High Blood Pressure

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High Blood Pressure

Nondrug Strategies with Maximum Effect

Doctors aren't sure what causes blood pressure to increase above 140/90 mmHg (millimeters of mercury), considered a healthy upper limit. Diseases affecting the kidneys, adrenals or other glands can occasionally raise blood pressure--a condition that doctors call secondary high blood pressure, says Lois Anne Katz, M.D., professor of clinical medicine at New York University School of Medicine and associate chief of nephrology and associate chief of staff for ambulatory care at New York Veterans Affairs Medical Center, both in New York City.

But 19 times out of 20, high blood pressure happens for no apparent reason, she adds.

The kidney plays a major role in blood pressure regulation, says Dr. Katz. "It's possible that sometime in the future we might find a gene that affects the kidney and causes high blood pressure."

All we really know for sure is that women who are overweight, have diabetes or are African-American carry the greatest risk of getting high blood pressure, she says. Women who take birth control pills also have a slightly increased risk, although no one is quite sure why.

"High blood pressure is very common among women," adds Dr. Katz. According to the American Heart Association, if you're between ages 35 and 55, chances are about one in four that you have it, while nearly one out of two women over the age of 55 have it.

Uncontrolled, high blood pressure increases your risk of heart disease, kidney failure and stroke. But, for most women, elevated blood pressure can be controlled before it has a chance to do any harm, says Dr. Katz.

THE NONDRUG ROUTE

In some cases, doctors prefer that women with high blood pressure try nondrug strategies first, says Dr. Katz. And here's what they suggest.

Drop extra pounds. "People who lose a considerable amount of weight--say 20 or 30 pounds--can sometimes bring their blood pressure down," says Dr. Katz. Losing excess weight may actually cause a chemical change in the body that alters metabolism, she says. It decreases the amount of insulin you produce, which can sometimes be a factor in triggering high blood pressure.

The best way to lose excess weight is to listen to your body's appetite signals, adds Dr. Katz. Eat only when you're hungry (not around the clock), stop eating when you're full and avoid foods that are high in fat or sugar (or both). Also, keep portions modest. Gradually, weight should come down.

Work fruit, beans and potatoes into the menu. Loading up on potassium-rich fruits and vegetables is an important part of any blood pressure-lowering program, says Linda Van Horn, R.D., Ph.D., professor of preventive medicine at Northwestern University Medical School in Chicago. Aim for potassium levels of 2,000 to 4,000 milligrams a day, she says.

When To See A Doctor Even if you've never been told that you have high blood pressure, it's good to have it checked at least once a year, because early detection (and control) is the key to preventing untoward effects, like heart or kidney disease. And you should definitely have your blood pressure checked if you become pregnant. "Sometimes blood pressure goes up during pregnancy," says Lois Anne Katz, M.D., professor of clinical medicine at New York University School of Medicine and associate chief of nephrology and associate chief of staff for ambulatory care at New York Veterans Affairs Medical Center, both in New York City. Because blood pressure normally declines in pregnancy, she explains, a rise is of great concern. During pregnancy a small but significant increase in blood pressure could be a sign of pre-eclampsia (a serious complication requiring immediate medical attention) if accompanied by excessive weight gain and the presence of protein in the urine, says Dr. Katz.

No one knows exactly how potassium lowers blood pressure, but a study at the Johns Hopkins Medical Institutions in Baltimore found that those who took 3,120 milligrams a day lowered their systolic blood pressure (the top number of a blood pressure reading) an average of nearly seven points and reduced their diastolic pressure (the bottom number of the reading) an average of about two points.

Top sources of potassium are orange juice, potatoes, bananas, beans, cantaloupe, honeydew melon and dried fruits such as prunes and raisins.

Work that body. Aerobic exercise--activities that use your major muscles and raise your heart rate, like biking, running and swimming--also seems to bring down blood pressure, perhaps by keeping your blood vessels more flexible, says Linda L. Colle Gerrond, M.D., director of the Center for Women's Health at the Shawnee Mission Medical Center near Kansas City, Kansas. Regular exercise also burns fat and calories, making it easier to lose or maintain weight.

To help control your blood pressure, Dr. Gerrond recommends 30 minutes of aerobic exercise three times a week as long as your physician says that you're ready. For a successful long-term program, do the exercises you like best, she suggests.

Use salt judiciously. In most people, eating salt does not increase the risk of high blood pressure, says Dr. Katz. But for some reason, it may affect a few. So if you have high blood pressure, it doesn't hurt to use salt judiciously--don't add it to foods at the table, and limit super-salty foods like chips to a once-in-a-while indulgence.

"Keep daily salt to no more than one teaspoonful--or its equivalent (2,000 milligrams) in sodium from food," she says.

Take calcium supplements. Although not all doctors agree, some research suggests that calcium is an important nutrient in keeping blood pressure levels healthy in at least some women, says Dr. Gerrond. In a study at the University of Florida Health Science Center in Jacksonville, researchers found that 2,000 milligrams of calcium a day reduced the onset of high blood pressure in pregnant women by 54 percent. Doctors don't know the exact mechanism that seems to be at work. But experts say that women should be sure to get the optimum daily intake for calcium, which is:

* 1,000 milligrams a day if you're under age 50 or on hormone replacement therapy

* 1,200 to 1,500 milligrams daily if you're pregnant or nursing

* 1,500 milligrams a day if you're postmenopausal and not taking estrogen, or if you're over age 65

"Most women don't consume enough milk, yogurt or other food sources of calcium, presumably because they're worried about the calories," says Dr. Gerrond. Nonfat dairy products or calcium supplements (or a combination of both) can help assure you consume protective amounts.

Trash tobacco. For those just starting, the powerful chemicals in inhaled cigarette smoke prompt blood vessel walls to constrict temporarily, increasing pressure on blood coursing through the arteries, says Dr. Katz. In addition, smoking greatly increases your risk for stroke, often blamed on high blood pressure. So if you smoke, quit.

Save alcohol for special occasions (or don't drink at all). Drinking alcohol in excess tends to raise blood pressure, so doctors advise moderation or abstinence. If you enjoy drinking, Dr. Katz suggests limiting yourself to two glasses of wine or bottles of beer a day at the most. And if you don't drink, don't start.