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Guide to Lowering Blood Pressure

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Blood pressure is the force of blood against the walls of arteries. Blood pressure rises
and falls throughout the day. When blood pressure stays elevated over time, it’s called
high blood pressure.

The medical term for high blood pressure is hypertension. High blood pressure is dangerous

because it makes the heart work too hard and contributes to atherosclerosis (hardening
of the arteries). It increases the risk of heart disease   and stroke, which are the
first- and third-leading causes of death among Americans. High blood pressure also can
result in other conditions, such as congestive heart failure, kidney disease, and blindness.
A blood pressure level of 140/90 mmHg or higher is considered high. About two-thirds
of people over age 65 have high blood pressure. If your blood pressure is between
120/80 mmHg and 139/89 mmHg, then you have pre hypertension. This means that you
don’t have high blood pressure now but are likely to develop it in the future unless you
adopt the healthy lifestyle changes.

People who do not have high blood pressure at age 55 face a 90 percent chance of
developing it during their lifetimes. So high blood pressure is a condition that most
people will have at some point in their lives.

Both numbers in a blood pressure test are important, but for people who are age 50
or older, systolic pressure gives the most accurate diagnosis of high blood pressure.
Systolic pressure is the top number in a blood pressure reading. It is high if it is
140 mmHg or above.

R i s k Fa c to r s f o r H e a r t D i s e a s e


Risk factors are conditions or behaviors that increase your chances of developing a disease. When you have
more than one risk factor for heart disease, your risk of developing heart disease greatly multiplies. So if
you have high blood pressure, you need to take action. Fortunately, you can control most heart disease
risk factors.

[table id=1 /]

How Can You Prevent or Control High Blood Pressure?


If you have high blood pressure, you and your health care provider need to work together as
a team to reduce it. The two of you need to agree on your blood pressure goal. Together, you
should come up with a plan and timetable for reaching your goal.

Blood pressure is usually measured in millimeters of mercury (mmHg) and is recorded as
two numbers—systolic pressure (as the heart beats) “over” diastolic pressure (as the heart
relaxes between beats)—for example, 130/80 mmHg. Ask your doctor to write down for
you your blood pressure numbers and your blood pressure goal level.

Monitoring your blood pressure at home between visits to your doctor can be helpful.
You also may want to bring a family member with you when you visit your doctor.
Having a family member who knows that you have high blood pressure and who

understands what you need to do to lower your blood pressure often makes it easier to make
the changes that will help you reach your goal.

• Maintain a healthy weight.
• Be physically active.
• Follow a healthy eating plan.
• Eat foods with less sodium (salt).
• Drink alcohol only in moderation.
• Take prescribed drugs as directed.
*Being overweight or obese increases your risk of developing high blood pressure.

In fact, your blood pressure rises as your body weight increases. Losing even 10 pounds can
lower your blood pressure—and losing weight has the biggest effect on those who are
overweight and already have hypertension.

Overweight and obesity are also risk factors for heart disease. And being overweight or
obese increases your chances of developing high blood cholesterol and diabetes—two
more risk factors for heart disease.

Two key measures are used to determine if someone is overweight or obese. These are
body mass index, or BMI, and waist circumference.

BMI is a measure of your weight relative to your height. It gives an approximation of
total body fat—and that’s what increases the risk of diseases that are related to being
overweight.

But BMI alone does not determine risk. For example, in someone who is very muscular
or who has swelling from fluid retention (called edema), BMI may overestimate body fat.
BMI may underestimate body fat in older persons or those losing muscle.

That’s why waist measurement is often checked as well. Another reason is that too much
body fat in the stomach area also increases disease risk. A waist measurement of more
than 35 inches in women and more than 40 inches in men is considered high.

As you lose weight, be sure to follow a healthy eating plan that includes a variety of
foods. A good plan to follow is the one given in box 6. Some tips to make the plan lower
in calories appear in box 8.7

Being physically active is one of the most important things you can do to prevent or
control high blood pressure. It also helps to reduce your risk of heart disease.

