After 20 years of battling high blood pressure, Rose Marie Shullo feared she was losing the war. Despite taking different medications in various doses to tame her hypertension, it still hovered around 150/95 mmHg, more than 30 points above normal.

WINNING NUMBERS - In addition to exercise, a healthy diet and meditating, Rose Marie Shullo of San Diego keeps close tabs on her blood pressure. CNS Photo by Don Kohlbauer.

"My blood pressure was always a little bit high, but then menopause happened, and I got older, and it just crept up higher and higher," the 58-year-old San Diego woman says. "Nothing seemed to work very well, and I thought it was just something I was going to have to live with."

But her cardiologist wasn't about to give up.

"This (blood pressure reading) can be better," said Dr. Mimi Guarneri, medical director for the Scripps Center for Integrative Medicine, when she checked out Shullo last year. "We're going to take control of it."

She enrolled Shullo in Scripps' Mindfulness-based Stress Reduction program and recommended a low-fat diet and more exercise.

Within just over three months, these lifestyle changes started paying off and Shullo's blood pressure began to drop. Today, her blood pressure is an impressively healthy 118/60 mmHg.

"I felt so empowered," says Shullo, who in addition to meditating, eating a low-fat/low-carbohydrate diet and exercising several times a week, is still on blood pressure medication. "I was finally doing things for me that were actually helping me. And making me feel better."

While medication is often necessary to help control blood pressure, it's no replacement for a healthy lifestyle, doctors say.

"I tell patients (with high blood pressure) that I'll start you on medication and maybe we can get you off of it, but you have to do your part of the bargain," Guarneri says.

For many people, it's not a question of either blood pressure medication or a healthy lifestyle. It's a lifelong combination of both.

"What you eat, your activity level and other lifestyle changes are complementary to medication for hypertension," says cardiologist Dr. Denise Barnard, director of Women's Cardiovascular Health at the University of California, San Diego Medical Center. "Not only might it mean you need less medicine, but by making a conscientious effort (to live a more healthy life), you'll be more aware of hypertension and how it can be a risk to life."

Nearly one in three American adults, or 65 million people, have high blood pressure. Although high blood pressure can be treated and controlled, it can never be cured.

People with uncontrolled high blood pressure are three times more likely to develop coronary heart disease and six times more likely to develop congestive heart failure, the American Heart Association says. High blood pressure is the No. 1 modifiable risk factor for stroke.

For every 20 points of systolic (top number) blood pressure above normal and every 10 points of diastolic pressure above normal, you double your risk for death by cardiovascular disease, Barnard says.

"It doesn't matter if you're male, female, young or old. If your blood pressure numbers are high, it's a lifetime risk," she says.

The following are some healthy lifestyle changes that can change your blood pressure and possibly save your life:

- Eat a nutritious diet, low in fat and sugar and high in vitamins, minerals and fiber.

Many doctors recommend the DASH (Dietary Approaches to Stop Hypertension) eating plan, which includes lots of fruits, vegetables and low-fat dairy products. Low in sodium, the DASH diet is a lifelong eating guide and can reduce your blood pressure by up to 14 points, according to the National Heart Lung and Blood Institute.

- Limit sodium. Too much sodium can lead to fluid retention and increased blood pressure. The U.S. Dietary Guidelines recommend that healthy adults consume no more than 2,300 milligrams of sodium a day (about 1 teaspoon). However, people over 50, African-Americans and those with high blood pressure and who are sensitive to sodium should limit salt intake to 1,500 milligrams a day.

"Even though only 25 percent of the population is sodium sensitive, it's still a good idea for all of us to reduce our sodium," Guarneri says.

- Eat plenty of potassium. You need at least 3,500 milligrams a day from foods such as yogurt, cantaloupe, spinach and bananas. Potassium helps rid the body of too much sodium by acting as a diuretic.

