About one in every four American adults has high blood pressure. High blood pressure is especially dangerous because it often gives no warning signs or symptoms. Fortunately, though, you can find out if you have high blood pressure by having your blood pressure checked regularly. If it is high, you can take steps to lower it. Just as important, if your blood pressure is normal, you can learn how to keep it from becoming high. This fact sheet will tell you how.
The National Heart, Lung, and Blood
Institute--part of the National Institutes of Health--sponsors a nationwide
education program to help people avoid the ill effects of high blood pressure,
and to help prevent high blood pressure altogether (see box below).
The National High Blood Pressure Education Program (NHBPEP), coordinated by the National Heart, Lung, and Blood Institute (NHLBI), works to reduce death and disability related to high blood pressure. The program also promotes prevention of this important public health problem. This nationwide network is composed of many organizations and gives information to health professionals, patients, family members, and the public about the dangers of this serious problem.
made to date has been impressive! The NHBPEP has helped to improve blood
pressure control, contributing to a 50 percent decrease in deaths from
coronary heart disease and a 57 percent decrease in deaths from stroke
over the last 20 years. Many Americans are alive today because they are
controlling their high blood pressure.
Since blood is carried from the heart to all of your body's tissue and organs in vessels called arteries, blood pressure is the force of the blood pushing against the walls of those arteries. In fact, each time the heart beats (about 60-70 times a minute at rest), it pumps out blood into the arteries. Your blood pressure is at its greatest when the heart contracts and is pumping the blood. This is called systolic pressure. When the heart is at rest, in between beats, your blood pressure falls. This is the diastolic pressure.
Blood pressure is always given as these two numbers, systolic and diastolic pressures. Both are important. Usually they are written one above or before the other, such as 120/80 mm Hg, with the top number the systolic, and the bottom the diastolic.
Different actions make your blood pressure go up or down. For example, if you run for a bus, your blood pressure goes up. When you sleep at night, your blood pressure goes down. These changes in blood pressure are normal.
Some people have blood pressure that stays up all or most of the time. Their blood pushes against the walls of their arteries with higher-than-normal force. If untreated this can lead to serious medical problems like these:
Arteriosclerosis ("hardening of the arteries"). High blood pressure harms the arteries by making them thick and stiff. This speeds the build up of cholesterol and fats in the blood vessels like rust in a pipe, which prevents the blood from flowing through the body, and in time can lead to a heart attack or stroke.
Heart Attack. Blood carries oxygen to the body. When the arteries that bring blood to the heart muscle become blocked, the heart cannot get enough oxygen. Reduced blood flow can cause chest pain (angina). Eventually, the flow may be stopped completely, causing a heart attack.
Enlarged heart. High blood pressure causes the heart to work harder. Over time, this causes the heart to thicken and stretch. Eventually the heart fails to function normally causing fluids to back up into the lungs. Controlling high blood pressure can prevent this from happening.
Kidney Damage. The kidney acts as a filter to rid the body of wastes. Over a number of years, high blood pressure can narrow and thicken the blood vessels of the kidney. The kidney filters less fluid, and waste builds up in the blood. The kidneys may fail altogether. When this happens, medical treatment (dialysis) or a kidney transplant may be needed.
Stroke. High blood
pressure can harm the arteries, causing them to narrow faster. So, less blood
can get to the brain. If a blood clot blocks one of the narrowed arteries, a
stroke (thrombotic stroke) may occur. A stroke can also occur when very high
pressure causes a break in a weakened blood vessel in the brain (hemorrhagic
Anyone can develop high blood pressure, but some people are more likely to develop it than others. For example, high blood pressure is more common--it develops earlier and is more severe--in African-Americans than in whites.
In the early and middle adult years, men have high blood pressure more often than women. But as men and women age, the reverse is true. More women after menopause have high blood pressure than men of the same age. And the number of both men and women with high blood pressure increases rapidly in older age groups. More than half of all Americans over age 65 have high blood pressure. And older African-American women who live in the Southeast are more likely to have high blood pressure than those in other regions of the United States.
