Hypertension

Also indexed as:Blood Pressure (High), Elevated Blood Pressure, High Blood Pressure, Nightime Hypertension

Beat hypertension—Lower your blood pressure with simple lifestyle changes to protect yourself from this hidden health problem. According to research or other evidence, the following self-care steps may be helpful.

Need to Know

Living with:

• Watch what you eat
  Choose a diet low in cholesterol and animal fat, and high in produce, whole grains, legumes, and low-fat dairy, with some nuts and seeds.
• Get more soy
  Add 10 grams of soy protein or 16 ounces soy milk twice daily into your diet to help lower blood pressure.
• Boost heart health with supplemental garlic
  600 to 900 mg a day of a standardized garlic extract can improve heart and blood vessel health, and also has a mild blood pressure–lowering effect.
• Try CoQ10
  Taking 100 mg a day of this powerful antioxidant may have a significant impact on your blood pressure after one to several months.
• Sidestep salt
  Avoid using too much table salt, limit salty fast foods, and read labels to find low-sodium foods (less than 140 mg per serving) in your grocery store.
• Take minerals
  Supplements of calcium (800 to 1,500 mg a day) and magnesium (350 to 500 mg a day) may be helpful.

Reducing your Risk:

• Sidestep salt   
  Avoid using too much table salt, limit salty fast foods, and read labels to find low-sodium foods (less than 140 mg per serving) in your grocery store.
• Watch what you eat
  Choose a diet low in cholesterol and animal fat, and high in produce, whole grains, legumes, and low-fat dairy, with some nuts and seeds.
• Maintain a healthy weight
  Lose excess weight and keep it off with a long-term program of healthier eating and regular aerobic exercise for 30 to 60 minutes per day, four or more days per week.
• Go vegetarian
  Vegetarians have lower blood pressure than meat eaters, partly because of the mineral potassium in fruits and vegetables, which helps blood pressure.
• Limit alcohol
  Keep daily alcohol intake to two drinks or less per day, and fewer than 9 drinks per week for women to help prevent hypertension.

About this Condition

Approximately 90% of people with high blood pressure have “essential” or “idiopathic” hypertension, for which the cause is poorly understood. The terms “hypertension” and “high blood pressure” as used here refer only to this most common form and not to pregnancy-induced hypertension or hypertension clearly linked to a known cause, such as Cushing’s syndrome, pheochromocytoma, or kidney disease. 

Hypertension must always be evaluated by a healthcare professional. Extremely high blood pressure (malignant hypertension) or rapidly worsening hypertension (accelerated hypertension) almost always requires treatment with conventional medicine. People with mild to moderate high blood pressure should work with a doctor before attempting to use the information contained here, as blood pressure requires monitoring and in some cases the use of blood pressure-lowering drugs.

As with conventional drugs, the use of natural substances sometimes controls blood pressure if taken consistently but does not lead to a cure for high blood pressure. Thus, someone whose blood pressure is successfully reduced by weight loss, avoidance of salt, and increased intake of fruits and vegetables would need to maintain these changes permanently in order to retain control of blood pressure. Left untreated, hypertension significantly increases the risk of stroke and heart disease.

Symptoms

Essential hypertension is usually without symptoms until complications develop. The symptoms of complications depend on the organs involved.

Healthy Lifestyle Tips

Smoking is particularly injurious for people with hypertension. The combination of hypertension and smoking greatly increases the risk of heart disease–related sickness and death. All people with high blood pressure need to quit smoking.

Consumption of more than about three alcoholic beverages per day appears to increase blood pressure. Whether one or two drinks per day meaningfully increases blood pressure remains unclear.

Daily exercise can lower blood pressure significantly. A 12-week program of Chinese T’ai Chi was reported to be almost as effective as aerobic exercise in lowering blood pressure. Progressive resistance exercise (e.g., weight lifting) also appears to help reduce blood pressure. At the same time, blood pressure has been known to increase significantly during the act of lifting heavy weights; for this reason, people with sharply elevated blood pressure, especially those with cardiovascular disease, should approach heavy strenuous resistance exercise with caution. In general, people over 40 years of age should consult with their doctors before starting any exercise regimen.

Most people with high blood pressure are overweight. Weight loss lowers blood pressure significantly in those who are both overweight and hypertensive. In fact, reducing body weight by as little as ten pounds can lead to a significant reduction in blood pressure. Weight loss appears to have a stronger blood pressure-lowering effect than dietary salt restriction.

A specific chiropractic adjustment has been shown to produce a sustained reduction in blood pressure that was equivalent to that produced by two blood pressure-lowering medications.

Holistic Options

Anxiety in men (but not women) has been linked to development of hypertension. Several research groups have also shown a relationship between job strain and high blood pressure in men. Some researchers have tied blood pressure specifically to suppressed aggression.

Although some kind of relationship between stress and high blood pressure appears to exist, the effects of treatment for stress remain controversial. An analysis of 26 trials reported that reductions in blood pressure caused by biofeedback or meditation were no greater than those seen with placebo. Though some stress management interventions have not been helpful in reducing blood pressure, those trials that have reported promising effects have used combinations of yoga, biofeedback, and/or meditation. Some doctors continue to recommend a variety of stress-reducing measures, sometimes tailoring them to the needs and preferences of the person seeking help.

Preliminary laboratory studies in animals and humans suggest that acupuncture may help regulate blood pressure. Most, but not all, preliminary trials also suggest that acupuncture may be an effective way to lower blood pressure. Whether blood pressure goes back up after acupuncture is discontinued remains an unsettled question.

Auricular (ear) acupressure has been reported to be an effective treatment for hypertension, though in one case the improvement was not significantly better than use of traditional herbal medicines.

