Cut salt. Exercise. Lose weight. Take medication. In 2014, the plan for managing high blood pressure — or hypertension — might sound familiar. Still, if you have high blood pressure, all these changes can feel new and overwhelming. With risks such as stroke, heart attack, kidney disease and blindness, you can’t ignore high blood pressure — but you can learn how to tame it.
Know Your Numbers — and Seek Treatment When Necessary
Do you know what your blood pressure is? Many people don’t, says Bandar Alsaif, a volunteer blood pressure mentor and master trainer with the American Heart Association. “Know your status,” he says. “That’s the first step.”
People with high blood pressure can feel fine for years before symptoms arise — that’s why it’s called the silent killer. When is blood pressure considered high? Normal blood pressure is under 120/80. From 120/80 to 139/89 is pre-hypertension. The threshold for high blood pressure is 140/90, while anything over 180/110 is hypertensive crisis — an emergency. When somebody’s blood pressure is 140/90 or above, “that should draw our attention,” says John Bisognano, president- elect for the American Society of Hypertension.
| Blood Pressure Category | Systolic mm Hg (upper #) | Diastolic mm Hg (lower #) | |
|---|---|---|---|
| Normal | less than 120 | and | less than 80 |
| Prehypertension | 120 — 139 | or | 80 — 89 |
| High Blood Pressure (Hypertension) Stage 1 | 140 — 159 | or | 90 — 99 |
| High Blood Pressure (Hypertension) Stage 2 | 160 or higher | or | 100 or higher |
| (Emergency care needed) | Higher than 180 | or | Higher than 110 |
| American Heart Association |
Orville Howe, 67, a retired tool maker in Mustang, Oklahoma, has had high blood pressure since his early 20s. “If I had to take a physical or anything, they would tell me, ‘Your blood pressure’s kind of high,'” he recalls.” And so OK, they didn’t say I needed to do anything for it.” So it went until he started medication in his early 40s. Now he’s on multiple blood pressure drugs, which keep his level down to about 140/80 — unless he gains weight. Then he’s back up to 190/100, which his doctor warns is a “wake-up call.” He exercises every morning — calisthenics and a walk. His big hurdle is food. His “old-fashioned” mother was a cook in restaurant. “She could fry the chicken and make that potatoes and gravy, and me and my siblings just lapped it up,” he says. Today, he keeps a sharp eye on his salt intake and stays away from canned goods like soup.
[Read: When You Don’t Follow Your Doctor’s Orders .]
Salt Smarts
You don’t have to swear off salt, but you do have to watch it. “We’re really focusing patients to have a modest salt intake,” says Bisognano, who is director of the Hypertension Clinic at the University of Rochester Medical Center. That’s about 3 to 5 grams of sodium per day, he says. People “don’t need to excessively restrict themselves,” he says, but should avoid eating a lot of canned or salty foods, and stay away from the ever-salty buffet.
“If you’re eating a fairly low-sodium diet and you’d like some potato chips, it’s probably not going to put you over the top,” he says. But if a routine meal involves a heavily salted steak, with soup and a pickle on the side — that’s over the top. “It’s another one of the boring medical things where we say ‘everything in moderation,'” Bisognano says, “and we’ve learned that a moderate salt intake is what people probably have to strive for.”
The American Heart Association advises most Americans to consume less than 1,500 milligrams of sodium a day for the best effect on blood pressure. For a low-salt, heart-healthy diet, consider the DASH plan — Dietary Approaches to Stop Hypertension — developed by the National Heart, Lung and Blood Institute.
[Read: No, There’s Not a Magic Pill for Weight Loss .]
From Walking to Marathons
“A little more physical activity goes a long way,” Bisognano says. “If [people] just get out and do an extra 30 minutes of something, even if it’s the equivalent of walking the dog, whether they have a dog or not, just something to get them out of the house.”
On the flip side, an intense fitness regimen alone might not be enough to keep blood pressure down to healthy levels for everyone. There’s a genetic component to hypertension — it runs in families. “I have marathon runners who are on five blood pressure drugs,” he says.
[Read: What to Expect After Suffering a Stroke .]
Making Medications Work for You
The common first-line drug treatment used to be an inexpensive diuretic or water pill, but people don’t like the frequent trips to the restroom. Now, Bisognano says, with most of the medications having gone generic and many prescriptions costing only $4 for a 30-day supply at larger chain stores, doctors and patients have more choices.
Medications are classified according to how they lower blood pressure. Calcium channel blockers include amlodipine (Norvasc), diltiazem (Cardizem), verapamil (Calan) and nifedipine (Procardia XL). Angiotensin-converting enzyme inhibitors are another class: ACE inhibitors include benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec) and lisinopril (Zestril).
