Your Guide to Living Well With Hypertension

Your Guide to Living Well With Hypertension

Introduction

Hypertension is a common and potentially dangerous condition. According to the Center for Disease Control and Prevention (CDC), nearly half of American adults, or around 108 million people, have hypertension. Unfortunately, only 24% of these adults with hypertension have the condition under control.

This guide will discuss hypertension, its symptoms, causes and risk factors as well as how to prevent and treat it. At the end is a glossary of hypertension terms.

What Is Hypertension?

Hypertension is another way of saying high blood pressure. To understand hypertension, it is important to understand blood pressure. Blood pressure is the pressure of blood as it pushes against the walls of your arteries. It is measured using two readings: systolic and diastolic. The systolic blood pressure measures the pressure when your heart contracts and the diastolic measures the resting pressure in-between contractions. 

Two numbers comprise a blood pressure reading. The systolic blood pressure is the first number and the diastolic is the second number provided in a reading. This can be expressed as [systolic number] over [diastolic number]. For example, 120 over 80 or 120/80.

According to the latest guidelines from the American College of Cardiology/American Heart Association, high blood pressure or hypertension is when your systolic blood pressure is 130 or higher or when your diastolic blood pressure is 80 or higher.

People with high blood pressure are at increased risk for heart attack and stroke, which are the leading causes of death in the United States. Having hypertension also increases the risk of developing kidney disease, blindness, dementia and other serious health problems. Nearly half of American adults, about 108 million people, have hypertension, but only about a quarter of them have the condition under control.

Hypertension terms can be confusing. If you are not familiar with them, see the “Glossary of Hypertension Terms” section of this guide.

Symptoms of Hypertension

The main reason so many people with hypertension do not have it under control is that it usually has no symptoms. Someone with even dangerously high levels of hypertension can have it for years without feeling anything different. 

In rare cases, a person with high blood pressure may experience headaches, shortness of breath or nosebleeds, but many times these symptoms are not attributed to the root cause. When these symptoms are present, hypertension is usually at a severe or even life-threatening stage.

What Causes Hypertension?

For most adults with hypertension, there is no identifiable cause. It develops slowly over years, so people who are older are at a higher risk. This is called primary, or essential, hypertension. 

Secondary hypertension is when high blood pressure is caused by an underlying health condition or medication. These include: 

• Diabetes
• Obstructive sleep apnea
• Kidney disease
• Adrenal gland tumors
• Thyroid problems
• Congenital birth defects in blood vessels
• Medications like birth control pills, cold medicine, decongestants, over-the-counter pain relievers and some prescription drugs
• Certain illegal drugs such as cocaine and amphetamines

If your doctor tells you that you have high blood pressure, it is important to tell them about any medication or drugs you regularly take or have taken recently so they can advise you and change your prescription medication if necessary. 

Although people over 65 are more likely to get high blood pressure, it can happen at any age. Even children can get high blood pressure; in fact, according to the National Institute of Health (NIH), the incidence of hypertension in children has increased along with childhood obesity.

Risk Factors

Although health professionals do not know what causes the majority of hypertension cases (primary hypertension), there are certain factors that increase the risk of having hypertension. They are as follows:

• Age – The risk of high blood pressure increases with age for both men and women, but women are more likely to develop hypertension for the first time after age 65, while men are more likely to have it beforehand. 
• Being of African heritage – Hypertension is more common and tends to result in more serious complications in those of African descent.
• Family history – Hypertension has a genetic factor, so if close family members have it, the risk increases.
• Being overweight or obese – Those who are overweight require more blood flow, which stresses the artery walls and results in high blood pressure.
• Being inactive – Having a sedentary lifestyle makes you at higher risk for hypertension.
• Using tobacco products – Both smoking and chewing tobacco raise blood pressure in the short term and long term by damaging the artery walls and causing them to narrow. Being exposed to secondhand tobacco also increases risk.
• Having too much salt in your diet – When you eat too much salt, it increases the amount of fluid that your body retains, which increases blood pressure.
• Drinking too much alcohol – Heavy drinking (more than one drink a day for women and more than two for men) can damage your heart over time.
• Stress – Stress can temporarily increase blood pressure, and chronic stress may lead to developing unhealthy habits that can impact blood pressure.

Types of Hypertension

Aside from the causes of hypertension (essential or secondary), the types of hypertension are mainly based on degree. In other words, they focus on how high your blood pressure is.

Diagnosing Hypertension

Hypertension is diagnosed by taking your blood pressure, either at a doctor’s office, with a personal device at home or at a pharmacy. Blood pressure is measured in millimeters of mercury, written as mm Hg. Healthy blood pressure means having a systolic of 120 or less and a diastolic of less than 80 mm Hg. 

It is important to note that blood pressure fluctuates throughout the day and is based on factors such as stress (including that of being in a doctor’s office, also called “white coat hypertension”) or taking certain types of medication. Therefore, one high blood pressure reading does not mean that hypertension is present; the diagnosis is only made if at least one of the numbers is consistently outside of the parameters.

Degrees of Hypertension & When Each Is Diagnosed

Type of Hypertension	Systolic		Diastolic
Elevated blood pressure (prehypertension)	120-129 mm Hg	and	80 mm Hg or lower
Stage 1	130-139 mm Hg	or	80-89 mm Hg
Stage 2	140 mm Hg or higher	or	90 mm Hg or higher
Hypertensive urgency (an emergency situation that requires urgent medical care) if symptomatic	180 mm Hg or higher	and/or	120 mm Hg or higher

If you are diagnosed with high blood pressure, your doctor may order some additional tests to confirm the diagnosis, try to identify underlying conditions that may be causing the problem and check for complications. These may include: 

• Ambulatory monitoring – This device allows you to take your blood pressure at home and measures your blood pressure numerous times throughout the day to see how it fluctuates. Check with your insurance company to see if the cost for this is covered.
• Urine and blood tests – Your doctor may want to see if you have high cholesterol by giving you a blood test or check for kidney damage via a urinalysis test. 
• Electrocardiogram (EKG) – An EKG measures heart activity by placing sensors on the chest. When there is hypertension, an EKG can be used to discover if the patient has left ventricular hypertrophy (LVH), which is damage to the heart that is potentially dangerous, or irregular heartbeat.
• Echocardiogram – This test uses sound waves to produce images of the heart and can identify some kinds of heart disease.

Hypertension During Pregnancy

When a pregnant woman has high blood pressure, whether it was pre-existing (chronic hypertension) or develops during pregnancy (gestational hypertension), she and her baby are at risk for complications. 

Gestational Hypertension

This is when a woman gets hypertension while pregnant and does not have protein in the urine or other heart or kidney problems (which are part of preeclampsia). Gestational hypertension usually goes away after birth, but it is a risk factor for developing hypertension later in life.

Preeclampsia/Eclampsia

Preeclampsia is high blood pressure along with signs of heart, kidney or liver damage that happen after the 20th week of pregnancy. It often has no symptoms, but some women will have swollen hands and feet or abnormal weight gain. If the preeclampsia is severe, your doctor might want to manage it with monitoring and/or medication. Or, if the pregnancy is past 37 weeks, the doctor might want to deliver the baby early by inducing labor or performing a C-section. 

In rare cases, a woman can get preeclampsia up to six weeks after giving birth, called postpartum preeclampsia. Postpartum preeclampsia may require emergency medical care. 

Eclampsia is also a possible condition. Eclampsia is preeclampsia with seizures.

Pregnancy Complications

Pregnancy complications of high blood pressure include maternal stroke, a need to induce (artificially stimulate) labor, placental abruption, preterm delivery and low birth weight.

Placental abruption is when the placenta separates from the uterine wall. This can negatively affect the baby’s supply of oxygen and nutrients and cause heavy bleeding in the mother, putting both mother and baby at risk.

