Lifestyle Changes In Hypertension

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If you have been diagnosed with hypertension, then you are likely to need treatment. Lifestyle modifications form the forefront of treatment and can make a big difference to the long term impact of the health of the patient.

Below are some important steps to take so that you can take control of your blood pressure (the scientific references are placed in paranthesis and are listed at the bottom of the article).

1. Stop smoking

Studies have shown that smoking can increase blood pressure and the heart rate. In fact, a close association has been noticed between smoking and ‘malignant hypertension’ (Tuomilehto, 1982). The nicotine in smoke can lead to changes in the caliber of blood vessels by releasing certain compounds. These compounds are believed to increase blood pressure. This effect is particularly exaggerated in older men who were heavy or moderate smokers (Primatesta, 2001).

Stopping smoking is an important step in blood pressure control. In addition, it also reduces the risk of cardiovascular disease.

2. Eat healthy foods

The sodium content in salt is directly linked to blood pressure – the higher the sodium consumed, the higher is the blood pressure. It is therefore essential that salt content in the food be reduced as much as possible to keep the blood pressure under check.

In the United States, a diet called the DASH diet is being advocated. DASH stands for Dietary Approach to Stop Hypertension. According to the DASH diet website, the diet is ‘is a plant-focused diet, rich in fruits and vegetables, nuts, with low-fat and non-fat dairy, lean meats, fish, and poultry, mostly whole grains, and heart healthy fats‘. It basically requires the individual to eat more vegetables and fruits along with low saturated fats and dairy products. Alcohol is consumed in moderation.

Studies have shown that the DASH diet can reduce the systolic blood pressure by 5.5 mmHg and diastolic blood pressure by 3 mmHg (Bacon, 2004).

But is the DASH diet helpful for Indians? The answer is yes. The diet concentrates on having a very limited amount of sodium in the diet, often not exceeding 2 grams per day. The amounts of processed foods and smoked foods is drastically reduced. Scientists and researches state that the DASH diet is not just good for those with hypertension, but it is also beneficial for those who have a family history of the condition and are at risk.

There are a number of books available on Amazon that describe the DASH diet, including numerous recipes. You can view the selection here.

3. Exercise regularly

Exercise can treat almost any ailment, and high blood pressure is no exception.

Currently, the American Heart Association recommends at least 150 minutes of moderate intensity aerobic exercise a week to maintain heart health. However, for the Indian population, it would be better to exercise an hour a day to get some benefit. Exercise is particularly beneficial when a patient suffers from ‘pre-hypertension’ – a stage when the blood pressure is above the normal range but not high enough to be called hypertension.

Regular aerobic physical activity can reduce systolic blood pressure by 4 mmHg and diastolic blood pressure by 2.5 mmHg.

What about weight training?

Numerous scientific studies have demonstrated the benefit of regular exercise on maintaining heart health. In a recent study published by the Mayo Clinic Group USA, systematic review of available studies demonstrated that isometric resistance training can lower systolic and diastolic pressure (Carlson, 2014). The effect would most certainly add on to the benefit of aerobic exercises performed regularly.


4. Reduce your salt intake

Salt is a notorious risk factor in the development of high blood pressure, and probably warranted a mention higher up in this article. The sodium content in salt is responsible for holding on to bigstock-Eat-Less-Salt-8008321water, thus raising blood pressure.

It is strongly recommended that the total amount of salt consumed everyday not exceed 4 gms. This would amount to a sodium content of less than 2.3 grams per day. Older people should cut down even further – less than 1.5 gms of sodium per day, especially if they have diabetes or kidney disease.

Instead of salt, you could use potassium salt substitutes that are currently available on the market. They can reduce systolic blood pressure by a 4-8 mmHg in patients with high blood pressure. However, these must be avoided by those who have kidney problems.

It is important for you to know how much salt you are consuming on a regular basis. Ask your family member not to add salt to your food at all. Within a few days of eating salt-less food, your taste buds will adapt and you will be still able to enjoy these foods.

If you like buying ready meals or foods from the supermarket, make sure you read the label to ensure that the sodium content is not too high. Avoid pickles, papads and all processed foods (like cheeses).

5. Lose weight

Obese individuals and those who are overweight can find it quite difficult to reduce their blood pressure. In fact, reducing body weight by 1% can reduce blood pressure by 1 mmHg. To put this into perspective, if a 100 kg man loses 1 kg, they drop their blood pressure by 1 mmHg. While this may not seem like much, combined with the other lifestyle changes, it can make a world of difference.

In people who are overweight, losing 4.5 kg can reduce BP remarkably, and might even prevent the development of blood pressure. Lose up to 10 kg, and you could reduce your systolic blood pressure by almost 10 mmHg!

6. Avoid alcohol

It is a well known fact that alcohol is bad for health, especially when consumed in large amounts. It is best to avoid alcohol completely if possible, but if you have to have a drink, do so in moderation.

In a study that looked at 500+ subjects with high blood pressure, consumption of >1 drink per day was associated with higher levels of diastolic blood pressure in an ambulatory blood pressure recording. Those with light intake (< 2 per week) had a beneficial effect on their heart function (Jaubert, 2013).

7. Manage your stress

Stress is a recognised risk factor in the development of high blood pressure. If you are experiencing dome form of stress, make sure you find a way to handle the stress through yoga, exercise or indulging in a hobby. It can make a world of difference to manage your blood pressure.

Check out our post on stress and heart disease for more information.

The above measures are all needed to ensure the blood pressure reduces significantly. In those in whom the above do not work, then medical therapy is needed along with these lifestyle modifications.

What To Ask Your Doctor

If you are worried about your blood pressure, then here are some questions you could ask your doctor.

1. What is the best diet to control my blood pressure?

2. Can I exercise regularly or visit the gym?

3. Should I avoid any foods?

4. Should I avoid any activities?

Always make a note of the questions you wish to ask your doctor on a piece of paper before your consultation.

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1. Tuomilehto, Jaakko, Jyrki Elo, and Aulikki Nissinen. “Smoking among patients with malignant hypertension.” BMJ 284.6322 (1982): 1086-1086.

2. Primatesta, Paola, et al. “Association between smoking and blood pressure evidence from the health survey for England.” Hypertension 37.2 (2001): 187-193.

3. Carlson, Debra J., et al. “Isometric exercise training for blood pressure management: a systematic review and meta-analysis.” Mayo Clinic Proceedings. Vol. 89. No. 3. Elsevier, 2014.

4. Bacon, Simon L., et al. “Effects of exercise, diet and weight loss on high blood pressure.” Sports Medicine 34.5 (2004): 307-316.

5. Jaubert, Marie-Perrine, et al. “Alcohol consumption and ambulatory blood pressure: a community-based study in an elderly cohort.” American journal of hypertension 27.5 (2014): 688-694.

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Dr Vivek Baliga B
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