High Blood Pressure: How Lifestyle Changes Can Help

Blood pressure (BP) refers to the force that blood exerts on the blood vessels as it circulates through your body vessels. Hypertension commonly known as ‘high blood pressure’ increases the risk of heart disease, strokes, vascular disease, kidney disease, eye disorders and can cause damage to various other organs. There is an overwhelming focus on medication in controlling blood pressure with many patients on a cocktail of blood pressure lowering medications. The advent of various hypertension medications has been revolutionary and undoubtably has helped saved millions of lives over the years. Whilst one cannot deny these benefits, the importance of lifestyle changes is often neglected in GP consultations. Lifestyle advice and counselling may not necessarily replace the need for blood pressure lowering medications but can serve as a useful adjunct. In addition, it provides an entry point into a discussion about lifestyle and chronic diseases. It may provide a stepping stone and allow the contemplation of behaviour change.

What is Considered High Blood Pressure?

Blood pressure is usually recorded with 2 numbers. The top number is the systolic blood pressure, which is the force at which your heart pumps blood around the body, and diastolic blood pressure which is the pressure when the heart relaxes and fills with blood. High blood pressure is considered to be over 140/90 mmHg (or > 150/90) if over the age of 80 years. Ideal blood pressure is considered to be between 90/60 and 120/80.

What are the Symptoms of High Blood Pressure?

In the West most people diagnosed with high blood pressure tend to be asymptomatic. They are normally diagnosed at a consultation with their doctor or a routine medical. Symptoms when they do occur more include headaches, nose bleeds, blurred vision, dizziness, confusion and nausea.

Risk Factors for High Blood Pressure

– Age

– Family History: There are around one hundred genetic mutations which have been identified for high blood pressure. In addition to these specific mutations, a family history of high blood pressure can increase risk though the exact pattern of genetic inheritance is not known.

– Ethnicity: Those of an African – Caribbean background have a greater risk of high blood pressure.

– Sex: Prior to the age of 55 years, males are more likely to develop high blood pressure, however after the age of 55 years females are more likely to develop it. This is likely to be because the female hormone oestrogen confers a protective benefit before menopause by keeping blood vessels wide and blood pressure low.

– Lifestyle: Dietary Too much dietary salt, insufficient potassium, not enough exercise, excess alcohol and smoking

How do Lifestyle Interventions Influence blood pressure?

For the benefit of the individual but also the NHS at large, it serves only advantageous to reduce usage of antihypertensives if clinically appropriate. Putting more focus on lifestyle interventions rather than medication can reduce millions of pounds of expenditure for the NHS but also reduces risk of drug side effects and interactions.

Weight loss, stress reduction, increased physical activity, increased protein intake, increased potassium dietary intake, reduction in alcohol, reduction in salt and sugar, and smoking cessation all have roles to play in improving hypertension. The degree to which each of these interventions influences hypertension varies a great deal, however.

*Dietary Approaches to Stop Hypertension eating plan – This way of eating focuses on fruits, vegetables, wholegrains and lean meats.

INTERVENTIONSBP REDUCTION
(mmHg)
CAVEAT
Increased protein intake2–3Depends on baseline protein intake; minimum effective dose is unknown
Weight loss5–20About 1 mmHg for every 1 kg (2.2 lb) reduction in body weight; effect eventually plateaus as body weight normalizes
DASH diet*8–14Depends on the baseline diet pattern; DASH diet tested was rich in fruits and vegetables and low in fat and saturated fat
Reduced salt intake2–8Depends on baseline salt intake; aim for reduction of at least 1,000 mg (1 g)
Increased potassium intake4–5With an intake of 3,500–5,000 mg (3.5–5 g) per day, particularly from potassium-rich foods
Increased physical activity4–9A mix of endurance and resistance may be more effective than either alone
Reduced alcohol intake2–4Depends on baseline alcohol intake

Sodium is a known regulator of high blood pressure. Sodium concentration is detected by cells in the kidney. Increasing intake of high sodium foods causes the body to hold onto more water which increases blood pressure and puts extra pressure on the cardiovascular system. However, the importance of salt reduction for example has been overstated in food guidelines and may reflect only a 2-8mm Hg decrease with the most significant improvements being in those with pre-existing high blood pressures. Studies have shown adhering to the UK guidelines of taking less than 1 teaspoon of salt (6 grams) per day has negligible benefits in those with normal blood pressures.

Weight loss by far has the largest impact on blood pressure with studies showing an impressive 1mmHg drop in systolic blood pressure with each 1kg drop in weight.

A dietary measure which is often understated is the impact of sugar and ultra-processed carbohydrates particularly in those who already have pre-existing elevated blood pressure or diabetes. Spikes in insulin levels can cause sodium to be retained leading to high blood vessel volume and blood pressure.

There is some evidence to show that supplements containing cocoa, garlic, fish oil and nitrate can also decrease blood pressure.

Take Home:

(1) High blood pressure often arises without symptoms but undetected and untreated can be a risk factor for a variety of serious diseases including heart disease and kidney disease.

(2) Modern pharmaceuticals have been utilised to good effect over the past few decades to reduce blood pressure saving millions of lives globally.

(3) When it comes to matters of health, living in the 21st century in the West is a double-edged sword. We are blessed to be living in an age of technology and effective pharmaceuticals, however, never have we lived in a more stressful time, with easy access to highly palatable ultra-processed foods in which we are more sedentary than ever. We should not rest our laurels and be taking a more proactive approach where lifestyle and blood pressure is concerned.  

References:

MedlinePlus (medlineplus.gov)

Appel LJ, et al. Dietary approaches to prevent and treat hypertension: a scientific statement from the American Heart AssociationHypertension. (2006)

Adapted from Examine.com

NICE Guidelines on Hypertension (niceguidelines.org.uk/hypertension)

British Heart Foundation (www.bhf.org.uk/informationsupport/risk-factors/high-blood-pressure)