Preventing and Managing Hypertension

Hypertension can be prevented. Lifestyle changes can help prevent and prevent the necessity for medications in some cases:

• Medical intervention
• Losing weight
• Eating well
• Getting regular exercise 
• Quitting unhealthy habits
• Using medical devices
• Complementary medicine
• General wellness

If your blood pressure is in the healthy range or if you have prehypertension, you can take steps that prevent high blood pressure. These lifestyle changes are the same as those recommended for people with hypertension, but if implemented early, they may help you avoid chronic hypertension and its associated complications. 

Recommendations include: 

• Eating a healthy diet (see the “Food and Nutrition” section of this guide)
• Getting to or remaining at a healthy weight (see the “Losing Weight” section of this guide)
• Getting or staying physically active (see the “Exercise and Hypertension” section of this guide)
• Not smoking or quitting smoking (see the “Quitting Unhealthy Habits” section of this guide)
• Limiting alcohol intake (see the “Quitting Unhealthy Habits” section of this guide)
• Getting enough sleep (see the “Sleep” section of this guide)
• Managing stress (see the “Stress Management” section of this guide)

Healthcare

It is important to have your blood pressure taken at least once a year in combination with an annual exam. 

Doctor Visits

Medical experts advise everyone to visit their doctor for a wellness checkup once a year. At this annual checkup, your doctor will usually check your blood pressure, ask you questions about your habits and any symptoms and will run a series of other tests to detect health problems. 

If your blood pressure is in the prehypertension or hypertension range, your doctor will explain your results and will discuss management strategies, possibly including medication. If high blood pressure is an issue, your doctor may want to take additional tests to confirm the diagnosis or have you self-monitor to see if it is temporary or chronic. Even if your home readings are within your target range, it is still important to see your doctor regularly.

You may go to your family doctor, general practitioner or internist for blood pressure monitoring and management. Or, if you are diagnosed with hypertension, you may want to see a cardiologist, a doctor specializing in the heart and circulatory system.

Self-Monitoring

The American Heart Association and the American Medical Association urge Americans to self-monitor their blood pressure. Doing so has numerous benefits, including convenience, a better chance of predicting cardiovascular events and eliminating “white coat hypertension” associated with the stress of being in a doctor’s office. There are several options to self-monitor your blood pressure.

Buying a Blood Pressure Monitor and Checking It at Home  

Blood pressure monitors consist of an inflatable cuff that goes around your arm and a gauge for readouts. They are sold at most pharmacies, medical supply stores and online. The devices cost anywhere from $17 to $60, but most of them are around $35. According to Mayo Clinic, digital monitors that are fitted on the upper arm are the most accurate. The American Heart Association does not recommend devices that measure blood pressure at the wrist or finger.

Checking Your Blood Pressure at a Pharmacy

Most pharmacies have a free blood pressure device that you can use. The upside of this is that there is no cost; the downside is that you will have to walk or drive to the pharmacy regularly, and you are limited to the pharmacy’s hours of operation.

Getting a Loaner From Your Doctor

Some doctor’s offices have blood pressure monitors that they lend out to patients who have Stage 2 hypertension. Ask your doctor’s office if they have a unit to lend you.

Tips for How to Take Your Own Blood Pressure

Here are some steps you can take to try to get the most accurate results: 

• Having your doctor look at the monitor first – Before you throw away the packaging and receipt, consider bringing the monitor to your doctor’s office. Asking your doctor if the type of device is best for you, having your doctor check its accuracy, and asking for a demonstration on the best way to use it are all good recommendations. 
• Measuring your blood pressure twice a day – For best results, you want to consider taking your blood pressure in the morning before eating, exercising or taking any medications. Then you may follow this same guideline when you take it the second time in the evening. It is a good idea to take your readings around the same time each day. Also, each time you take a reading, it’s a good idea to do it several times to make sure that a result is not an outlier. Keep a log.
• Avoid eating, caffeine, tobacco and alcohol for half an hour before measuring – Since these can all impact your blood pressure, avoiding them before measuring will give you a more accurate reading. Accuracy will also be improved if you go to the bathroom before measuring, as having a full bladder can increase blood pressure slightly.
• Sit up – Sitting with your back straight and supported, with your feet flat on the floor and uncrossed your legs improves reading accuracy.
• Position your arm properly – For best results, try raising your arm to the level of your heart and support it with a table, pillow or chair arm.
• Put the cuff on your bare arm, not over your sleeve – Another trick that improves accuracy is putting the cuff flush against your skin. Rolling up your sleeve may cause an inaccurate reading if the sleeve tightens around your upper arm.
• Quiet, please – Consider not talking to anyone, looking at your phone or watching TV while taking your blood pressure, since these can all elevate your reading.
• Do it again – To check accuracy, you may want to wait for one to three minutes after your first reading, and then take another reading.
• Write it down – If your device does not automatically log blood pressure readings, it is best practice to write them down or enter them in an app so you have a record you can share with your doctor.

Home readings are typically about five points lower than when you take them at a doctor’s office. Morning readings also tend to be slightly higher than those taken later in the day. If you notice that your blood pressure is unusually high or is high over time, contact your doctor’s office.

Blood Pressure Monitoring Apps

Although there are smartphone apps that claim to check your blood pressure, these are not recommended by medical experts because they are not accurate. However, there are apps that allow you to record and track your blood pressure and share the results with your doctor. Here are some of them: 

• Qardio
  • Apple: https://apps.apple.com/us/app/qardio-heart-health/id855275752
  • Android: https://play.google.com/store/apps/details?id=com.getqardio.android&hl=en_IN 
• Blood Pressure Companion (Apple only)
  • https://apps.apple.com/us/app/blood-pressure-companion/id458537528 
• Blood Pressure Tracker (Android only)
  • https://play.google.com/store/apps/details?id=com.aadhk.lite.bptracker&hl=en_IN 

Medication

Once you have been diagnosed with hypertension, it is important that it is managed appropriately. Medication is one way to get your blood pressure under control. If your doctor thinks that medication is warranted, the medication prescribed will depend on your blood pressure readings and your overall health as well as other medications you may be taking. Below are common blood pressure medications: 

• Diuretics – This type of medication helps to eliminate excess sodium and water from the body. It is often the first type of medication tried. Examples include:
  • Chlorthalidone
  • Hydrochlorothiazide (Microzide and other brands)
• Angiotensin-converting enzyme (ACE) inhibitors – These medications help relax blood vessels by blocking the formation of a chemical in the body that narrows them. Examples include:
  • Lisinopril (Prinivil, Zestril and other brands)
  • Benazepril (Lotensin and other brands) 
  • Captopril
• Angiotensin II receptor blockers (ARBs) – These help relax blood vessels by blocking the receiving of the chemical that narrows them. Examples include:
  • Candesartan (Atacand and other brands)
  • Losartan (Cozaar and other brands)
• Calcium channel blockers – This classification of medication relaxes blood vessels and some of these medications slow heart rate. Examples include:
  • Amlodipine (Norvasc)
  • Diltiazem (Cardizem, Tiazac, others)
  • Felodipine
  • Isradipine
  • Nicardipine
  • Nifedipine (Adalat CC, Procardia)
  • Nisoldipine (Sular)
  • Verapamil (Calan, Verelan)

When taking blood pressure medication, your doctor is likely to tell you that it is important to take it as prescribed. Skipping doses or stopping taking them altogether can cause a dangerous and sudden spike in your blood pressure called rebound hypertension. If you do not feel like the medication is working or if you are suffering from severe side effects, tell your doctor.

Losing Weight

Being overweight or obese increases your risk of hypertension. In fact, as your body weight increases, so does your blood pressure. Even a modest weight loss of 10 pounds can lower your blood pressure. Those who already have hypertension and are overweight will see the biggest impact of losing weight on their blood pressure numbers.

