How to re­duce blood pres­sure

Lesotho Times - - Health -

AT­LANTA — Doc­tors have long known that sys­tolic blood pres­sure be­low 120 was con­sid­ered nor­mal and meant a lower risk of heart dis­ease and kid­ney prob­lems. But they would of­ten only treat pa­tients if that top num­ber crept above 140, the thresh­old for of­fi­cially hav­ing high blood pres­sure.

Re­cent find­ings from a large Na­tional In­sti­tutes of Health study now sug­gest that it’s worth treat­ing pa­tients in that pre­hy­per­ten­sion gray area of 120 to 140, in or­der to bring them down into the nor­mal range.

The find­ings, which have not yet been pub­lished and are still pre­lim­i­nary, found lower rates of heart at­tack, stroke and death among peo­ple with high blood pres­sure who brought that top num­ber down to 120. In or­der to reach that goal, study par­tic­i­pants in the 120 group took an av­er­age of three blood pres­sure med­i­ca­tions, whereas the 140 group took two med­i­ca­tions.

“This is no­table be­cause there (are) a lot of peo­ple out there with blood pres­sure in the 130s that we might pre­vi­ously have left alone, but if the re­sults of this trial (are) as we think they are, it might be rea­son to try to get them to 120,” said Dr. John D. Bisog­nano, pro­fes­sor of medicine at the Univer­sity of Rochester Med­i­cal Cen­tre and pres­i­dent-elect of the Amer­i­can So­ci­ety of Hy­per­ten­sion.

The fi­nal re­sults of the NIH study will ar­rive in the com­ing months, but “it has changed in my prac­tice. Like if I have some­one in the low 140s, I no longer say that’s sort of close. ... I try to push them down into the mid-130s if they are non­di­a­betic,” Bisog­nano said. (Although this strat­egy might also help peo­ple with di­a­betes, Bisog­nano added, the NIH study only looked at peo­ple over 50 who did not have di­a­betes.) The fo­cus is on the top num­ber in a blood pres­sure read­ing be­cause it’s a bet­ter pre­dic­tor of heart at­tack and stroke than the bot­tom num­ber, the di­as­tolic pres­sure, Bisog­nano said.

So how can pa­tients take their blood pres­sure down to 120?

If that be­comes the new goal, many peo­ple will prob­a­bly need to start a blood pres­sure med­i­ca­tion or add another to their cur­rent reg­i­men, Bisog­nano said. But there are also a num­ber of lifestyle in­ter­ven­tions they may be able to tap into in­stead of tak­ing a new drug. Here are their op­tions:

Med­i­cate Many peo­ple have to take blood pres­sure med­i­ca­tion just to stay close to the 140 mark, Bisog­nano said. Some may even run marathons and lead oth­er­wise healthy lives, but just can’t get down in the nor­mal range, pos­si­bly be­cause they are ge­net­i­cally pre­dis­posed to high blood pres­sure.

To get down to 120, these peo­ple may have to take more blood pres­sure med­i­ca­tion. The most com­mon, Bisog­nano said, are the “ABCDS”: ACE in­hibitors, beta block­ers, cal­cium chan­nel block­ers and di­uret­ics. Typ­i­cally, pa­tients who need more than one med­i­ca­tion would take one from each of these classes.

Although the ABCDS can lead to side ef­fects, such as de­hy­dra­tion, headache and weak­ness, most peo­ple can tol­er­ate them and the prob­lems are usu­ally not se­vere, Bisog­nano said. In ad­di­tion, “we are in a golden age of hy­per­ten­sion treat­ment, where al­most all of the drugs are cheap,” he said.

A medium dose of one of these med­i­ca­tions usu­ally brings sys­tolic blood pres­sure down by about 10 points, said Dr. Karen Margolis, di­rec­tor of clin­i­cal re­search at Healthpart­ners In­sti­tute for Ed­u­ca­tion and Re­search.

Lose weight Weight loss can lower blood pres­sure about as much as tak­ing a sin­gle blood pres­sure med­i­ca­tion, Margolis said. Re­search sug­gests that los­ing about 9 pounds could re­duce sys­tolic blood pres­sure by 4.5 points, and one study found that main­tain­ing weight loss of about 7 pounds for a year could even bring it down by 11 points.

It is not clear why weight loss is so ben­e­fi­cial for blood pres­sure, Bisog­nano said. It may lead to changes in cir­cu­la­tion, or it may be be­cause of the di­etary changes that can ac­com­pany weight loss, such as eat­ing less salt. “(How­ever) we have to ap­pre­ci­ate how dif­fi­cult it is to lose weight,” es­pe­cially if you are busy, Bisog­nano said. “Some­times you can do it and some­times you can­not.”

Ex­er­cise Along with weight loss, ex­er­cise is prob­a­bly the best way to lower blood pres­sure with­out the pos­si­ble side ef­fects of med­i­ca­tion, Bisog­nano said. It makes ar­ter­ies more flex­i­ble and bet­ter able to di­late, which di­rectly re­duces sys­tolic blood pres­sure, he said.

