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	James L. Holly, M.D.

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Your Life Your Health - Hypertension: Part III: What Can I Do? - Continued

James L. Holly,M.D.

June 24, 2004

Your Life Your Health - The Examiner

For the past several weeks, we have been addressing the silent killer, which is hypertension. The problem with high blood pressure is that in the majority of cases there are NO symptoms warning you of the danger. The only way to be certain that you do not have hypertension is to have periodic blood pressure readings taken by your health care provider.

The cardinal principles in life-style changes for the treatment of blood pressure and/or for the prevention of hypertension are weight loss and exercise. We now continue our discussion of what life-style changes can either prevent or treat blood pressure

Limiting Salt in Your Diet

The role that sodium plays in hypertension is somewhat controversial. Sodium, found in table salt and processed foods, appears to affect blood pressure in some people while having little effect on others.

Some people can reduce their blood pressure simply by reducing the salt in their diet. These people are considered "salt sensitive," meaning that their blood pressure goes up when they eat more salt and goes down when they eat less salt. People who are most likely to be salt sensitive include:

Older people
African-Americans
People with diabetes

People with high blood pressure can benefit from a moderately reduced sodium intake in several other ways, as well. Cutting back on the salt in your diet may also:

Reduce the need for medications to treat high blood pressure
Reduce potassium loss with diuretic treatment (blood pressure treatment that reduces blood volume)
Protect you from osteoporosis and kidney stones
Possibly reverse a condition known as left ventricular hypertrophy, the thickening of the muscle in the wall of the left ventricle that can occur with uncontrolled hypertension

Hypertension experts recommend that dietary sodium intake be restricted to no more than 2400 milligrams, or one teaspoon, of sodium a day. This is about two-thirds of the amount of sodium that Americans normally consume per day, the bulk of which (75%) comes from processed foods.

You can reduce the sodium in your diet with a few simple steps:

Cut down on salt used at the table.
Taste food before adding salt.
Remove the salt shaker from the table.
Cut down on salt used when cooking.
Reduce the amount of salt added to half the amount suggested.
Replace salt with alternative flavorings like pepper, garlic, lemon juice, herbs, and spices.
Eat sensibly at restaurants.
If you eat at fast-food restaurants, ask for a nutritional analysis of the foods, so you can check the sodium content of different items.
In Chinese restaurants, ask for food without monosodium glutamate (MSG).
Check labels on food purchased at the grocery store.
Use labels to compare the amount of sodium in canned, frozen, and packaged foods.
Look for foods or seasonings that are labeled "low sodium" or "sodium free."
Whenever possible, start with fresh food that you can season yourself.

Getting Enough Potassium and Calcium in Your Diet

Potassium and calcium may also help to reduce your risk of developing high blood pressure, or lower your blood pressure if it is already high.

Potassium

Studies suggest that high potassium intake may protect against the development of high blood pressure and help people with high blood pressure control their blood pressure. On the other hand, blood pressure may increase if you don't get enough potassium in your diet.

The best sources of potassium are fresh fruits and vegetables, especially bananas, prunes, grapefruits, tomatoes, and potatoes. If you eat enough of these foods, it will be easy to get the recommended 3500 milligrams of potassium daily. A banana, for example, contains about 500 milligrams potassium, while a medium-sized potato contains more than 700 milligrams potassium.

Potassium is even more important if your doctor prescribes certain types of medications, called diuretics, which cause the body to lose potassium. If potassium levels become too low, heart rhythms may be disturbed.

Because some medications (such as potassium-sparing diuretics) and medical conditions (such as kidney disease) are associated with increased potassium levels, you should check with your doctor before using any potassium-containing salt substitutes or potassium supplements. Potassium levels that are too high are extremely dangerous and can be lethal.

Calcium

Not getting enough calcium in your diet may also increase your risk for high blood pressure. Although increasing your calcium intake may also help to lower blood pressure, this effect is small, so calcium supplements are not generally recommended to lower blood pressure.

Getting enough calcium in your diet is important for other reasons. High blood pressure increases the risk of osteoporosis by causing calcium loss through the urine. Calcium regulates smooth muscle tone in blood vessels, is important for general health, and may help prevent some gastrointestinal cancers.

Limiting Fat and Cholesterol in Your Diet

Experts are exploring the link between fat and cholesterol intake and blood pressure. Early studies have shown that changes in fat intake may lower blood pressure. These changes include decreasing total fat intake, while increasing intake of polyunsaturated fats relative to saturated, and/or increasing intake of fish oils.

Saturated fats are found in tropical oils such as palm and coconut oil, and in vegetable oils that have been chemically changed to make them solid at room temperature, a process called hydrogenation. Cholesterol is only found in animal foods like beef, pork, lamb, and dairy products. Both types of fat can contribute to high cholesterol levels, and may play a role in raising blood pressure.

