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Lifestyle Changes to Lower Blood Pressure

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DASH and Blood Pressure Reduction

Your Guide To Lowering Your Blood Pressure With DASH

Most Americans Still Eating Too Much Salt “"People are trying to follow the guidelines, but it's difficult because there's so much sodium in the processed and restaurant food we eat," said Dr. Mary Cogswell who led the study at the Centers for Disease Control and Prevention in Atlanta. The American Heart Association (AHA) and the U.S. Department of Agriculture recommend that most healthy people limit the sodium they eat to 2,300 milligrams a day. Less than 10% of people in the study met this recommendation. Dr. Cogswell's team found that most U.S. adults are eating far more sodium than recommended -- 3,371 milligrams per day, on average. … Research suggests that a high salt diet can raise blood pressure. On the other hand, it's been shown that potassium may reduce that effect by helping the kidneys get rid of sodium the body doesn't need. … Dietary guidelines recommend people eat 4,700 milligrams of potassium a day-that's about the same amount of potassium as you'd get from 10 bananas or eight sweet potatoes, two of the best sources of the mineral. But according to the new study, less than 2% of people are meeting the guidelines. Those surveyed ate 2,632 milligrams of potassium a day, on average.”

Highlighted Articles

Diet and the Prevention of Chronic Disease “DASH has as its core the increased consumption of fresh fruits and vegetables and low-fat dairy products. Fruits and vegetables are important because of the low-caloric and high-nutrient density of such foods and the satiating effects of fiber. Low-fat dairy consumption provides calcium that is needed for bone health and other health outcomes. Other components of DASH include nuts, legumes (dried beans and peas), whole grains, and limiting salt and added sugar intake. … DASH was originally developed and studied as a diet to reduce high blood pressure in a randomized controlled trial published in The New England Journal of Medicine [10] in 1997. In this study, a diet rich in fruits, vegetables, and low-fat dairy products and low in saturated fat was compared with a control diet and shown to result in substantial reductions in blood pressure. All of the diets had the same 3 grams per day of sodium. After 8 weeks, the systolic blood pressure of the participants assigned to the DASH diet was, on average, 5.5 mm Hg lower and diastolic blood pressure was 3 mm Hg lower compared with participants on the control diet. Subsequent prospective observational studies have shown the DASH diet to have a number of other beneficial health effects. An analysis of the Nurses' Health Study showed that women who were in the highest quintile of consumption of a DASH-style diet and also had low consumption of processed meats and sugar-sweetened beverages had lower risk for coronary heart disease over almost 25 years of follow-up.[11] Other studies have shown beneficial effects in colorectal adenoma, metabolic syndrome, congestive heart failure, and obesity. … he Mediterranean diet is a food plan that came from the olive-growing countries bordering the Mediterranean Sea (Greece, Spain, and Italy) in the 1960s. A landmark ecological study that began in the 1950s was important to the origins of this eating pattern's health benefits and showed that mortality rates in selected countries near the Mediterranean Sea were substantially lower compared with those in westernized countries, such as the United States and Great Britain.[16] In 1993, the dietary pattern was defined at the International Conference on the Diets of the Mediterranean as being characterized by high consumption of olive oil, legumes, unrefined grains, fruits, and vegetables; moderate consumption of dairy products; moderate-to-high consumption of fish; low consumption of meat; and moderate consumption of alcohol. In early studies, the cardiovascular benefits of this eating plan were thought to be primarily from its lower saturated fat content.[17] It was later understood that the health benefits with respect to fat intake were not only the result of the low saturated fat content but also from the high content of beneficial fats. Monounsaturated fats, found in high levels in olive oils, and polyunsaturated fats, found in both fatty fish and nuts, were key reasons for the beneficial health effects of the diet (Table 2).”

Non-pharmacological aspects of blood pressure management: what are the data? (Kidney Int. 2011)

The effects of dietary patterns on plasma renin activity: results from the Dietary Approaches to Stop Hypertension trial. (J Hum Hypertens. 2011)

DASH without the dash (of salt) can lower blood pressure. (Nutr Rev. 2001)

A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. (N Engl J Med. 1997)

Dietary Approaches to Stop Hypertension: a summary of study results. DASH Collaborative Research Group. (J Am Diet Assoc. 1999)

Sodium and potassium intakes among US adults: NHANES 2003-2008. (Am J Clin Nutr. 2012)

Long-Term Salty Diets Tied Again to High Blood Pressure "And once you've developed hypertension, lowering your salt intake most likely won't be enough to normalize your blood pressure," he said.

