by Richard Glickman-Simon, MD Hypertension (high blood pressure) is a classic example of a silent disease. Like most major chronic degenerative conditionscancer, diabetes, coronary artery diseasehypertension tends to produce its symptoms long after the disease process has begun. When people with hypertension become aware of their condition, their symptoms are rarely due to the high blood pressure itself, but rather from the irreversible harm it has already caused to the brain, heart, eyes, and/or kidneys. This is the bad news. Now for the good news. Hypertension is easily diagnosed and most cases are highly treatableeven curable. Essential hypertension, the most common type, has no known cause, but it progresses very slowly, typically taking decades to wreak its havoc on the body. That leaves ample time for diagnosis and treatment. Diagnosis usually occurs with regular blood pressure screening. Unless blood pressure is consistently very high (greater than 160/100 mmHg) or there are other serious medical problems in addition to hypertension, use of medications may be delayed until lifestyle changes are tried. Note that while a blood pressure of 140/90 is generally considered the cutoff for high blood pressure, growing evidence indicates that it is healthiest to keep blood pressures down to 120/80 or below.
Unlike many other chronic degenerative diseases, most cases of essential hypertension are potentially curable. But the cure requires a commitment to substantial lifestyle change, without which hypertensive patients should expect to be on medicine for the rest of their lives. People with a strong genetic predisposition to high blood pressure or those with secondary causes for their hypertension (like kidney disease) do not generally respond to lifestyle interventions and may require medications. Lifestyle Changes There is considerable scientific evidence that adopting the following five lifestyle modifications can help you avoid, reduce, or even eliminate the need for anti-hypertensive medications. Achieve and maintain a healthy weight. If you make just one lifestyle modification, it should be to lose weight if you are overweight. Not only is obesity a major contributor to hypertension, it is also associated with other cardiovascular risks like high cholesterol and diabetes. The best way to lose weight is to combine a moderate exercise program with a healthy diet. A registered dietitian and/or a personal trainer can help you get started. Limit salt intake. Not everyone responds to salt in the same way, but some people's blood pressure is affected by the amount of salt they eat. Since there is no easy way to determine who is salt sensitive and who is not, the best advice is to keep your salt intake downless than 6 grams (6,000 mg) per day of sodium chloride (NaCl). This can be difficult in an era of processed foods, which tend to be high in salt. Check the Nutrition Facts label on the foods you buy to see how much sodium they contain.
The best way to limit sodium is to eat a diet rich in fruits, vegetables, and freshly prepared foods, which are naturally low in sodium. Eat plenty of fruits, vegetables, and non-fat dairy. A recent large clinical investigation (the DASH study) showed that a diet rich in fresh fruits, vegetables, and low-fat dairy products can significantly lower blood pressure in hypertensive patients when compared to a typical American diet. There is speculation that the antioxidant nutrients (vitamins C and E, and beta-carotene), potassium, calcium, and magnesium in these foods may have contributed to the blood pressure-lowering factors. Other studies, however, investigating the value of these nutrients in isolation from food have not shown consistently positive results. When it comes to blood pressure control (and most other chronic diseases), supplementing an unhealthy diet is no substitute for eating a healthy one. Exercise regularly. Even independent of its favorable effects on weight, regular aerobic exercise can lower blood pressure. The duration and frequency necessary to prevent or treat high blood pressure has not been well established. However, you are more likely to persevere over the long term with a low intensity exercise program (eg, brisk walking 30 minutes per day) than a high intensity one. Remember, once the exercise stops, so do its benefits.
Moderate alcohol consumption. While moderate alcohol consumption may, on balance, be beneficial to your health, excessive alcohol is clearly associated with increased blood pressure. Men should restrict their alcohol consumption to two drinks per day. For women, the limit is one drink. Other Interventions Other factors that may help reduce your blood pressure include the following: Omega-3 fatty acids. There is some evidence that a diet rich in essential fatty acids, in particular omega-3 fatty acids, may help reduce blood pressure in hypertensive patients. Omega-3 fatty acids are abundant in fatty, cold-water fish (eg, salmon, mackerel, herring) and in flaxseeds, which you can add to cereals, casseroles, baked goods, and other foods. Coenzyme Q10. A powerful antioxidant found in virtually every cell in the body, coenzyme Q10 has been shown to reduce blood pressure in a number of small studies. Garlic. Of the many herbs that have been investigated for their effect on blood pressure, garlic has probably received the most attention in human studies. While garlic appears to confer a number of benefits to cardiovascular health, its effect on blood pressure is probably minimal.
Stevia. Best known as a non-sugar sweetener, extracts of the herb Stevia rebaudiana have shown blood pressure lowering properties in two studies.
Mind-body interventions. The relationship between psychologic stress and blood pressure is complex. While an emotionally stressful event temporarily raises blood pressure, people who experience chronic or recurrent stress may or may not develop hypertension over the long-term.
Various mind-body techniques can help reduce stress:
- Transcendental meditation
- Progressive muscle relaxation (PMR)
- Medical hypnosis
Even though there is little scientific evidence that these interventions will help every hypertensive patient, their excellent safety records make them attractive options.
Massage. There is substantial evidence that massage therapy benefits patients, at least in part, by minimizing the stress response. Certain hypertensive patients, therefore, may respond in much the same way as they would to a mind-body intervention. There is some research suggesting that massage therapy may even be superior to PMR for hypertension.
Qi Gong. Qi Gong is an ancient Chinese healing art that combines meditation, breathing, movement, and spiritual practices. Qi Gong appears to be beneficial for a number of chronic conditions including hypertension. While no study has clearly documented an anti-hypertensive effect, Qi Gongs safety and its multiple potential health benefits make it a worthwhile alternative to consider.
Last reviewed January 2008 by Michael J. Fucci, DO Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.