Overweight and obese people are at a higher risk for heart disease as well as high blood cholesterol and diabetes, each of which are also risk factors for heart disease. To determine if someone is overweight or obese, two measurements are used: body mass index (BMI) and waist circumference.

Body Mass Index (BMI)

Body mass index, or BMI, is the relationship between your height and your weight. 

If your BMI is…	Then you are…
Under 18.5	Underweight
18.5 to 24.9	Healthy weight
25.0 to 29.9	Overweight
30 or more	Obese

Check yours with the CDC’s adult BMI calculator here: https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html. 

Waist Circumference

Sometimes BMI can be misleading. For example, muscle weighs more than fat. Therefore, someone who is very muscular and lean may have a high BMI. In that case, waist circumference can give a more accurate estimate of body fat. A waist circumference of more than 35 inches in women or 40 inches in men is considered to be high.

Best Practices for Weight Loss 

Weight loss should be gradual to be healthy. Medical experts recommend having a goal of losing no more than ½ pound to 2 pounds per week. Since one pound is equal to 3,500 calories, to lose one pound a week, eat 500 fewer calories per day or burn 500 extra calories per day. 

A combination of increased physical activity and eating fewer calories has the best chance of success. Luckily, both of those changes are also recommended to lower your blood sugar so you should be able to do them at the same time, and they are explained below.

If you are eating fewer calories and/or being more active and are not losing weight, there may be other causes such as insulin resistance, thyroid problems or menopause (for women). Talk to your doctor to see if one of these is complicating your weight loss efforts.

Food and Nutrition

The food that you eat can have a direct effect on your blood pressure, so it is important to eat healthy food that will help lower, not raise, your blood pressure. Generally speaking, it is best to:

• Eat food that is lower in fat, salt and calories.
• Eat food that is high in fiber, including fruits, vegetables and whole grains.
• Reduce the amount of salt added to food.
• Reduce the amount of oil, butter and other fat used as condiments or to prepare food.

What You Need to Know About Sodium

Sodium is the main component of salt, so this guide will use the terms interchangeably. Sodium is the number one food additive to reduce for people with hypertension. The reason is that when you eat too much salt, your body retains more water in order to flush the salt away. The extra water increases your blood volume, and therefore your blood pressure.

The American Heart Association recommends keeping salt intake to under 1,500 milligrams a day. This amounts to a little less than two-thirds of a teaspoon of salt daily. However, the Dietary Guidelines for Americans puts the maximum daily amount of sodium at 2,300 mg. Talk to your doctor about the right daily sodium intake for you.

How to Reduce Your Sodium Intake

Reducing your salt to be within the recommendations is about more than just not using table salt. Salt is in many packaged foods and is used to season cooked food, both at home and in restaurants. Here are some tips to lower your sodium intake: 

• You may want to consider not using table salt
• Using sodium-free seasoning mixes, dried and fresh herbs, lemon juice and vinegar to season food rather than add salt to food when cooking it can be a flavorful alternative
• Prepared food labeled “sodium-free,” “low sodium” and “unsalted” will alert you that they are suitable for a low sodium diet
• Checking labels for sodium will help you make good choices
• Eating home-cooked meals as much as possible will give you more control over the amount of salt you ingest, since restaurant food tends to be high in salt
• Using salt substitutes may be a good option (ask your doctor about this before using, as some may interfere with blood pressure medications or exacerbate other health issues)
  • AlsoSalt
  • Morton Salt Substitute
  • NoSalt
  • Nu-Salt

Although it may be difficult at first, a few months after you start reducing your salt intake, your taste buds should adjust and you may feel more satisfied with the taste of lower sodium foods. 

Sodium Content in Food

Even whole foods (food that is minimally processed) may contain sodium. Here are some different types of food and their sodium content:

Food	Sodium in Milligrams (mg)
Fresh meat 3 oz., cooked	Less than 90 mg
Shellfish, 3 oz	100-325 mg
Canned tuna, 3 oz	300 mg
Lean ham, 3 oz	1,025 mg
Whole milk, 1 cup	120 mg
Skim or 1% milk, 1 cup	125 mg
Swiss cheese, 1 oz	75 mg
Low-fat cheese, 1 oz	150 mg
Cottage cheese (regular), ½ cup	455 mg
Fresh, frozen or no-salt-added canned vegetables, ½ cup	Less than 70 mg
Regular canned vegetables, ½ cup	Up to 470 mg
Tomato juice, canned, ¾ cup	660 mg
Bread, 1 slice	110-175 mg
Ready to eat shredded wheat, ¾ cup	Less than 5 mg
Cooked cereal (unsalted), ½ cup	Less than 5 mg
Instant cooked cereal, 1 packet	180 mg
Frozen entrees, 8 oz	500-1,570 mg

Low-Sodium Foods That May Help With Hypertension

These foods are high in nutrients and low in sodium, fat and calories. Some even lower blood pressure: 

• Low-fat dairy including skim or 1% milk
• Low-fat and low-salt cheese
• Yogurt and Greek yogurt (calcium-rich foods can lower blood pressure)
• Lean meat including skinless turkey and chicken
• Low-salt, ready to eat cereals, preferably whole grain
• Cooked hot cereal (but not instant)
• Vegetables, preferably fresh or frozen but also canned with no added salt
  • Vividly colored green, orange and red vegetables are high in potassium and minerals that can help lower blood pressure
• Fruits, preferably fresh or frozen, but also canned with no added salt
• Plain bread, pasta, rice (preferably whole grain and brown) and potatoes
• Unsalted seeds and nuts (these are mineral-rich foods that lower blood pressure)
• Lower-salt prepared foods
• Dark chocolate

Dark chocolate has been shown to lower blood pressure. People eating around 100 grams of dark chocolate daily had a reduction in systolic blood pressure of 4.7 mm Hg and diastolic blood pressure of 2.8 mm Hg on average. The National Institute of Health recommends that people with hypertension eat 10 to 30 grams of dark chocolate (70% or more cacao) daily.

High Sodium Foods to Avoid

The following foods are very high in sodium, and should be avoided or replaced with low sodium versions: 

• Processed meat such as bacon, deli meats, sausage and ham
• Canned soup, bouillon or dried soup mixes
• Condiments including ketchup, soy sauce, salad dressings
• Frozen and boxed mixes to add to potatoes, rice and pasta
• Snack foods like pretzels, popcorn, peanuts and chips
• Pickled or marinated food in brine (vinegar- and lemon juice-based marinades are not a problem)

Grocery Shopping Tips

To make sure you are buying the best food for your condition (and avoid buying food that will raise your blood pressure), follow these tips the next time you go to the grocery store:

• Making a list – By planning your meals ahead of time and only putting the needed items on your list, you can make sure you have healthy food and stop yourself from buying items that will sabotage your eating plan.
• Shopping the perimeter of the store first – Grocery stores usually put the whole foods against the outer walls and the packaged/processed goods in the aisles. You will find fruits and vegetables, meats, fish, seafood and whole grains around the edges. Then, head to the interior of the store for healthy packaged goods like frozen fruits and veggies, nuts, oatmeal, etc.
• Eating before going – When you shop hungry, you are more likely to make unhealthy impulse purchases.
• Reading nutrition labels – It’s good to look for foods that are low in sodium, saturated fat and added sugars. These can vary widely between brands or flavors. Also, look for food labels with the American Heart Association’s Heart-Check mark.
• Choosing proteins packed in water – When buying canned fish, chicken or other protein, it’s good to look for those packed in water instead of oil and labeled as “low sodium” or “no salt added.”
• Going for whole grains – On bread and other grain-based products, whole grain should be the first ingredient. It’s best to avoid those that say “enriched flour” or “multi-grain” first.

