High blood pressure treatment that patients need to know

When her gynecologist told her she had high blood pressure, Marie had a simple solution: switch doctors. After all, she had gone to him for a different problem, and this was the first time he had ever checked her blood pressure.

“He said, ‘Oh my God, you’re like a bomb waiting to explode.’ I said, ‘I didn’t come here for that, I came here for something else,’” she explained.

Two years later, Marie went to see her general medical doctor, who was also a family friend. “He looked me dead in my face and said, ‘I’ve known you since you were a teenager and you don’t want to die. Would you like somebody to be wiping the dribble from your mouth, would you like to walk with a dragging foot?’”

This time, she heeded her doctor’s warning. She began the medications he prescribed, even though she didn’t like taking pills. She also began making changes in her everyday life. These behavioral changes, or “lifestyle modifications,” are recommended by the federal government’s National High Blood Pressure Program. The program also recommends these changes for people with “pre-hypertension,” blood pressure that’s above normal but not yet in hypertensive range (120-139 for the top, or systolic, number, and 80-89 for the bottom, or diastolic, number).

Lifestyle changes alone aren’t sufficient for many people with high blood pressure. But combined with medicine, they worked for Marie. After two years, her blood pressure fell to the normal range, and she no longer needs pills. The headaches and shortness of breath that she used to experience have also receded.

High blood pressure is rampant, and it’s one of the most common reasons why people develop strokes, heart problems, and kidney failure. It usually does its damage insidiously, and many people with high blood pressure don’t have any symptoms until they have a stroke or heart trouble.

Below are lifestyle modifications recommended by the National High Blood Pressure Education Program (NHBPEP), which have helped people like Marie. Please note that while these lifestyle changes are important, they are not a substitute for medication, if that’s what your doctor recommends.

Lose Weight
If you are overweight, getting your weight to a normal range is one of the most potent things you can do to lower your blood pressure. The NHBPEP recommends that people ideally get their weight down to normal range, which they define as a Body Mass Index (BMI) of 18.5 to 24.9 (there are many on-line tools to help you calculate your BMI).

If that’s not possible, even losing 10 pounds can help many people lower their systolic blood pressure (the top number) by 5 to 20 points (millimeters of mercury, to be exact). Marie lost 75 pounds by exercising and ending her lifelong habit of eating lunch at McDonald’s and drinking soda. “It was like a wake-up call,” she said. “I just did a 180.”

Following the DASH Diet
The DASH diet consists of fruits, vegetables, low fat dairy products, and foods that are low in fat. According to the NHBPEP, adopting the DASH diet will drop systolic blood pressure about 8 to 14 points in most people. The DASH diet contains a lot of potassium, and people with kidney problems should check with their doctors before adopting it, since they are at risk of developing dangerously high potassium levels. Marie began cooking more fish and vegetables, and learned to include more vegetables and less oil in her favorite Bahamian dishes.

Restricting Sodium
According to the NHBPEP, lowering sodium intake to 2.4 grams a day (about 1 teaspoon of salt) will lower systolic blood pressure by 2 to 8 points. For many people, following an even lower sodium diet – 1600 mg, combined with following the DASH diet, can be as effective at lowering blood pressure as a prescription medicine, according to the NHBPEP.

The quickest way to lower your sodium intake is to stay away from canned and processed foods and limit your eating at restaurants. A fuller list of ways to reduce sodium intake can be found in a recent Doctor’s Word column.

Your taste buds will adapt to a low-sodium diet, even though it’s tough at first. “It was very very hard,” Marie said of her experience cutting sodium from her diet. “But once you give it a week, you start developing a taste for it.”

Aerobic Physical Activity
Brisk walking, or some other regular aerobic physical activity, at least 30 minutes per day, will lower systolic blood pressure by 4 to 9 points, according to the NHBPEP. After getting her heart checked by her doctor, Marie began walking for 30 to 45 minutes every day. She also increased her walking by parking in a more distant space at the grocery store.

Limit alcohol consumption
For men, this means no more than 2 drinks a day, and for women, no more than 1 drink a day. (A drink is one 12 ounce beer, 5 ounce glass of wine, or 1.5 ounces of whiskey). The NHBPEP says this will lower systolic pressure by 2 to 4 points on average.

Don’t smoke
Smoking can trigger heart problems, and the combination of smoking and high blood pressure is dangerous. It can seem difficult to quit, but it is possible to escape the smoking trap.

Learn to manage how you respond to stressful situations
There’s good evidence that people who respond angrily to stressful situations are more likely to develop heart problems. Marie said she used to have tantrums before when she got frustrated, but now she takes life one day at a time. “You can’t change things, so you have to relax and let it go,” she said.

Keep track of your blood pressure.
Many fire departments will check blood pressure for free, either at regular screenings or on a drop-in basis. Check with your local department. The National Health Lung and Blood Institute has a useful card that can help you understand what the reading means.

Don’t skip your medications
Of all the medications doctors prescribe, blood pressure medicine is one of the most important. Skipping a dose on your own can be dangerous. If you’re having side effects, call your doctor or nurse practitioner right away. It’s also important to tell them if you’re worried about paying for prescriptions, since many highly effective, first-line blood pressure medicines are available in generic form, at a relatively low cost.

