Hypertension updates: some new ways to investigate blood pressure issues.

6 days ago4 min read

Even in this age of technological advancements, I still prefer the traditional method of taking my patients' blood pressure using a manual cuff. It may be considered 'old school ', but it's a practice I deeply respect and appreciate for its reliability and accuracy.

I am not afraid to admit that, and I am proud that I was trained that way and have stuck with it.

Recently, I found myself in a situation that many of my patients can relate to. My blood pressure started to rise, a direct result of the collective stress that was prevalent during the election time. This personal experience made me even more empathetic towards my patients' struggles with hypertension.

I went out and bought a fancy OMRON Bluetooth BP cuff for my own use. This cuff, equipped with advanced technology, allows for easy and accurate blood pressure monitoring. I really thought it was worth the time invested in exploring more about the causes of high blood pressure.

Sure, I have written protocols and articles on blood pressure and treated thousands of patients for blood pressure issues by now. Therapeutics work, and people generally move on with good blood pressure management.

Yet, I have not explored root-cause testing, which may extract the root cause of a hypertension case.

Here are some laboratory tests that can help to reveal the underlying causes of hypertension:

Routine Tests: Doctors commonly use these tests to screen for underlying health conditions and can help determine if further investigation is needed.

Complete Blood Count with Differential and Platelets (CBC w/ Diff/ PLT): This test can rule out immune system dysfunction and assess for irregular patterns in red blood cell indices, which could affect blood pressure regulation.
Comprehensive Metabolic Panel -14 (CMP-14): This test examines kidney and liver function and evaluates electrolytes and proteins like albumin, which influence blood pressure.
Thyroid Stimulating Hormone (TSH): This test is the standard for evaluating thyroid health. Low TSH levels can lead to overactive thyroid hormones (T4 and T3), which can cause vasoconstriction, increased heart rate, and elevated metabolism.

Specific Tests: If the routine tests are regular or inconclusive, these more specific tests can be used to investigate potential causes of hypertension.

Angiotensin Converting Enzyme: This test measures the enzyme responsible for converting angiotensin I to angiotensin II, a potent vasoconstrictor.
Antidiuretic Hormone (ADH): This test measures the hormone that increases vasoconstriction by promoting sodium and water retention.
Aldosterone: This test assesses the hormone that increases blood pressure by retaining sodium and water in response to potassium and sodium fluctuations.
Cystatin-C: This test evaluates kidney function more accurately than traditional methods. Elevated levels may indicate microvascular kidney disease, which can potentially contribute to hypertension.
Renin: This test measures the enzyme that triggers the production of angiotensin, which can lead to vasoconstriction.
Catecholamines (fractionated): This test measures the levels of the neurotransmitters norepinephrine, epinephrine (vasoconstrictors), and dopamine (vasodilator), which impact blood pressure. I would predict this is what was high in me during election time.
Cortisol: This test measures the hormone produced by the adrenal cortex, which can reduce vasodilation and contribute to vasoconstriction. It is also high during times of stress.
Asymmetric Dimethylarginine (ADMA): Elevated levels of this amino acid analogue can inhibit nitric oxide production, impair endothelial function, and lead to cardiovascular problems, including hypertension. I tested this for myself, and it was normal.
B-Type Natriuretic Peptide (BNP): Elevated levels of this peptide, produced by the heart, can indicate stress on the heart muscle and potential cardiovascular issues. This would cause deep concern and a need for much better blood pressure control.
C-reactive protein (high sensitivity) (CRP hs): Elevated levels of this inflammatory marker may contribute to vasoconstriction and hypertension. So many things impact this, but diet is one big component!
Trimethylamine N-oxide (TMAO): High levels of this gut bacteria byproduct have been linked to an increased incidence of hypertension. A leaky gut might contribute to hypertension.
Cholinesterase: This test measures the enzyme that breaks down acetylcholine, a neurotransmitter involved in relaxation. Elevations in cholinesterase can contribute to vasoconstriction.
Magnesium RBC: This test measures the level of magnesium, a mineral crucial for muscle relaxation and blood vessel dilation. Low levels may contribute to hypertension.

Insurance coverage varies for this type of testing. I have personally been working with some direct lab companies where we can get significantly discounted lab tests through Labcorp, so it bypasses being denied from insurance and being stuck with a hefty bill.

The big question with any lab is….If so, then what? This question is crucial in the context of hypertension testing and management. It prompts us to consider the implications of the test results and how they can guide our next steps. By the way, always ask that question to me if we are working together. It is a great intellectual question to parse out the usefulness of testing. Each of these lab values gives a therapeutic direction to address hypertension. Sometimes, the answer may be pharmaceutical, gut repair, herbal medication, lifestyle changes, diet changes, or any combination of these.

So, what’s my story? It's a work in progress. I've chosen not to rely on medications for blood pressure management. Instead, I've embraced QiGong, exercise, and an herbal medicine from Metagenics that helps regulate cortisol. This approach, coupled with my awareness of my family's hypertensive genes, empowers me to take control of my health and manage my blood pressure effectively.