In fact, the southeastern states have some of the highest rates of death from stroke. High blood pressure is the key risk factor for stroke. Other risk factors include cigarette smoking and overweight. These 11 states--Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, and Virginia--have such high rates of stroke among persons of all races and in both sexes that they are called the "Stroke Belt States."
Finally, heredity can make some families
more likely than others to get high blood pressure. If your parents or grandparents
had high blood pressure, your risk may be increased. While it is mainly a disease
of adults, high blood pressure can occur in children as well. Even if everyone
is healthy, be sure you and your family get your blood pressure checked. Remember,
high blood pressure has no signs or symptoms.
Having your blood pressure checked is quick, easy, and painless. Your blood pressure is measured with an instrument called a sphygmomanometer (sfig-mo-ma-nom-e-ter).
It works like this: A blood pressure
cuff is wrapped around your upper arm and inflated to stop the blood flow in
your artery for a few seconds. A valve is opened and air is then released from
the cuff and the sounds of your blood rushing through an artery are heard through
a stethoscope. The first sound heard and registered on the gauge or mercury
column is called the systolic blood pressure. It represents
the maximum pressure in the artery produced as the heart contracts and the blood
begins to flow. The last sound heard as more air is released from the cuff is
the diastolic blood pressure. It represents the lowest pressure
that remains within the artery when the heart is at rest.
Blood pressure is always expressed in two numbers that represent the systolic and diastolic pressures. These numbers are measurements of millimeters (mm) of mercury (Hg). The measurement is written one above or before the other, with the systolic number on the top and the diastolic number on the bottom. For example, a blood pressure measurement of 120/80 mm Hg is expressed verbally as "120 over 80." See the table below which shows categories for blood pressure levels in adults.
If your blood pressure is less than
140/90 mm Hg, it is considered normal. However, a blood pressure below 120/80
mm Hg is even better for your heart and blood vessels. People use to think that
low blood pressure (for example, 105/65 mm Hg in an adult) was unhealthy. Except
for rare cases, this is not true. High blood pressure or "hypertension" is classified
by stages and is more serious as the numbers get higher.
CATEGORIES FOR BLOOD PRESSURE LEVELS IN ADULTS*
(Age 18 Years and Older)
|Blood Pressure Level (mm Hg)|
|High Blood Pressure|
those not taking medicine for high blood pressure and not having a short
term serious illness. These categories are from the National High Blood
Pressure Education Program.
(< means less than > means greater than or equal to)
For most people, there is no single known cause of high blood pressure. This type of high blood pressure is called "primary" or "essential" hypertension. This type of blood pressure can't be cured, although in most cases it can be controlled. That's why it's so important for everyone to take steps to reduce their chances of developing high blood pressure.
In a few people, high blood pressure
can be traced to a known cause like tumors of the adrenal gland, chronic kidney
disease, hormone abnormalities, use of birth control pills, or pregnancy. This
is called "secondary hypertension." Secondary hypertension is usually cured
if its cause passes or is corrected.
Everyone--regardless of race, age,
sex, or heredity--can help lower their chance of developing high blood pressure.
1) Maintain a healthy weight, lose weight if you are overweight,
2) Be more physically active,
3) Choose foods lower in salt and sodium, and
4) If you drink alcoholic beverages, do so in moderation.
These rules are also recommended for treating high blood pressure, although medicine is often added as part of the treatment. It is far better to keep your blood pressure from getting high in the first place.
Another important measure for your health is to not smoke: while cigarette smoking is not directly related to high blood pressure, it increases your risk of heart attack and stroke.
Let's look more closely at the four rules to prevent high blood pressure and for keeping a healthy heart:
As your body weight increases, your blood pressure rises. In fact, being overweight can make you two to six times more likely to develop high blood pressure than if you are at your desirable weight. Keeping your weight in the desirable range is not only important to prevent high blood pressure but also for your overall health and well being.
It's not just how much you weigh that's important: it also matters where your body stores extra fat. Your shape is inherited from your parents just like the color of your eyes or hair. Some people tend to gain weight around their belly; others, around the hips and thighs. "Apple-shaped" people who have a pot belly (that is, extra fat at the waist) appear to have higher health risks than "pear-shaped" people with heavy hips and thighs.
