Dangerous hypertension can be tamed over time
Roughly a third of American adults, more than 75 million people, have high blood pressure, or hypertension. Despite this staggering number, only about half of diagnosed patients adequately control their blood pressure. More than 90 percent of adult cases are “essential” hypertension, which means no clear cause can be found.
Without treatment, hypertension can raise the risk for stroke, coronary disease, heart failure, hardening of the arteries, sexual dysfunction, dementia, loss of kidney function and poor circulation.
A married, 45-year-old patient came to me recently. Although he had no known history of hypertension, he was worried about a strong family history: Both of his parents have hypertension, and his paternal grandfather died from a stroke.
Ever since having children,
he’d had little time for exercise and rest, and he weighed 225 pounds. His body mass index was 33.6 — firmly in the obese category.
He admitted that he got little exercise and that his diet was not healthy — he made poor meal choices, and often had two to four alcoholic beverages a day. He was unaware of how much sodium his food contained.
The most important first step to taming hypertension is to detect it. Those annual or more than annual blood-pressure checks at your doctor’s office are essential to discovering both the existence of a problem and its severity.
My patient’s blood pressure was 154/93, and on repeat, 147/92. A onetime measurement of high blood pressure does not render a diagnosis of hypertension, but it was clear that his required intervention to improve his overall health and to lower his blood pressure.
Once a diagnosis is made, hypertension can be managed with one or more of numerous medications on the market. However, many patients prefer to try lifestyle changes, which can be effective in both preventing and treating essential hypertension.
Among these changes:
Cut sodium intake. Essential hypertension is unlikely to develop if you consume less than 1.2 grams of sodium per day. The Centers for Disease Control and Prevention recommends limiting consumption to less than 2.3 grams. However, Americans ingest, on average, almost four times that amount. The problem is that many prepackaged foods have high levels of sodium.
Exercise. Regular aerobic exercise has been shown to decrease systolic blood pressure (the higher number) by 5 points. With intense exercise, an improvement of up to 15 points is attainable.
Lose weight. A large study found that weight loss of 9 pounds can lead to a decrease in systolic blood pressure of 6 points, and diastolic pressure (the lower number) by 3 points over the long term.
Increase intake of fruits and vegetables. The famous DASH (Dietary Approaches to Stop Hypertension) diet, rich in fruits and vegetables, lowered blood pressure in hypertensive patients by a systolic pressure of 11 points and diastolic pressure of 5.5 points in an eight-week trial.
Decrease alcohol intake. Studies have shown that drinking more than two alcoholic beverages daily can increase risk for hypertension by 1.5 to 2 times compared with non-drinkers.
In many ways, my patient was an ideal candidate for gaining control of his hypertension. Ultimately, he succeeded in improving his diet and reducing sodium and alcohol intake significantly. He found it more difficult to find time to exercise, but he started walking to work more, and made weekend hikes part of his family routine.
His efforts paid off: After six months, his blood pressure was 138/ 85 — not ideal, but greatly improved. He was happy with the outcome and promised to improve his diet further, find more time for exercise and lose 15 more pounds — a worthy, life-affirming goal.