Lifestyle Changes:

Healthy lifestyle changes are an important first step for lowering blood pressure. Current guidelines recommend that people should:

• Exercise at least 30 minutes a day
• Maintain normal weight
• Reduce sodium (salt) intake
• Increase potassium intake
• Limit alcohol consumption to no more than one or two drinks a day
• Consume a diet rich in fruits, vegetables, and low-fat dairy products while reducing total and saturated fat intake. (The DASH diet is one way of achieving such a dietary plan.)
• Quit smoking

DASH Diet

The salt-restrictive DASH diet (Dietary Approaches to Stop Hypertension) is proven to help lower blood pressure, and may have additional benefits for preventing heart disease and stroke. Effects on blood pressure are sometimes seen within a few weeks. This diet is not only rich in important nutrients and fiber but also includes foods that contain far more potassium (4,700 mg/day), calcium (1,250 mg/day), and magnesium (500 mg/day) and much less sodium (salt) than are found in the average American diet.

A diet that is effective in lowering blood pressure is called Dietary Approaches to Stop Hypertension (DASH).

DASH diet recommendations:

• Limit sodium (salt) intake to no more than 2,300 mg a day (a maximum intake of 1,500 mg a day is an even better goal).
• Reduce saturated fat to no more than 6% of daily calories and total fat to 27% of daily calories. (But, include dairy products that are non- or low-fat. Low-fat dairy products appear to be especially beneficial for lowering systolic blood pressure).
• When choosing fats, select monounsaturated oils, such as olive or canola oils.
• Choose whole grains over white flour or pasta products.
• Choose fresh fruits and vegetables every day. Many of these foods are rich in potassium, fiber, or both, possibly helping lower blood pressure.
• Include nuts, seeds, or legumes (dried beans or peas) daily.
• Choose modest amounts of protein (no more than 18% of total daily calories). Fish, skinless poultry, and soy products are the best protein sources.
• Other daily nutrient goals in the DASH diet include limiting carbohydrates to 55% of daily calories and dietary cholesterol to 150 mg. Patients should try to get at least 30 g of daily fiber.

Restricting Salt and Increasing Potassium

Salt. Some sodium (salt) is necessary for health, but the amount is vastly lower than that found in the average American diet. High salt intake is associated with high blood pressure (hypertension). It is a good idea for everyone to restrict their salt intake to less than 2,300 mg (about 1 teaspoon) a day. Some people over age 50, or who have high blood pressure, may need to reduce sodium intake to less than 1,500 mg daily. This lowering of blood pressure may also help protect against heart failure and heart disease.

Some people (especially African-Americans, older adults, people with diabetes, overweight people, and people with a family history of hypertension) are “salt sensitive,” which means their blood pressure responds much more to salt than other people. People with salt sensitivity have a higher than average risk of developing high blood pressure as well as other heart problems

Salt substitutes, such as Nusalt and Mrs. Dash, (which contain mixtures of potassium, sodium, and magnesium) are available, but they can be risky for people with kidney disease or those who take blood pressure medication that causes potassium retention.

Potassium. A potassium-rich diet is important for reducing blood pressure. For people without risks for potassium excess, potassium-rich foods can help offset dietary salt intake. These foods include bananas, oranges, pears, prunes, cantaloupes, tomatoes, dried peas and beans, nuts, potatoes, and avocados. For people without risk factors for excess potassium levels, the recommended daily intake of potassium is 3,500 mg a day.

Some patients may need to take potassium supplements. However, people who take medications that limit the kidney's ability to excrete potassium, such as ACE inhibitors, dogixin or potassium-sparing diuretics, should not take potassium supplements and should be aware of excess potassium in their diet.

Other Dietary Considerations

Fiber. Increasing fiber in the diet may help reduce blood pressure levels.

Fish Oil and Omega 3 Fatty Acids. Omega 3 fatty acids (docosahexaenoic and eicosapentaneoic acids) are found in oily fish. Studies indicate that they may have specific benefits for many medical conditions, including heart disease and hypertension. They appear to help keep blood vessels flexible and may help protect the nervous system. Fatty acids are also available in supplements, but their long-term effects on blood pressure are unknown.

Calcium. Calcium regulates the tone of the smooth muscles lining blood vessels. Studies have found that people who have sufficient dietary calcium have lower blood pressure than those who do not. Hypertension itself increases calcium loss from the body. The effects of extra calcium on blood pressure, however, are mixed, with some even showing higher pressure.

Weight Loss

Even modest weight loss in overweight people, particularly in the abdominal area, can immediately lower blood pressure. Weight loss, especially when accompanied by salt restriction, may allow patients with mild hypertension to safely reduce or go off medications. The benefits of weight loss on blood pressure are long-lasting.

Exercise

Regular exercise helps keep arteries elastic, even in older people, which in turn ensures blood flow and normal blood pressure. Doctors recommend at least 30 minutes of exercise on most days.

High-intensity exercise may not lower blood pressure as effectively as moderate intensity exercise and may be dangerous in people with hypertension. Older people and those with uncontrolled hypertension or other serious medical conditions should check with their doctors before starting an exercise program.

Good Sleep Habits

Certain sleep disorders, especially sleep apnea, are associated with hypertension. Even chronic, insufficient sleep may raise blood pressure in patients with hypertension, placing them at increased risk of heart disease and death. Stress hormone levels increase with sleeplessness, which can activate the sympathetic nervous system, a strong player in hypertension. Patients who have chronic insomnia or other severe sleep disturbances (particularly sleep apnea) may want to consult a sleep expert. Patients with hypertension who are habitually poor sleepers should consider long-acting blood pressure medications to help counteract the increase in blood pressure that occurs in the early morning hours.

Stress Reduction

Stress reduction may help blood pressure control. Yoga, t� ' ai chi, and relaxation techniques such as meditation may be beneficial.