats: Some nuts provide healthy Omega-3s fats, such as walnuts, Brazil nuts that are heart-healthy and may contribute to overall cardiovascular well-being.

6. Garlic:

   • Allicin Content: Garlic contains allicin, a compound with potential blood pressure-lowering properties. Allicin is thought to relax blood vessels and improve blood flow.

   • Antioxidant Effects: Garlic also exhibits antioxidant effects, helping to combat oxidative stress and inflammation in the cardiovascular system.

Food To Avoid:

• High-Sodium Foods: Many processed and packaged foods, such as canned soups, beans, frozen meals, and snacks, contain high levels of sodium. Excessive sodium intake can lead to water retention, increased blood volume, and elevated blood pressure. The balance between sodium and potassium is crucial for regulating blood pressure. High sodium intake, without an adequate intake of potassium-rich foods, can disrupt this balance.

• Added Sugars: Minimize the consumption of sugary beverages, bottled juice, confectionery items and processed sweets to mitigate insulin resistance.

• Trans Fats: Found in many processed and fried foods, these fats can contribute to inflammation and cardiovascular issues. Example - chips, dough-nuts, deep-fried Indian savories and sweets.

Foods To Limit:

• Chicken and Turkey: Poultry, particularly conventionally raised chicken and turkey, can contain higher levels of omega-6 fatty acids. This is partly because the feed given to these animals may include grains rich in omega-6.

• Pork: conventionally raised pork, may have a higher omega-6 content due to the animals' diets and being a monogastric animal, it doesn't process omega-6s from its diet well (ruminant animals like lamb, goat, cow, buffalo - can).

• Grains: Of course! As they elevate blood glucose and insulin levels. Sustained elevation of these levels cause Insulin Resistance (I've covered this already).

My Nutrition Tips For A Holistic Approach:

1. Grass-Fed and Pasture-Raised Options: Choose grass-fed or pasture-raised meat when possible. These animals tend to have a more favorable omega-3 to omega-6 ratio in their meat.

2. Diversify Protein Sources: Include a variety of protein sources in your diet, such as fish, seafood, and vegetarians - dairy and plant-based proteins. This helps balance the overall omega-3 to omega-6 ratio.

3. Use Healthy Cooking Oils: When cooking, use oils with a better omega-3 to 6 ratio, such as olive oil, avocado oil, ghee or butter.

4. Include Omega-3 Rich Foods: Increase the consumption of omega-3-rich foods like fatty fish (salmon, mackerel, sardines), flaxseeds, hemp hearts (vegetarians), and walnuts to counterbalance omega-6 intake.

   
   

What Exercises To Do?

• Aerobic Exercise: Aim for at least 120 minutes of moderate-intensity aerobic exercise per week. This can be further divided into sessions of at least 30 minutes, four days a week. These are...

  • Brisk Walking - An accessible and effective form of aerobic exercise for all fitness levels.

  • Jogging - Can provide higher intensity for those with a higher fitness level.

  • Cycling - Outdoor cycling are excellent options for cardiovascular fitness but is not suitable for those with back, and knee concerns.

  • Swimming - A full-body workout that is gentle on the joints.

    
    

• Strength Training: Include strength training exercises for major muscle groups at least two days a week. Aim for 2-3 sets of 8-12 repetitions for each exercise. They could be...

  • Weightlifting - Using free weights or resistance machines to target specific muscle groups.

  • Bodyweight Exercises - Including squats, lunges, push-ups, and planks.

  • Resistance Bands: Providing variable resistance for muscle engagement.

What Not To Do?

• Extreme or Very Intense Activities - While high-intensity interval training (HIIT) can be effective, sessions lasting longer than 30 minutes may temporarily elevate blood pressure. It's essential to tailor intensity and duration based on your fitness level.

  Frequency - Limit intense workouts to 2 times per week, allowing for adequate recovery.

  Note: Individuals with hypertension or other cardiovascular concerns should consult their doctor before engaging in very intense activities.

• Improper Preparation: Skipping warm-up exercises can lead to a sudden increase in blood pressure. Incorporate 5 minutes of light aerobic activity and dynamic stretches before the main workout. A proper cool down, including static stretching, helps gradually lower heart rate and blood pressure.

• Overtraining: Excessive workout volume, inadequate rest, sleep, and insufficient recovery can contribute to elevated stress hormones and, consequently, increased blood pressure. Include rest days in the weekly routine to allow the body to recover.

• Timing of Exercise: Some individuals may experience a temporary rise in blood pressure after evening workouts. However, this effect varies between individuals, and regular exercise generally contributes to long-term blood pressure control. As a rule, avoid high intensity aerobic exercises, running or power lifting in the late evening/night time if you already have high blood pressure.

In understanding blood pressure, we’ve come a long way—from the early manometers to uncovering the impact of insulin resistance and inflammation. The best part? Much of what affects your blood pressure is within your control.