Diets low in saturated fats and cholesterol have been shown to reduce the risk of heart disease. The role of such dietary changes in people with essential hypertension and no other cardiovascular risk factors is less clear.

Since high blood pressure and high cholesterol levels commonly occur together, reducing your intake of dietary fats may be important. Experts recommend that individuals with both conditions make significant dietary changes and/or take medications to lower their risk of coronary heart disease.

You can reduce the fat and cholesterol in your diet without sacrificing flavor. Here are some easy ways to cut back on fat and cholesterol:

Eat three balanced meals a day, including multiple servings of fruits and vegetables.
Cut fat off meat.
Use nonstick sprays or cookware.
Pour off the liquid fat when you cook meat.
Experiment with an occasional vegetarian meal.
Bake, broil, steam, microwave, or barbecue your food instead of frying it.
Find substitutes for fat to use for seasoning food.
Find low-fat or nonfat versions of items like salad dressings, frozen desserts, and baked goods.
Read labels when you buy prepared foods, and find the brand that is lowest in fat content.
Plan for low-fat snacks, like fruits or vegetables, and carry them with you so you will not be tempted to buy "junk food."
When eating out, look for "heart healthy" items on the menu.
Use low fat or nonfat dairy products, such as skim milk.
Use liquid vegetable oils instead of margarine, hydrogenated vegetable oils, or butter.

Limiting Alcohol Intake

Alcohol abuse causes about 10 percent of high blood pressure cases. People who drink three or more alcoholic drinks a day risk hypertension, while binge-drinkers have even higher blood pressures. Alcohol abuse also increases the risk for stroke, liver disease, and other serious conditions. It can also reduce the effectiveness of medications used to treat high blood pressure.

Yet limited alcohol intake does not raise blood pressure and has even been shown to lower risk of cardiovascular disease. Experts recommend that alcohol intake be limited to no more than 1 oz of ethanol per day. This could include two 12-oz beers, two 5-oz glasses of wine, or one 2-oz shot of 100-proof whiskey.

Women and lighter-weight individuals should restrict their alcohol intake to half this amount. This is because women absorb more ethanol than men, and lighter individuals are more susceptible to the effects of alcohol than heavier people. If you have any concerns about your alcohol intake, you should consult your doctor.

Quitting the Tobacco Habit

Avoiding tobacco in any form - including cigarettes, pipes, chewing tobacco, and cigars - can help to improve anyone's health. Those who quit smoking usually experience beneficial cardiovascular effects over the course of one year.

Each time you smoke a cigarette, your blood pressure rises for a short time. This sudden increase in blood pressure appears to be temporary, much like the short-term increase in blood pressure associated with the intake of caffeine-containing products such as coffee, tea, and colas.

However, smokers in one study had blood pressures up to 10 points higher than nonsmokers. Cigarette smoking increases the risk for other cardiovascular disease and cancer, and may also interfere with the effects of medications used to treat high blood pressure.

Your doctor can help you stop smoking, should you decide to quit. There are a number of available products (e.g., nicotine patch, gum, medication) designed to help you quit smoking.

Smoking cessation materials are also readily available from voluntary health organizations and federal agencies. The American Cancer Society http://www.cancer.org or American Lung Association http://www.lungusa.org can provide you with information about programs you can follow at home or classes in your area.

Managing Stress

Although stress can increase blood pressure, it is not considered a major cause of high blood pressure. A number of studies have not proven that relaxation therapies or biofeedback to significantly reduce blood pressure. But these techniques do have other benefits. They can help to reduce anxiety and give you a sense of well-being. They also can help you make other important lifestyle changes, such as changes in dietary and alcohol intake, or quitting smoking.

Here are some techniques that can help you manage stress:

Think ahead about times you may be under increased stress. Plan ways to avoid the situation, if possible.
If you feel tense, take a walk or go for a swim. Exercise is a wonderful natural tranquilizer.
Get a massage. A massage is a wonderful opportunity to relax mind, body, and spirit.
Breathe. When you are under stress, concentrate on drawing air deeply into your lungs and let your abdomen expand - not just your chest.
Explore yoga or other techniques for stress reduction.
Practice complete relaxation for a short time every day. Sit comfortably and relax your muscles in turn - first your legs, then your arms, then your shoulders, then your body, neck, and face. Imagine a soothing scene, like an empty beach on a calm, warm day. Empty everything else from your mind.
If you feel unable to cope, ask your doctor to recommend a mental health professional who can assist you in dealing with stress.

These measures can significantly improve your health. Remember, no one, absolutely no one is responsible for making you healthier. That is your responsibility. And, you cannot expect someone else to help you get healthy, if you are unwilling to accept this responsibility.

Remember, it is your life and it is your health.

Other Articles in the Hypertension Series

	Hypertension: Part I: What is Your Hypertension IQ? Hypertension: Part II: What Can I Do? Hypertension: Part IV: The DASH Diet Hypertension: Part V: Dash Diet Continued

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