Aug 31,2007 00:00
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.
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.- Too much black licorice. True licorice candy contains glycyrrhic acid, which affects the body's use of a hormone that helps to regulate sodium and water balance. Excessive amounts of black licorice can cause blood pressure to rise in people who are sodium sensitive.