Healthful Eating Habits

Limiting sodium and following a healthful diet that is low in fat helps prevent or control hyper- tension, even in people of normal weight. Potas- sium helps protect against high blood pressure, in part by enhancing the excretion of salt. This nutri- ent occurs in certain foods, especially fruits and vegetables. If you take potassium in supplements, you will not derive the same bene?t that you get from consuming it in your diet. Most people get enough potassium through eating foods that con- tain it; the exception is those on diuretic drugs, who may need to take supplements.
Your intake of sodium (salt) in foods is a critical factor in controlling blood pressure. Too much salt causes you to retain water, thereby increasing blood volume and blood pressure. Although sodium is an essential mineral, health experts recommend that a person consume less than 2,400 milligrams (mg, or 2.4 g) per day, which is only about 1 teaspoon of table salt. That includes all salt contained in foods, as well as the salt you add while you are cooking or at the table. A typical American diet often includes about 4,000 mg (4 g) of salt—far more than a person needs. To control high blood pressure, or if you are over 50 or black, limit daily sodium intake to 1,500 mg or less.
All animal products, such as meat and dairy products, contain sodium. Processed and restaurant foods are notoriously high in sodium; to see a clear example of that, check the nutrition label on a can of soup or a bottle of ketchup. You can consume signi?cant quantities of salt without ever picking up a salt shaker. Three-fourths of the salt that peo- ple in the United States consume comes from processed or restaurant food. By contrast, fresh fruits, vegetables, and grains have little or no sodium unless you add it.

Exercise Regularly

Being physically active is a great way to help manage your blood pres- sure and bene?t your overall health in many other ways at the same time. During aerobic exercise, the heart works harder and pumps more blood to supply oxygen to the hard-working muscles. You might think that this action would increase blood pressure over time. But the increase in heart output is accompanied by widening of the blood vessels that supply the muscles, substantially reducing the resistance to blood ?ow. Regular exercise actually increases the number of capillaries that supply muscle tissue, further reducing resistance. Your heart, arteries, and lungs become more ?t, helping to protect you against heart disease.
Also, exercise is the essential calorie-burning partner to sensible dieting as a means of controlling your weight. A moderate exercise program combined with a healthful diet will make it much easier to lose that extra ten pounds (or more), which can signi?cantly lower your blood pressure. The bene?ts of exercise do not stop there: physical activity helps protect against not only high blood pressure, but also against heart disease, diabetes, stroke, and cancer. Plus, exercise lifts your mood, protects against osteoporosis, and helps you manage stress, so it enables you to work toward several of your goals at once.
You do not need to become an athlete. Aerobic exercise (which means exercise that causes the body to use oxygen to fuel the muscles) includes a broad range of activities such as walking, bicycling, climbing stairs, social dancing, and gardening. In order to get the cardiovascular bene?ts, you should aim for exercising 20 to 30 minutes at a time at least 5 days a week; recent government recommendations advise 1 hour a day if you are overweight. Most people can start a moderate exercise plan without consulting their doctors. If you are already moderately active, you will get greater bene?t from exercising longer or more often, or choosing a more vigorous form of activity. If you are not sure how to get started, try a simple walking program. Set aside time 5 days a week or more to walk around your neighborhood, take a lunchtime break from work, or go to a gym or a shopping mall.
• Week 1. Walk slowly for 5 minutes to warm up your muscles, walk briskly for 5 minutes to get your heart working, then walk slowly for 5 minutes to cool down.
• Week 2. Do 5 minutes of warm-up walking, increase your brisk walking to 7 minutes, then cool down for 5 minutes.
• Week 3 and beyond. Walk slowly for 5 minutes, then increase your brisk walking by 2 minutes each week until you are up to 30 minutes or more, fol- lowed by 5 minutes of slower walking.
Many people can start their exercise program more intensively, walking 20 minutes briskly, rather than 5 minutes, in week 1, then increasing that baseline of 20 for weeks 2 and 3. However, if you are over 50 and have not been physically active, if you have already had a heart attack, or if you have a family history of heart dis- ease, talk to your doctor before increasing your level of activity. If you have heart disease already, your doctor might use a stress test to assess your capacity to exercise and to individualize your exercise program.
Even if you do not engage in formal exercise or set aside a special time for walking, you can increase your fitness by becoming more active in your daily life. Examples include walking rather than driving short dis- tances, parking far away from a store or mall entrance, and walking up one ?ight or down two ?ights of stairs. Purchase and use a pedometer to measure how many steps you walk every day, and gradually increase your activity until you walk at least 10,000 steps per day.

What Is Salt Sensitivity?

In most people, the body regulates salt concentration carefully, and any excess salt will be eliminated in the urine or in perspiration. But for many people, eating too much salt causes their blood pressure to rise, a condi- tion known as salt sensitivity.
For reasons that are not clear, some groups of people are more likely to be salt-sensitive than others. For example, as many as 70 percent of black people are salt-sensitive. Older people are also more likely to react this way. Almost half the people with high blood pressure are salt-sen- sitive, which is why salt reduction is such a prominent part of treatment. There is no way to test for salt sensi- tivity except to eat less salt for a while to see if your blood pressure goes down. The cumulative effects of a high-salt diet eventually raise blood pressure in most people.