Association of sweetened beverage intake with incident hypertension. (J Gen Intern Med. 2012)

Mediterranean Diet and Blood Pressure Reduction

Mediterranean diet

More evidence for Mediterranean diet

The Mediterranean Diet “A growing body of research continues to prove that eating a diet rich in plant foods and healthy fats is good for you. Studies show that following a Mediterranean diet protects against the development of heart disease, metabolic syndrome, some types of cancer, obesity, type 2 diabetes, dementia, Alzheimer’s disease -- and also leads to a longer lifespan. The health effects of a Mediterranean diet have been studied extensively in the last 10 years, resulting in better science and more clinical evidence. “There are numerous health benefits, the strongest and most profound evidence is the protection of cardiovascular disease and diabetes,” says Dariush Mozaffarian, MD, DrPH, a researcher, cardiologist, associate professor, and codirector of the cardiovascular epidemiology program at Harvard School of Public Health. Health benefits are not attributed to diet alone; it is the whole package, which includes the lifestyle of the people who live along the Mediterranean. “In addition to the wide variety of delicious, nutrient-rich foods -- the protective effect of leisurely dining, family involvement, and physical activity make the Mediterranean diet even more powerful,” says Connie Diekman, MEd, RD, author of The Everything Mediterranean Diet Book. … There is no single Mediterranean diet. Instead, each region across Europe -- from Spain to the Middle East -- customizes the basic diet to take advantage of food availability and cultural preferences. Similarities include a reliance on plant foods such as vegetables, fruits, beans, whole grains, nuts, olives, and olive oil along with some cheese, yogurt, fish, poultry, eggs, and wine. These foods form the basis of the plan and provide thousands of micronutrients, antioxidants, vitamins, minerals, and fiber that work together to protect against chronic disease. Most of the foods on the plan are fresh, seasonal whole foods - they're not processed. Preparation methods tend to be simple; foods are rarely deep-fried. Only small amounts of saturated fat, sodium, sweets, and meat are part of the plan. … Olive oil is what most people associate with a Mediterranean-type diet. But it's not just any olive oil; it needs to be extra virgin. … Nutrition experts tout the traditional Mediterranean diet as a first-rate diet plan. U.S. News and World Report ranked it second to the DASH diet as best diet overall.”

Highlighted Articles

Mediterranean diet: Choose this heart-healthy diet option

The Mediterranean Diet and Incidence of Hypertension (Am. J. Epidemiol. (2009))

Effect of the Mediterranean Diet on Blood Pressure: the Ambulatory Blood Pressure Substudy (Journal of Hypertension 2010)

Adherence to a Mediterranean dietary pattern in early life is associated with lower arterial stiffness in adulthood: the Amsterdam Growth and Health Longitudinal Study. (J Intern Med. 2012)

Exercise and Blood Pressure Reduction

American College of Sports Medicine position stand. Exercise and hypertension. (Med Sci Sports Exerc. 2004)

Exercise: A drug-free approach to lowering high blood pressure “Becoming more active can lower your systolic blood pressure — the top number in a blood pressure reading — by an average of 5 to 10 millimeters of mercury (mm Hg). That's as good as some blood pressure medications. For some people, getting some exercise is enough to reduce the need for blood pressure medication. If your blood pressure is at a desirable level — less than 120/80 mm Hg — exercise can keep it from rising as you age. Regular exercise also helps you maintain a healthy weight, another important way to control blood pressure. But to keep your blood pressure low, you need to keep exercising. It takes about one to three months for regular exercise to have an impact on your blood pressure. The benefits last only as long as you continue to exercise.”

Physical Activity and Blood Pressure

Highlighted Articles

Aerobic Exercise Reduces Blood Pressure in Resistant Hypertension (Hypertension 2012) “Physical exercise is able to decrease blood pressure even in subjects with low responsiveness to medical treatment. It should be included in the therapeutic approach to resistant hypertension.”

High-intensity interval training and hypertension: maximizing the benefits of exercise? (Am J Cardiovasc Dis. 2012) “Regular exercise is a well-established intervention for the prevention and treatment of several chronic diseases, including hypertension [4,5]. Higher levels of physical activity and cardiorespiratory fitness have shown to reduce the risk of hypertension in healthy normotensive persons [6,7]. Moreover, exercise can reduce BP in hypertensive adults [8-11], and has shown to improve several factors involved in the pathophysiology of hypertension [11-15]. … A number of studies within the last few years have consistently showed greater health-related benefits of HIT when compared to traditional CMT. Although large multicenter prospective studies are needed to advance our conclusions, studies by our group and others indicate that exercise intensity may have an important role in preventing and controlling hypertension, as shown by the greater benefits of HIT than CMT for reversing key alterations present in the physiopathology of this disease in both hypertensive patients and normotensive subjects at high familial for hypertension.”