- Lose excess weight. The larger your body mass, the more blood you need to supply oxygen and nutrients to your tissues. As the volume of blood circulated through your blood vessels increases, so does the pressure on your artery walls. Losing just 10 pounds can help reduce your blood pressure by several points. Weight loss can also increase the effectiveness of blood pressure medication.

- Get physical. You need at least 30 to 60 minutes of exercise most days of the week.

"Exercise helps in a multitude of ways. It increases your physical condition, tones blood vessels, which helps lower blood pressure, helps you lose weight, reduce cholesterol and lower blood sugar," says Barnard, adding it's not necessary to spend hours sweating at the gym.

"Doing an activity that you enjoy - walking or cycling - on a daily basis will work as well as a hard workout to help bring down your blood pressure," she says.

- Reduce stress. According to a study in the journal Hypertension, 20 minutes of meditation twice a day was shown to reduce systolic blood pressure by 10 points and diastolic pressure by more than six.

To help better cope with stress, try some deep breathing, meditation or yoga. Get a massage. Or seek professional therapy or counseling.

"If you're constantly feeling pressure and under deadlines or if you're angry or hostile, then that's absolutely going to impact your blood pressure," Guarneri says, explaining that when the body is under stress, certain hormones are secreted that raise blood pressure.

- Quit smoking. The nicotine in tobacco products can raise your blood pressure by 10 points or more. Although the increase may last only 30 to 60 minutes after using tobacco, repeated elevations through the day means your blood pressure may remain constantly high.

In addition, chemicals in tobacco can damage your arteries and cause fluid retention, both of which can raise blood pressure.

- Limit alcohol. The general rule is no more than one drink a day for women and two a day for men. In very small amounts alcohol can help prevent heart attacks and coronary artery disease, but drinking in excess can raise blood pressure by several points.

The following are some other nonlifestyle factors that may raise blood pressure and what you can do to counter them:

- Some medications and supplements, including various pain relievers, antidepressants, decongestants and certain herbal supplements (ginseng and Saint-John's-wort) may increase blood pressure. Tell your doctor about all medications and supplements you take.

- Sleep apnea, a condition in which you stop breathing repeatedly during the night, doesn't allow the brain and heart to get enough oxygen during sleep and can produce hormones that raise blood pressure. The condition, often associated with snoring, needs medical attention.

- Hormone therapy, birth control pills or becoming pregnant can increase blood pressure in some women. Talk to your doctor and have your blood pressure taken frequently.

- Race. Certain ethnic groups are more at risk for hypertension. They include African-Americans, Hispanics, westernized Asians and some American Indians.

"If you are of an ethnic group that is more prone to high blood pressure, you need to be more aware of monitoring your blood pressure yourself," says Barnard, who suggests getting a monitoring cuff and checking it daily.

- Age. The risk of high blood pressure increases as you get older (men over 45, women over 55) and you need to be more diligent about a healthy lifestyle.

Don't think you're in the clear if you're not hypertensive at age 55 or 60.

"You still have the risk of getting high blood pressure when you're 80 because blood vessel tone weakens and arteries harden," Barnard says.

- Genetics. Although genetics can play a role in hypertension, Guarneri says too many people use it as an excuse. Genes rarely act alone to produce disease, she says, noting that 70 percent to 90 percent of our health and longevity is determined by our lifestyle and environment.

Diabetes increases your risk of developing high blood pressure because it predisposes the arteries to atherosclerosis (hardening of the arteries).

High blood pressure for diabetics is 130/80 mmHg.

- White-coat syndrome. Some people get nervous when they go to the doctor, which can raise blood pressure. Guarneri has these patients check their own blood pressure regularly or puts a 24-hour blood pressure monitor on them to see fluctuations during the day.

"White-coat syndrome is usually a signal that we need to teach them stress-management techniques," says Guarneri, noting that someone with white-coat hypertension probably has elevated blood pressure at other times of the day, too.

