HIGH BLOOD PRESSURE
Sanford Pinna, M.D.
Hypertension (High Blood Pressure) kills and disables
more people than all other diseases combined!
Hypertension combined with Diabetes means a very
short life span.
This article will give you and understanding of what causes
hypertension and how it can be treated.
Fortunately, it can be treated, and you, the patient, should
treat it first. If you cannot treat you will need the help of a
medical doctor who will definitely be able to control the
pressure in almost all cases.
Before we describe hypertension,
we should reflect about its value in nature.
If we could not raise our blood
pressure, we could not fight,
nor could we run away. We could do
none of the things necessary
High blood pressue is nature’s gift
for the survival of all animals. Constant
high blood pressure is a product of
Hypertension is a disease of our type of civilization.
The definition is extremely simple:
If your DIASTOLIC PRESSURE (THE LOWER READING)
IS OVER 80 you have Hypertension (High Blood Pressure)
If your SYSTOLIC PRESSURE (THE HIGHER READING)
IS OVER 120 you have Hypertension (High Blood Pressure)
These criteria are established and accepted by all
reputable doctors in the world. Those doctors who
accept higher numbers are playing games with the
death or disability of their patients, according to all
World wide, one quarter of all the people
on this planet suffer from Hypertension!
(Don’t let this number surprise you, one hundred
percent of all people, suffer from getting older!)
If we segment the world population into age
groups, we see that the percentage of the world population
with hypertension increases rapidly with age.
From practically no hypertension at age ten,
we find over sixty percent of the population of the world over
sixty has hypertension.
The reason for the age related
hypertension is that the arteries of older people have
less elastin and are therefore more rigid and do not
open as well with each pulse of blood. The result higher
blood pressure; particularly, higher systolic blood
We can see that one of the primary causes of
hypertension is simply aging.
(God, evidently didn’t like old people hanging around. )
(Corollary: Try to stay youngÃ¢â‚¬”at least in your thinking)
If we look around the world, we find that African
genes play a big role in the prevalence of hypertension.
Asian genes play a big role in the lack of hypertension.
Caucasian (white) genes have a mixed role. Some
European countries have high rates, others low rates.
With Caucasian (white) people, evidently behavior
and cultural factors play a major role.
In the U.S., doctors recognize that African Americans
have a greater predilection to hypertension and stroke and
and treat these patients with more care.
In Japan, although the Japanese have a lower
tendency to hypertension, because of their huge
salt intake, they have higher incidences of stroke
than other populations.
The environment includes diet and life style.
People living in urban (city) environments have a
higher incidence of hypertension than people living in rural
areas. This is due to the increased stress of urban living and
also to a diet with increased salt (sodium) content.
SALT which contains Sodium is a major cause of
Sodium retains water in the blood circulation and
thereby increases the Volume of the blood. As we will see
in the mechanism of hypertension, Volume is one of
the three major factors that produce hypertension.
STRESS is a common factor in everyday living.
Stress causes the release of hormones that produce increased
pumping of the heart, more forceful pumping of the heart
and, most importantly, increased contraction of the muscles
of the arteries. The increased pumping and contraction
immediately raises the blood pressure.
OBESITY is caused by those environmental factors
that are involved in eating. These factors include economic
forces that produce marketing of food productsÃ¢â‚¬”marketing
of cheap and fat producing products. Marketing that
promotes the eating of garbage instead of nutritious food.
The environment includes governments, run
by money interest groups, who develop educational
systems where children are intentionally taught to
eat food that produces obesity.
HOW DOES OBESITY CAUSE HYPERTENSION?
The body is a container. It is filled with blood.
If you want to fill a container with water, you need
a pump, a hose and water.
If the container is large, like a battleship, you need
a very strong pump, a strong hose and tons of water.
The pressure from the pump and inside the hose will be
If the container is small, like a rowboat, you need
a small pump, a small hose and a few gallons of water. The
pressure from the pump and inside the hose will be low.
If you are fat, you have more blood than normal and
more arteries than normal and your heart must pump harder
than normal. Hence your blood pressure must be higher than
THE THREE CAUSES OF HYPERTENSION
There are only three mechanisms or causes of hypertension:
1. VOLUME OF BLOOD
2. FORCE OF HEART CONTRACTION
3. FORCE OF ARTERIAL CONTRACTION.
VOLUME OF BLOOD
The volume of blood is determined,
almost entirely, by
the volume of water in the blood.
Approximately 83 percent of
blood is water. This volume
depends almost entirely on its sodium (salt)
content. The regulation of the sodium
content is almost entirely by the kidneys.
