Diet and Health Guidelines to Lower Risk of High Blood Pressure

Presented by Janice Hermann, PhD, RD/LD

OCES Adult and Older Adult Nutrition Specialist

What Is Blood PressureBlood pressure is the pressure on the blood

vessel wallsA blood pressure reading consists of two numbers,

for example 120/80 The first number is called systolic

Pressure when the heart contractsThe second number is called diastolic

Pressure when the heart is resting between contractions

How is Blood Pressure Classified

Systolic mm Hg Diastolic mm Hg

Recommended

Blood Pressure

< 120 < 80

Borderline-high Blood Pressure

120-139 80-89

High Blood Pressure

≥ 140 ≥ 90

Diagnosing High Blood PressureTo diagnose high blood pressure you need

two high blood pressure readings, taken several weeks apart, with either the systolic or diastolic or both consistently above 140/90Blood pressure changes throughout the dayJust going to the doctor may make some people’s

blood pressure rise

Diagnosing High Blood PressureHigh blood pressure can progress silently and

without symptomsEstimated 1/3 of people with high blood pressure

and are unaware However, with detection and proper treatment

high blood pressure can be controlledPeople need to have their blood pressure checked

regularly, at least every two years

Children Should Have Blood Pressure Checked TooChildren should have blood pressure checked

regularly tooHigh blood pressure in children may signal an

underlying disease or early onset of high blood pressure

Effect of High Blood PressureHigh blood pressure is a serious health

problemHigh blood pressure causes the heart to work

harder, and over time may damage blood vesselsDamage to blood vessels in the heart may

increase the risk of heart diseaseDamage to blood vessels in the brain may increase

the risk of strokeDamage to blood vessels in the kidney may

increase the risk of kidney damage

Causes of High Blood PressureBlood pressure arises from:

Contractions of the heart muscle that pump blood away from the heart (cardiac output) and

Resistance that blood encounters as it moves through the arteries (peripheral resistance)

When either cardiac output or peripheral resistance increases, blood pressure rises

Causes of High Blood PressureCardiac output is raised when:

Heart rate increasesBlood volume increases

Sodium retentionFluid retention

Causes of High Blood PressurePeripheral resistance is mostly affected by

physical and chemical signals that alter the blood vessel diameterSignals from the nervous system influence the

heart’s pumping activity and blood vessel diameterSignals from hormones promote fluid retention

and blood vessel constrictionThe kidneys also control section of hormones

involved in sodium and water retention and blood vessel constriction

Causes of High Blood PressureHigh blood pressure is a very complex

condition Primary or essential hypertension develops

without an identifiable cause (95%)Most cases of high blood pressure have no

identifiable causeSecondary hypertension is caused by a

specific disorder (5%)Usually due to abnormalities in organs or

hormones involved in regulating blood pressure

Causes of High Blood PressureCauses of secondary hypertension

Chronic kidney disease interferes with the removal of sodium and water from the blood, thus increasing blood volume and blood pressure

Atherosclerosis in the renal blood vessels may cause increased production of hormones that stimulate water retention and blood vessel constriction

Causes of High Blood Pressure

Causes of secondary hypertensionArtery stiffness and thickening due to age,

diabetes, atherosclerosis and other reasons can increase resistance to blood flow, increasing blood pressure

Hormonal disorders, including some thyroid diseases and adrenal disorders, can also cause high blood pressure

Risk FactorsThere are factors that may affect high blood

pressureFamily history of high blood pressureBeing overweightIncreasing agePhysical inactivitySmokingDiabetesHigh sodium intake (sodium sensitive people)High alcohol intakeHigh fat dietLow potassium, calcium and magnesium intake

Family HistoryHigh blood pressure tends to run in familiesPeople in the same family may have similar

lifestyle and dietary habits that increase their risk of developing high blood pressure

High blood pressure is more prevalent and severe among African Americans

OverweightBeing overweight is a risk for high blood

pressure Carrying excess weight in the abdomen is a

greater risk for high blood pressure than carrying excess weight in the hips and thighs

Bringing weight down may be all some people need to do to control their blood pressure

Obesity

Rate of high blood pressure increases with overweight

Rate of High Blood Pressure

Men Women

Obese 38% 32%

Healthy weight 18% 16%

Weight ManagementWeight management recommendations are:

To maintain body weight in a healthy range, balance calories from foods and beverages with calories expended

To prevent gradual weight gain over time, make small decreases in food and beverage calories and increase physical activity

Age

Blood pressure tends to increase with ageMen typically begin having an increase in blood

pressure by age 45 to 50Women typically begin having an increase in

blood pressure after menopauseHowever, just because you get older doesn’t

mean you will develop high blood pressure

Physical ActivityPhysical activity can help you:

Lose weightLower total cholesterolLower LDL-cholesterolLower triglyceridesIncrease HDL-cholesterol

All of which can lower the risk of:High blood pressureHeart diseaseStrokeDiabetesObesity

Physical ActivityEngage in regular physical activity and reduce

sedentary activities to promote health, psychological well-being, and a healthy body weight

Physical activity recommendations are:150 minutes of moderate-intensity per week or75 minutes of vigorous-intensity per week

