Blood pressure is the force of blood against the walls of arteries. Blood pressure rises and falls throughout the day. When blood pressure stays elevated over time, it’s called high blood pressure.
The medical term for high blood pressure is hypertension. High blood pressure is dangerous because it makes the heart work too hard and contributes to atherosclerosis (hardening of the arteries). It increases the risk of heart disease (see box 1) and stroke, which are the first- and third-leading causes of death among Americans. High blood pressure also can result in other conditions, such as congestive heart failure, kidney disease, and blindness.
Box 1: Risk Factors for Heart Disease
A blood pressure level of 140/90 mmHg or higher is considered high. About two-thirds of people over age 65 have high blood pressure. If your blood pressure is between 120/80 mmHg and 139/89 mmHg, then you have prehypertension. This means that you don’t have high blood pressure now but are likely to develop it in the future unless you adopt the healthy lifestyle changes described in this brochure. (See box 2.)
People who do not have high blood pressure at age 55 face a 90 percent chance of developing it during their lifetimes. So high blood pressure is a condition that most people will have at some point in their lives.
Both numbers in a blood pressure test are important, but for people who are age 50 or older, systolic pressure gives the most accurate diagnosis of high blood pressure. Systolic pressure is the top number in a blood pressure reading. It is high if it is 140 mmHg or above.
Box 2: Blood Pressure Levels for Adults
If you have high blood pressure, you and your health care provider need to work together as a team to reduce it. The two of you need to agree on your blood pressure goal. Together, you should come up with a plan and timetable for reaching your goal.
Blood pressure is usually measured in millimeters of mercury (mmHg) and is recorded as two numbers—systolic pressure (as the heart beats) “over” diastolic pressure (as the heart relaxes between beats)—for example, 130/80 mmHg. Ask your doctor to write down for you your blood pressure numbers and your blood pressure goal level.
Monitoring your blood pressure at home between visits to your doctor can be helpful. You also may want to bring a family member with you when you visit your doctor. Having a family member who knows that you have high blood pressure and who understands what you need to do to lower your blood pressure often makes it easier to make the changes that will help you reach your goal.
The steps listed in this brochure will help lower your blood pressure. If you have normal blood pressure or prehypertension, following these steps will help prevent you from developing high blood pressure. If you have high blood pressure, following these steps will help you control your blood pressure.
This brochure is designed to help you adopt a healthier lifestyle and remember to take prescribed blood pressure-lowering drugs. Following the steps described will help you prevent and control high blood pressure. While you read them, think to yourself . . . “I Can Do It!”
Finding YOUR Target Weight
Being overweight or obese increases your risk of developing high blood pressure. In fact, your blood pressure rises as your body weight increases. Losing even 10 pounds can lower your blood pressure—and losing weight has the biggest effect on those who are overweight and already have hypertension.
Overweight and obesity are also risk factors for heart disease. And being overweight or obese increases your chances of developing high blood cholesterol and diabetes—two more risk factors for heart disease.
Two key measures are used to determine if someone is overweight or obese. These are body mass index, or BMI, and waist circumference.
BMI is a measure of your weight relative to your height. It gives an approximation of total body fat—and that’s what increases the risk of diseases that are related to being overweight.
But BMI alone does not determine risk. For example, in someone who is very muscular or who has swelling from fluid retention (called edema), BMI may overestimate body fat. BMI may underestimate body fat in older persons or those losing muscle.
That’s why waist measurement is often checked as well. Another reason is that too much body fat in the stomach area also increases disease risk. A waist measurement of more than 35 inches in women and more than 40 inches in men is considered high.
Check the chart in box 3 for your approximate BMI value. Check box 4 to see if you are at a normal weight, overweight, or obese. Overweight is defined as a BMI of 25 to 29.9; obesity is defined as a BMI equal to or greater than 30.
If you fall in the obese range according to the guidelines in box 4, you are at increased risk for heart disease and need to lose weight. You also should lose weight if you are overweight and have two or more heart disease risk factors. (See box 1.) If you fall in the normal weight range or are overweight but do not need to lose pounds, you still should be careful not to gain weight.
Boxes 3 and 4: "Body Mass Index" and "What Does Your BMI Mean?"
If you need to lose weight, it’s important to do so slowly. Lose no more than 1/2 pound to 2 pounds a week. Begin with a goal of losing 10 percent of your current weight. This is the healthiest way to lose weight and offers the best chance of long-term success.
There’s no magic formula for weight loss. You have to eat fewer calories than you use up in daily activities. Just how many calories you burn daily depends on factors such as your body size and how physically active you are. (See box 5.)
One pound equals 3,500 calories. So, to lose 1 pound a week, you need to eat 500 calories a day less or burn 500 calories a day more than you usually do. It’s best to work out some combination of both eating less and being more physically active.
And remember to be aware of serving sizes. It’s not only what you eat that adds calories, but also how much.