Beta-blockers, such as atenolol (Tenormin), metoprolol (Lopressor), nadolol (Corgard) and propranolol (Inderal), are now considered more as third- or fourth-line treatments, Bisognano says, in part because of sexual side effects (like erectile dysfunction) in men. However, he notes, sexual dysfunction can be a sign of cardiovascular disease in people with high blood pressure, rather than a drug side effect. Aldosterone antagonists, which include spironolactone (Aldactone) and eplerenone (Inspra), are used for harder-to treat hypertension.
Each medication is capable of lowering blood pressure by 10 or 12 points at the most, Bisognano says. “So if [patients] start off 20 or 30 points above their goal, they’re going to need three or four medications,” he says. “And there’s not one magic medication — people just tolerate some medications better than others.”
He points to a small study in the August 27 issue of the Journal of the American Medical Association that found high-risk patients had better results when they monitored their blood pressure at home and used a flow chart to adjust their medication accordingly.
[See: U.S. News Quiz: Do You Know Your Stroke Risk Factors? ]
Try This at Home
A team approach works best when it comes to blood pressure control, says Mary Ann Bauman, a physician and spokeswoman for the American Heart Association. That team includes the pharmacist, doctor, nurse, specialist when needed — and the patient.
Blood pressure readings patients take at home are likely more accurate than those taken during office visits, says Bauman, who’s on staff with Integris Family Care Central in Oklahoma City. That’s partly due to white coat hypertension, where just being in the office makes your blood pressure rise. But there’s also masked hypertension, where blood pressure is lower in the doctor’s office. “By getting all those multiple readings at home, we can better assess,” she says. When choosing your at-home monitor, digital versions are fine, but make sure the cuff goes on your upper arm rather than your wrist, she says. While drugstore machines are OK, she adds, the calibration can be off from multiple users.
In his work with Miami-area residents, Alsaif teaches proper positioning for blood pressure monitoring: seated, with legs and ankles uncrossed, and your arm raised to the level of your heart and resting on a table or other surface.
Stress Busters
Bisognano says that while long-term stress has been “very mildly linked with high blood pressure,” the real connection may be how stress causes people to do things that increase their blood pressure — such as gaining weight, eating a higher-salt diet and more fast food, and being more sedentary. Stress-reduction techniques such as yoga and meditation help, he says, “and they can lower blood pressure by a good 10 or 15 points.” You don’t have to go to a studio to try either of these classes — they’re also offered at places like the local YMCA.
Sleep is a factor in blood pressure: “People with sleep apnea tend to have more high blood pressure, and treating it improves blood pressure modestly,” he says.
[See: 8 Ways Meditation Can Improve Your Life .]
Takes a Community
“The number is staggering — 78 million people in the U.S. have high blood pressure,” Bauman says. That’s why the American Heart Association is reaching communities with programs like Check. Change. Control. Part of the program’s goal is to reach out to African Americans adults — more than 40 percent of whom have hypertension.
In the program, mentors like Alsaif — now a Ph.D. student in public health at Florida International University — educate people on heart health and engage them in monitoring and managing their blood pressure. When Alsaif would sit with people and ask why they didn’t take their medicine, they’d tell him the drugs made them dizzy — or men would complain of sexual performance problems — and he’d urge them to talk to their health care providers. People who didn’t exercise often didn’t have a safe place to do so, he says. He would suggest solutions like walking in groups, or even just walking in place to get in their 10,000 steps a day. At times, screening would catch dangerously high blood pressure levels, and mentors sent people straight to the emergency room.
In cooking classes, people learned how to make affordable healthy foods such as salads and dressing made from scratch, and how to read nutritional labels and stay away from foods high in sodium and saturated fats. They were asked to stay away from soda and high-sugar drinks, and mentors suggested alternatives, such as fresh lemon and lime juice. Class handouts included recipes, and Alsaif says “what people really like is that every recipe has the estimated cost of the meal per person, so they can compare healthy food prices with fast food.”
Moderation, Not Perfection
It’s easy to set the bar too high in blood pressure control, Bisognano says, and health care providers play a part. “On [patients’] first visit, we often tell them they’re too heavy; they don’t exercise enough; and they have to adopt something like the DASH diet,” he says. “And that’s just a huge thing for most people to accept and implement.”
Managing high blood pressure is a lifelong process, he says. Consider your situation — it makes a difference whether you’re a working mother with small children or a retiree. “At different points in one’s life, one can do more with less effort,” Bisognano says. With patients, he adds, “I always joke that every time I’ve lost weight it’s been easy. It’s just between those times it’s been impossible.”
[Read: Are You at Risk for Heart Failure? ]
More from U.S. News
How to Help Aging Parents Manage Medications
10 Ways to Lower Your Risk of Stroke
The Best Foods for Lowering Your Blood Pressure
When You Learn You Have High Blood Pressure originally appeared on usnews.com