It doesn’t take a lot of effort to become physically active. All you need is 30 minutes
of moderate-level physical activity on most days of the week. Examples of such activities
are brisk walking, bicycling, raking leaves, and gardening. For more examples, see box 5.
You can even divide the 30 minutes into shorter periods of at least 10 minutes each.
For instance: Use stairs instead of an elevator, get off a bus one or two stops early, or
park your car at the far end of the lot at work. If you already engage in 30 minutes of
moderate-level physical activity a day, you can get added benefits by doing more. Engage
in a moderate-level activity for a longer period each day or engage in a more vigorous
activity.

Most people don’t need to see a doctor before they start a moderate-level physical
activity. You should check first with your doctor if you have heart trouble or have had
a heart attack, if you’re over age 50 and are not used to moderate-level physical activity,
if you have a family history of heart disease at an early age, or if you have any other
serious health problem.

E x a m p l e s o f M o d e r a t e – L e v e l P h ys i c a l A c t i v i t i e s

Common Chores Sporting Activities
Playing volleyball for 45–60 minutes
Playing touch football for 45 minutes
Walking 2 miles in 30 minutes (1 mile in 15 minutes)
Shooting baskets for 30 minutes
Bicycling 5 miles in 30 minutes
Dancing fast (social) for 30 minutes
Performing water aerobics for 30 minutes
Swimming laps for 20 minutes
Playing basketball for 15–20 minutes
Jumping rope for 15 minutes
Running 1
1/2 miles in 15 minutes (1 mile in 10 minutes)
Washing and waxing a car for 45–60 minutes
Washing windows or floors for 45–60 minutes
Gardening for 30–45 minutes
Wheeling self in wheelchair for 30–40 minutes
Pushing a stroller 1
1/2 miles in 30 minutes
Raking leaves for 30 minutes
Shoveling snow for 15 minutes
Stair walking for 15 minutes
Lower Your Blood Pressure by Being Active.

What you eat affects your chances of getting high blood pressure. A healthy eating plan
can both reduce the risk of developing high blood pressure and lower a blood pressure
that is already too high.

For an overall eating plan, consider DASH, which stands for “Dietary Approaches to
Stop Hypertension.” You can reduce your blood pressure by eating foods that are low in
saturated fat, total fat, and cholesterol, and high in fruits, vegetables, and lowfat dairy
foods. The DASH eating plan includes whole grains, poultry, fish, and nuts, and has low
amounts of fats, red meats, sweets, and sugared beverages. It is also high in potassium,
calcium, and magnesium, as well as protein and fiber. Eating foods lower in salt and
sodium also can reduce blood pressure.

The number of servings that is right for you may vary, depending on your caloric need.
The DASH eating plan has more daily servings of fruits, vegetables, and grains than
you may be used to eating. Those foods are high in fiber, and eating more of them may
temporarily cause bloating and diarrhea. To get used to the DASH eating plan, gradually
increase your servings of fruits, vegetables, and grains. Box 7 offers some tips on how to
adopt the DASH eating plan.

A good way to change to the DASH eating plan is to keep a diary of your current eating
habits. Write down what you eat, how much, when, and why. Note whether you snack
on high-fat foods while watching television or if you skip breakfast and eat a big lunch.
Do this for several days. You’ll be able to see where you can start making changes.

If you’re trying to lose weight, you should choose an eating plan that is lower in calories.

Again, a food diary can be helpful. It can tell you if there are certain times that you eat but
aren’t really hungry or when you can substitute low-calorie foods for high-calorie foods.