How much exercise is required to reduce blood pressure in essential hypertensives: a dose-response study. (Am J Hypertens. 2003)

Twenty-four hour ambulatory blood pressure monitoring to evaluate effects on blood pressure of physical activity in hypertensive patients. (Clin J Sport Med. 2007) “This reduction, evaluated with Ambulatory Blood Pressure Monitoring (ABPM), confirms that physical exercise should be a part of lifestyle changes for the management of hypertension both in untreated hypertensive patients or high-risk subjects for hypertension, and also for hypertensive patients in association with pharmacological therapy.”

Aerobic interval training reduces blood pressure and improves myocardial function in hypertensive patients. (Eur J Cardiovasc Prev Rehabil. 2011) "This study indicates that the blood pressure reducing effect of exercise in essential hypertension is intensity dependent. Aerobic interval training is an effective method to lower blood pressure and improve other cardiovascular risk factors."

Exercise and hypertension. (Aust Fam Physician. 2005)

How much exercise is required to reduce blood pressure in essential hypertensives: a dose-response study. (Am J Hypertens. 2003)

Isometric exercise training lowers resting blood pressure. (Med Sci Sports Exerc. 1992)

Sleep and Blood Pressure Reduction

How Is Sleep Apnea Treated?

Obstructive sleep apnea - Lifestyle Changes “Body position greatly affects the number and severity of episodes of obstructive sleep apnea, with at least twice as many apneas occurring in people who lay on their back as in those who sleep on their side. This may be due to the effects of gravity, which cause the throat to narrow when a person lies on the back. (Indeed, astronauts show a marked reduction in apneas and snoring in the weightlessness of space.) Positional sleep apnea affects people of all ages, including young children. As a first step in dealing with sleep apnea, the patient should simply try rolling over onto the side. Patients who sleep on their backs and have 50 - 80 apneas per hour can sometimes nearly eliminate them when they shift to one side or the other. (Changing positions is less effective the more overweight a person is, but it still helps.)”

Highlighted Articles

Cerebrovascular Consequences of Obstructive Sleep Apnea (Journal of the American Heart Association 2012) “Cardiovascular diseases associated with OSA include hypertension, heart failure, stroke, cardiac arrhythmias, myocardial ischemia and infarction, and pulmonary arterial hypertension.1–3,5,7 In addition, OSA is associated with metabolic dysregulation (insulin resistance and lipid disorders), which in turn is a risk factor for cardiovascular diseases.1,3,7 Figure 1 shows characteristics of OSA and the pathological cascade that can lead to cardiovascular diseases. … Estimates of the incidence of OSA vary from <5% to up to 25% of the adult population in the Western world.1–3,9–12 OSA almost certainly will become an even greater health problem in the future because 2 of the prominent risk factors for OSA, obesity and older age, are on the rise.1,3,11,13–15 Of further significance to the public health dilemma are the facts that (1) ?85% of people with clinically significant OSA go undiagnosed, and (2) OSA can continue for years without the individual being aware of it.”

Sleep Apnea and Cardiovascular Disease (Circulation 2008) “Obstructive apneas may induce severe intermittent hypoxemia and CO2 retention during sleep, with oxygen saturation sometimes dropping to =60%, disrupting the normal structured autonomic and hemodynamic responses to sleep.68 Apneas can occur repetitively through the night and are accompanied by chemoreflex-mediated increases in sympathetic activity to peripheral blood vessels and consequent vasoconstriction.69,70 Toward the end of apneic episodes, blood pressure (BP) can reach levels as high as 240/130 mm Hg. … To determine the interaction between OSA in patients with drug-resistant hypertension, defined as a clinic BP of =140/90 mm Hg while taking a combination of =3 antihypertensive drugs titrated to maximally recommended doses, Logan et al145 noted that the prevalence of OSA, defined as an AHI of =10, was 83%. In another study,146 sleep apnea was found to be an independent predictor of uncontrolled hypertension in patients <50 years of age. Increased aldosterone has been suggested as a possible contributor to resistant hypertension in sleep apnea. The weight of evidence has led the most recent Joint National Committee on the Detection and Management of Hypertension to identify OSA as an important identifiable cause of hypertension.”

Snoring as an independent risk factor for hypertension in the nonobese population: the Korean Health and Genome Study. (Am J Hypertens. 2007)

Association between sleep and blood pressure in midlife: the CARDIA sleep study. (Arch Intern Med. 2009) “Reduced sleep duration and consolidation predicted higher blood pressure levels and adverse changes in blood pressure, suggesting the need for studies of whether interventions to optimize sleep may reduce blood pressure.”

Blood pressure is elevated in children with primary snoring. (J Pediatr. 2009)

Obstructive sleep apnea: the most common secondary cause of hypertension associated with resistant hypertension. (Hypertension. 2011)

Ambulatory blood pressure monitoring in chinese children with obstructive sleep apnea/hypopnea syndrome. (Pediatr Pulmonol. 2012) “OSAHS children had a higher nocturnal BP than non-OSAHS children and dysregulation of BP control reflected by decreased nocturnal BP dipping. Frequency of oxygen desaturation, apneas, and obesity were related to BP.”

