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Hypertension is considered a "lifestyle disease." This m

Portsmouth Herald - 6/17/2018

Hypertension is considered a "lifestyle disease." This means that factors related to how we take care of ourselves appear to play a major role in what happens to our blood pressure numbers. Although medications can be one response to increases in blood pressure, lifestyle changes can make a large dent in our risk and may even cancel the need for medications and their potential side effects.

Why is high blood pressure a concern? It can lead to problems such as cardiovascular disease (heart attack, stroke, heart failure) and kidney failure. Because it is related to lifestyle issues, persons with elevated blood pressure may be at risk for other health problems as well.

A few months ago, the American Heart Association and the American College of Cardiology updated their guidelines for defining high blood pressure. The purpose was to more specifically categorize the various levels of high blood pressure in order to establish more tailored recommendations for appropriate treatment of blood pressure concerns.

Based on the previous guidelines, high blood pressure (hypertension) was defined as numbers 90. With the new guidelines, this range is now being called "high blood pressure - stage 2".

Since the previous guidelines were established, research has indicated that persons with numbers lower than this threshold may still be at risk for cardiovascular problems as compared to persons with normal blood pressure. This next level down (now being defined by the numbers 130-139/80-89) is being called "high blood pressure - stage 1". Previously it was referred to as "pre-hypertension".

Persons with numbers between 120-129/ 80 are now told they have "elevated blood pressure", while those with numbers 120/ 80 have "normal blood pressure".

As noted with the new guidelines, each of these defined categories of blood pressure is now associated with more specific recommendations which helps to fine-tune treatment to the individual. The guidelines encourage addressing rising blood pressure numbers sooner and more aggressively treating those at greater cardiovascular risk. There is also a stronger emphasis on making lifestyle changes rather than just using medications to resolve blood pressure concerns.

In addition, the new guidelines may reduce the risk of persons being over-medicated. Fine-tuning medication is especially important for older adults - a population with a high percentage of persons with some level of high blood pressure. In some situations, medications were causing blood pressures to get too low resulting in dizziness, fainting, and a possible increase in the risk of falling and fractures.

The new guidelines suggest that persons with "normal blood pressure" should follow healthy lifestyle practices and have annual checkups with their health care provider. For those with "elevated blood pressure", the guidelines encourage a shift towards more positive lifestyle habits and a reassessment within 3-6 months.

For persons with high blood pressure - stage 1, the goal is a 10-year heart disease and stroke assessment. If their risk is 10%, they should follow the guidelines for "elevated blood pressure". If their risk if higher than 10%, the recommendation is to start medication and initiate positive lifestyle changes with reassessment monthly until blood pressure normalizes.

For those with "high blood pressure - stage 2", the guidelines suggest lifestyle changes plus taking two different classes of medication and having monthly checkups until blood pressure is normalized.

What lifestyle changes can help lower blood pressure? As applicable, a person should quit smoking, moderate alcohol intake, work towards a healthy body weight, limit sodium intake, increase the intake of dietary sources of potassium and fiber, limit the intake of added sugars/red meat/highly processed foods, choose healthier food options overall, and increase physical activity.

The American Heart Association endorses the DASH diet (Dietary Approaches to Stop Hypertension). This diet is moderate in calories, contains a high amount of dietary fiber (whole grains, nuts, seeds, fruit, vegetables, beans), includes a lot of fruit and vegetables (to help increase potassium/fiber), suggests a moderate intake of animal proteins (no more than about 3oz. at each lunch and dinner), adequate calcium intake from sources low in saturated fat, and to replace the animal protein option at a lunch or dinner meal with a source of plant protein (beans, nuts, seeds) at least 4-5 times a week. It also suggests limiting sodium intake to 1500mg/day.

Both cardiovascular and strength exercise (to increase/sustain muscle mass) appear to be helpful. Individuals should begin physical activity at their current level of fitness and increase gradually, with consideration of their medical issues and/or any physical constraints (and approval from their health care provider).

Positive lifestyle changes can both reduce the risk of increased blood pressure and address already elevated blood pressure numbers. These changes may also reduce the need for medication and their potential side effects. Besides getting to the root of the problem of high blood pressure, positive lifestyle habits also promote a better quality of life and overall better health!

Pam Stuppy, MS, RD, CSSD, LD is a registered, licensed dietitian with nutrition counseling offices in York, ME and Portsmouth, NH. She is also the nutritionist for Phillips Exeter Academy, presents workshops nationally, and is Board Certified as a Specialist in Sports Dietetics. (See www.pamstuppynutrition.com for more nutrition information, some healthy cooking tips, and recipe ideas).

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