Uncovering the Connection: Hypertension (HTN) and GERD

Both hypertension (HTN) and gastroesophageal reflux disease (GERD) are serious conditions. Some people only live with one of them, while some live with both states, and some individuals don’t know they have one or the other.

Understanding Hypertension (HTN)

HTN or high blood pressure may affect up to 25% of the world’s population. Unfortunately, it is a common cardiovascular disorder among Western societies due to poor diet, increased sodium intake, lack of physical inactivity, increased stress/psychosocial disorders, and smoking. The force of blood pushing against the artery walls is consistently too high, making it more difficult for the heart to pump blood throughout the body efficiently. 

A blood pressure reading greater than or equal to 130/80 mmHg is considered hypertensive. 120-129/80 is considered elevated blood pressure and puts you at risk of developing HTN. A normal blood pressure reading is 120/80 mmHg or lower.

The potential consequences associated with HTN include an increased risk of:

          -Heart attack or stroke

          -Aneurysm

          -Heart failure

          -Kidney failure/kidney disease

          -Eye problems

          -Metabolic syndrome

          -Dementia or changes in memory/cognitive understanding

Common Risk Factors Shared by HTN and GERD

Did you know that there is a link between HTN and GERD? It is very common for people who have hypertension to have silent GERD (or Laryngopharyngeal Reflux/LPR).

GERD, which stands for gastroesophageal reflux disease, is characterized by acid reflux and potential damage to the esophagus due to the regurgitation of gastric acid. This condition often occurs when the lower esophageal sphincter (LES) doesn't function properly. It is different from occasional acid reflux because it happens regularly. 

Silent reflux, or LPR, refers to esophageal damage from acid reflux but without typical GERD symptoms. This means someone could have GERD and not know it is occurring, but the damage remains. Recent research has suggested that many GERD patients belong to this subgroup.

People who have silent reflux and HTN have many risk factors in common:

Age: Both silent reflux and HTN become more common with age.

Obesity: Excess body weight is a common risk factor for both conditions.

Stress: Chronic stress is connected to an increased risk of HTN and is known to increase silent reflux symptoms.

Lifestyle Habits: Smoking, alcohol consumption, and lack of physical activity can exacerbate silent reflux and HTN.

Poor Management: Not managing one condition effectively can lead to complications that increase the risk of the other, including poor dietary choices. This can include consuming a diet high in sodium and processed foods with high blood pressure or acidic, spicy, or fatty foods with silent reflux.

Medications and Their Role in HTN and GERD

Moreover, they actually influence one another: people diagnosed with GERD are more likely to have HTN, and people diagnosed with HTN are more likely to have GERD due to the effects of certain antihypertensive drugs like calcium channel blockers. On the flip side, H2 agonists and proton pump inhibitors, medications used to treat GERD, have also demonstrated the potential to cause HTN. How is this?

Calcium channel blockers: these drugs can reduce the pressure of the LES and movement within the esophagus. They also can increase esophageal acid exposure time.

Proton pump inhibitors (PPIs) may affect nitric oxide activity, leading to endothelial dysfunction (narrowing of the heart’s blood vessels) that could potentially lead to hypertension, but more studies are needed.

Managing HTN and GERD Together

Scientific research has proven that adopting a heart-healthy diet such as the DASH diet (Dietary Approaches to Stop Hypertension) reduces blood pressure. In return, it also reduces the occurrence of GERD, as demonstrated by research. This connection might be linked to the decreased reliance on or even the absence of antihypertensive medications, coupled with the overall enhancement in one's diet and daily habits.

Of course, if you have GERD, certain foods may exacerbate your reflux symptoms, and avoiding those would continue to be vital in managing symptoms of GERD. If you are on chronic PPI use, talk with your medical provider about other options for managing your GERD with medications and see about weaning off these medications due to their potential cardiovascular risks.

Other general diet and lifestyle modifications that can help reduce your occurrence of GERD and HTN:

          *Eat regular scheduled meals

          *Avoid snacking on highly processed foods

          *Limit added salt intake- try to consume lower-sodium foods

          *Regular exercise/physical activity

          *Avoid alcohol intake

          *Stop smoking

          *Find ways to manage stress/anxiety (fun outlets, therapy, etc)

You may also benefit from additional supplements that treat GERD and HTN, but always talk with your healthcare provider first to ensure these won’t interfere with your medications.

• Magnesium
• Melatonin
• Ginger

If you have questions about diet and these chronic diseases, talk with a registered dietitian to tailor your diet to ensure you get the best food sources to promote optimal health!

1. _{Aregawi, L. G., Shokrolahi, M., Gebremeskel, T. G., & Csiki, Z. (2023). The effect of ginger supplementation on the improvement of dyspeptic symptoms in patients with functional dyspepsia. Cureus.}
2. _{Ariel, H., & Cooke, J. P. (2019). Cardiovascular risk of proton pump inhibitors. Methodist DeBakey Cardiovascular Journal, 15(3), 214.}
3. _{Beigrezaei, S., Sasanfar, B., Nafei, Z., Behniafard, N., Aflatoonian, M., & Salehi‐Abargouei, A. (2023). Dietary approaches to stop hypertension (DASH)-style diet in association with gastroesophageal reflux disease in adolescents. BMC Public Health, 23(1).}
4. _{DASH Eating Plan | NHLBI, NIH. (2001, January 4). NHLBI, NIH.}
5. _{Gobind, A. (2021). The role of magnesium supplement in laryngopharyngeal reflux disease. International Journal of Otorhinolaryngology and Head and Neck Surgery, 8(1), 47.}
6. _{He, S., Liu, Y., Xu, J., Luo, G., Cao, L., & Long, X. (2018). Prevalence and Predictors of Silent Gastroesophageal Reflux Disease in Patients with Hypertension. Gastroenterology Research and Practice, 2018, 1–9.}
7. _{High blood pressure (hypertension) - Symptoms & causes - Mayo Clinic. (2022, September 15). Mayo Clinic.}
8. _{Kandil, T., Mousa, A. A., Elgendy, A., & Abbas, A. M. (2010). The potential therapeutic effect of melatonin in gastro-esophageal reflux disease. BMC Gastroenterology, 10(1).}
9. _{Pinheiro, L. C., Oliveira-Paula, G. H., De Lima Portella, R., Guimaraes, D., De Angelis, C. D., & Tanus-Santos, J. E. (2016). Omeprazole impairs vascular redox biology and causes xanthine oxidoreductase-mediated endothelial dysfunction. Redox Biology, 9, 134–143.}
10. _{Rosanoff, A., Costello, R. B., & Johnson, G. H. (2021). Effectively Prescribing oral magnesium therapy for hypertension: A Categorized Systematic review of 49 clinical trials. Nutrients, 13(1), 195.}
11. _{Sahardi, N. F. N. M., & Makpol, S. (2019). Ginger (Zingiber officinale Roscoe) in the Prevention of Ageing and Degenerative Diseases: Review of Current Evidence. Evidence-based Complementary and Alternative Medicine, 2019, 1–13.}
12. _{Scheer, F. A., Van Montfrans, G. A., Van Someren, E. J., Mairuhu, G., & Buijs, R. M. (2004). Daily nighttime melatonin reduces blood pressure in male patients with essential hypertension. Hypertension, 43(2), 192–197.}
13. _{Yoshida, K. (2010). Effects of anti-hypertensive drugs on esophageal body contraction. World Journal of Gastroenterology, 16(8), 987.}