Beverages That Lower Blood Pressure 

In addition to eating foods with less sodium, fat and calories, what you drink can also have an effect on your blood pressure. These beverages have been shown to lower blood pressure: 

• Tomato juice – In a study, scientists found that just one cup of tomato juice reduced both systolic and diastolic blood pressure and, as a bonus, LDL cholesterol. It’s good to make sure the tomato juice you buy is unsalted.
• Beet juice – Beet juice, especially from raw beets, contains nitrates, compounds that lower blood pressure.
• Prune juice – In addition to relieving constipation, prune juice can lower systolic blood pressure. Try to make sure it is 100% prune juice without additives.
• Pomegranate juice – Drinking at least one cup of 100% pomegranate juice with no added sugar lowers both systolic and diastolic numbers, likely due to having nutrients like folate and vitamin C.
• Skim milk – The calcium in skim milk lowers blood pressure. You may consider aiming for 2-3 servings of low-fat dairy products daily.
• Black and/or green tea – Drinking hot or iced brewed black tea or green tea lowers blood pressure. Green tea is even more effective than black tea. Just try to avoid iced tea mixes, which tend to have a lot of added sugar and may be less effective.

Meal Planning With Proven Diets 

If you plan ahead, it is easier to achieve your healthy eating goals. You will be more likely to eat food that lowers your blood pressure and avoid those that raise it. Some tips include bringing healthy snacks and meals from home when you will be out of the house, planning your meals for the week and buying ingredients for them at the beginning of the week so making dinner is relatively stress-free. 

When planning to go out to eat, it’s a good idea to take a look at the menu online to make sure that they have healthy choices. If not, you may choose a different restaurant or order your food with no added salt. 

To help you with planning, you may want to follow one of the recommended diets for reducing blood pressure: the DASH diet or the Mediterranean diet.

DASH Diet

The Dietary Approaches to Stop Hypertension or DASH, diet is a diet based on research sponsored by the National Institutes of Health and created specifically to lower blood pressure. DASH was ranked by U.S. News and World Report as the best overall diet, the healthiest diet and the best diet for diabetes. In addition to lowering blood pressure, it has been proven to reduce cholesterol and is associated with a lower risk of several kinds of cancer, heart disease and heart failure, stroke, kidney stones, depression and diabetes.

DASH is filled with plants (fruits and vegetables), low-fat and non-fat dairy, fish and poultry, whole grains and healthy fats. It also includes a small amount of lean meat and sweets. There are several modifications of DASH, including DASH Diet Mediterranean, DASH Diet for Weight Loss and DASH Diet Younger You, which is a vegetarian version.

According to Mayo Clinic, following the DASH diet can lower your blood pressure in as little as two weeks. If you stick with it, your systolic blood pressure can drop by 8-14 points. Since there is some disagreement about how much sodium adults should ingest per day, there are two DASH plans: one for 2,300 mg of sodium and one for 1,500 mg of sodium daily.

DASH Guidelines

The standard (2,300 mg sodium per day) DASH diet includes 2,000 calories as follows: 

Food Category	# of Servings	Types of Foods and Serving Sizes
Grains	6-8 /day	1 slice whole-wheat bread, 1 oz dry cereal, ½ cup cooked oatmeal, ½ cup brown rice, ½ cup whole wheat pasta
Vegetables	4-5 / day	1 cup raw spinach, lettuce or other leafy green vegetables, ½ cup raw or cooked other vegetables
Fruits	4-5 / day	1 medium apple, orange or pear, ½ cup fresh, frozen or canned fruit, 4 oz fruit juice with no sugar added
Dairy	2-3 / day	1 cup skim or 1% milk, 1 cup low-fat yogurt with no sugar added, 1 ½ oz part-skim cheese
Animal protein	6 / day or fewer	1 egg, 1 oz of cooked meat, poultry or fish
Nuts, seed and legumes	4-5 / week	⅓ cup nuts, 2 tbsp seeds or nut butter, ½ cup cooked beans or peas
Fats	2-3 / day	1 tsp margarine, 1 tbsp mayonnaise, 2 tbsp salad dressing
Sweets	5 / week or fewer	1 tbsp sugar, jelly or jam, ½ cup sorbet, 1 cup lemonade

DASH Recipes

Below are a few examples of DASH recipes. You can find more by searching online or by purchasing one of various DASH cookbooks. 

Cinnamon French Toast

This is a low-fat version of the classic breakfast. 

Ingredients (Serves 2):

• 4 egg whites
• 1 teaspoon vanilla
• 1 teaspoon powdered sugar
• 1/8 teaspoon ground nutmeg
• 4 slices cinnamon bread
• 1/4 teaspoon ground cinnamon
• 1/4 cup maple syrup

Directions: 

In a small bowl, combine the egg whites, vanilla and nutmeg. Whisk to mix evenly. Dip the bread into the egg mixture, coating both sides.

Place a nonstick frying pan or griddle over medium heat. When a drop of water sizzles as it hits the pan, add the bread. Sprinkle with cinnamon. Cook until both sides are golden brown, about 4 to 5 minutes on each side.

Place 2 slices of French toast on individual plates. Add 1 teaspoon powdered sugar and 2 tablespoons maple syrup to each. Serve immediately.

Nutrition per serving: 

Calories – 299
Fat – 3 g
Protein – 11 g
Carbohydrate – 57 g
Sodium – 334 mg

Baked Salmon with Southeast Asian Marinade

This recipe can be made in the oven or on the grill, wrapped in tin foil.

Ingredients (Serves 2):

• 1/2 cup pineapple juice (no sugar added)
• 2 garlic cloves, minced
• 1 teaspoon low-sodium soy sauce
• 1/4 teaspoon ground ginger
• 2 salmon fillets, each 4 ounces
• 1/4 teaspoon sesame oil
• Freshly ground black pepper, to taste
• 1 cup diced fresh fruit, such as pineapple, mango and papaya

Directions: 

In a small bowl, add the pineapple juice, garlic, soy sauce and ginger. Stir to mix evenly. Arrange the salmon fillets in a small baking dish. Pour the pineapple juice mixture over the top. Put in the refrigerator and marinate for 1 hour. Turn the salmon periodically as needed.

Heat the oven to 375 F. Lightly coat two squares of aluminum foil with cooking spray. Place the marinated salmon fillets on the aluminum foil. Drizzle each with 1/8 teaspoon sesame oil. Sprinkle them with pepper and top each with 1/2 cup diced fruit. Wrap the foil around the salmon, folding the edges to seal. Bake until the fish is opaque throughout when tested with the tip of a knife, about 10 minutes on each side. Transfer the salmon to individual plates and serve immediately.

Nutrition per serving: 

Calories – 247
Fat – 7 g
Protein – 27 g
Carbohydrate – 19 g
Sodium – 192 mg

Spinach Frittata

This is an Italian omelet with the add-ins mixed into the eggs rather than folded inside them.

Ingredients (Serves 4):

• 1 teaspoon olive oil
• 1 garlic clove, minced
• 3 cups baby spinach leaves
• 3 whole eggs, plus 4 egg whites
• 1/4 teaspoon freshly ground black pepper
• 1/2 yellow onion, chopped (about 1/2 cup)
• 1/4 cup minced red bell pepper
• 2 waxy red or white potatoes, about 3/4 pound total weight, peeled and shredded
• 2 tablespoons chopped fresh basil
• 1/4 cup shredded part-skim mozzarella or provolone cheese

Directions: 

Heat the oven on the broil setting. Position the rack 4 inches from the heat source.

In a large, nonstick frying pan with a flameproof handle or cast iron skillet, heat 1/2 teaspoon of the olive oil over medium heat. Add the garlic and saute until softened, about 1 minute. Stir in the spinach and cook until it wilts, 1 to 2 minutes. Transfer to a bowl. Set the frying pan aside.