No matter where the extra weight is, you can reduce your risk of high blood pressure by losing weight. Even small amounts of weight loss can make a big difference in helping to prevent high blood pressure. Losing weight, if you are overweight and already have high blood pressure, can also help lower your pressure.
To lose weight, you need to eat fewer calories than you burn. But don't go on a crash diet to see how quickly you can lose those pounds. The healthiest and longest-lasting weight loss happens when you do it slowly, losing 1/2 to 1 pound a week. By cutting back by 500 calories a day by eating less and being more physically active, you can lose about 1 pound (which equals 3,500 calories) in a week.
Losing weight and keeping it off involves a new way of eating and increasing physical activity for life. Here's how to eat and get on your way to a lower weight:
Choose foods low in calories
and fat. Naturally, choosing low-calorie foods cuts calories. But did
you know that choosing foods low in fat also cuts calories? Fat is a concentrated
source of calories, so eating fewer fatty foods will reduce calorie intake.
Some examples of fatty foods to cut down on are: butter, margarine, regular
salad dressings, fatty meats, skin of poultry, whole milk dairy foods like cheese,
fried foods, and many cookies, cakes, pastries and snacks. See the table below
for low fat foods that you can enjoy instead.
Baked, broiled or poached: chicken and turkey (without the skin); fish; lean cuts of meat
(like round or sirloin).
Skim, 1%, or evaporated skim milk and lower-fat, low-sodium cheeses.
Fresh, frozen, or canned fruit.
Fresh, frozen, or canned (no salt added) vegetables (without cream or cheese sauces).
Plain rice and pasta, English muffins, bagels, sandwich breads and rolls, and soft tortillas.
Cold (ready-to-eat) cereals, lower in sodium and cooked hot cereals (not instant since
they are higher in sodium).
Note: When choosing cheeses, breads, and cereals, use the food label to choose those lower in fat and sodium.
Choose foods high in starch
and fiber. Foods high in starch and fiber, like those shown in the
table, are excellent substitutes for foods high in fat. They are lower in calories
than foods high in fat. These foods are also good sources of vitamins and minerals.
Note: Use the food label to choose breads and cereals lower in sodium.
Limit serving sizes. To lose weight, it's not just the type of foods you eat that's important, but also the amount . To take in fewer calories, you need to limit your portion sizes. Try especially to take smaller helpings of high calorie foods like high fat meats and cheeses. And try not to go back for seconds.
Here's a good tip to help you control or change your eating habits: keep track of what you eat, when you eat, and why, by writing it down. Note whether you snack on high fat foods in front of the television, or if you skip breakfast and then eat a large lunch. Once you see your habits, you can set goals for yourself: cut back on TV snacks and, when you do snack, have fresh fruit, unsalted air-popped popcorn, or unsalted pretzels. If there's no time for breakfast at home, take a low fat muffin, bagel (skip the cream cheese), or cereal with you to eat at work. Changing your behavior will help you change your weight for the better.
Increase physical activity.
There's more to weight loss than just eating less. Another important ingredient
is increasing physical activity, which burns calories. Cutting down on fat and
calories combined with regular physical activity can help you lose more weight
and keep it off longer than either way by itself. Check the table below to see
how many calories you can burn during different activities.
CALORIES BURNED DURING PHYSICAL ACTIVITIES
|Activity||Calories Burned Up Per Hour|
|Walking briskly (3.5 mph)|
|Cycling (5.5 mph)|
|Jogging (9 min./mile)|
|Very strenuous activity:||920||740|
|Running (7 min./mile)|
vary depending on a variety of factors including environmental conditions.
** Healthy man, 175 pounds; healthy woman 140 pounds.
Source: Dietary Guidelines for Americans, U.S. Department of Agriculture, U.S. Department of Health and Human Services, Third edition, 1990 (adapted from McArdle, et al., "Exercise Physiology, " 1986).