SmokingSmoking increases your risk of high blood

pressure Smoking raises blood pressure level and heart rateSmoking lowers HDL-cholesterolSmoking increases the tendency of blood to clot

DiabetesHigh blood pressure is more common in

people who have uncontrolled diabetes Insulin resistance, commonly associated with

obesity, signals the pancreas to produce more insulinHigh insulin signals the kidneys to retain sodium

and thus may increase the risk of developing high blood pressure

SodiumYour kidneys regulate the sodium level in

your body Most people aren't affected by excess

dietary sodium because their bodies just get rid of excess sodium in the urine

Sodium Sensitive PeopleHowever, some people are sodium-sensitiveFor sodium-sensitive individuals, too much

sodium in the diet can increase blood pressure

Sodium Sensitive PeopleFor sodium-sensitive people, lowering

sodium intake may help lower blood pressure55% white73% African Americans

Unfortunately, there’s no easy way to know who may be a sodium-sensitive individual

Sodium Sensitive PeoplePeople most likely to be sodium-sensitive:

Family history of high blood pressureChronic kidney diseaseDiabetesAfrican AmericanOver 50 years of ageOverweight

How Much SodiumDietary Guidelines recommend

People reduce daily sodium intake to less than 2,300 mg (approximately 1 teaspoon of salt) and

Further reduce sodium intake to less than 1,500 mg sodium among those:51 years of age or olderof any age who are African American or have

hypertension, diabetes or chronic kidney disease

How Much SodiumThe DRI for sodium is:

1,500 mg/day for people 19-50 years of age1,300 mg/day for people 51-70 years of age1,200 mg/day for people >70 years of age

The Upper Level for sodium intake for adults is 2,300 mg/day

On average, most adults consume significantly more, 4,000 to 6,000 milligrams of sodium daily

Where Is SodiumAs much as 75% of the sodium in your diet

comes from salt added to foods during processing

About 15% comes from salt added during cooking and at the table

Only 10% comes from the natural content in foods

Replacing Sodium LossesAlthough you lose sodium and some other

minerals in perspiration, the amount lost is usually smallRegular meals and snacks eaten after physical

activity will normally replace electrolytes (sodium and potassium) lost in perspiration

In extreme heat beverages containing electrolytes such as Gatorade or Powerade help replace fluids and electrolytes lost in perspiration

AlcoholHeavy alcohol consumption, 3 or more

drinks daily, is strongly associated with increased risk of high blood pressureEffect of moderate alcohol intake on blood

pressure unknownRecommended alcohol intake is:

Not more than one alcoholic drink a day for women

Not more than two alcoholic drinks a day for men

Alcohol

Role of alcohol with high blood pressure is unclearMay contribute extra calories which may

increase body weight

Fat, Trans Fat, Saturated Fat & CholesterolHigh fat, trans fat, saturated fat and

cholesterol intakes are linked to high cholesterol, LDL-cholesterol, and triglycerides which contributes to atherosclerosis and high blood pressure

Atherosclerosis narrows the blood vessels and decreases blood flow to the kidneys

Fat, Trans Fat, Saturated Fat & Cholesterol

The kidneys try to increase blood flow to the kidneys by expanding blood volume and constricting smaller blood vessels

However, blood pressure increases not only in the kidneys, but all over the body, which further damages blood vessels and increases atherosclerosis

Fat, Trans Fat, Saturated Fat & Cholesterol

Lowering total fat, saturated fat, cholesterol and trans fat helps lower blood cholesterol and triglycerides, which may lower atherosclerosis

Reducing fat helps with weight loss, which may lower blood pressure

Fat, Trans Fat, SaturatedFat & Cholesterol

Recommendations are:Keep total fat intake between 20 to 35 % of

calories, with most fats coming from polyunsaturated and monounsaturated fats

Consume less than 10 percent of calories from saturated fatty acids

Consume less than 300 mg/day of cholesterolKeep trans fatty acid consumption as low as

possible

Other Dietary FactorsToo little of some other nutrients including

potassium, calcium and magnesium, may have an important link to high blood pressure

Adequate intakes of these minerals may have a protective effect against high blood pressure

Other Dietary FactorsPotassium has roles with:

Maintaining fluid balanceMuscle contraction

Calcium has roles with:Activating messengers that help maintain normal

blood pressureMagnesium has roles with:

Heart functionLessening blood vessel constriction

Other Dietary FactorsFruits and vegetables are good sources of

potassiumMilk and dairy products are a good source of

all three nutrientsThe best guideline is to follow the USDA Daily

Food Plan

Other Dietary FactorsFor some individuals potassium may be

beneficial, but for individuals with kidney problems potassium may be restricted.

Check with your doctor before using a potassium chloride salt substitute.

Emotional StressFor some people, stress may be a factor for

high blood pressureLearning how to relieve stress improves the

overall quality of one's life

Lower Risk of High Blood PressureFollow Dietary Guidelines

Maintain a healthy weightBe physically active each dayConsume ample fruits, vegetables or dairy products

to provide calcium, potassium, and magnesium Keep total fat, saturated fat, trans fat, and

cholesterol intakes within recommended levelsKeep sodium intake below 2,300 mg or 1,500 mgUse alcohol in moderation

Abstain from smokingKeep diabetes in control