In a bowl, whisk together the whole eggs, egg whites and pepper. Set aside.

Return the frying pan to medium heat and heat the remaining 1/2 teaspoon olive oil. Add the onion and saute until soft and translucent, about 4 minutes. Stir in the bell pepper and the potatoes and cook until the potatoes begin to brown but are still tender-crisp, 4 to 5 minutes.

Spread the potatoes in an even layer in the pan. Spread the spinach evenly over the potatoes. Sprinkle with the basil. Pour in the beaten eggs and sprinkle evenly with the cheese. Cook over medium heat until slightly set, about 2 to 3 minutes.

Carefully place the pan in the oven and broil until the frittata is brown and puffy and completely set, about 3 minutes. Gently slide onto a serving platter and cut into 4 wedges. Serve immediately.

Nutrition per serving: 

Calories – 186
Fat – 6 g
Protein – 13 g
Carbohydrate – 20 g
Sodium – 176 mg

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Mediterranean Diet

The Mediterranean Diet is based on the foods typically eaten by people in countries bordering the Mediterranean Sea including Spain, Italy, Greece, Turkey, Israel, Lebanon, Egypt, Morocco and others. The Mediterranean Diet is consistently ranked one of the best and healthiest diets and is recommended, along with DASH, by the American Heart Association.

Although the exact recipes and spices used in Mediterranean countries may vary, they share in common a diet rich in fruits, vegetables, grains, legumes, nuts and seeds with olive oil as the main fat used and dairy, eggs, fish and poultry in small to medium amounts. A small amount of wine can be consumed, and fruit is often eaten for dessert. Red and processed meat is very limited and dairy consumption is moderate. Fresh herbs are used abundantly.

Following the Mediterranean Diet has been shown to lower both systolic and diastolic blood pressure, reduce risk of cardiovascular disease and cancer and, when adhered to long-term, it may slow age-related blood pressure increases. 

Mediterranean Guidelines

The Mediterranean Diet has looser guidelines than the DASH Diet. It includes: 

Food Category	# of Servings	Types of Foods and Serving Sizes
Grains	3-5 /day	1 slice whole-wheat bread, 1 oz dry cereal, ½ cup cooked oatmeal, ½ cup brown rice, ½ cup whole wheat pasta
Vegetables	5-8 / day	1 cup raw spinach, lettuce or other leafy green vegetables, ½ cup raw or cooked other vegetables
Fruits	6-7 / day	1 medium apple, orange or pear, ½ cup fresh, frozen or canned fruit
Dairy	1-2 / day	1 cup skim or 1% milk, 1 cup low-fat yogurt with no sugar added, 1 ½ oz part-skim cheese
Animal protein	3 / week or fewer	3 oz of cooked poultry or fish, with more fish than poultry
1 / week or fewer	3 oz of red meat
Legumes	3 / week or more	⅓ cup nuts, 2 tbsp seeds or nut butter, ½ cup cooked beans or peas
Nuts and seeds	1 / day	A handful of raw nuts
Fats	No specific limit set	Olive oil is the principal source of fat, although it may also come from nuts, seeds, avocados and fatty fish like salmon
Alcohol	Up to 1 / day	1 5-oz glass of wine for women; 2 5-oz glasses of wine for men
Sweets	1-2 / week	1 tbsp sugar, jelly or jam, ½ cup sorbet, 1 cup lemonade; Or instead, eat fruit for dessert

Mediterranean Recipes

These are a few examples of Mediterranean Diet recipes. You can find more by searching online or by purchasing one of the various Mediterranean Diet cookbooks. 

Mediterranean Scrambled Eggs

These tasty scrambled eggs are filled out with plenty of vegetables.

Ingredients (Serves 2):

• 1 tbsp olive oil
• 1 yellow pepper, diced
• 2 spring onions, sliced
• 8 cherry tomatoes, quartered
• 2 tbsp sliced black olives
• 1 tbsp capers
• 4 eggs
• 1/4 tsp dried oregano
• Black pepper
• Fresh parsley, to serve (optional)

Directions: 

Heat the oil in a frying pan medium-high and add the diced pepper and chopped spring onions. Cook for a few minutes, until slightly soft. Add the tomatoes, olives and capers and cook for one more minute.

Crack the eggs into the pan and immediately scramble with a spoon or spatula. Add the oregano and black pepper and stir until the eggs are fully cooked. Serve warm, topped with fresh parsley if desired.

Nutrition per serving: 

Calories – 249
Fat – 17 g
Protein – 13.5 g
Carbohydrate – 13.3 g
Sodium – 334 mg

Grilled Eggplant and Tomato Pasta

This satisfying meal has an abundance of flavors and textures. 

Ingredients (Serves 4):

• 1 pound plum tomatoes, chopped
• 4 tbsp extra-virgin olive oil
• 2 teaspoon chopped fresh oregano
• 1 clove garlic, grated
• ½  teaspoon ground pepper
• ¼ teaspoon crushed red pepper
• ½ teaspoon salt
• 1 ½ pounds eggplant, cut into ½” thick slices
• ½ cup chopped fresh basil
• 8 ounces whole-wheat penne pasta
• ¼ cup shaved ricotta salata or crumbled feta cheese

Directions: 

Put a large pot of water on the stove to boil. Preheat the grill to medium-high. Toss tomatoes with 3 tbsp oil, oregano, garlic, pepper, crushed red pepper and salt in a large bowl.

Brush eggplant with the remaining olive oil. Grill, turning once until tender and charred in spots, about 4 minutes on each side. Let cool for 10 minutes, then chop into bite-sized pieces and combine with tomato mixture and basil.

Cook pasta according to package directions, drain. Serve the tomato and eggplant mixture on the pasta, sprinkle with cheese and serve.

Nutrition per serving: 

Calories – 449
Fat – 19.2 g
Protein – 13.5 g
Carbohydrate – 62.1 g
Sodium – 392 mg

Charred Shrimp & Pesto Buddha Bowls

This delicious meal comes together in less than 30 minutes. You can substitute fish, chicken, tofu or another protein for the shrimp or change up the vegetables to suit your taste. The dressing can be made ahead of time and refrigerated for up to 2 days.

Ingredients (Serves 4):

• ⅓ cup prepared pesto
• 2 tbsp balsamic vinegar
• 1 tbsp extra-virgin olive oil
• ½ teaspoon salt
• ¼  teaspoon ground pepper
• ¼ teaspoon crushed red pepper
• ½ teaspoon salt
• 1 pound peeled and deveined large shrimp (16-20 shrimps), patted dry
• 4 cups arugula
• 2 cups cooked quinoa
• 1 cup halved cherry tomatoes
• 1 avocado, sliced

Directions: 

Whisk pesto, vinegar, oil, salt and pepper in a large bowl. Set aside 4 tablespoons of the mixture in a small bowl. 

Heat a large cast-iron skillet over medium-high heat, add shrimp and cook, stirring until just cooked through with a slight char, 4-5 minutes. Remove to a plate.

Add arugula and quinoa to the large bowl with the vinaigrette and toss to coat. Divide arugula mixture among 4 bowls. Top with tomatoes, avocado and shrimp. Drizzle each bowl with 1 tablespoon of the reserved pesto mixture.

Nutrition per serving: 

Calories – 429
Fat – 22 g
Protein – 30.9 g
Carbohydrate – 29.3 g
Sodium – 571 mg

Exercise, Health and Hypertension

In conjunction with eating healthy food, getting enough exercise is an important way to lower blood pressure. Exercise strengthens the heart so it does not have to work so hard to pump blood throughout the body. A less forceful heartbeat puts less stress on the arteries, thereby lowering blood pressure. Exercise alone can lower systolic blood pressure by an average of between 4 and 9 mm/Hg. This reduction is equivalent to that of some blood pressure medications. 