The association between sleep apnea and young adults with hypertension. (Laryngoscope. 2012)

Lifestyle Changes

'How I learned to reduce my blood pressure'

Managing High Blood Pressure With Lifestyle Changes (video)

Hypertension Risk Cut By Two Thirds By Leading A Healthy Lifestyle “"Four modifiable lifestyle factors: alcohol consumption, physical activity, consumption of vegetables and keeping normal weight have a remarkable effect on the development of hypertension," said Professor Jousilahti. "Lifestyle modification has a huge public health potential to prevent hypertension. While our research suggests that lifestyle modification may produce greater reductions in hypertension in men than women, it also shows large benefits in women, and adherence to all four healthy lifestyle factors had a nearly similar effect in both sexes. Both men and women should take steps towards a healthier lifestyle to decrease their risk of hypertension." He concluded: "Our study was focused on prevention of hypertension and therefore included subjects who did not have hypertension at baseline. But the results should apply to the treatment of patients with hypertension, who can reduce their blood pressure by modifying the four lifestyle factors alone, or by making these modifications while taking blood pressure lowering medication."”

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Ongoing Case Study: Effects of Diet, Exercise and Sleep on Blood Pressure, Pulse Rate, and Blood Oxygen Saturation Percentages

Ongoing Case Study

Lifestyle Changes: From Hypertension Stage 2 to Below Normal Blood Pressure

(See navigation column to the left for links to comments and results. Excel spreedsheets saved in Excel Format take longer to upload and you will be asked questions about opening the file, but you will have access to the information in the notes. In PDF Format, they will upload much faster, but you will not have access to the information in the notes.)

Reasons for Study: Subject found that his BP measured over 160/100 and decided to make immediate lifestyle changes regarding diet, exercise and sleep. Subject wanted to document the effects of his lifestyle changes on blood pressure and blood oxygen saturation levels and also to determine whether snoring/sleep apnea was a contributing factor to his high blood pressure. This study involves a combination of factors that might reduce blood pressure. It is not a scientific study where the effects of one variable on blood pressure is being determined.

Primary Lifestyle Changes: 1). Reduced salt and processed foods, 2). Increased fruits, vegetables, and fish, 3). Switched to low fat or skim organic milk, 4). Increased exercise. Subject had been eating daily at restaurants (mostly fast-food) and therefore ingesting a high amount of processed, salty, foods. Subject decided to follow more of the DASH/Mediterranean diets. DASH (Dietary Approach to Stopping Hypertension) is documented and highly recommended to reduce blood pressure. The Mediterranean type nutrition is similar. Exercise has also been shown to reduce blood pressure. Subject had been exercising, but increased the intensity and frequency.

Methods: A blood pressure wrist monitor was used to measure BP and pulse rate. An Oximeter was used to measure blood oxygen saturation levels and pulse rate. Blood pressure was taken during the day in a sitting position, while at bedtime and rising time, measurements were taken lying down (supine) in bed. Before measurements, subject relaxed and rested for 3-5 minutes. Subject continued with normal breathing during monitoring. Four measurements were taken each time. The highest and lowest numbers were eliminated. The average of the two remaining numbers was used as the BP measurement for that session. Averages between numbers were rounded to the higher number (e.g. 117 and 118 were rounded off to 118 as the BP measure). The same averaging was done for the Pulse Rate measurements. The Oximeter was placed on the left hand ring finger for testing. All food, fluids, exercise, sleep positions, systolic and diastolic blood pressure, pulse rate and blood oxygen saturation percentage data were entered into a Daily (hourly) Journal in detail and then this information was transferred to an Excel spreadsheet. The spreadsheets were saved in both Excel and PDF formats.

Results: Blood pressure measurements decreased from Stage 2 Hypertension to Below Normal blood pressure levels – from late January and early February 2012 to August, 2012.

Summary: The DASH/Mediterranean diet and Exercise dramatically decreased this subject's blood pressure - from over 160/100 to below 120/80. Salt has been shown in studies to increase blood pressure - the more salt intake the higher the blood pressure. A substantial decrease in salt intake appears to have been a major contributing factor for the blood pressure decline. The salt reduction was possible by eliminating a large proportion of processed foods from restaurants in the diet. Salt was never added to food prepared at home. An increase in fruits and vegetables in the diet may have also been a factor. An increase in the intensity and frequency of exercise appears to have been a major factor also in the BP reduction.

Ongoing Study: Subject will continue with the lifestyle changes and will monitor his blood pressure, pulse rate and oxygen saturation levels. It is still to be determine what effect snoring has on his blood pressure. It does not appear that the subject suffers from sleep apnea, as defined in the literature. Subject will also continue to document his food intake, exercise and sleep patterns since that helps him maintain the lifestyle changes.

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