Besides losing weight, there are
other reasons to be more active: being physically active can reduce your risk
for heart disease, help lower your total cholesterol level and raise HDL-cholesterol
(the "good" cholesterol that does not build up in the arteries), and help lower
high blood pressure. And people who are physically active have a lower risk
of getting high blood pressure--20 to 50 percent lower--than people who are
not active. You don't have to be a marathon runner to benefit from physical
activity. Even light activities, if done daily, can help lower your risk of
heart disease. So you can fit physical activity into your daily routine in small
but important ways. See table below.
BE MORE ACTIVE EVERYDAY
Use the stairs instead of the elevator.
Get off the bus one or two stops early and walk the rest of the way.
Park farther away from the store or office.
Ride a bike.
Work in the yard or garden.
More vigorous exercise has added benefits. It helps improve the fitness of the heart and lungs. And that in turn protects you more against heart disease. Activities like swimming, brisk walking, running, and jumping rope are called "aerobic." This means that the body uses oxygen to make the energy it needs for the activity. Aerobic activities can condition your heart and lungs if done at the right intensity for at least 30 minutes, three to four times a week. But if you don't have 30 minutes for a break, try to find two 15-minute periods or even three 10-minute periods. Try to do some type of aerobic activity in the course of a week.
Most people don't need to see a doctor
before they start exercising, since a gradual, sensible exercise program has
few health risks. But if you have a health problem like high blood pressure;
if you have pains or pressure in the chest or shoulder area; if you tend to
feel dizzy or faint; if you get very breathless after a mild workout; or are
middle-age or older and have not been active, and you are planning a vigorous
exercise program, you should check with your doctor first. Otherwise, get out,
get active, and get fit--and help prevent high blood pressure. The
sample walking program at the end of this fact sheet can help you get
Americans eat more salt (sodium chloride) and other forms of sodium than they need. And guess what? They also have higher rates of high blood pressure than people in other countries who eat less salt.
Often, if people with high blood pressure cut back on salt and sodium, their blood pressure falls. Cutting back on salt and sodium also prevents blood pressure from rising. Some people like African-Americans and the elderly are more affected by sodium than others. Since there's really no practical way to predict exactly who will be affected by sodium, it makes sense to limit intake of salt and sodium to help prevent high blood pressure.
All Americans, especially people
with high blood pressure, should eat no more than about 6 grams of salt a day,
which equals about 2,400 milligrams of sodium. That's about 1 teaspoon of table
salt. But remember to keep track of ALL salt eaten--including
that in processed foods and added during cooking or at the table. Americans
eat 4,000 to 6,000 milligrams of sodium a day, so most people need to cut back
on salt and sodium. See the table below for the range of sodium in some types
Check food labels for the amount of sodium in foods. Choose those lower in sodium most of the time. Look for products that say "sodium free," "very low sodium," "low sodium," "light in sodium," "reduced or less sodium," or "unsalted," especially on cans, boxes, bottles, and bags.
Buy fresh, plain frozen, or canned with "no salt added " vegetables. Use fresh poultry, fish and lean meat, rather than canned or processed types.
Use herbs, spices, and salt-free
seasoning blends in cooking and at the table instead of salt.
|Meat, Poultry and Fish|
|Bay leaf, marjoram, nutmeg, onion, pepper, sage, thyme||Curry powder, garlic, rosemary, mint||Garlic, onion, sage, pepper, oregano||Bay leaf, curry powder, ginger, marjoram, oregano||Ginger, marjoram, oregano, paprika, poultry seasoning, rosemary, sage, tarragon, thyme||Curry powder, dill, dry mustard, lemon juice, marjoram, paprika, pepper|
|Carrots||Corn||Green Beans||Greens||Peas||Potatoes||Summer Squash||Winter Squash||Tomatoes
|Cinnamon, cloves, marjoram, nutmeg, rosemary, sage||Cumin, curry powder, onion, paprika, parsley||Dill, curry powder, lemon juice, marjoram, oregano, tarragon, thyme||Onion, pepper||Ginger, marjoram, onion, parsley, sage||Dill, garlic, onion, paprika, parsley, sage||Cloves, curry powder, marjoram, nutmeg, rosemary, sage||Cinnamon, ginger, nutmeg, onion||Basil,
bay leaf, dill, marjoram, onion, oregano, parsley, pepper
Cook rice, pasta, and hot cereals without salt. Cut back on instant or flavored rice, pasta, and cereal mixes because they usually have added salt.
