High Blood Pressure (Hypertension)

What You Can Do to Control Your Blood Pressure

Lifestyle changes play an important role in managing high blood pressure. Although permanent changes in lifestyle and diet are sometimes difficult to achieve, they may eliminate the need for drug treatment or allow reductions in the dosages of medications.

A recent study showed that well-motivated individuals with Stage 1 and 2 hypertension were able to adopt changes in diet and lifestyle that led to significant weight loss, reduced sodium and alcohol intake, and increased physical activity. These people significantly reduced their blood pressures.

Lifestyle changes carry other benefits, as well. They can keep high blood pressure from developing in the first place, reduce other cardiovascular risk factors, and improve your overall health.

Experts recommend the following lifestyle modifications for the prevention and management of hypertension:

  • Lose weight, if you’re overweight
  • Increase aerobic physical activity
  • Reduce your sodium intake
  • Maintain an adequate intake of dietary potassium and calcium
  • Reduce your intake of dietary saturated fat and cholesterol
  • Limit your alcohol intake
  • Stop smoking
  • Manage stress

Losing Weight Safely

Being overweight goes hand in hand with high blood pressure. Excess abdominal fat is also associated with high cholesterol levels, diabetes, and heart disease.

Fortunately, most people with high blood pressure can significantly reduce their blood pressure by losing as little as 10 pounds. Weight loss also reduces the risk of heart disease and enhances the effects of some medications used to treat high blood pressure.

Any overweight individual who has high blood pressure should take steps to reduce body weight. These measures include dietary changes and exercise. A nutritionist can also help you develop a healthful weight loss diet.

How To Information:

Here are some guidelines for losing weight and keeping it off:

  • Lose weight slowly. Plan to lose no more than two to four pounds a month.
  • Cut down on fatty foods. Eat a balanced diet that includes lots of fruits and vegetables.
  • Get more exercise. Exercise will help you to burn calories, and it will also help you to lose fat, not muscle.

Becoming Physically Active

Besides reducing the risk of high blood pressure and other cardiovascular disease, physical activity can enhance weight loss and general health. The best type of exercise for preventing and reducing high blood pressure is regular aerobic physical activity, which includes things like walking, cycling, swimming, jogging, aerobic dance classes, rowing, dancing, and skating – in short, anything that raises your heart rate for an extended period of time. Whatever activity you choose, make sure to start slowly and build up gradually.

People with high blood pressure can effectively lower their blood pressure with moderate physical activity (such as 30 to 45 minutes of brisk walking most days). People with normal blood pressure can also benefit from exercise. Compared with people who are fit and physically active, sedentary people with normal blood pressure have a 20% to 50% greater chance of developing high blood pressure.

Need To Know:

Most individuals can safely increase their physical activity without an extensive medical evaluation. But those with cardiovascular disease or other serious medical problems may need a thorough evaluation and referral to a medically supervised exercise program. Talk to your doctor about what is recommended for you before starting to exercise.

Nice To Know:

Q. If I exercise vigorously, like jogging, won’t that be dangerous because my heart rate will speed up?

A. It is true that your heart rate will speed up when you exercise, causing your blood pressure to rise temporarily. But normally your body compensates by causing blood vessels to relax. With regular exercise, your heart will pump blood more efficiently. However, you should always check with your doctor before exercising. Some individuals (such as those with heart disease) may need to take special precautions, including a thorough medical evaluation, before beginning an exercise program. The hearts of some individuals are also more susceptible to increased stress associated with exercising.

How To Information:

To make sure that you are not placing too much strain on your heart, you should monitor your heart rate by checking your heart rate. To determine your heart rate, use your index and third finger to find the pulse at your wrist or neck, count for six seconds, and add a zero. Since heart rates that are generally safe for people who are exercising vary with different factors (including age and state of health), you should ask your doctor what is a safe range for you.

How To Information:

Walking is one of the simplest, cheapest, and easiest ways to increase your physical activity level. For most people, walking is a good starting point,

  • Start by buying a comfortable, well-fitted pair of walking shoes.
  • Take short walks whenever you can fit them in. That might mean walking to the post office at lunch, or taking the dog for a walk in the evening.

Later, aim for longer exercise sessions:

  • Start by walking for at least 15 to 20 minutes several times a week.
  • Gradually build up to at least 30 minutes, five times a week.

Need To Know:

Exercise is one of the best ways to enhance your overall health and decrease blood pressure. However, exercise also puts additional strain on your heart. Here are some safety rules to follow when exercising:

  • Do not get out of breath. If you find it hard to hold a conversation while you are exercising, slow down.
  • If you have any symptoms such as chest pain or extreme shortness of breath, stop immediately and contact your doctor.
  • If you want to try more vigorous activity, check with your doctor first. He or she may first want you to take a stress test.
  • Do not engage in muscle-building types of exercise (e.g., weight lifting) without checking with your doctor first. These types of exercise may raise your blood pressure.

