Preventing and Managing High Blood Pressure

High blood pressure, also known as hypertension, affects 30% of Americans, and the older one gets, the higher the chances are of developing this condition. It has been called the “silent killer” as it is responsible for a significant number of heart attacks, strokes, and kidney disease. However, a lot of patients are unaware that they have the disease (up to 8%) or do not have any symptoms from it. The risk factors for developing high blood pressure include advancing age, family history, obesity or weight gain, race (more common in African-Americans), high salt intake, excessive alcohol consumption, and being physically inactive. Looking at this list, it is obvious that while one cannot change their age, race or family history, the other factors can be modified by key lifestyle changes. Let’s talk about those.

Salt
Sodium has been associated with a higher risk of developing hypertension, and certain individuals are “salt-sensitive,” where the blood pressure becomes more elevated with a certain level of salt intake compared to non-salt sensitive persons. In patients who have high blood pressure, a high salt intake can make their medications become less effective. Most medical organizations and societies recommend a sodium intake of 2.3 grams (2300 mg) or less per day. Food labels provide the sodium content per serving, and gives a general idea of whether you are getting your entire day’s worth of salt per serving or if it is truly “low sodium.” For my patients who don’t want to bother with adding up sodium throughout the day, the general rule of thumb I tell them is to avoid processed or canned food, as well as fast food, as these tend to be very high in sodium.

Salt substitutes typically contain potassium instead of sodium, which may be fine for some people, but in those with kidney issues, an excess of potassium in their diet can be problematic. If you would like to use salt substitutes, ask your physician if this is something that you can do safely. Likewise, experiment with using non-salt options to flavor food – herbs and spices can be used to make food tasty without using salt.

Reducing alcohol consumption
Moderate alcohol consumption has been defined as no more than 2 drinks per day for men and 1 drink per day in women. If you consume alcohol only while watching the football game on Saturdays and didn’t drink at all during the week, this does not mean that if you are a male, you can consume 14 drinks on that day (2 drinks per day x 7 days should be 14 drinks, right?). No. Anything above the recommended daily amount mentioned above will count as “excessive.” This blood pressure-lowering benefit of moderating alcohol intake has been shown for people who drink excessively, and if you already do not consume alcohol, this does not mean that you should start.

Weight gain and obesity
The presence of obesity at 18 years of age and at midlife has been associated with the development of hypertension. Weight gain of 10-20 lbs. has also been shown to increase the risk of developing high blood pressure, and this risk is even higher with greater weight gain. Excess weight also makes blood pressure medications less effective. On the other hand, for every 2-lb weight loss achieved, the blood pressure is lowered by 1 point. A sustained weight loss of more than 12 lbs. reduces the risk of developing high blood pressure by as much as 26%. Weight loss also has a number of benefits on overall health. Always discuss with your physician regarding which weight loss strategy will be safe for you.

Increased physical activity
Being physically inactive (extended sitting time at work, watching television for long periods, etc.) increases your risk of developing hypertension (and other diseases like diabetes, certain cancers and Alzheimer’s disease) and also your risk of early death. The simple act of replacing an hour of one’s day with non-exercise activity (such as performing household chores, yard work, or walking) in persons who are physically inactive has been shown to decrease mortality significantly. For most people, 150 minutes per week of moderate-intensity activity (such as walking for 30 minutes, 5 days a week) is recommended, and it is important to ease into an exercise regimen slowly, in order to let your body adjust. People with known heart, kidney, or lung disease and older folks should discuss exercise options with their physician prior to starting.
By: Sasha Acelajado, MD