7.5 million people in Canada live with hypertension, which is defined as blood pressure greater than 140/90mmHg on two or more consecutive blood pressure readings. What does this mean clinically and why do we care so much about this?
Blood pressure is a marker of an individuals risk for diseases such as heart attack, cardiovascular disease and stroke. Therefore, when increased beyond a healthy level it is essential to initiate treatment to prevent the end outcome of these diseases. Pharmaceutical therapies such as Angiotensin- converting Enzyme Inhibitors (ACEI), Angiotensin II Receptor Blockers (ARB), Calcium Channel Blockers (CCB) and Beta-Blockers (BB) are very effective, and are often the choice of therapy for hypertensive patients. The type of drug is chosen based on age, cultural background and preexisting pathologies. However, one of the most effective therapies for hypertension is diet and lifestyle.
Based on The Hypertension Canada 2016 Guidelines, lifestyle interventions to assist in lowering blood pressure are as follows:
1. Physical Exercise – 30-60 minutes per day, moderate intensity, 4-7 days per week
– This needs to be cardiovascular exercise such as walking, running, cycling or swimming. Lifting heavy weights can actually increase blood pressure, so stick to cardio and moderate weight lifting. If cardiovascular exercise is fairly new to you, start with what is comfortable for you. Walking for 30-60 minutes is a great start and you can always increase your pace (or incline if using a treadmill) as your body adapts!
Tip: Invest in a heart rate monitor! This will allow you to see the changes in your heart rate at certain paces. It only takes around 3 rounds of exercise at the same pace for your heart to adapt. Once you notice your heart rate decrease you can increase your pace to what you feel comfortable with. As your heart adapts you will be able to maintain higher paces with less exertion!
2. Weight Reduction – maintain a healthy BMI (Body Mass Index).
– Underweight: BMI is less than 18.5
– Normal weight: BMI is 18.5 to 24.9
– Overweight: BMI is 25 to 29.9
– Obese: BMI is 30 or more.
You can calculate your BMI here. The higher the BMI, the greater risk of health diseases such as diabetes, heart disease and cancer. To lower your BMI to the normal range, diet and lifestyle are key. Following the above 30-60 minutes of cardiovascular exercise 4-7 days per week and adopting a diet high in vegetables, fruit, whole grains, lean protein and healthy fats while eliminating processed foods will help achieve a healthy body weight.
3. Alcohol Consumption – <1-2 drinks per day.
– Men: maximum of 14 standard drinks per week
– Women: maximum of 9 standard drinks per week
A standard drink is 5 oz of wine, a 12 oz beer (341ml), or 1.5 oz spirits. Having three drinks in one sitting will temporarily increase blood pressure, but drinking frequently can increase it long term. If you have hypertension, avoid alcohol or only drink in moderation.
4. Dietary Recommendations – DASH diet
– The DASH diet (or Dietary Approach to Stop Hypertension) is fairly easy to follow and is not overly limiting. You can find more about the diet and recommended servings here. By simply increasing the amount of fruits and vegetables consumed you can lower the risk of cardiovascular disease by 7%. The DASH diet can decrease your risk by 18%. Even better, the Mediterranean diet is the best for weight loss and preventing negative health outcomes. It includes the majority of your meals based on fruits and vegetables (more vegetables than fruit), then fish, chicken, nuts, seeds and olive oil (unheated). Consume minimal red meat, sweets or processed foods.
5. Sodium Intake – 2000mg per day.
– In one teaspoon of salt there is 2300mg of sodium, which is more than the recommended upper limit! Try tracking your sodium intake for a day to help determine the magnitude of modification that may be needed. Limiting processed foods, sandwich meats, processed bread and not over-seasoning food can help decrease your sodium intake to within the healthy range. Water follows salt in the body, so when sodium levels are high there is excess water being held in the body which can result in increased blood pressure and edema (swelling of tissues).
6. Potassium– increase dietary potassium
– Potassium counteracts sodium by helping the kidney to excrete excess sodium, which can result in lower blood pressure if salt is a contributing factor. Some foods that are high in potassium are avocado, spinach, sweet potato, coconut water and bananas. Do not increase dietary potassium if at risk for hyperkalemia (increased potassium in the blood).
7. Stress Management– Cognitive Behavioral Therapy (CBT) or relaxation.
– Blood pressure is increased when stress hormones are high. When stressed, the body’s sympathetic nervous system kicks in which is the “flight or fight” response. This results in vasoconstriction of the blood vessels, which increases blood pressure. Becoming aware of your stressors and how your body responds is the first step to stress reduction. Techniques such as deep breathing, yoga, acupuncture, massage and exercise produce great stress reduction results.
Tools to Assess Risk:
– The Framingham Risk Calculator can determine your 10 year risk of developing cardiovascular disease.
– This Risk/Benefit Calculator can estimate 10 year risk of heart disease and the magnitude by which certain interventions can improve this
– A Heart Age Calculator can determine how old your heart is compared to your biological age
Hyperlipidemia (high cholesterol) is another contributing factor to high blood pressure. Increased LDL (bad cholesterol) and triglycerides with decreased HDL (good cholesterol) increases the risk of atherosclerosis, which is the formation of plaques in the arteries. These plaques cause narrowing which constricts the amount of blood able to flow through freely. This forces the heart to pump harder in order to overcome this resistance within the body which results in high blood pressure. Increased cholesterol is caused by a diet high in saturated and trans fats.
Tips on lowering cholesterol
– Adopt a diet high in fruits and vegetables, whole grains, healthy fats and lean protein such as the Mediterranean diet.
– Consume 2 TBSP of olive oil and a handful of almonds per day
– Switch to paper filtered coffee. Non paper-filtered coffee (espresso, keurig without a filter, french press etc.) can increase LDL levels profoundly. This is due to a compound called cafestol that increases cholesterol and is not removed unless a filter is used.
– Consider supplementing with a high quality fish oil. Consult your naturopathic doctor about recommended dosing.