Quitting SmokingTobacco smoke contains literally thousands of substances that, alone or in combination, damage your health in many ways. In addition to damaging your lungs, smoking does harm throughout your cardiovas- cular system. It does not directly cause persistent high blood pressure, but it temporarily raises your blood pressure by constricting the diam- eter of the arteries to your heart, depriving your heart muscle of blood and oxygen. Every time you smoke a cigarette, your blood pressure goes up for about 30 minutes. A pack-a-day habit keeps your blood pressure up for 10 hours.
Exposure to tobacco smoke over time damages the protective lining of your artery walls, making them more susceptible to the formation of plaque. Plaque narrows the arteries and interferes with blood ?ow to your heart, your brain, and the rest of your body. Smoking also causes your blood to clot more easily, for reasons that are not fully understood. The clots more easily adhere to the inner surfaces of arteries roughened by plaque. Smoking also decreases the good cholesterol in your blood; see “Managing Your Cholesterol Level,” .
Smokeless tobacco products are not the way out. Although it is dif- ?cult to give up any tobacco habit, the enormous health bene?ts make it worth it. So if you smoke, quit. (For tips on aids to help you stop smoking, see the box above.) If you do not smoke now, do not even think about starting.

Managing Stress

Though stress does not cause high blood pressure, it can keep your blood pressure up when you are upset. The body normally responds to stress with the so-called ?ght-or-?ight response, which prepares the body either to meet challenges or to avoid them. A temporary increase in heart rate and blood pressure is a part of this physiological response, and it is stronger in some individuals than in others. Although stress is somewhat dif?cult to measure, research demonstrates some general ?ndings:

• In some individuals, blood pressure spikes in response to stressful situations, and these people are at greater risk of developing high blood pressure.
• Some people cope with stress in unhealthy ways, such as overeat- ing, smoking, or drinking alcohol, which become contributing factors to high blood pressure.
You may not be able to alter your body’s unconscious response to stress, and you cannot always avoid stressful situations, but you can learn relaxation techniques or coping activities like physical exercise that will help modify the harm to your health. You can also talk to your doctor about the level of stress in your life as one of the factors involved in your high blood pressure.

Limiting Alcohol Consumption

Over time, heavy drinking increases your chances of developing high blood pressure. It also contributes to the development of heart disease in other ways. If you are taking hypertension medications such as beta- blockers, alcohol may interfere with their action. If you have high blood pressure, talk to your doctor speci?cally about how alcohol in large quantities affects your blood pressure. In moderation, drinking has ben- e?cial effects and is associated with lower risk of developing heart dis- ease. Moderation generally means up to two drinks a day for men or one drink a day for women , whether each drink is a glass of wine, a beer, or a mixed drink.

limited to your blood pressure alone; they also improve your heart health, reduce your chances of stroke and kidney disease, and give you an overall sense of well-being. No matter how many predisposing fac- tors for high blood pressure apply to you—being male, being black, having hypertension in your family, being older—you can reduce your blood pressure somewhat with changes in lifestyle. These are the areas to work on:
• Start eating a low-fat, low-salt diet such as the DASH diet (see below).
• Lose weight if you are overweight.
• Exercise regularly.
• Drink alcohol in moderation.
• If you smoke, quit.
• Learn to manage stress.
• Do not take over-the-counter medications that can raise blood pressure, including decongestants or “energy products.”

Prehypertension

If you have prehypertension (with readings consistently 120/80 or higher but below 140/90), you are in a group that used to be called high normal. Almost one-third of the U.S. adult population now falls into the prehypertensive category. The most recent guidelines identify this range as a warning zone, because people in it are considerably more likely to develop true hypertension later in life. The designation of “prehypertension” re?ects evidence showing that the risk of heart disease actually begins to climb at readings above 115/75 mm Hg. From that level, every increase of 20/10 mm Hg doubles the risk of death from heart disease. Changing to a healthy lifestyle is the only way to prevent this progression into high blood pressure.
If you are in the prehypertensive category, you have a good reason to get motivated to start managing your blood pressure immediately through nondrug treatment. Even though you do not have high blood pressure, you can start making changes in your lifestyle that will bring your readings down to a lower, healthier level without medication; see pages 46–47. Lifestyle changes alone are likely to help you at this early stage. You and your doctor can start talking about setting priorities and taking de?nite steps to form some new habits.
Start with your eating habits. Eat 8 or more servings of fruits and vegetables each day and less fat and saturated fat. Limit salt intake to less than 1,500 mg per day, or about 3?5 of a teaspoon of salt. If you are overweight, losing weight can be important. The bene?ts of weight reduction start early, with a loss of as little as 10 to 15 pounds, because with every 3 pounds you lose, there is an average corresponding drop of about 2 mm Hg in your systolic pressure. Build just 30 minutes of exer- cise into your schedule, at least ?ve days a week. Limit your alcohol intake to no more than one drink per day for women and two drinks for men (whether hard liquor, wine, or beer). These changes may not seem easy at ?rst, but they will pay big dividends if they mean you will not have to take medications.

Systolic Hypertension

The guidelines also say that systolic pressure (the top number) of more than 140 mm Hg should be treated regardless of the diastolic level (bottom number). Either your systolic or your diastolic number—or both—may be elevated. As you get older, your diastolic pressure usually decreases and the systolic pressure begins to rise.
If only your systolic reading is high and your diastolic reading is nor- mal, you have the most common form of high blood pressure. It is called isolated systolic hypertension, and new guidelines emphasize its importance. Treating isolated systolic hypertension early, with lifestyle changes and medications if necessary, reduces the future risk of devel- oping heart disease and stroke. For example, with each reduction of 5 mm Hg in your systolic blood pressure, death from stroke is reduced about 14 percent and from heart disease by 9 percent. The potential impact on your quality of life is enormous.