Making these changes can not only help you live healthier, but also transform other aspects of your life. Marie now works as a health educator, and believes others can succeed at making these changes in their daily lives, if they are motivated. “I’m not only teaching it, I lived it,” she said recently. “I’m not telling you anything I didn’t experience myself.”

Erin Marcus is an internal medicine physician and writes at New America Media.

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  • Anonymous

    What is odd is that lifestyle modifications are often now seen as “alternative medicine” these days.

    • anon

      I wouldn’t describe lifestyle modifications as “alternative medicine”… it’s just that counseling someone on lifestyle issues takes time, and the growing number of people who can give that time are “alternative medicine” practitioners.

  • http://pedremd.wordpress.com PedreMD

    I think what happens is that doctors are trigger-happy when it comes to medication. It only takes a few seconds to write a prescription, but it takes minutes to really sit down and talk to a person about how their lifestyle has resulted in the health issue they are facing. You need to peel away the layers of misconception and make them realize that what they are doing is bad for their health. This can mean different things for different people. Often times, lifestyle modifications are de-emphasized by doctors (who may not fully believe in them themselves or only mention them in passing without really digging deeper). However, I have seen patients turn around cholesterol levels, blood pressure, sugar with very diligent dedication to a new lifestyle and eating habits (far beyond was I was taught was possible in medical school or thereafter). The numbers quoted in this post as far as the influence of diet on blood pressure are below what can be achieved with the proper changes, from what I have seen in my practice. Marie’s story is inspirational! A person like her (eating fast-food) needs an oil change for blood pressure lowering. What does this mean — well, rebuilding the cell membranes with good, healthy fats (the omega-3′s) and phosphatidylcholine so that the body can remove the toxic trans-fats from these foods that have built up over the years and created sick cellular membranes. Often, this requires the proper guided supplementation. A healthy cell membrane means healthier ion channels to help control the flow of ions, and consequently help control the blood pressure.

    I do want to add another means I have seen to help lower blood pressure in patients — the addition of a pet into their lives. I believe this especially helps people that live alone and may feel lonely. The right dog or cat can actually help bring down the person’s blood pressure. I believe it is due to the comfort a non-judgemental animal gives its owner.

    The final point here reminds us to always analyze the community in which a person lives. A dietary and lifestyle overhaul is most successful when everyone in the household is on board. Always analyze the person’s environment, as that played a strong role in getting them to where they are now and it will be integral to their recovery.

  • http://www.themindrelaxer.com The Mind Relaxer

    Thanks for that long and informative post regarding HB treatment.

  • http://www.brightonyourhealth.com Mary Brighton, MS, RD

    Great post! Hypertension is a hidden killer. Medicines for high blood pressure also have negative side effects which cause some non-compliance issues in some patients. If all doctors could be trained in lifestyle medicine, or at least taking minutes as one commentor said to educate people to explain the importance of lifestyle changes to lower blood pressure, there would be less stroke, heart attacks and kidney problems. (I am sure there are doctors that do this, but not all of them!)
    Another problem is that people do not take enough effort into their own, what I label “person health reform.” People expect doctors and health professionals to have all the answers. We must take control of our own health, aim for healthier lifestyles, be a positive role model for our children/grandchildren (who will experience an epidemic of high blood pressure in the next generation I predict) .
    Taking control of our health and lifestyles are critical: our American health system depends on it, and our friends and family need us to stay healthy too!!!
    Mary Brighton

  • http://www.brightonyourhealth.com Mary Brighton, MS, RD

    I totally agree with Hospitalist. Positive healthy lifestyles need to happen and are molded during childhood or early adulthood.
    After that..barriers to change and “bad habits” are certaintly habit forming…
    Let’s educated parents/caregivers/grandparents to get these kids on the right track..I cannot imagine what things are going to be like for them in 20 years…

    Mary Brighton

  • BobBapaso

    Congratulations, accurate and comprehensive, I’ve nothing to add.

  • Hospitalist

    Great post. However, I wonder why we always talk about “lifestyle modification” after a patient presents with high blood pressure, diabetes, etc. Why wait until you have a disease to do something about it? Sometimes, the way the recommendations are worded make me wonder if the American public reads these as “things only people with high blood pressure should do” rather than “everyone should do these things but it is more important for people with high blood pressure to be vigilant about it.” This would mean targeting the younger, currently healthy crowd who often don’t go to their physician. I think a more widespread public campaign for teaching could help this population prevent the need for “lifestyle” talks with their physicians when they are 45.

  • moose

    And still weight is blamed for high blood pressure, despite repeated studies that show this is not the case.

    There were studies done at Duke where fat patients were helped to eat healthier and exercise more but forbidden to lose weight. Those who stuck with the exercise and better diet had the result of better cholesterol numbers and lower blood pressure.

    Ironically it’s long since been known that the most likely people to have “hidden” high blood pressure are skinny black men. Yet we continue to blame obesity instead of the actual lifestyle.

    Not all people who eat junk food and don’t exercise are fat, just as not all fat people eat junk food and don’t exercise. Doctors need to remember to treat the patient, not the stereotype.