Lifestyle Medicine for Hypertension

InformalJohnJohn A. Patterson MD, MSPH
July 2012

Do you know your blood pressure numbers?

Knowing your blood pressure, and keeping it normal, can save your life!Partnering with your primary care provider (PCP) is essential to prevent hypertension and treat it if it develops.
The top (systolic) number is the pressure when the heart is contracting to pump blood. The bottom (diastolic) number is the pressure when the heart is refilling with blood between beats. Normal blood pressure is less than 120 / 80, also called ‘120 over 80’. Prehypertension is defined as a blood pressure between 120 and 139 systolic or between 80 and 89 diastolic. Medications are not usually necessary at this level but lifestyle changes are advised to prevent the pressure from going higher. Hypertension (high blood pressure) is defined as a systolic pressure of 140 or higher or a diastolic pressure of 90 or higher. If your PCP documents a blood pressure at this level on two consecutive visits, anti-hypertensive medication is usually prescribed in addition to lifestyle changes.
Before this commitment to drug therapy, it is recommended that you check your blood pressure at home to determine whether your office readings are due to ‘white coat hypertension’. Many people whose blood pressure readings are high in medical and dental offices have normal blood pressure at home. You can purchase a reliable digital blood pressure monitor for under $60. Keep a record of your home readings and discuss them with your PCP, who may also recommend an ambulatory monitor that automatically records your pressure between office visits.
Approximately two thirds of people over age 65 have hypertension that needs to be treated medically. Known as the ‘silent killer’, hypertension can cause heart attacks, congestive heart failure, kidney failure, blindness and stroke, leading to years of disability as well as premature death. The tragic irony is that, at least for many people, hypertension is preventable.
Hypertension can be caused by certain medical conditions and can be a side effect of some medications. Your PCP can help you detect any such reversible cause of hypertension. The vast majority of cases of hypertension have no such obvious cause and are referred to as ‘essential hypertension’. There are several factors that contribute directly or indirectly to the development of hypertension without being direct causes of it. These include a high fat diet, lack of regular physical exercise, being overweight, stress and a family history of hypertension.
Lifestyle changes are recommended for both prehypertension and hypertension. In prehypertension, these lifestyle changes may prevent hypertension from ever developing. In hypertension, they may reduce or even eliminate the need for medications to bring pressures down below 140 over 90.
The advantage of lifestyle changes is that, unlike the negative side effects often associated with medication, lifestyle changes are often associated with positive side benefits in addition to lowering blood pressure.
The DASH eating plan refers to Dietary Approaches to Stop Hypertension. It is recommended for healthy people wanting to prevent hypertension as well as for people with prehypertension and hypertension. The DASH eating plan favors fruits, vegetables, whole grains, poultry, fish, nuts, and low fat dairy foods. It is low in fat, cholesterol, red meats, sweets, and sugared beverages. Reducing salt and sodium in the diet can lead to even further blood pressure reductions for many people. Current recommendations are for the general public to consume less than 1 tsp of table salt daily. Your PCP can advise you regarding ‘food as medicine’ by using DASH, salt restriction and other dietary approaches to blood pressure management.
Maintaining a healthy weight is important to blood pressure management. In overweight individuals, as little as 5-10 pounds of weight loss can help lower elevated pressures. Your PCP can advise you regarding maintaining a healthy weight.
Regular physical exercise can help prevent and treat hypertension. The current national recommendation is for the general public to get at least 30 minutes of moderate exercise daily. If you have prehypertension, hypertension or any serious medical condition or have not exercised in years, discuss with your PCP the best way to safely begin to use ‘exercise as medicine’.
Excessive alcohol intake can raise blood pressure. It is recommended that women limit alcohol intake to 1 drink daily and men to 2 drinks daily. Despite controversial claims that moderate alcohol intake may have benefits for the heart, it is not recommended that non-drinkers begin drinking.
Research is inconclusive as to the relationship between stress and hypertension. Though it may not directly cause hypertension, stress can prevent your adherence to the healthy lifestyle changes that can keep pressures down. So, managing stress may indirectly help you manage your blood pressure. A variety of relaxation techniques can help some people reduce high blood pressure while also helping improve sleep and digestion, stabilize emotions, and reduce headaches and other pain problems. Commonly used examples of stress management and relaxation techniques include autogenic training, biofeedback, meditation, imagery and progressive muscle relaxation. Your PCP can help you select a technique and a practitioner you can both trust.
Modern research suggests that two ancient health practices can help some people reduce high blood pressure and manage stress while offering other positive health benefits. Tai chi is an ancient Chinese moving meditation that has been shown to help some people reduce high blood pressure and improve overall cardiovascular fitness as well as improve balance, prevent falls and improve the body’s immune response to the virus that causes shingles. Yoga is an ancient mind body approach that has been shown to help some people reduce high blood pressure while also helping relieve anxiety, depression, back pain and other pain problems. Discuss your interest in these approaches with your PCP who can help you evaluate certified teachers in your community.
Garlic has been found to help some people reduce high blood pressure but may interfere with blood clotting and with certain medications.
Tell your PCP if you are considering any of these complementary lifestyle approaches, especially if you are taking prescription medication or your blood pressure is poorly controlled (not consistently below 140 over 90).

Resources-
DASH Eating Plan (Dietary Approaches to Stop Hypertension)
http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf

Family Doctor (the American Academy of Family Physicians’ Patient Education site)
www.familydoctor.org  (Search for hypertension)

National Heart, Lung and Blood Institute
www.nhlbi.nih.gov

National Center for Complementary and Alternative Medicine
www.nccam.nih.gov

Dr Patterson is past president of the Kentucky Academy of Family Physicians and is board certified in family medicine and integrative holistic medicine. He is on the family practice faculty at the University of Kentucky College of Medicine and the University of Louisville School of Medicine, Saybrook University’s School of Mind Body Medicine (San Francisco) and the Center for Mind Body Medicine (Washington, DC). He operates the Mind Body Studio in Lexington, where he offers integrative medicine consultations. He can be reached through his website at www.mindbodystudio.org