As you lose weight, be sure to follow a healthy eating plan that includes a variety of foods. A good plan to follow is the one given in box 6. Some tips to make the plan lower in calories appear in box 8.
Being physically active is one of the most important things you can do to prevent or control high blood pressure. It also helps to reduce your risk of heart disease.
It doesn’t take a lot of effort to become physically active. All you need is 30 minutes of moderate-level physical activity on most days of the week. Examples of such activities are brisk walking, bicycling, raking leaves, and gardening. For more examples, see box 5.
Box 5: Examples of Moderate-Level Physical Activities
You can even divide the 30 minutes into shorter periods of at least 10 minutes each. For instance: Use stairs instead of an elevator, get off a bus one or two stops early, or park your car at the far end of the lot at work. If you already engage in 30 minutes of moderate-level physical activity a day, you can get added benefits by doing more. Engage in a moderate-level activity for a longer period each day or engage in a more vigorous activity.
Most people don’t need to see a doctor before they start a moderate-level physical activity. You should check first with your doctor if you have heart trouble or have had a heart attack, if you’re over age 50 and are not used to moderate-level physical activity, if you have a family history of heart disease at an early age, or if you have any other serious health problem.
What you eat affects your chances of getting high blood pressure. A healthy eating plan can both reduce the risk of developing high blood pressure and lower a blood pressure that is already too high.
For an overall eating plan, consider DASH, which stands for “Dietary Approaches to Stop Hypertension.” You can reduce your blood pressure by eating foods that are low in saturated fat, total fat, and cholesterol, and high in fruits, vegetables, and lowfat dairy foods. The DASH eating plan includes whole grains, poultry, fish, and nuts, and has low amounts of fats, red meats, sweets, and sugared beverages. It is also high in potassium, calcium, and magnesium, as well as protein and fiber. Eating foods lower in salt and sodium also can reduce blood pressure.
Box 6 gives the servings and food groups for the DASH eating plan. The number of servings that is right for you may vary, depending on your caloric need.
The DASH eating plan has more daily servings of fruits, vegetables, and grains than you may be used to eating. Those foods are high in fiber, and eating more of them may temporarily cause bloating and diarrhea. To get used to the DASH eating plan, gradually increase your servings of fruits, vegetables, and grains. Box 7 offers some tips on how to adopt the DASH eating plan.
A good way to change to the DASH eating plan is to keep a diary of your current eating habits. Write down what you eat, how much, when, and why. Note whether you snack on high-fat foods while watching television or if you skip breakfast and eat a big lunch.
Do this for several days. You’ll be able to see where you can start making changes.
If you’re trying to lose weight, you should choose an eating plan that is lower in calories. You can still use the DASH eating plan, but follow it at a lower calorie level. (See box 8.) Again, a food diary can be helpful. It can tell you if there are certain times that you eat but aren’t really hungry or when you can substitute low-calorie foods for high-calorie foods.
Boxes 6, 7, 8: "The DASH Eating Plan," "Tips on Switching to the DASH Eating Plan," "How to Lose Weight on the DASH Eating Plan"
Use More Spices and Less Salt
An important part of healthy eating is choosing foods that are low in salt (sodium chloride) and other forms of sodium. Using less sodium is key to keeping blood pressure at a healthy level.
Most Americans use more salt and sodium than they need. Some people, such as African Americans and the elderly, are especially sensitive to salt and sodium and should be particularly careful about how much they consume.
Most Americans should consume no more than 2.4 grams (2,400 milligrams) of sodium a day. That equals 6 grams (about 1 teaspoon) of table salt a day. For someone with high blood pressure, the doctor may advise less. The 6 grams includes all salt and sodium consumed, including that used in cooking and at the table.
Before trying salt substitutes, you should check with your doctor, especially if you have high blood pressure. These contain potassium chloride and may be harmful for those with certain medical conditions.
Box 9 offers some tips on how to choose and prepare foods that are low in salt and sodium.
Box 9: Tips To Reduce Salt and Sodium
With herbs, spices, garlic, and onions, you can make your food spicy without salt and sodium. There’s no reason why eating less sodium should make your food any less delicious! See box 10 for some great ideas on using spices.
Box 10: Tips for Using Herbs and Spices
Experiment with these and other herbs and spices. To start, use small amounts to find out if you like them.
Shopping for Foods That Will Help You Lower Your Blood Pressure
By paying close attention to food labels when you shop, you can consume less sodium.
Sodium is found naturally in many foods. But processed foods account for most of the salt and sodium that Americans consume. Processed foods that are high in salt include regular canned vegetables and soups, frozen dinners, lunchmeats, instant and ready-to-eat cereals, and salty chips and other snacks.
Use food labels to help you choose products that are low in sodium. Box 11 shows you how to read and compare food labels.
As you read food labels, you may be surprised that many foods contain sodium, including baking soda, soy sauce, monosodium glutamate (MSG), seasoned salts, and some antacids.
