BLOOD PRESSURE CONTROL WITHOUT DRUGS. FOOD

1. 1.GUIDELINES: Losing body weight reduces blood pressure

Every kilogram lost reduces blood pressure by 1 mm Hg

Insurance industry actuarial reports have identified a striking relationship between body weight and high blood pressure and a direct relationship between overweight/ obesity and hypertension. Epidemiological studies identified a direct relationship between body mass index and blood pressure that is continuous and almost linear, with no evidence of a threshold (1). The relationship between obesity at a young age and change in obesity status over time is strongly related to future risk of hypertension. If your health care professional recommends that you lose weight, there’s a simple rule to follow: move more and eat well. Gradually increase your level of physical activity beyond the AHA (American Heart Association) recommendation of 150 minutes of moderate-intensity aerobic activity per week, lower the number of calories you take in and eat a healthy diet. Achievement and maintenance of weight loss through behavior change are challenging but possible over prolonged periods of follow-up. For those who do not meet their weight loss goals with non-pharmacological interventions, pharmacotherapy or minimally invasive and bariatric surgical procedures can be considered.

2. GUIDELINES: Proper nutrition reduces blood pressure

- DASH diet reduces blood pressure by 11 mm Hg

Consume a diet rich in fruits, vegetables, whole grains, and low-fat dairy products with reduced content of saturated and total fat.

3. GUIDELINES: Reducing sodium intake reduces blood pressure

О- Optimal goal is <1500 mg daily reducing blood pressure by 5-6 mm Hg Sodium intake is positively associated with blood pressure in a lot of studies and accounts for much of the age-related increase in blood pressure. In addition to the well-accepted and important relationship of dietary sodium with blood pressure, excessive consumption of sodium is independently associated with an increased risk of stroke and cardiovascular diseases (1). Salt sensitivity is a quantitative trait in which an increase in sodium load disproportionately increases blood pressure. Salt sensitivity is especially common in blacks, older adults, and those with a higher level of blood pressure or comorbidities such as chronic kidney disease, diabetes, or the metabolic syndrome. Current techniques for recognition of salt sensitivity are impractical in routine clinical practice, so salt sensitivity is best considered as a group characteristic. Individuals can take action to reduce their dietary intake of sodium by choice of fresh foods, use of food labels to choose foods that are lower in sodium content, choice of foods with a “no added sodium” label, judicious use of condiments and sodium-infused foods, use of spices and low-sodium flavorings, careful ordering when eating out, control of food portion size, and avoiding or minimizing use of salt at the table. A reduction in the amount of sodium added during food processing, as well as fast food and restaurant food preparation, has the potential to substantially reduce sodium intake without the need for a conscious change in lifestyle.

UIDELINES: Increasing potassium intake reduces blood pressure

- The optimal target is >3500-5000 mg per day (derived from potassium-rich foods) reduces blood pressure by 4-5 mm Hg Potassium intake is inversely related to blood pressure in large amounts of clinical studies. A higher level of potassium seems to blunt the effect of sodium on blood pressure, with a lower sodium–potassium ratio being associated with a lower level of blood pressure than that noted for corresponding levels of sodium or potassium on their own. Likewise, epidemiological studies suggest that a lower sodium–potassium ratio may result in a reduced risk of cardiovascular risk (2). Good sources of dietary potassium include fruits and vegetables, as well as low-fat dairy products, selected fish and meats, nuts, and soy products. Four to five servings of fruits and vegetables will usually provide 1500 to >3000 mg of potassium. This can be achieved by a diet, such as the DASH diet, that is high in potassium content.

5. GUIDELINES: Limiting alcohol consumption reduces blood pressure

- In individuals who drink alcohol reduce alcohol to men <2 drinks daily and women <1 drink daily reduces blood pressure by 4 mm Hg

References:

1. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published correction appears in Hypertension. 2018 Jun;71(6):e136-e139] [published correction appears in Hypertension. 2018 Sep;72(3):e33]. Hypertension. 2018;71(6):1269-1324. doi:10.1161/HYP.0000000000000066
2. Perez V, Chang ET. Sodium-to-potassium ratio and blood pressure, hypertension, and related factors. Adv Nutr. 2014 Nov 14;5(6):712-41. doi: 10.3945/an.114.006783. PMID: 25398734; PMCID: PMC4224208.