Spinal manipulation may lower blood pressure (at least temporarily) in healthy people, according to most preliminary and controlled trials. However, some research suggests the effect is no better than the blood pressure-lowering effect of sham (“fake”) manipulation.

In hypertensive people, temporary decreases in blood pressure have also been reported after spinal manipulation. However, most, but not all, trials suggest that manipulation produces only short-term decreases in blood pressure in hypertensive people.

Eating Right

The right diet is the key to managing many diseases and to improving general quality of life. For this condition, scientific research has found benefit in the following healthy eating tips.

Recommendation	Why
Add some fiber	Several studies have shown that adding around 7 grams of fiber per day to the diet reduces blood pressure, although other studies have not shown a benefit. Several double-blind trials have shown that adding 6.5–7 grams of fiber per day to the diet for several months leads to reductions in blood pressure. However, other trials have not found fiber helpful in reducing blood pressure. The reason for these discrepant findings is not clear.
Fry with good oils	Frying with more stable oils (such as olive oil) does not appear to increase high blood pressure risk, unlike cooking with unstable oils such as sunflower, corn, canola, and flaxseed. Reusing vegetable oils for frying, especially oils with high concentrations of unsaturated fatty acids (such as sunflower or safflower oil) has been associated with an increased risk of high blood pressure. Presumably, this increased risk is due to some of the degradation products (such as lipid peroxides or polymers) that result from the excessive heating of these oils. Frying with more stable oils, such as olive oil, is not associated with an increased risk of high blood pressure.
Limit sugar	Some doctors recommend that people with high blood pressure eat less sugar, as it has been reported to increase blood pressure in short-term trials. Sugar has been reported to increase blood pressure in animals and humans in short-term trials. Though the real importance of this experimental effect remains unclear, some doctors recommend that people with high blood pressure cut back on their intake of sugar.
Try a vegetarian diet	Vegetarians have lower blood pressure than meat eaters, partly because fruits and vegetables contain potassium—a known blood pressure–lowering mineral.  Vegetarians have lower blood pressure than do people who eat meat. This occurs partly because fruits and vegetables contain potassium—a known blood pressure-lowering mineral. The best way to supplement potassium is with fruit, which contains more of the mineral than do potassium supplements. However, fruit contains so much potassium that people taking “potassium-sparing”diuretics can consume too much potassium simply by eating several pieces of fruit per day. Therefore, people taking potassium-sparing diuretics should consult the prescribing doctor before increasing fruit intake. In the Dietary Approaches to Stop Hypertension (DASH) trial, increasing intake of fruits and vegetables (and therefore fiber) and reducing cholesterol and dairy fat led to large reductions in blood pressure (in medical terms, 11.4 systolic and 5.5 diastolic) in just eight weeks. Even though it did not employ a vegetarian diet itself, the outcome of the DASH trial supports the usefulness of vegetarian diets because diets employed by DASH researchers were related to what many vegetarians eat. The DASH trial also showed that blood pressure can be significantly reduced in hypertensive people (most dramatically in African Americans) with diet alone, without weight loss or even restriction of salt. Nonetheless, restricting salt while consuming the DASH diet has lowered blood pressure even more effectively than the use of the DASH diet alone.
Try some tomato	In one study, supplementing with a tomato extract significantly lowered blood pressure in people with hypertension. In a double-blind trial, supplementation with a tomato extract significantly lowered both systolic and diastolic blood pressure, compared with a placebo, in people with hypertension. The amount of extract used was 250 mg per day (providing 15 mg per day of lycopene plus other carotenoids) for eight weeks.
Cut back on coffee	In some studies, coffee drinking has led to small increases in blood pressure. Many doctors tell people with high blood pressure to avoid caffeinated products. Right after consuming caffeine from coffee or tea, blood pressure increases briefly. In trials lasting almost two months on average, coffee drinking has led to small increases in blood pressure. The effects of long-term avoidance of caffeine (from coffee, tea, chocolate, cola drinks, and some medications) on blood pressure remain unclear. A few reports have even claimed that long-term coffee drinkers tend to have lower blood pressure than those who avoid coffee. Despite the lack of clarity in published research, many doctors tell people with high blood pressure to avoid consumption of caffeine.
Sidestep salt	Avoid using too much table salt, limit salty fast foods, and read labels to find low-sodium foods in your grocery store. Primitive societies exposed to very little salt suffer from little or no hypertension. Salt (sodium chloride) intake has also been definitively linked to hypertension in western societies. Reducing salt intake in the diet lowers blood pressure in most people. The more salt is restricted, the greater the blood pressure-lowering effect. Individual studies sometimes come to differing conclusions about the relationship between salt intake and blood pressure, in part because blood pressure-lowering effects of salt restriction vary from person to person, and small to moderate reductions in salt intake often have minimal effects on blood pressure—particularly in young people and in those who do not have hypertension. Nonetheless, dramatic reductions in salt intake are generally effective for many people with hypertension. With the prevalence of salted processed and restaurant food, simply avoiding the salt shaker no longer leads to large decreases in salt intake for most people. Totally eliminating salt is more effective, but is quite difficult to achieve. Moreover, while an overview of the research found “There is no evidence that sodium reduction presents any safety hazards,” reports of short-term paradoxical increases in blood pressure in response to salt restriction have occasionally appeared. Therefore, people wishing to use salt reduction to lower their blood pressure should consult with a doctor.
Try a hypoallergenic diet	In one study, people with migraines who also had high blood pressure experienced a significant drop in blood pressure when put on a hypoallergenic diet. Food allergy was reported to contribute to high blood pressure in a study of people who had migraine headaches. In that report, all 15 people who also had high blood pressure experienced a significant drop in blood pressure when put on ahypoallergenic diet. People who suffer migraine headaches and have hypertension should discuss the issue of allergy diagnosis and elimination with a doctor.