5 steps to get your blood pressure under control

NEW YORK – In the United States, nearly half of adults have high blood pressure. Known as a silent killer, hypertension can contribute to heart attack, stroke and heart failure without causing symptoms.

Where hypertension was once thought to affect mostly older people, research now shows that an increasing share of people aged 35 to 64 are dying of heart disease related to it.

“Hypertension matters so much because it’s the most modifiable risk factor for cardiovascular disease, stroke and now, the evidence suggests, this may be true for cognitive decline,” said Dr Eduardo Sanchez, chief medical officer for prevention at the American Heart Association.

Lifestyle changes and medication can help bring blood pressure down, which changes the trajectory dramatically when it comes to heart attack and stroke, he added.

Even simple steps can help get your blood pressure in check.

Know your numbers

It sounds obvious, but just knowing your blood pressure is a great place to start. More than half of people with uncontrolled hypertension are not aware they have it, according to some estimates.

Blood pressure, the force that blood exerts on your arterial walls, is measured in millimetres of mercury (mm Hg) and given in two numbers. The top number, systolic pressure, measures the force when blood is pumped out of the heart, while the bottom number, diastolic pressure, measures the force between beats, when the heart is filling with blood.

Normal blood pressure is below 120/80 mm Hg. Above that level, Dr Sanchez said, damage begins to occur to blood vessels and organs they supply, including the kidneys, heart and brain.

It is important to have your blood pressure checked at least annually, said Dr Jennifer Cluett, director of the Complex Hypertension Clinic at Beth Israel Deaconess Medical Center in Boston. Make sure it is measured the right way: with the right size cuff and when you are sitting with both feet flat on the floor, have your upper arm supported at heart level and are not talking.

Up to 30 per cent of patients also may experience “white coat hypertension”, when blood pressure levels are elevated at the doctor’s office. For this reason, blood pressure management guidelines recommend checking at home, too, to confirm a diagnosis and manage the condition.

Understand your personal risk

There can be many causes of hypertension, said Dr Fatima Coronado, associate director for science in the division for heart disease and stroke prevention of the Centers for Disease Control and Prevention. It develops over time as a result of genetic and environmental factors, such as smoking, excess weight and poor sleep.

People whose parent or grandparent suffered a heart attack or stroke can be at increased genetic risk for high blood pressure, Dr Coronado said. Age influences risk because arteries stiffen as people get older.

Some women develop high blood pressure during pregnancy, which can be dangerous to the mother and foetus. Dr Martha Gulati, director of the Davis Women’s Heart Center at Houston Methodist, said the condition should be treated during pregnancy, and women should be followed by a cardiologist afterwards as they are at increased risk of high blood pressure and cardiovascular disease.

Follow a heart-healthy diet

You have heard it before: Eat healthy for your heart. Specifically, the Dietary Approaches to Stop Hypertension (DASH) diet was found to be the most effective of 22 lifestyle changes and stress-reducing techniques at reducing blood pressure, according to an analysis of more than 100 studies.

One reason may be that it centres foods rich in potassium, an electrolyte that helps the body get rid of sodium and relaxes the artery walls. Sodium causes the body to retain water, increasing the fluid and pressure inside blood vessels.

Bananas are not the only easy source of potassium. One avocado or a cup of diced cantaloupe contains more of it, and citrus fruit such as oranges and leafy greens such as spinach and Swiss chard are also rich in the electrolyte.

You can lower your blood pressure further if, in combination with DASH, you reduce your sodium intake, Dr Gulati said. The American Heart Association recommends that people consume no more than 2,300mg of sodium a day – and ideally, much less. In the US, most of the sodium in people’s diets comes from restaurant meals and processed foods.

Alcohol intake is also associated with increased blood pressure. Doctors suggest aiming for total abstinence. The benefits of cutting back seem greatest for those who consume more than two drinks a day.

Get moving and release stress

Aerobic exercise, which strengthens the heart so it can pump with less effort, was the second most effective intervention, after the DASH diet.

Isometric resistance exercise – when you contract muscles and hold a position, as in a wall squat and plank – was the third. Isometric exercise may help blood vessels dilate, which improves blood flow.

Exercise can also reduce stress, as can meditation and yoga. Other kinds of prayer and religious practice may also reduce stress, Dr Sanchez said.

And while exercise is beneficial even if you do not lose weight, Dr Cluett said, dropping excess kilos can also reduce blood pressure.

Do not be afraid of medication

The goal of treatment is to keep blood pressure below 130/80 mm Hg, though less than 120/80 mm Hg is better. Often, that requires medication. There are several effective, generic options doctors can prescribe.

Patients may need to take multiple types, which doctors said can sometimes be a deterrent. Single-pill combinations that include two or more blood pressure medications in one tablet make them easier to take. While some medications can cause side effects such as frequent urination or leg swelling, doctors can tweak medicine regimens to mitigate those.

Even if you are on medication, changes to your diet and exercise can still help and lower the odds of all sorts of negative health outcomes. “Lifestyle changes help more than just your blood pressure number,” Dr Cluett said. NYTIMES