It takes around three months of exercising to start seeing improvements in blood pressure. Once you see an improvement, it is important to note that in order for exercise to keep blood pressure under control, you will need to keep exercising on a regular basis to continue getting the benefits.

Types of Exercise

There are several types of exercise: aerobic (cardio), weightlifting (strength training) and flexibility/balance. Although a blend of all of these types of exercise is the recommendation for overall health, when it comes to hypertension, the main type to concentrate on is aerobic. 

Aerobic, or cardio, exercise is any kind of activity that increases heart and breathing rates. Some examples are: 

• Playing sports like tennis, soccer or basketball
• Climbing stairs
• Walking, jogging or running
• Bicycling
• Swimming 
• Dancing
• Doing jumping jacks
• Household chores such as cleaning the floor, raking leaves or gardening

Weight lifting can temporarily increase blood pressure during exercise, especially when using very heavy weights. However, it can have positive long-term effects on lowering blood pressure. Talk to your doctor before doing weight lifting to find out if it is recommended and, if so, what is the maximum amount that you can safely lift. Your doctor may suggest that you lift lighter weights but do more repetitions. 

If you do get the go-ahead from your doctor, make sure to breathe throughout the exercise, as holding your breath can result in dangerous blood pressure spikes. 

Stop exercising and seek immediate medical care if:

• You feel severely out of breath.
• You feel dizzy.
• You have chest, arm, neck or jaw pain or pressure.
• You have an irregular heartbeat.

The Right Amount of Exercise

The general recommendation from the Department of Health and Human Services is at least 150 minutes of moderate aerobic exercise or 75 minutes of vigorous aerobic activity per week. You can accomplish this by exercising for 30 minutes, five days a week, or in any combination that works for your schedule. In addition, the National Institute of Health recommends weight training 2-3 times per week. Weight training should consist of two or three sets of 10 to 12 repetitions of between 8 and 10 exercises working both upper and lower muscle groups.  

If you are not physically active, it may feel overwhelming to reach these activity goals. It is not necessary to do it all at once; any added exercise is beneficial. Start with a goal of 10 additional minutes of moderate activity per day and then gradually increase the time and/or the intensity.

When to Check with Your Doctor First

Getting enough physical activity is a nearly universal recommendation for people with high blood pressure. However, there are some types of people who should check with their doctor before starting a new exercise program. These include the following: 

• Men older than 45 or women older than 55
• Smokers or those who have quit smoking within the past 6 months
• Those who are overweight or obese
• Those with chronic health conditions like diabetes, cardiovascular disease or lung disease
• Those with high cholesterol 
• Those who have previously had a heart attack
• Those with a family history of heart disease before age 55 in men or 65 in women
• Those who feel pain or discomfort in chest, jaw, neck or arms during activity
• Those who get dizzy when exercising
• Those who are not sure if they are in good health
• Those who have not been exercising regularly
• Those who are currently on medication (some medication works differently in the body with exercise, or may affect the way the body reacts to exercise)

Exercise Tips

Use these tips to make sure that you are getting the most out of your exercise routine: 

• If you have a job in which you sit for hours at a time, take breaks by getting up and moving around at least one time every hour, even if it is just to get a cup of water. 
• Incorporate more movement into everyday activities. For example, park further away when you are going to a store, take the stairs instead of the elevator and put on music and dance while you are cleaning your house.
• Spread your physical activity throughout the week.
• Include some stretching exercises, before and after cardio or weightlifting. This will not only improve your flexibility but it will also warm up your muscles and make you less prone to injury.
• Choose an activity that you enjoy like taking a walk, bicycling, playing a sport or dancing
• Combine exercise with something else you like, such as talking to a friend, listening to an audiobook or just enjoying nature.
• Do different types of exercise to keep your routine fresh.
• Know what moderate exercise is for you. When exercising moderately, you should still be able to talk, but not as easy as you would at rest.
• Keep breathing. Holding your breath while exercising can cause a spike in your blood pressure.
• Get a workout buddy. Exercising with a spouse, family member or friend will make your activity more pleasant and adds some motivation since you can both hold each other accountable.
• Keep a log of your physical activity, with the type of activity, duration and how you feel. You can download a physical activity log from the American Heart Association here: https://www.heart.org/-/media/files/health-topics/cardiac-rehab/activity-log.pdf 

Exercises To Relieve The Symptoms of Hypertension & Where/How to Do Them

Exercise	Where/How
Take a brisk walk	Outside your home In a park  At a shopping mall On a home treadmill At the gym on a treadmill
Bicycling	Outside your home On a bike trail On a home stationary bike At the gym on a stationary bike
Hiking	At a park
Lifting weights	At home with hand weights or resistance bands While walking (with light hand weights)At the gym
Swimming	At home, if you have a swimming pool At the gym, if it has a swimming pool At a community center or public pool In a local body of water where swimming is allowed

A Note About Yoga & Tai Chi

These forms of exercise involve slow movement and controlled breathing. Tai chi looks like the practitioners are moving in slow motion and has been shown to reduce high blood pressure (in combination with medication or doing more intense exercise). Yoga can also be helpful in reducing high blood pressure but check with your doctor before you start as they may want you to avoid doing certain poses or to do them in a modified manner.

Quitting Unhealthy Habits

There are some habits that increase your risk of cardiovascular disease and other serious conditions when paired with high blood pressure. Quitting these unhealthy habits can reduce your risk and improve your overall health. 

Tobacco Use

Smoking cigarettes increases blood pressure temporarily. Although scientists have not found that tobacco causes hypertension in the long run, both smoking and breathing in secondhand smoke increase your risk for atherosclerosis, a build-up of plaque inside the arteries. High blood pressure accelerates atherosclerosis, which can lead to coronary heart disease, heart attack, stroke, gangrene, chest pain or chronic kidney disease.

Tobacco interferes with the efficacy of certain types of hypertension medication, so if you have been diagnosed with hypertension requiring medication, tell your doctor if you smoke or use tobacco products, including vaping and marijuana use.

Doctors recommend that patients under care for hypertension who smoke begin a tobacco cessation program. Ask your doctor for tobacco cessation program recommendations.

Excessive Alcohol Consumption

While moderate alcohol consumption does not adversely affect blood pressure, heavy drinking raises it temporarily, and repeated binge drinking leads to long-term increases. There are other reasons to be cautious with alcohol if you have high blood pressure. Alcohol is high in calories and may contribute to weight gain, which can cause blood pressure to increase. It can interfere with blood pressure medications, so be honest with your doctor about your alcohol intake and ask about its effect on your hypertension medication, if any.

The risk for arrhythmia or irregular heart rate is increased for some people.

Levels of Alcohol Consumption

Men and women are categorized differently as it relates to moderate, heavy and binge drinking. Learn more below. 

Type of Drinking	Men	Women
Moderate	2 drinks a day or less	1 drink a day or less
Heavy	More than 4 drinks a day	More than 3 drinks a day
Binge	5 or more drinks within a 2-hour period	4 or more drinks within a 2-hour period

Alcoholic Drink Serving Sizes

• Beer – 12 ounces (355 milliliters)
• Wine – 5 ounces (148 milliliters)
• 80-proof distilled spirits – 1.5 ounces (44 milliliters)

Heavy drinkers who cut back to the moderate level can lower their systolic blood pressure by around 5.5 mm Hg and their diastolic blood pressure by about 4 mm Hg. 

According to Mayo Clinic, those with high blood pressure or irregular heart rates should avoid alcohol or only drink it in moderation.

Complementary Medicine

While those with high blood pressure should be under the care of a medical doctor (see “Doctor Visits” section of this guide), some people use other methods to manage blood pressure in conjunction with medical care and advice. Always talk to your doctor about any supplements or other therapies you are using or are considering using to manage your blood pressure. 