Lower Your Blood Pressure by Eating Right

Th e D A S H E a t i n g P l a n

Grains and grain products
Vegetables
Fruits
Low fat or fat free dairy foods
Lean meats, poultry, and fish
Nuts, seeds, and dry beans
Fats and oils
Sweets

Ti p s o n S w i t c h i n g to t h e D A S H E a t i n g P l a n

• Change gradually. Add a vegetable or fruit serving at lunch and dinner.
• Use only half the butter or margarine you do now.
• If you have trouble digesting dairy products, try lactase enzyme pills or drops—they’re available
at drugstores and groceries. Or buy lactose-free milk or milk with lactase enzyme added to it.
• Get added nutrients such as the B vitamins by choosing whole grain foods, including whole
wheat bread or whole grain cereals.
• Spread out the servings. Have two servings of fruits and/or vegetables at each meal, or add
fruits as snacks.
• Treat meat as one part of the meal, instead of the focus. Try casseroles, pasta, and stir-fry dishes.
Have two or more meatless meals a week.
• Use fruits or lowfat foods as desserts and snacks.

H o w To L o s e W e i g h t o n t h e D A S H E a t i n g P l a n


The DASH eating plan was not designed to promote weight loss. But it is rich in low-calorie foods
such as fruits and vegetables. You can make it lower in calories by replacing high-calorie foods
with more fruits and vegetables—and that also will make it easier for you to reach your DASH
eating plan goals. Here are some examples:
To increase fruits:
• Eat a medium apple instead of four shortbread cookies. You’ll save 80 calories.
• Eat 1/4 cup of dried apricots instead of a 2-ounce bag of pork rinds. You’ll save 230 calories.
To increase vegetables:
• Have a hamburger that’s 3 ounces instead of 6 ounces. Add a 1/2 cup serving of carrots and
a 1/2 cup serving of spinach. You’ll save more than 200 calories.
• Instead of 5 ounces of chicken, have a stir fry with 2 ounces of chicken and 1 1/2 cups of raw
vegetables. Use a small amount of vegetable oil. You’ll save 50 calories.
To increase lowfat or fat free dairy products:
• Have a 1/2 cup serving of lowfat frozen yogurt instead of a 1 1/2-ounce milk chocolate bar. You’ll
save about 110 calories.
And don’t forget these calorie-saving tips:
• Use lowfat or fat free condiments, such as fat free salad dressings.
• Eat smaller portions—cut back gradually.
• Choose lowfat or fat free dairy products to reduce total fat intake.
• Use food labels to compare fat content in packaged foods. Items marked lowfat or fat free are
not always lower in calories than their regular versions. See box 11 on how to read and compare
food labels.
• Limit foods with lots of added sugar, such as pies, flavored yogurts, candy bars, ice cream,
sherbet, regular soft drinks, and fruit drinks.
• Eat fruits canned in their own juice.
• Snack on fruit, vegetable sticks, unbuttered and unsalted popcorn, or bread sticks.
• Drink water or club soda.

Use More Spices and Less Salt
An important part of healthy eating is choosing foods that are low in salt (sodium
chloride) and other forms of sodium. Using less sodium is key to keeping blood pressure
at a healthy level.

Most Americans use more salt and sodium than they need. Some people, such as African
Americans and the elderly, are especially sensitive to salt and sodium and should be
articularly careful about how much they consume.

Most Americans should consume no more than 2.4 grams (2,400 milligrams) of sodium
a day. That equals 6 grams (about 1 teaspoon) of table salt a day. For someone with high
blood pressure, the doctor may advise less. The 6 grams includes all salt and sodium
consumed, including that used in cooking and at the table.

Before trying salt substitutes, you should check with your doctor, especially if you have
high blood pressure. These contain potassium chloride and may be harmful for those
with certain medical conditions.

Some tips on how to choose and prepare foods that are low in salt and sodium.

Ti p s To R e d u c e S a lt a n d S o d i u m


• Buy fresh, plain frozen, or canned “with no salt added” vegetables.
• Use fresh poultry, fish, and lean meat, rather than canned or processed types.
• Use herbs, spices, and salt-free seasoning blends in cooking and at the table.
• Cook rice, pasta, and hot cereal without salt. Cut back on instant or flavored rice,
pasta, and cereal mixes, which usually have added salt.
• Choose “convenience” foods that are low in sodium. Cut back on frozen dinners,
pizza, packaged mixes, canned soups or broths, and salad dressings—these
often have a lot of sodium.
• Rinse canned foods, such as tuna, to remove some sodium.
• When available, buy low- or reduced-sodium or no-salt-added versions of
foods—see box 11 for guidance on how to use food labels.
• Choose ready-to-eat breakfast cereals that are low in sodium.

