Bringing Down Your Blood Pressure

By Janis Jibrin, M.S., R.D., for SmartBalance.com

The good news about high blood pressure: You can usually get it under control. In fact, with some lifestyle changes, you could be rid of it altogether. The very bad news: if it stays high, it can be life-threatening. The other bit of bad news is that you may have absolutely no idea you have it. Because until it becomes life-threatening, there are usually no symptoms at all.


So, if you haven’t had your blood pressure checked in the past year, that’s your first order of health business. You might even be able to get tested for free at a local drugstore. Don’t put it off; even if you had great blood pressure numbers a few years ago that doesn’t mean you still do. That’s because blood pressure tends to rise with age. For example, even if you have normal blood pressure at age 55, there is a 90 percent chance of developing high blood pressure at age 80.1 Currently, about one in three American adults have high blood pressure, also called hypertension.1 And nearly that many have prehypertension, which can lead to hypertension.1


Don’t get discouraged by the stats; keep in mind that this is a highly treatable condition. Follow the “Better Blood Pressure Strategies” section of this article—and it may help lower your numbers or prevent the condition from ever happening.


Decoding Blood Pressure Numbers

As you can see from this chart, normal blood pressure means that both the top (systolic) and bottom (diastolic) are under the cut-offs. But for all the other categories, only one of the numbers needs to be high. Risk for heart disease increases with each increasing stage of blood pressure.
Categories for Blood Pressure Levels in Adults (measured in millimeters of mercury, or mmHg)


Systolic (top number)

Diastolic (bottom number)

Normal Less than 120 And Less than 80
Prehypertension 120–139 Or 80–89
High blood pressure
Stage 1 140–159 Or 90–99
Stage 2 160 or higher Or 100 or higher
Source: National Heart, Lung and Blood Institute website. “What is High Blood Pressure?”2


Bring It Down!


While you’re quietly reading this article, your circulatory system is in full swing, starting with the heart, which pumps approximately 60 to 100 beats per minute. With each beat, it sends blood into the arteries; the force exerted against artery walls is “blood pressure.” Healthy arteries are nice and elastic; expanding to accommodate the rush of blood, then contracting in between beats. Hypertension damages arteries and are a trigger for atherosclerosis—the narrowing of arteries with cholesterol-laden plaque, which can lead to heart disease.3 And, in turn, these narrowed and stiffened arteries further raise blood pressure.


The way you live can have a major impact on whether you develop hypertension—the main lifestyle influencers are listed below. But sometimes your blood pressure is out of your control—age, genetics and an underlying illness may create a situation where only medication can bring numbers down. But even if these cards are stacked against you, good diet, exercise and other lifestyle habits may still help.


A word on medication: If your healthcare provider prescribes it, take it! You can still work on losing weight and any of the other lifestyle strategies listed below. Just let your doctor know about any lifestyle changes you’re planning on making. It’s very important to schedule follow-up visits, because your new habits may cause blood pressure to fall. In that case you may need to adjust your medication dose, or, if you’re lucky, go off meds altogether!


