Dr. Boz [Annette Bosworth, MD] - The CORRECT way to treat high blood pressure

If your doctor says to lower your salt intake to treat blood pressure, I disagree. There is a better way to treat blood pressure, and you must treat it. Blood pressure is the most vital metric that you control to be healthy. This should be a public service announcement for everyone, even if you don't have high blood pressure. I'm going to give you the tools to prevent blood pressure from being a problem.

Let's start with salt. Manipulating your salt is the short game. The long game, the way to master and win, is to control your hormones. So why do I want you to have lower blood pressure, even if salt isn't the answer? It's because of what happened in 2015: the SPRINT trial. This has changed the way I treat blood pressure. Within my career, before this trial, I told patients to keep their blood pressure in the 120s over 80s. That's the top number being 120 millimeters of mercury, to pump the blood forward. When the heart is filling, the relaxed phase of blood pressure, we wanted that pressure to be 80 millimeters of mercury or less.

Prior to this trial, there was an argument that we were being too aggressive about treating blood pressure. So they divided patients into two groups: one who let their blood pressure drift a little higher, like in the 130s, and others who kept their blood pressure below 120 and below 80. The trial was stopped early because it was deadly to keep that blood pressure in the 130s over 90s. In other words, you lived longer and protected your kidneys, eyes, and end organs when the top number was in the 110s and the bottom number was in the 70s.

Let's take a step backwards. This process that we are trying to manipulate is a closed-loop fluid system, a hydrostatic system. There is no pool of fluid, a reservoir somewhere, where you can manipulate the pressure inside those hoses of your body, the arteries and veins within this system. We care a lot about how much fluid you are pumping around and how fast you're pumping it around, and this results in a pressure. That pressure causes the damage. When the pressure was higher, the endothelial lining, or that skin layer inside your arteries, would become hardened. It would change things like the glycocalyx and increase the hardening of your arteries by changing what those cells look like and changing what the muscle was doing in all of your arteries.

When patients present with high blood pressure, the first line of treatment is to use medications that slow down their heart rate and relax their blood vessels. Because lowering blood pressure is most important when it comes to my own health, I want to outsmart the hormone to prevent this problem from ever being part of my medical history. So how do I outsmart aldosterone, that salt hormone? I use a superior hormone: insulin. Insulin is the biggest predictor of whether or not your aldosterone is on the rise. High levels of insulin equate to high levels of aldosterone, which increases your blood pressure. In fact, I could guarantee that if you have high insulin, your blood pressure is higher than it should be.

If you have a history of high blood pressure and you want to add back the salt, the first step is lowering the blood sugar. You must start with blood sugar before you can start adding salt back to your diet. Don't go stopping your blood pressure medication immediately if you've had a history of high blood pressure, which means you've had a history of high insulin. You will tend to improve things, and then you might drift backwards. Keeping your blood pressure controlled is the job between you and your doctor, and I would not take it lightly. It will predict your health. Without manipulating these hormones, it might seem impossible to control your blood pressure without medications. It is possible, but it is a slow and steady process. If you've been under the influence of high insulin for years and you're trying to reverse problems, there's nothing better than focusing on how to reverse those problems with your heart. Check out the next video to watch "Prevention of Heart Disease," and know that it's not about cholesterol.