Limiting Salt In Your Diet

The role that sodium plays in hypertension is somewhat controversial. Sodium, found in table salt and processed foods, appears to affect blood pressure in some people while having little effect on others.

Some people can reduce their blood pressure simply by reducing the salt in their diet. These people are considered “salt sensitive,” meaning that their blood pressure goes up when they eat more salt and goes down when they eat less salt.

People who are most likely to be salt sensitive include:

  • Older people
  • Black people
  • People with diabetes

People with high blood pressure can benefit from a moderately reduced sodium intake in several other ways, as well. Cutting back on the salt in your diet may also:

  • Reduce the need for medications to treat high blood pressure
  • Reduce potassium loss with diuretic treatment (blood pressure treatment that reduces blood volume)
  • Protect you from osteoporosis and kidney stones
  • Possibly reverse a condition known as left ventricular hypertrophy, the thickening of the muscle in the wall of the left ventricle that can occur with uncontrolled hypertension

Need To Know:

Hypertension experts recommend that dietary sodium intake be restricted to no more than 2400 milligrams, or one teaspoon, of sodium a day. This is about two-thirds of the amount of sodium that Americans normally consume per day, the bulk of which (75%) comes from processed foods.

How To Information:

You can reduce the sodium in your diet with a few simple steps:

  • Cut down on salt used at the table.
    • Taste food before adding salt.
    • Remove the salt shaker from the table.
  • Cut down on salt used when cooking.
    • Reduce the amount of salt added to half the amount suggested.
    • Replace salt with alternative flavorings like pepper, garlic, lemon juice, herbs, and spices.
  • Eat sensibly at restaurants.
    • If you eat at fast-food restaurants, ask for a nutritional analysis of the foods, so you can check the sodium content of different items.
    • In Chinese restaurants, ask for food without monosodium glutamate (MSG).
  • Check labels on food purchased at the grocery store.
    • Use labels to compare the amount of sodium in canned, frozen, and packaged foods.
    • Look for foods or seasonings that are labeled “low sodium” or “sodium free.”
    • Whenever possible, start with fresh food that you can season yourself.

Getting Enough Potassium And Calcium In Your Diet

Potassium and calcium may also help to reduce your risk of developing high blood pressure, or lower your blood pressure if it is already high.

  • Potassium. Studies suggest that high potassium intake may protect against the development of high blood pressure and help people with high blood pressure control their blood pressure. On the other hand, blood pressure may increase if you don’t get enough potassium in your diet.

    The best sources of potassium are fresh fruits and vegetables, especially bananas, prunes, grapefruits, tomatoes, and potatoes. If you eat enough of these foods, it will be easy to get the recommended 3500 milligrams of potassium daily. A banana, for example, contains about 500 milligrams potassium, while a medium-sized potato contains more than 700 milligrams potassium.

    Potassium is even more important if your doctor prescribes certain types of medications, called diuretics, which cause the body to lose potassium. If potassium levels become too low, heart rhythms may be disturbed.

Need To Know:

Because some medications (such as potassium-sparing diuretics) and medical conditions (such as kidney disease) are associated with increased potassium levels, you should check with your doctor before using any potassium-containing salt substitutes or potassium supplements. Potassium levels that are too high are extremely dangerous and can be lethal.

  • Calcium. Not getting enough calcium in your diet may also increase your risk for high blood pressure. Although increasing your calcium intake may also help to lower blood pressure, this effect is small, so calcium supplements are not generally recommended to lower blood pressure.

    Getting enough calcium in your diet is important for other reasons. High blood pressure increases the risk of osteoporosis by causing calcium loss through the urine. Calcium regulates smooth muscle tone in blood vessels, is important for general health, and may help prevent some gastrointestinal cancers.

Limiting Fat And Cholesterol In Your Diet

Experts are exploring the link between fat and cholesterol intake and blood pressure. Early studies have shown that changes in fat intake may lower blood pressure. These changes include decreasing total fat intake, while increasing intake of polyunsaturated fats relative to saturated, and/or increasing intake of fish oils.

Saturated fats are found in tropical oils such as palm and coconut oil, and in vegetable oils that have been chemically changed to make them solid at room temperature, a process called hydrogenation. Cholesterol is only found in animal foods like beef, pork, lamb, and dairy products. Both types of fat can contribute to high cholesterol levels, and may play a role in raising blood pressure.