Better Blood Pressure Strategies

  • Don’t smoke. Both smoking and inhaling secondhand smoke can raise blood pressure by encouraging plaque buildup and damaging artery walls in other ways.4 That’s one reason smokers have such astronomical heart disease rates. About one in five deaths in the U.S. are due to smoking, and of those, 40 percent of them are heart disease–related.
  • Maintain a healthy weight. For many people, this means a body mass index (BMI) less than 25. The more you weigh, the higher your blood pressure tends to rise. But, fortunately, in many cases, losing the weight also can help bring down hypertension. In a study of 181 men and women with hypertension living in Baltimore, MD, losing an average of 5.25 pounds dropped blood pressure by 77 percent.5 Our Steps to Heart-healthier Diet Part Oneand Part Two is a terrific way to cut calories healthfully, and our Eight-Week Exercise Program will help you burn more calories as well.
  • Exercise. Being physically active helps lower blood pressure in a number of ways.6 It helps you lose weight, which, in turn, lowers blood pressure. It also decreases chronic inflammation, which is thought to raise blood pressure.7 (Also, the reverse may be true: High blood pressure appears to raise inflammation.) While short-term inflammation is useful to the body (think about immune cells swarming around a wound to fight bacteria); chronic inflammation may lead to heart disease, cancer, dementia and other conditions. In addition to lowering blood pressure, exercise helps your heart in a number of other ways. For instance, it may help reduce LDL (“bad” cholesterol) and increase HDL (“good” cholesterol).6For guidelines on how much exercise you need, try out our Eight-Week Exercise Programyou can start no matter how fit you are.
  • Limit sodium. Sodium, which comprises 40 percent of salt—causes the body to retain water, which increases blood volume, thereby increasing blood pressure. Some people are particularly sodium sensitive, meaning the more sodium they take in, the higher their blood pressure, even if their blood pressure is in the normal range. And we’re eating too much of it—87 percent of Americans are taking in more than the recommended daily limit of 2,300 mg.1 That limit is even lower—just 1,500 mg—for people with hypertension or at high risk for the condition. It’s estimated that about a quarter of new cases of hypertension could be prevented if people kept sodium to no more than 2,300 mg.1About 75 percent of the sodium in the typical American diet comes from processed foods and restaurant meals; 10 to 12 percent occurs naturally; and another 10 to 12 percent is in foods cooked at home and salt added at the table.8 To cut back, you need a three-pronged strategy (For more tips, read New Strategies for Slashing Salt).
  • Eat more “whole” foods that are as close to nature as possible. That means, instead of frozen-in-sauce vegetables, use fresh or frozen without salt. Sure, canned beans and canned tomatoes are convenient and healthy, but make them even better by buying “no salt added,” or at the very least, check labels for no more than 150 mg sodium per half cup. Cook plain whole grains, not the kind in a box with all the seasonings (adding your own fresh herbs and sautéed onions tastes better, anyway). When shopping, always compare food labels and put the lower sodium products in your cart (i.e., some cereal has 0 to 5 mg sodium per serving; whereas, others have 250 mg or more).
  • Cook with little to no salt, but it’s OK to add it at the table. When cooking, try to add no more than 1/4 teaspoon sodium per four servings. Pump up other flavors, such as herbs (fresh or dried), hot pepper, lemon and orange juice and zest. Once the food is on your plate, taste it. If it really needs more salt, add a dash (about 1/16 teaspoon) just before you put it in your mouth. The impact of those salt crystals on your tongue goes a long way. For instance, you get more of a satisfying salt flavor from adding a dash of salt to your sautéed zucchini or other vegetables just before you take a bite than if you’d used a lot more salt in cooking.
  • Avoid fast-food restaurants, limit all restaurant food and take care when you do eat out. Check out the nutrition information on fast-food and chain restaurant websites—it’s shocking. You can meet—or exceed—your daily sodium limit in just one meal. And you could also get doused with sodium at nonchain restaurants; without nutrition info, you’ll never know. In these places, your only defense is to ask for dishes that are not preseasoned, like salads (use olive oil and vinegar to dress) and grilled fish.
  • Have at least 8 1/2 servings of fruits and vegetables daily. The reason: potassium. Fruits and vegetables are the richest sources of this mineral, which helps dampen sodium’s blood pressure-raising effects.9 In other words, even if you’re overdoing the sodium, if you’re getting plenty of potassium, your blood pressure may be less likely to rise.Potassium, by reducing blood pressure, reduces risk for heart disease and stroke.10 Yet only two percent of Americans get the recommended daily 4,700 mg of potassium. Skimping on potassium doesn’t just affect blood pressure, but, through a complex effect on acid-base balance in the body, causes demineralization of bone, which can lead to osteoporosis.