Water molecules attach to the sodium
ions and stay with them.
If there are more sodium ions,
more water will stay in the blood
and the volume will go up. When
the volume goes up the
pressure goes up. It is like blowing
air in a balloon. The more
air the higher the pressure and
the tighter the balloon.
Eat more salt, add more
sodium to your blood. Add
more sodium, keep more water
in your blood. More water=
more volume =higher blood pressure.
The kidneys serve as the valves to allow
water to exit from the body. They are extremely
complex. If the kidneys
do not function normally, water will
accumulate in the blood
stream, the volume will rise and
hypertension will result.
There are doctors who specialize in kidney function.
They spend years studying the disease and treatment of
the kidneys. They are called Nephrologists. Hypertension
which is caused by kidney malfunction is generally referred
to these specialists.
If we think of the body as simply a large tube,
blocked at one end with only a valve to let water out
(the kidneys) and a pump at the other end which
takes water from the tube and the mouth, we have
a good concept of the circulation of the body.
Water gets into the pump through the mouth
and also from the tube.
The pump (heart) pumps, the water goes
through the tube, and then leaks out the end with
The tube is not rigid. It is somewhat elastic
and can contract.
If you can understand this paragraph, you
can understand hypertension.
We saw that the VOLUME was important.
The HEART/PUMP is just as important.
A pump can pump “hard,” and a pump
can pump fast. A pump can pump “hard” and fast.
The pumping of the heart is regulated by the
nervous system and by hormones in the blood stream.
The heart is covered with nerve fibers, some
of which produce a fast beat, and some a slow beat.
When we are frightened, excited or aroused,
our hearts beat rapidly.
As we saw, the heart is pumping water into
the tube. The faster it pumps, the greater the pressure
against the tube wall. A fast heart produces hypertension.
The heart can also increase the pressure of its
pumping by contracting its muscle forcibly. This
can be called pumping “hard.”
When the heart pumps “hard” the increased
pressure is felt against the walls of the tube and we
When we are frightened, excited or aroused, our
hearts pump fast and “hard” and our pressure goes up.
If we are under “stress” our heart pumps hard and
Chronic stress is a cause of hypertension.
Hormones, such as adrenalin, are released in
our body, from the glands in our kidneys. They, too,
cause the heart to pump hard and fast. These hormones,
produced chronically, cause hypertension.
FORCE OF ARTERIAL CONTRACTION
Arteries are essentially elastic muscular tubes.
The muscle layer lies in the center of the artery and
composes most of the width of the arterial wall.
Like any muscle, the arterial muscle can relax and
contract. When relaxed the arterial can be widely distended.
When contracted, the space inside the artery becomes very
The muscle of the arteries is controlled by the nervous
system and by hormones in the blood.
The same type of nerves that control the heart control the
arterial muscles. They operate under the same conditions.
Anxiety, arousal and stress produce contraction and hypertension.
The hormones in the blood that cause the hear to
pump hard and fast also cause the arterial muscle to contract.
But, there is a group of hormones that are unique
to the arterial muscle.
They are called the RENIN ANGIOTENSIN SYSTEM.
RENIN ANGIOTENSIN SYSTEM
These terms are probably new for most readers.
However, one must never be intimidated by terms. Terms
are only symbols that point to something in the real world.
The real world object can always be understood, perhaps,
not exactly, but in a fundamental way.
I will go over each term and explain what molecule
it represents, and how that molecule behaves.
Not to worry
RENIN is the bad guy!
Too much RENIN and you’re in trouble.
RENIN is a molecule made in the kidney. His job is to
load your kidney up with water, so that your kidney feels fat
All your dumb kidney wants to do is pee.
Your kidney doesn’t care about your well being. If it’s peeing,
it’s happy, and you can go to hell!
By the way, the cells that produce RENIN are genetically
controlled. If you’ve got African genes, you’re in trouble. You
have a lot of those cells.
HOW DO YOUR KIDNEYS KNOW YOU NEED RENIN?
Your kidneys are clever. They want to pee and they
need water. In order to get water they need the blood pressure
high enough to push the blood through their processing plant.
So, the kidneys use spies.
They have blood pressure spy agents in the arteries in
your NECK. These guys are called: BARO-RECEPTORS.
“BARO” MEANS PRESSURE. “RECEPTOR”
MEANS MEASURING DEVICE.
“BARO-RECEPTOR” MEANS “PRESSURE
These gadgets, the baro-receptors, send a message
to your kidneys.