Spice It Up and Use Less SodiumExperiment with these and other herbs and spices. To start, use small amounts to find out
if you like them.

Shopping for Foods That Will Help You Lower Your Blood Pressure
By paying close attention to food labels when you shop, you can consume less sodium.
Sodium is found naturally in many foods. But processed foods account for most of the
salt and sodium that Americans consume. Processed foods that are high in salt include
regular canned vegetables and soups, frozen dinners, lunchmeats, instant and ready-to-eat
cereals, and salty chips and other snacks.
Use food labels to help you choose products that are low in sodium. Box 11 shows you
how to read and compare food labels.
As you read food labels, you may be surprised that
many foods contain sodium, including baking soda,
soy sauce, monosodium glutamate (MSG), seasoned
salts, and some antacids.

Ti p s f o r U s i n g H e r b s a n d S p i c e s


Herbs and Spices Use in Basil Soups and salads, vegetables, fish, and meats
Cinnamon Salads, vegetables, breads, and snacks
Chili Powder Soups, salads, vegetables, and fish
Cloves Soups, salads, and vegetables
Dill Weed and Dill Seed Fish, soups, salads, and vegetables
Ginger Soups, salads, vegetables, and meats
Marjoram Soups, salads, vegetables, beef, fish, and chicken
Nutmeg Vegetables, meats, and snacks
Oregano Soups, salads, vegetables, meats, and snacks
Parsley Salads, vegetables, fish, and meats
Rosemary Salads, vegetables, fish, and meats
Sage Soups, salads, vegetables, meats, and chicken
Thyme Salads, vegetables, fish, and chicken

With herbs, spices, garlic, and onions, you can make your food spicy without salt and
sodium. There’s no reason why eating less sodium should make your food any less
delicious.

Easy on the Alcohol

Drinking too much alcohol can raise blood pressure. It also can harm the liver, brain, and heart.
Alcoholic drinks also contain calories, which matters if you are trying to lose weight.
If you drink alcoholic beverages, drink only a moderate amount—one drink a day for women,
two drinks a day for men.
What counts as a drink?
• 12 ounces of beer (regular or light, 150 calories),
• 5 ounces of wine (100 calories), or • 1 1/2 ounces of 80-proof whiskey (100 calories).

C o m pa r e L a b e l s


Food labels can help you choose items lower in sodium, as well as calories, saturated fat, total fat, and cholesterol. The label
tells you:

Amount per serving
Nutrient amounts are provided for one serving. If you eat more or less
than a serving, add or subtract amounts. For example, if you eat
1 cup of peas, you need to double the nutrient amounts on the label.
Number of servings There may be more than one serving in the package, so be sure
to check serving size.
Nutrients
You’ll find the milligrams of sodium
in one serving.
Percent daily value
Percent daily value helps you compare products and tells you if the
food is high or low in sodium.
Choose products with the lowest
percent daily value for sodium.
FROZEN PEAS
Nutrition Facts
Serving Size: 1/2 cup
Servings Per Container: about 3
Amount Per Serving Calories: 60 Calories from Fat: 0 % Daily Value*
Total Fat 0g 0%
Saturated Fat 0g 0%
Cholesterol 0mg 0%
Sodium 125mg 5%
Total Carbohydrate 11g 4%
Dietary Fiber 6g 22%
Sugars 5g
Protein 5g
Vitamin A 15% • Vitamin C 30%
Calcium 0% • Iron 6%
* Percent Daily Values are based on a
2,000 calorie diet.
 

 

(source: http://www.nhlbi.nih.gov/health/public/heart/hbp/hbp_low/hbp_low.pdf)

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