Diets low in saturated fats and cholesterol have been shown to reduce the risk of heart disease. The role of such dietary changes in people with essential hypertension and no other cardiovascular risk factors is less clear.

Need to Know:

Since high blood pressure and high cholesterol levels commonly occur together, reducing your intake of dietary fats may be important. Experts recommend that individuals with both conditions make significant dietary changes and/or take medications to lower their risk of coronary heart disease.

How To Information:

You can reduce the fat and cholesterol in your diet without sacrificing flavor. Here are some easy ways to cut back on fat and cholesterol:

  • Eat three balanced meals a day, including multiple servings of fruits and vegetables.
  • Cut fat off meat.
  • Use nonstick sprays or cookware.
  • Pour off the liquid fat when you cook meat.
  • Experiment with an occasional vegetarian meal.
  • Bake, broil, steam, microwave, or barbecue your food instead of frying it.
  • Find substitutes for fat to use for seasoning food.
  • Find low-fat or nonfat versions of items like salad dressings, frozen desserts, and baked goods.
  • Read labels when you buy prepared foods, and find the brand that is lowest in fat content.
  • Plan for low-fat snacks, like fruits or vegetables, and carry them with you so you will not be tempted to buy “junk food.”
  • When eating out, look for “heart healthy” items on the menu.
  • Use low fat or nonfat dairy products, such as skim milk.
  • Use liquid vegetable oils instead of margarine, hydrogenated vegetable oils, or butter.

Limiting Alcohol Intake

Alcohol abuse causes about 10 percent of high blood pressure cases. People who drink three or more alcoholic drinks a day risk hypertension, while binge-drinkers have even higher blood pressures. Alcohol abuse also increases the risk for stroke, liver disease, and other serious conditions. It can also reduce the effectiveness of medications used to treat high blood pressure.

Yet limited alcohol intake does not raise blood pressure and has even been shown to lower risk of cardiovascular disease. Experts recommend that alcohol intake be limited to no more than 1 oz of ethanol per day. This could include two 12-oz beers, two 5-oz glasses of wine, or one 2-oz shot of 100-proof whiskey.

Women and lighter-weight individuals should restrict their alcohol intake to half this amount. This is because women absorb more ethanol than men, and lighter individuals are more susceptible to the effects of alcohol than heavier people.

Need to Know:

If you have any concerns about your alcohol intake, you should consult your doctor. Sudden stopping of heavy drinking can cause problems (including high blood pressure).

Quitting The Tobacco Habit

Avoiding tobacco in any form – including cigarettes, pipes, chewing tobacco, and cigars – can help to improve anyone’s health. Those who quit smoking usually experience beneficial cardiovascular effects over the course of one year.

Each time you smoke a cigarette, your blood pressure rises for a short time. This sudden increase in blood pressure appears to be temporary, much like the short-term increase in blood pressure associated with the intake of caffeine-containing products such as coffee, tea, and colas.

However, smokers in one study had blood pressures up to 10 points higher than nonsmokers. Cigarette smoking increases the risk for other cardiovascular disease and cancer, and may also interfere with the effects of medications used to treat high blood pressure.

Your doctor can help you stop smoking, should you decide to quit. There are a number of available products (e.g., nicotine patch, gum, medication) designed to help you quit smoking.

Smoking cessation materials are also readily available from voluntary health organizations and federal agencies. The American Cancer Society http://www.cancer.org or American Lung Association http://www.lungusa.org can provide you with information about programs you can follow at home or classes in your area.

Managing Stress

Although stress can increase blood pressure, it is not considered a major cause of high blood pressure. A number of studies have not proven that relaxation therapies or biofeedback to significantly reduce blood pressure. But these techniques do have other benefits. They can help to reduce anxiety and give you a sense of well-being. They also can help you make other important lifestyle changes, such as changes in dietary and alcohol intake, or quitting smoking.

How To Information:

Here are some techniques that can help you manage stress:

  • Think ahead about times you may be under increased stress. Plan ways to avoid the situation, if possible.
  • If you feel tense, take a walk or go for a swim. Exercise is a wonderful natural tranquilizer.
  • Get a massage. A massage is a wonderful opportunity to relax mind, body, and spirit.
  • Breathe. When you are under stress, concentrate on drawing air deeply into your lungs and let your abdomen expand – not just your chest.
  • Explore yoga, meditation, or other techniques for stress reduction.
  • Practice complete relaxation for a short time every day. Sit comfortably and relax your muscles in turn – first your legs, then your arms, then your shoulders, then your body, neck, and face.
  • Imagine a soothing scene, like an empty beach on a calm, warm day. Empty everything else from your mind.
  • If you feel unable to cope, ask your doctor to recommend a mental health professional who can assist you in dealing with stress.


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