For example: “Not enough pressure! Release
the Renin molecules!”
“The pressure is O.K, Boss. Keep those Renin molecules on
If you have a lot of cells making Renin, they escape even
if your pressure is normal.
Your kidneys also have spies in your nervous system.
They know, exactly, when you are upset. If your boss or girl
friend screamed at you, those spies tell your kidneys: “Get
the Renin out, this Ass-Hole is worried.”
If there is not enough salt in your blood, the renin
cells get very upset. They Love salt! The more salt
the better. Salt draws in water. More water, more chance
to pee. Send out those Renin guys when the salt is low.
WHAT DOES RENIN DO?
Renin is like a politician. He works with other
The crook he works with is a molecule that
hides in the LIVER.
That crook’s name is: angio-tensin-ogen.
“ANGIO” MEANS “ARTERY”
“TENSIN” MEANS “HIGH PRESSURE”
“OGEN” MEANS “GENERATE”
READ IT BACKWARDÃ¢â‚¬”GENERATE HIGH PRESSURE in the ARTERY
ANGIO-TENSIN-OGEN is the molecule that makes ANGIO-TENSIN-I
ANGIO=TENSIN-I becomes a student.
Students are frequently molested by outsiders who would
like the students to become criminals.
One of these creeps is called: “ACE”
“ACE” MEANS: ANGIO-TENSIN CONVERTING ENZYME
“ACE” converts Angio-Tensin-I into Angio-Tensin-II
“ACE” CONVERTS ANGIO TENSIN- I
ANGIO TENSIN- II
WHERE DOES “ACE” COME FROM?
ACE is made in small cells which line arteries in the
lungs and also in the kidneys. It is very prevalent in the
blood. Not only does it cause Angio-tensin-I to convert
to Angio-Tensin-II, but it involved in the disease of
diabetes. That is why people with diabetes and hypertension
are given Ace Inhibitors.
Angio-tensin-I was a nice student.
After his conversion into Angio-Tensin-II
he becomes a criminal!
Criminals are bad guys. They hurt people.
Angio-Tensin-II goes right up to your arteries and
squeezes them. Your arteries contract all over your body
and your blood pressure shoots up.
WHAT TO DO?
If you are a Doc and a patient comes to you with
high blood pressure, you know you have to do something.
Hypertension cause stroke, heart attacks and ruins the kidneys.
YOU REMEMBER THE THREE CAUSES OF
1. VOLUME 2. HEART PUMPING 3. ARTERIAL CONTRACTION
You look at your patient. If he is fat, he has too
much volume and too many arteries. His heart is pumping
harder and raising his pressure. The extra volume is raising
TREATING THE HEART
The pharmaceutical industry has provided doctors
with many ways to keep the heart from pumping too
strongly and too rapidly.
We remember that hormones like adrenalin stimulate
the heart to beat faster and harder.
Adrenalin excites a “Receptor” on the surface of
the heart which then sends a message to the heart muscle
to contract faster and harder.
This “receptor” which is similar to a cell phone,
can be turned off. Turning off the “cell phone” is
called “blocking” the receptor.
The “receptor” itself is called a BETA RECEPTOR.
The “Beta Blockers” have been given names by the
pharmaceutical industry and they all end in “LOL”
EXAMPLES OF BETA BLOCKERS
The Beta Blockers slow down the heart beat and reduce
the force of contraction.
Another group of blockers which slow the heart
and reduce the force of contraction are called..
CALCIUM CHANNEL BLOCKERS
As their name implies, the Calcium Channel Blockers
block the flow of calcium which is need for the contraction of
muscle, including heart muscle.
These medicines all end with DIPINE
HERE IS A LIST OF SOME CALCIUM CHANNEL BLOCKERS
- Amlodipine (Norvasc, Azor)
- Aranidipine (Sapresta)
- Azelnidipine (Calblock)
- Barnidipine (HypoCa)
- Benidipine (Coniel)
- Cilnidipine (Atelec, Cinalong, Siscard)
- Clevidipine (Cleviprex)
- Efonidipine (Landel)
- Felodipine (Plendil)
- Lacidipine (Motens, Lacipil)
- Lercanidipine (Zanidip)
- Manidipine (Calslot, Madipine)
- Nicardipine (Cardene, Carden SR)
- Nifedipine (Procardia, Adalat)
- Nilvadipine (Nivadil)
- Nimodipine (Nimotop)
- Nisoldipine (Baymycard, Sular, Syscor)
- Nitrendipine (Cardif, Nitrepin, Baylotensin)
- Pranidipine (Acalas)
TREATING THE VOLUME
Doctors have been treating the VOLUME of blood for
A thousand years ago, doctors learned that if you
simply “BLED” a patient by cutting his vein and letting
the blood flow out, you could cure heart failure!