Box 11: Compare Labels
Easy on the Alcohol
Drinking too much alcohol can raise blood pressure. It also can harm the liver, brain, and heart. Alcoholic drinks also contain calories, which matters if you are trying to lose weight.
If you drink alcoholic beverages, drink only a moderate amount—one drink a day for women, two drinks a day for men.
What counts as a drink?
- 12 ounces of beer (regular or light, 150 calories),
- 5 ounces of wine (100 calories), or
- 1 1/2 ounces of 80-proof whiskey (100 calories).
If you have high blood pressure, the lifestyle habits noted above may not lower your
blood pressure enough. If they don’t, you’ll need to take drugs.
Even if you need drugs, you still must make the lifestyle changes. Doing so will help your drugs work better and may reduce how much of them you need.
There are many drugs available to lower blood pressure. They work in various ways. Many people need to take two or more drugs to bring their blood pressure down to a
healthy level.
See box 12 for a rundown on the main types of drugs and how they work.
Boxes 12 and 13: "Blood Pressure Drugs" and "Tips to Help You Remember to Take Your Blood Pressure Drugs"
When you start on a drug, work with your doctor to get the right drug and dose level for you. If you have side effects, tell your doctor so the drugs can be adjusted. If you’re worried about cost, tell your doctor or pharmacist—there may be a less expensive drug or a generic form that you can use instead.
It’s important that you take your drugs as prescribed. That can prevent a heart attack, stroke, and congestive heart failure, which is a serious condition in which the heart cannot pump as much blood as the body needs.
It’s easy to forget to take medicines. But just like putting your socks on in the morning and brushing your teeth, taking your medicine can become part of your daily routine.
See box 13 for some tips that will help you remember to take your blood pressure drugs.
You can be taking drugs and still not have your blood pressure under control. Everyone—and older Americans in particular—must be careful to keep his or her blood pressure below 140/90 mmHg. If your blood pressure is higher than that, talk with your doctor about adjusting your drugs or making lifestyle changes to bring your blood pressure down.
Some over-the-counter drugs, such as arthritis and pain drugs, and dietary supplements, such as ephedra, ma haung, and bitter orange, can raise your blood pressure. Be sure to tell your doctor about any nonprescription drugs that you’re taking and ask whether they may make it harder for you to bring your blood pressure under control.
Remember—You Can Do It!
1. Maintain a healthy weight
- Check with your health care provider to see if you need to lose weight.
- If you do, lose weight slowly using a healthy eating plan and engaging in physical activity.
2. Be physically active
- Engage in physical activity for a total of 30 minutes on most days of the week.
- Combine everyday chores with moderate-level sporting activities, such as walking, to achieve your physical activity goals.
3. Follow a healthy eating plan
- Set up a healthy eating plan with foods low in saturated fat, total fat, and cholesterol, and high in fruits, vegetables, and lowfat dairy foods such as the DASH eating plan.
- Write down everything that you eat and drink in a food diary. Note areas that are successful or need improvement.
- If you are trying to lose weight, choose an eating plan that is lower in calories.
4. Reduce sodium in your diet
- Choose foods that are low in salt and other forms of sodium.
- Use spices, garlic, and onions to add flavor to your meals without adding more sodium.
5. Drink alcohol only in moderation
- In addition to raising blood pressure, too much alcohol can add unneeded calories to your diet.
- If you drink alcoholic beverages, have only a moderate amount—one drink a day for women, two drinks a day for men.
6. Take prescribed drugs as directed
- If you need drugs to help lower your blood pressure, you still must follow the lifestyle changes mentioned above.
- Use notes and other reminders to help you remember to take your drugs. Ask your family to help you with reminder phone calls and messages.
- What is my blood pressure reading in numbers?
- What is my goal blood pressure?
- Is my blood pressure under adequate control?
- Is my systolic pressure too high (over 140)?
- What would be a healthy weight for me?
- Is there a diet to help me lose weight (if I need to) and lower my blood pressure
- Is there a recommended healthy eating plan I should follow to help lower my blood pressure (if I don’t need to lose weight)?
- Is it safe for me to start doing regular physical activity?
- What is the name of my blood pressure medication? Is that the brand name or the generic name?
- What are the possible side effects of my medication? (Be sure the doctor knows about any allergies you have and any other medications you are taking, including over-the-counter drugs, vitamins, and dietary supplements.)
- What time of day should I take my blood pressure medicine?
- Should I take it with food?
- Are there any foods, beverages, or dietary supplements I should avoid when taking this medicine?
- What should I do if I forget to take my blood pressure medicine at the recommended time? Should I take it as soon as I remember or should I wait until the next dosage is due?
Reproduced from Your Guide to Lowering Blood Pressure by the National Heart, Lung and Blood Institute of the National Institutes of Health. NIH Publication 03-5232. May 2003.
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