Supplements

A number of vitamins, minerals and other nutrients have been found to lower blood pressure, but caution should be exercised. Some supplements can interact with blood pressure medication, and taking too much can cause serious side effects. When choosing a supplement, try to pick one that has undergone third-party testing for purity by the United States Pharmacopeia (USP) or NSF International.

Magnesium 

Magnesium is a mineral that can lower blood pressure by increasing the production of nitric oxide, a substance in the body that relaxes blood vessels. In a study, participants with chronic hypertension took 365 to 450 mg of magnesium daily and it significantly reduced their blood pressure.

There is a risk for taking too much magnesium, so consult your doctor before starting a magnesium supplement.

Vitamin D 

Most Americans are deficient in vitamin D, and this deficiency has been linked with high blood pressure. Ask your doctor to check your vitamin D levels to see if you are deficient in this important nutrient.

B-Complex Vitamins 

Vitamin B2 (riboflavin), B9 (folic acid) and B6 may help lower blood pressure. 

Potassium  

Potassium is the most commonly taken supplement for blood pressure regulation. It flushes excess sodium from the body and helps relax blood vessels.

There is also a toxicity risk for taking too much potassium, so consult your doctor before starting a potassium supplement.

CoQ10  

This molecule is available in food and also as a supplement. In a review of 17 studies, researchers found that CoQ10 significantly reduced systolic blood pressure.

L-Arginine 

This amino acid has been shown to reduce total blood pressure in those with severe hypertension and diastolic blood pressure in pregnant women with severe hypertension. It also improved blood vessel function and blood flow.

Vitamin C 

This antioxidant can help lower blood pressure. A review of 8 studies found that participants with hypertension who took 300 to 1,000 mg per day significantly reduced their blood pressure. Those with hypertension tend to be deficient in vitamin C.

Beetroot 

Beetroot supplements improve blood flow and have been shown to lower blood pressure in people with and without hypertension.

Garlic 

Garlic supplements have been shown to reduce blood pressure and the risk of heart disease. In a study, participants taking garlic supplements reduced systolic by 8.3 mm Hg and diastolic blood pressure by 5.5 mm Hg. Researchers estimated that this reduction decreases the risk of stroke, heart attack and coronary artery disease by up to 40%.

Fish Oil 

Fish oil is thought to reduce blood lipid levels, inflammation and high blood pressure. In a study, people with high blood pressure who were not on medication took omega-3 fats EPA and DHA including fish oil supplements and reduced systolic blood pressure by an average of 4.51 mm Hg and diastolic blood pressure by an average of 3.05 mm Hg.

Melatonin

This hormone is made by your body but is also available as a supplement. It is commonly used to promote sleep, but it also may reduce blood pressure. A review of 5 studies showed that it resulted in a significant reduction in blood pressure and that melatonin deficiency is linked to hypertension.

Green Tea 

Green tea is filled with antioxidants with numerous health benefits. A review of 24 studies showed that drinking green tea or taking green tea supplements for 3-16 weeks significantly reduced blood pressure in those with and without hypertension.

Ginger

Taking high dose supplements of this pungent root daily for up to 8 weeks reduced blood pressure in those aged 50 and younger. It also lowered blood pressure in people with metabolic syndrome, a condition that increases heart-disease risk, along with lowering triglycerides and fasting blood sugar.

Cinnamon

This aromatic spice has been shown to reduce systolic blood pressure by 6.2 mm Hg and diastolic by 3.9 mm Hg on average. The effect was stronger when taken consistently over 12 weeks.

Cardamom

Taking 3 grams of this intense spice for 12 weeks significantly reduced blood pressure and brought it to near normal levels. Scientists think it acts as a calcium channel blocker and helps remove excess water in the system. 

Holistic Remedies

There have been numerous studies on alternative and complementary approaches to managing high blood pressure and several practices have been shown to help.

Acupuncture

Acupuncture is a therapeutic modality in traditional Chinese medicine (TCM) that has been used for centuries. In acupuncture, thin needles are inserted into specific points on the body called meridians. In a study with people with mild to moderate hypertension, acupuncture reduced systolic blood pressure by 6.4 mm Hg and diastolic by 3.7 mm Hg compared to the control group. Another study found an even larger effect, with reductions of 14.8 mm Hg and 6.9 mm Hg for systolic and diastolic blood pressure, respectively.

Qigong

This TCM practice combines movement, controlled breathing and meditation. A meta-analysis of studies on the subject showed impressive decreases in systolic and diastolic blood pressure (12.1 mm Hg and 8.5 mm Hg, respectively). Researchers speculate that the slow, controlled breathing in qigong works by impacting parasympathetic nervous system activity, thereby lowering blood pressure.

Transcendental Meditation (TCM)

This is a form of meditation where a person sits twice a day with eyes closed and repeats a mantra. While the TCM organization has been controversial, the practice itself has been proven to lower blood pressure on average by 4.7 mm Hg for systolic and 3.2 mm Hg for diastolic.

Biofeedback

With biofeedback, you are hooked up to a machine via topical sensors at various places on your body, which measure and display certain vital signs. By relaxing your muscles and slowing breathing, you can lower your heartbeat and blood pressure.

Wellness Through Sleep and Stress Management

In addition to nutrition and exercise, sleep and stress management are important parts of your overall wellness and each can have an effect on blood pressure. 

Sleep

The recommended amount of sleep for adults is between seven and eight hours per night. Operating at a sleep deficit over time can cause high blood pressure in both adults and children.

Researchers think that, during sleep, your body regulates hormones related to stress and metabolism. Without adequate sleep, these hormones can get out of balance, causing high blood pressure as well as risk factors for both heart disease and diabetes. 

Recommended Amounts of Sleep by Age

Age	Number of Hours per 24-Hour Period (Including Naps, If Any)
Infants 0-1 year	15
Toddlers 1-3 years old	12-14
Preschoolers 3-6 years old	10-12
School-age 7-10 years old	10-11
Preteen/teenagers 12-18 years old	9
Adults	7-8

Those who get six hours or less of shut-eye can experience bigger increases in blood pressure. Unfortunately, this is a common occurrence experienced by more than 30% of Americans. This is particularly dangerous for people who have hypertension. This link between sleep deprivation and hypertension is prevalent among middle-aged people (32-59 years old), but less among those aged 60 and older. A study found that in middle-aged people, every hour of reduced sleep was associated with a 37% increase in the chance of hypertension.

Strangely, getting too much sleep, as defined by getting nine or more hours a night, is also associated with a higher risk of hypertension.

When we sleep, it is normal for blood pressure to decrease somewhere between 10% and 20% compared to our blood pressure when awake. This is called nocturnal dipping. When blood pressure does not lower at least 10% during sleep, there is a higher risk of cardiovascular mortality. 

Talk to your doctor if you are not getting the right amount of sleep. If you feel tired upon waking and you snore at night, you may be suffering from sleep apnea, a potentially serious but treatable condition that can increase your risk of hypertension and other heart problems.

Sleep Tips

Mayo Clinic recommends following these steps to get a better night’s sleep: 

• Sticking to a schedule – Going to bed and waking up at the same time every day, even to some extent, on the weekends can train your body to get the optimal amount of sleep. 
• Not trying to force yourself to sleep – If you do not fall asleep within 20 minutes, you may want to try leaving your bedroom and doing something relaxing, like reading, taking a bath or listening to soothing music. When you start to get tired, you can try to fall asleep again and repeat as needed.
• Not eating within 2-3 hours of bedtime – Not going to sleep right after eating, especially heavy or large meals can give your body time to digest. Avoiding nicotine, caffeine and alcohol near bedtime can make it easier to fall asleep.
• Preparing your room – To create an ideal space for sleeping, consider making your room cool, dark and quiet, although some people sleep better with “white noise” like from a fan. Watching television or looking at phones or tablets right before bed can confuse your body into thinking it is time to be awake.
• Limiting naps – Sleeping for a long time during the day can make it difficult to fall asleep at night. If you do nap, you may want to consider limiting it to no more than 30 minutes, and doing it earlier in the day.
• Getting some physical activity every day – Moving during the day can help promote sleep at night. Exercising earlier in the day, can give your body time for the adrenaline to dissipate since it can interfere with your sleep.
• Trying meditation – Meditation can help mentally separate you from your anxieties and worries. Some people find that the deep breathing relaxes them and starts the physiological processes of winding down for sleep.