Choose "convenience" foods that are lower in sodium. Cut back on frozen dinners, mixed dishes like pizza, packaged mixes, canned soups or broths, and salad dressings which often have a lot of sodium.
When available, buy low-or
reduced-sodium, or "no-salt-added" versions of foods like these:
Rinse canned foods like tuna to remove some sodium.
Drinking too much alcohol can raise your blood pressure. It may also lead to the development of high blood pressure. So to help prevent high blood pressure, if you drink alcohol, limit how much you drink to no more than 2 drinks a day. The "Dietary Guidelines for Americans" recommend that for overall health women should limit their alcohol to no more than 1 drink a day.
This is what counts as a drink:
Other things also may help prevent blood pressure. Here's a roundup of what's being said about them-and whether it's true or false.
foods rich in potassium will help protect some people from developing high blood
pressure. You probably can get enough potassium from your diet, so a supplement
isn't necessary. Many fruits, vegetables, dairy foods, and fish are good sources
of potassium (see table below for examples).
GOOD SOURCES OF POTASSIUM
Catfish Lean Pork Lean Veal
Cod Flounder Trout
Dry Peas and Beans Green Beans
Apricots Peaches Bananas
Prunes and Prune Juice Orange Juice
Lima Beans Stewed Tomatoes Spinach
Plantain Sweet Potatoes Pumpkin
Potatoes Winter Squash
SOURCE: Adapted from "Good Sources of Nutrients, Potassium"
U.S. Department of Agriculture, 1990
Calcium. Populations with low calcium intakes have high rates of high blood pressure. However, it has not been proven that taking calcium tablets will prevent high blood pressure. But it is important to be sure to get at least the recommended amount of calcium--800 milligrams per day for adults (pregnant and breastfeeding women need more)--from the foods you eat. Dairy foods like low fat selections of milk, yogurt, and cheese are good sources of calcium. Low fat and nonfat dairy products have even more calcium than the high fat types.
Magnesium. A diet low in magnesium may make your blood pressure rise. But doctors don't recommend taking extra magnesium to help prevent high blood pressure--the amount you get in a healthy diet is enough. Magnesium is found in whole grains, green leafy vegetables, nuts, seeds, and dry peas and beans.
Fish oils. A type
of fat called "omega-3 fatty acids" is found in fatty fish like mackerel and
salmon. Large amounts of fish oils may help reduce high blood pressure, but
their role in prevention is unclear. But taking fish oil pills is not recommended
because high doses can cause unpleasant side effects. The pills are also high
in fat and calories. Of course, most fish if not fried or made with added fat
are low in saturated fat and calories and can be eaten often.
Fats, Carbohydrates, and Protein. Varying the amount and type of fats, carbohydrates, and protein in the diet has little, if any, effect on blood pressure. But for overall heart health, it is crucial to limit the amount of fat in your diet, especially the saturated fat found in foods like fatty meats and whole milk dairy foods. Saturated fats raise your blood cholesterol level, and a high blood cholesterol level is another risk factor for heart disease. Foods high in fat are also high in calories.
Remember, foods high in complex carbohydrate (starch and fiber) are low in fat and calories--so eating these foods in moderate amounts instead of high fat foods can help you to lose weight if you are overweight or to prevent you from gaining weight.
Caffeine. The caffeine in drinks like coffee, tea, and sodas may cause blood pressure to go up, but only temporarily. In a short time your blood pressure will go back down. Unless you are sensitive to caffeine and your blood pressure does not go down, you do not have to limit caffeine to prevent developing high blood pressure.
Garlic or Onions. Increased amount of garlic and onions have not been found to affect blood pressure. Of course, they are tasty substitutes for salty seasonings and can be used often.