Blood pressure basics What is blood pressure? Blood pressure is the force of blood pushing against the walls of the arteries. Each time the heart beats (about 60 to 70 times a minute at rest), it contracts and pumps out blood. This is when blood pressure is the highest and is called systolic pressure, represented by the top number of a blood pressure reading. When the heart is at rest, between beats, blood pressure falls. This is the diastolic pressure, or the bottom number. How is it measured? Blood pressure is measured in millimeters of mercury. What are the symptoms of high blood pressure? There are no symptoms. That's why it's called "the silent killer." What do the numbers mean? The National Heart, Lung and Blood Institute divides blood pressure measurements into four general categories: Normal blood pressure: Below 120/80 mmHg, although most cardiologists agree that 115/75 mmHg is the gold standard. Once blood pressure rises above 115/75 mmHg, the risk of cardiovascular disease begins to increase. Prehypertension: 120 to 139 mmHg over 80 to 89 mmHg. This is higher than normal pressure and should serve as a warning to bring down the numbers. Within four years of being diagnosed with prehypertension, nearly one in three adults ages 35 to 64 and nearly one in two adults age 65 or older progress to high blood pressure. Stage 1 hypertension: A systolic pressure ranging from 140 to 159 mmHg or a diastolic pressure ranging from 90 to 99 mmHg. Stage 2 hypertension: The most severe. A systolic pressure of 160 mmHg or higher or a diastolic pressure of 100 mmHg or higher. (If you have diabetes or chronic kidney disease, high blood pressure is 130/80 mmHg.)

Finding out more about high blood pressure If you have high blood pressure, getting stressed out is definitely counterproductive. But figuring out what's best for you can be difficult. It is hoped some of these resources will provide helpful hints and peace of mind. WEB SITES www.nhlbi.nih.gov/hbp - The National Heart Lung and Blood Institute's "Your Guide to Lowering Your Blood Pressure" is divided into six informative sections: Blood Pressure, High Blood Pressure, Detection, Prevention, Treatment and Issues for Women. www.ash-us.org/about_hypertension/index.htm - To access the American Society of Hypertension's patient's guide, click on "ASH Pamphlet" on this page. The free brochure (in PDF) provides a description of the disorder and explanation of detection and treatments. www.ishib.org - The International Society on Hypertension in Blacks, which is devoted to ethnicity and health, has fact sheets on high blood pressure and on its impact on kidney and cardiovascular diseases. http://familydoctor.org - The American Academy of Family Physicians' site gives clear and concise information on many medical topics. Just type "blood pressure" in the search box, and on the page that comes up choose the top entry. http://www.mayoclinic.com/print/high-blood-pressure/HI00062 http://www.mayoclinic.com/health/high-blood-pressure/QZ00033 - While a little scary to read, it's important to know the damage high blood pressure can do. This page from the Mayo Clinic lays it out, and the second link brings you to a quiz that can help you determine if you're at risk. http://www.abc-of-yoga.com/yoga-and-health/yoga-for-hypertension.asp - If you think yoga might help, this site provides eight poses said to relieve high blood pressure. Click on the names of poses for step-by-step instructions. BOOKS "The DASH Diet Action Plan: Based on the National Institutes of Health Research: Dietary Approaches to Stop Hypertension," Marla Heller (2007) - A registered dietitian's take on the National Institutes of Health's recommended diet to prevent or lower high blood pressure. It features recipes and meal plans - with adjustments for three daily calorie-intake goals. "Harvard Medical School Guide to Lowering Your Blood Pressure," Aggie Casey and Herbert Benson (2005) - Dr. Benson and cardiac wellness expert Casey offer a program that includes nutrition, exercise, stress-reduction and relaxation. "Hypertension Cookbook," American Medical Association and Karen A. Levin (2005) - This handy book is packed with tips for controlling cholesterol, as well as low-fat, low-calorie recipes and suggestions for healthy snacks. DVD "Yoga and Blood Pressure" (2006) - In his "Let's Go!" series highlighting yoga as a cure for various ailments, practitioner Avneesh Tiwari presents a simple practice that may help regulate blood pressure. - Beth Wood