Stress Management 

While stress does raise blood pressure temporarily as stress hormones are released into the bloodstream, medical experts are still studying the links between chronic stress and blood pressure. Stress can lead to making poor choices like eating unhealthy food and drinking too much alcohol, and stress contributes to poor sleep, all of which impact blood pressure.

Tips to Manage Stress

While stress is a fact of life, there are strategies you can use to reduce and manage the stress you experience.

• Getting moving – Being active can be a great outlet to relieve stress and it has other heart-healthy benefits, as outlined in “Exercise & Hypertension” on page 21 of this guide)
• Using good time management – By planning your day, you can make sure that you do not feel rushed or pressured.
• Learning to say “no” – Just because someone asks you to do something does not mean you are obligated to do it. 
• Avoiding stressful situations – If you know that certain situations or people are always stressful for you, you may be able to limit the times you are in that circumstance or with that person.
• Practicing self-care – Whether it is sitting quietly by yourself, doing a hobby, treating yourself to a spa day or spending time with friends, self-care may boost your mood and help you de-stress.
• Focusing on experiencing gratitude and joy – Writing in a gratitude journal can remind you of the positive things in your life and doing things that are relaxing and fun can balance everyday stress.

When & How to Seek Help

Emotions such as anger, sadness and worry are all part of our everyday life. But when they become so extreme that they start to interfere with your ability to enjoy yourself, connect with family and friends, work or do daily tasks, it may be a sign that they have crossed over into a medical disorder such as depression or anxiety disorder. If you have tried the stress management tips above and have not gotten relief, or if these feelings have persisted for a long time, seek professional help.

Symptoms of emotional stress may include:

• Heaviness in the chest, increased heart rate or chest pain
• Grinding teeth or clenching jaw
• Shortness of breath
• Dizziness
• Changes in weight or eating habits
• Changes in sleep schedule
• Stomach pains, diarrhea or constipation
• Sexual difficulties
• Being more emotional than usual
• Feeling overwhelmed or on edge
• Forgetfulness
• Difficulty making decisions, concentrating or getting work done
• Using alcohol or drugs to relieve stress

Mental Health Resources

If you or a loved one have thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). The line is available 24/7.

There are a variety of places you can find a mental health professional. You might want to start with your family doctor to determine if your symptoms and their severity are consistent with a mental health disorder. You can ask your doctor for referrals to mental health providers, or find a provider online, through recommendations or on your insurance company provider list. Local county and city health departments and non-profit organizations may also offer mental health services at a reduced cost.

Glossary of Hypertension Terms

• Angiotensin-converting enzyme (ACE) inhibitors: This is a type of hypertension medicine that prevents the body from making the hormone angiotensin II. This hormone causes blood vessels to narrow, raising blood pressure. ACE inhibitors allow the vessels to widen and allow more blood to flow to the heart.
• Atherosclerosis: This is the build-up of fatty deposits in arteries, which if left untreated, can block blood flow or stiffen artery walls.
• Balloon angioplasty: This is a surgical procedure in which a small balloon at the tip of the catheter is inflated inside a narrowed artery to stretch it open and increase blood flow.
• Beta-blockers: These are a type of medicine used to treat hypertension, chest pain, and irregular heartbeat and to help prevent future heart attacks. Beta-blockers work by blocking the effects of adrenaline, which raises heart rate and stresses the heart. When the heart does not have to work so hard, blood pressure decreases. Beta-blockers also lower blood pressure by relaxing blood vessels.
• Calcium channel blockers: This is one kind of hypertension medicine that slows the movement of calcium into the cells of the heart and the artery walls. This relaxes the arteries and reduces blood pressure. Some calcium channel blockers also lower the heart rate.
• Congestive heart failure: This is when the heart cannot adequately pump blood. It can be caused by a number of factors, including untreated hypertension and heart attacks. Serious symptoms include swelling in the legs and shortness of breath. 
• DASH diet: The Dietary Approaches to Stop Hypertension (DASH) diet was specifically created for people with hypertension and is considered to be the healthiest way to eat.
• Diastolic blood pressure: This is the lowest pressure of blood against the walls of the arteries when the heart relaxes between beats. This is the second or bottom number in a blood pressure reading.
• Diuretics: A kind of medicine used to treat hypertension, diuretics remove excess salt and water from the blood by flushing it out through the kidneys. This increases the flow of urine and the need to urinate. 
• Echocardiogram: This is a diagnostic test that uses a device to bounce sound waves off the heart to create an image. The resulting image shows the blood flow in the heart’s chambers.
• Eclampsia: This is a condition in which pregnant women retain water and have hypertension, protein in the urine, and seizures.
• Electrocardiogram (EKG): This is a diagnostic test that measures the electrical activity, rate, and rhythm of the heartbeat via electrodes that are attached to the patient’s arms, legs, and chest.
• Essential hypertension: This is high blood pressure that does not have an apparent cause. The vast majority (95%) of high blood pressure falls into this category.
• Exercise stress test: This is a diagnostic test in which electrocardiogram readings are taken while the patient exercises on a treadmill or stationary bicycle to increase the heart rate.
• Heart attack: This is damage to the heart muscle caused by loss of blood flow to the heart.
• Hypertension: This is another term for high blood pressure.
• Hypertensive emergency: This is a critical event in which a severe elevation in blood pressure can lead to organ damage, including brain damage, heart attack, heart failure, stroke, and arterial bleeding. It requires immediate medical care.
• Hypertensive retinopathy: This is damage caused by hypertension to the blood vessels in the retina (the area at the back of the eye that contains the cells that are sensitive to light), potentially causing blindness.
• Hypertensive urgency: This is a range of dangerous situations that include organ damage (already present or getting worse) caused by high blood pressure.
• Magnetic resonance imaging (MRI): This is a medical imaging test that uses magnets to study and create images of the body. This test is particularly useful for studying soft tissues such as the heart and other organs in the body.
• Magnetic resonance arteriography (MRA): This is a type of MRI test that provides detailed pictures of blood vessels and can reveal where arteries might be narrowed or where blood flow is blocked.
• Potassium: This is an electrolyte that is used to make energy for all muscles, including heart muscles. A deficiency can cause high blood pressure and severe heart arrhythmias.
• Proteinuria: This is the presence of protein in the urine. This might indicate kidney disease or damage.
• Secondary hypertension: This is high blood pressure that is caused by conditions such as alcohol or drug abuse, pregnancy, kidney disorders, or taking certain medicines.
• Sphygmomanometer: This is a device that is used to measure blood pressure. The sphygmomanometer consists of an arm cuff, dial, pump, and valve.
• Stroke: This is an interruption of the blood supply to the brain that results in damaged brain tissue. An interruption can be caused by clots that block blood flow or by bleeding in the brain from a ruptured blood vessel or major injury.
• Systolic blood pressure: This is the highest force of blood against the walls of the artery when the heart contracts or squeezes blood into the blood vessels. This is the first or top number in a blood pressure reading.
• Transient ischemic attack (TIA): This is a “mini-stroke,” or a warning of a potential stroke. A TIA takes place when blood flow to part of the brain is briefly interrupted.