Stress can make blood pressure go up for a while and over time may contribute
to the cause of high blood pressure. So it's natural to think that stress management
techniques like biofeedback, meditation, and relaxation would help prevent high
blood pressure. But this doesn't seem to be the case: the few studies that have
looked at this have not shown that stress management helps to prevent high blood
pressure. Of course, stress management techniques are helpful if they help you
feel better or stick to a weight-loss and/or exercise program.
After going through all the things that may affect blood pressure, it's worth noting again the things that are sure to help you prevent high blood pressure:
1) Maintaining a healthy weight--losing weight if you are overweight,
2) Being more physically active,
3) Choosing foods low in salt and sodium, and
4) If you drink alcoholic beverages, doing so in moderation.
By following these guidelines, you
can help reduce or prevent high blood pressure for life--and, in turn, lower
your risk for heart disease and stroke
A SAMPLE WALKING PROGRAM
|Session A||Walk normally 5 min.||Then walk briskly 5 min.||Then walk normally 5 min.||15 min.|
Continue with at least three exercise sessions during each week of the program. If you find a particular week's pattern tiring, repeat it before going on to the next pattern. You do not have to complete the walking program in 12 weeks.
|Week 2||Walk 5 min.||Walk briskly 7 min.||Walk 5 min.||17 min.|
|Week 3||Walk 5 min.||Walk briskly 9 min.||Walk 5 min.||19 min.|
|Week 4||Walk 5 min.||Walk briskly 11 min.||Walk 5 min.||21 min.|
|Week 5||Walk 5 min.||Walk briskly 13 min.||Walk 5 min.||23 min.|
|Week 6||Walk 5 min.||Walk briskly 15 min.||Walk 5 min.||25 min.|
|Week 7||Walk 5 min.||Walk briskly 18 min.||Walk 5 min.||28 min.|
|Week 8||Walk 5 min.||Walk briskly 20 min.||Walk 5 min.||30 min.|
|Week 9||Walk 5 min.||Walk briskly 23 min.||Walk 5 min.||33 min.|
|Week 10||Walk 5 min.||Walk briskly 26 min.||Walk 5 min.||36 min.|
|Week 11||Walk 5 min.||Walk briskly 28 min.||Walk 5 min.||38 min.|
|Week 12||Walk 5 min.||Walk briskly 30 min.||Walk 5 min.||40 min.|
Week 13 and thereafter:
Check your pulse periodically to see if you are exercising within your target zone. As you get more in shape, try exercising within the upper range of your target zone. Gradually increase your brisk walking time to 30 to 60 minutes, three or four times a week. Remember that your goal is to get the benefits you are seeking and enjoy your activity.
* Here's how to check if you are within your target heart rate zone:
1) Right after you stop exercising, take your pulse: Place the tips of your first two fingers lightly over one of the blood vessels on your neck, just to the left or right of your Adam's apple. Or try the pulse spot inside your wrist just below the base of your thumb.
2) Count your pulse for 10 seconds and multiply the number by 6.
3) Compare the number to the right grouping below: look for the age grouping that is closest to your age and read the line across. For example, if you are 43, the closest age on the chart is 45; the target zone is 88-131 beats per minute.
|AGE||TARGET HEART RATE ZONE|
|20 Years||100-150 beats per minute|
|25 Years||98-146 beats per minute|
|30 Years||95-142 beats per minute|
|35 Years||93-138 beats per minute|
|40 Years||90-135 beats per minute|
|45 Years||88-131 beats per minute|
|50 Years||85-127 beats per minute|
|55 Years||83-123 beats per minute|
|60 Years||80-120 beats per minute|
|65 Years||78-116 beats per minute|
|70 Years||75-113 beats per minute|
SOURCE: Exercise and Your Heart, National Heart, Lung, and Blood Institute and the American Heart Association, NIH Publication No. 93-1677.
For more information on either high
blood pressure or weight and physical activity, contact:
National Heart, Lung, and Blood Institute Information Center
P.O. Box 30105
Bethesda, MD 20824-0105