When I was a student in Bologna University,
professors would tell us that this old fashioned way was
the quickest way to cure this life threatening condition
of Acute Heart Failure, where a patient cannot breath
because his lungs are filling with water.
I even asked a professor, one day, how much
blood one should bleed out.
He answered me in Italian: “Un bel bicchiere.”
Which means: “A good cup-full.”
Subsequently, I tried it once and it worked.
After blood letting, doctors tried the use of LEECHES!
Leeches are nice little worms which like to suck blood.
By sucking up a lot of blood they reduce volume and therefore
blood pressure. They are still used in India and other parts of
the world. They are used in the U.S. for a condition called
Polycythemia where too many red blood cells are produced.
DIURETICS OR “WATER PILLS”
All diuretics, or, as they are commonly called,
“Water Pills” work on different parts of the kidney to release
Normally, the blood passes through the kidney
and part of the water in the blood is released, along
with such waste products as urea.
A diuretic causes a greater release of water,
in general by also releasing sodium.
In this way, the volume of blood is reduced, and
the blood pressure is lowered.
There are five great groups of diuretics, each
acting in a unique way. The most common group used
for hypertension are called the “Thiazides.” Of
this group, “HYDRO-CHLORO-THIAZIDE” is the
one used in combination with other blood pressure
TREATING ARTERIAL CONTRACTION
As we saw above, arterial muscle contraction is caused
We also saw that Angio-Tensin-II is made from
Angio-Tensin-I by ACE (ANGIO-TENSIN-CONVERTING
WE CAN BLOCK ANGIO-TENSIN-II IN TWO
ONE. BLOCK “ACE.”
TWO. BLOCK ANGIO-TENSIN-II
Doctors have been blocking ACE for almost three
Doctors use ACE INHIBITORS to block ACE.
THE NAMES OF ACE INHIBITORS END IN
HERE IS THE LIST FROM WIKI
This is the largest group, including:
- Enalapril (Vasotec/Renitec)
- Ramipril (Altace/Tritace/Ramace/Ramiwin)
- Quinapril (Accupril)
- Perindopril (Coversyl/Aceon)
- Lisinopril (Lisodur/Lopril/Novatec/Prinivil/Zestril)
- Benazepril (Lotensin)
- Fosinopril (Monopril) is the only member of this group
Currently, many American doctors are using Lisinopril,
because of efficacy and cost. However, they each have a place.
Blocking Angio-Tensin-II is normally the last step in
These medications are called;
ANGIOTENSIN RECEPTOR BLOCKERS (ARB)
HERE IS THE LIST FROM WIKI
|Drug||Trade Name||Biological half-life [h]||Protein binding [%]||Bioavailability [%]||Renal/hepatic clearance [%]||Food effect||Daily dosage [mg]|
|Losartan||Cozaar||2 h||98.7%||33%||10%/90%||Minimal||50Ã¢â‚¬“100 mg|
|EXP 3174||6Ã¢â‚¬“9 h||99.8%||Ã¢â‚¬“||50%/50%||Ã¢â‚¬“||Ã¢â‚¬“|
|Valsartan||Diovan||6 h||95%||25%||30%/70%||40Ã¢â‚¬“50% decreased by||80Ã¢â‚¬“320 mg|
|Irbesartan||Avapro||11Ã¢â‚¬“15 h||90Ã¢â‚¬“95%||70%||1%/99%||No||150Ã¢â‚¬“300 mg|
|Telmisartan||Micardis||24 h||>99%||42Ã¢â‚¬“58%||1%/99%||No||40Ã¢â‚¬“80 mg|
|Eprosartan||Teveten||5 h||98%||13%||30%/70%||No||400Ã¢â‚¬“800 mg|
WE SAW THAT HYPERTENSION IS CAUSED BY;
1. INCREASED BLOOD VOLUME.
2. INCREASED HEART PUMPING.
3. INCREASED ARTERIAL CONTRACTION.
WE TREAT VOLUME WITH DIURETICS.
WE TREAT HEART PUMPING WITH BETA
BLOCKERS AND CALCIUM CHANNEL BLOCKERS.
WE TREAT ARTERIAL CONTRACTION WITH
1. ACE INHIBITORS AND 2. ANGIOTENSIN RECEPTOR
AND NOW YOU KNOW!