The Amer­i­can Col­lege of Car­di­ol­ogy and the Amer­i­can Heart As­so­ci­a­tion rec­om­mend 2½ hours a week of medium in­ten­sity phys­i­cal ac­tiv­ity, such as jog­ging, swimming and danc­ing.

One study found that 10 weeks of mod­er­ate ex­er­cise, such as walk­ing and cy­cling, for an hour three times a week re­duced sys­tolic blood pres­sure in seden­tary older adults by 5 points.

For some peo­ple, how­ever, the slog of go­ing to the gym af­ter a long work day may be worse than the side ef­fects of med­i­ca­tion, Bisog­nano said. But even be­ing a “week­end war­rior” can help. “Then, when your life per­mits you to do some­thing once or twice a week, you’ll be in phys­i­cal shape to do that,” Bisog­nano said.

Scale back the salt One of the most im­por­tant di­etary changes some peo­ple can make to lower blood pres­sure is re­duc­ing salt in­take, Bisog­nano said. Many of us con­sume 9 to 12 grams of salt a day, but the Amer­i­can Heart As­so­ci­a­tion rec­om­men­da­tion is 3 or 4 grams. In one study, scal­ing back daily salt lev­els from 8 grams to 4 grams was as­so­ci­ated with a drop of 6.7 points in sys­tolic blood pres­sure.

But only peo­ple whose blood pres­sure is af­fected by salt may reap this kind of blood pres­sure-low­er­ing ben­e­fit. “If you don’t have salt­sen­si­tive hy­per­ten­sion, it will not do much,” said Dr. Sa­muel Joseph Mann, pro­fes­sor of in­ter­nal medicine at New York-pres­by­te­rian Hos­pi­tal Weill Cor­nell Med­i­cal Col­lege.

About half of black peo­ple and a quar­ter of white peo­ple have salt-sen­si­tive hy­per­ten­sion, and the num­bers are higher in older peo­ple, Mann said. You can see if your hy­per­ten­sion is af­fected by salt by re­duc­ing your in­take for four or five days, such as by cut­ting out soups and pro­cessed foods and not eat­ing out, and mea­sur­ing your blood pres­sure at your drug­store be­fore and af­ter, Mann added.

Eat more fruits and veg­eta­bles If re­duc­ing salt is not enough, peo­ple with high blood pres­sure have an en­tire diet de­signed for them. Di­etary Ap­proaches to Stop Hy­per­ten­sion, or DASH, was de­vel­oped by the Na­tional In­sti­tutes of Health and has been voted one of the best over­all di­ets.

The DASH diet is high in fruits, veg­eta­bles and fiber, and low in sodium. It may fur­ther re­duce sys­tolic blood pres­sure by about 3 points com­pared with a reg­u­lar low-sodium diet, ac­cord­ing to a trial of DASH.

How­ever, a draw­back of the DASH diet is that it’s high in car­bo­hy­drates. This can stim­u­late the ap­petite and make it harder for peo­ple to lose weight, Bisog­nano said. If you are try­ing to lose weight and lower blood pres­sure, di­ets such as Zone and South Beach, which bal­ance carbs with pro­tein and fat, may be eas­ier to stick with for six months

or so, he added.

Snack on cho­co­late Not ev­ery tasty treat is bad for your blood pres­sure. Re­search sug­gests that peo­ple who ate more dark cho­co­late over a pe­riod of two to eight weeks had lower sys­tolic blood pres­sure by about 2 points. An­tiox­i­dants in co­coa, called fla­vanols, may help di­late ar­ter­ies.

Although this re­duc­tion in blood pres­sure is rel­a­tively small, it may com­ple­ment other in­ter­ven­tions. How­ever, Bisog­nano said, “if you have 400 calo­ries of dark cho­co­late, you don’t get to have 400 calo­ries of some­thing else.”

Don’t binge drink High blood pres­sure is another rea­son not to binge drink. Stud­ies sug­gest that al­co­hol re­duc­tion in­ter­ven­tions can re­duce sys­tolic blood pres­sure by about 4 points among peo­ple who con­sume be­tween 30 and 60 drinks a week. The Amer­i­can Heart As­so­ci­a­tion rec­om­mends that women stick to an av­er­age of one al­co­holic drink a day and men to two.

Med­i­tate It may not come as a sur­prise that med­i­ta­tion prac­tices that aim to im­prove fo­cus and re­duce anx­i­ety may also lower your blood pres­sure. An anal­y­sis of stud­ies of tran­scen­den­tal med­i­ta­tion us­ing a short mantra found it could re­duce sys­tolic blood pres­sure by nearly 5 points more than those who did not med­i­tate or used other re­lax­ation tech­niques.

“We know that tran­scen­den­tal med­i­ta­tion, and other re­lax­ation tech­niques such as yoga, def­i­nitely work if done regularly. The ques­tion is, can peo­ple do it regularly?” Bisog­nano said. — CNN

Ex­er­cis­ing and re­duc­ing salt can get blood pres­sure into the nor­mal range.

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