    Why 8 1/2 servings of fruits and vegetables? That’s how much it took to bring potassium levels close to 4,700 mg daily on the DASH study (Dietary Approaches to Stop Hypertension).11 This National Institutes of Health–funded study found that a low sodium, plant-rich (but not vegetarian) diet could significantly reduce blood pressure and body weight. If you try to get a fruit or vegetable on your plate at each meal, you can fairly easily rack up 8 1/2 servings. A serving is, in general, 1/2 cup raw or cooked fruits or vegetables. A cup of fruit at breakfast, a decent-sized salad for lunch (3 cups greens), and a cup of steamed broccoli at dinner, and you’re more than covered.

  • Limit alcohol. Drinking excessively—defined as three or more drinks per day for men and two or more for women—can make it 70 percent more likely that you’ll develop high blood pressure.1 It can also set you up for alcoholism, and increase breast cancer risk in women. So, if you drink, follow the American Heart Association guidelines: Have no more than an average of one to two drinks per day for men and one drink per day for women.A drink is qualifies as:
    • 12 ounces of beer
    • 4 ounces of wine
    • 1.5 ounces of 80-proof spirits (such as gin, vodka, whisky, etc.) or 1 oz. of 100-proof spirits.12
  • Manage stress. People who are more psychologically stressed—especially those who have a lot of anger, hostility and/or depression—may be at greater risk for heart disease.13Although episodes of stress can cause a temporary elevation in blood pressure (i.e., you’re running late to an important appointment, stuck in stop-and-go traffic), it’s not clear whether stress is a cause of chronic hypertension.14 Check out these tips for stress management.

How to get the motivation to make these lifestyle changes? If lowering blood pressure isn’t motivating you enough, there’s more! Adopt the “Better Blood Pressure Strategies” above, and you may lose weight, reduce your risk of heart disease, type 2 diabetes and other diseases. And you’ll look and feel a lot better!


Links found in this article:


1. Institute of Medicine. A population-based Policy and Systems Change Approach to Prevent and Control Hypertension. National Academies Press, 2010
2. National Heart Lung and Blood Institute website. What is High Blood Pressure? http://www.nhlbi.nih.gov/health/health-topics/topics/hbp/
3. Escobar, E. Hypertension and coronary heart disease. Journal of Human Hypertension, 2002;16 (Suppl 1), S61–S63
4. Prasad, D.S., et al. Smoking and cardiovascular health: A review of the epidemiology, pathogenesis, prevention and control of tobacco. Indian J Med Sci, 2009;63:520-33
5. Jiang, H., et al. Long-Term Effects of Weight Loss and Dietary Sodium Reduction on Incidence of Hypertension. Hypertension. 2000;35:544-549
6. Szostak, J and Laurant, P. The forgotten face of regular physical exercise: a “natural” anti-atherogenic activity. About one in five deaths in the U.S. are due to smoking, and of those, forty percent of them are heart disease-related.
7. Montecucco, F., et al. Inflammation in the pathophysiology of essential hypertension. J. Nephrol, 2011; 24(01): 23- 34
8. Brown, I.J., et al. Salt intakes around the world: implications for public health. International Journal of Epidemiology, 2009;38:791–813
9. Institute of Medicine. Dietary Reference Intakes: Water, Potassium, Sodium, Chloride, and Sulfate. National Academies Press, 2004.
10. Lanfranco, D., et al. Potassium Intake, Stroke, and Cardiovascular Disease: A Meta-Analysis of Prospective Studies. J. Am. Coll. Cardiol, 2011;57;1210-1219
11. Sacks, F.M., et al. “Effects on blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (DASH) diet. DASH-sodium collaborative research group.” The New England Journal of Medicine, vol. 344, no. 1, pp. 3–10, 2001.
13. Rutledge ,T. and Hogan, A. Quantitative Review of Prospective Evidence Linking Psychological Factors with Hypertension Development. Psychosomatic Medicine, 64:758–766 (2002)
14. Chida, Y. and Steptoe, A. Greater Cardiovascular Responses to Laboratory Mental Stress Are Associated with Poor Subsequent Cardiovascular Risk Status: A Meta-Analysis of Prospective Evidence. Hypertension, 2010;55:1026-1032.

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