Lower your blood pressure NATURALLY

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SEVEN MEDICALLY PROVEN, DRUGLESS WAYS TO THWART THIS LEADING KILLER

As his yoga teacher at Iyengar Yoga Institute of Los Angeles raises herself up lithely on all fours, demonstrating the backstretching "down dog" pose, David Shapiro, PhD, follows along. At 78, Dr. Shapiro, professor emeritus in the UCLA department of psychiatry & biobehavioral sciences and an early pioneer in studies linking stress reduction to lower blood pressure, is fit, not to mention as placid as a Zen garden. So it catches me off guard when he reveals that he, like so many Americans, takes medication for high blood pressure. But thanks to regular exercise, a healthy diet, and stress-reducing pursuits such as yoga, he says, he's been able to cut back on his medication significantly.

"I'm hoping to cut back altogether," says Dr. Shapiro, whose research has shown, among other things, that people with high blood pressure who make healthy lifestyle changes and manage their stress can often cut back on their meds and associated side effects, if not give them up entirely. Not surprisingly, he recommends these changes for everyone, even those who haven't been diagnosed with high blood pressure. With good reason. Last year, a report from the famed Framingham Heart Study warned that middle-aged and older Americans face a 90% chance of developing high blood pressure sometime in their lives. No small thing, since high blood pressure, while it causes no symptoms, boosts the risks of leading killers such as heart attack and stroke, as well as aneurysms, cognitive decline, and kidney failure.

Sitting in the back of the class, grimacing through yoga moves that no one but I seem to be having trouble with, I wonder if my odds of developing high blood pressure are even higher than average. I'm fit and fairly calm myself, but my father, who had untreated high blood pressure, or "hypertension," died of a stroke at 57. My mother has high blood pressure too. Among other things, heredity influences risk of high blood pressure. (See "Are You at Risk?" on p. 150.)

As I tally up my risk factors, the story I'm researching takes a personal turn. I vow to take the advice that experts such as Dr. Shapiro offer for controlling blood pressure: maintaining a healthy weight, exercising, eating right, and managing stress. "It takes all of these to fight the risk of high blood pressure," says Prevention advisor Redford B. Williams, MD, professor of psychiatry and medicine at Duke University Medical Center. I may even try to get good at yoga.

If you have normal blood pressure, following these steps can help lower those 90% odds that your numbers will rise. If you already have high blood pressure, they'll help you control it, possibly with a lower dose of medication, or none at all. Here's your to-do list.

1. Carry Less Excess
"When we're talking about preventing high blood pressure, by far the most important lifestyle factor to consider is weight," says Curtis Ellison, MD, chief of preventive medicine and epidemiology at Boston University School of Medicine.

Why excess weight translates to excess risk of high blood pressure is still a bit of a mystery, Dr. Ellison says. Among other things, obesity is associated with abnormalities in glucose and calcium metabolism and with certain hormonal changes that may be linked to high blood pressure, he notes.

"Almost everybody, if they lose a few pounds, is going to bring their blood pressure down," he says. In some cases, very few pounds will do the trick. In one study, people who lost an average of just 7.7 lb and kept it off were half as likely to have high blood pressure as those who hadn't lost weight.

The best way to lose weight? Exercise more, and eat less. For more on both tactics, read on.

2. Sweat It
Exercise helps lower blood pressure in a number of ways. It helps you shed excess pounds and manage stress. Regular aerobic exercise also strengthens your heart so it can pump blood more efficiently. That, in turn, lowers your resting heart rate, which is helpful because a slower heart rate translates into lower blood pressure. Regular aerobic workouts also help make your blood vessels more flexible, so they give more when your heart pumps blood, and that also translates into lower pressure.

Prevention recommends 30 minutes of moderate-intensity activity (such as walking, jogging, or cycling) at least 5 days a week.

"Moderate-intensity exercise appears to lower blood pressure as much as vigorous exercise," says Deborah Young, PhD, associate professor in the department of kinesiology at the University of Maryland.

3. Do the DASH Diet
Incorporating little fat, cholesterol, red meat, or sweets, but lots of fruits, vegetables, whole grains, and low-fat or fat-free dairy products, this diet takes its name from the comprehensive "Dietary Approaches to Stop Hypertension" study. The study followed more than 450 adults, about one-third of whom had high blood pressure, as they ate one of three diets: standard American fare, a similar diet that was higher in fruits and vegetables, and the DASH diet. While both the plan rich in fruits and vegetables and the DASH diet cut blood pressure, the DASH diet had the greatest effect, and after just 2 weeks.

Why does DASH work? "While the diet is rich in vitamins and minerals that have been linked to lower blood pressure, it's not these nutrients alone but the whole dietary package that works," explains Eva Obarzanek, PhD, a research nutritionist at the National Heart, Lung, and Blood Institute and a project officer for the DASH study.

Previous studies testing the blood pressure-lowering effects of supplements containing some individual nutrients were inconclusive. "It is possible that some nutrients have small effects individually, but when you get them all together in this diet, you see a significant effect on blood pressure," she says.

Though the DASH diet wasn't designed to promote weight loss, you can easily modify it so you'll trim down by cutting back on servings and substituting lower-calorie for higher-calorie food choices. For details, see "The Diet That Lowers Blood Pressure," below.

4. Shake Off Sodium
To get even better results, follow the DASH diet and cut back on sodium, Dr. Obarzanek suggests. A follow-up to the DASH study, called "DASH-Sodium," found that doing both lowered blood pressure more than following the diet alone. In the study, even people with normal blood pressure lowered their blood pressure when they cut back on sodium.

Certain groups of people--the elderly, African-Americans, and those with a family history of high blood pressure--are more likely than others to have blood pressure that's particularly salt (or sodium) sensitive. But since there's no way to tell whether any one individual is sodium sensitive, everyone should lower his sodium intake, says Dr. Obarzanek. How far? To 1,500 mg daily, about half the average American intake, she says. (Half a teaspoon of salt contains about 1,200 mg of sodium.)

Cutting sodium means more than going easy on the saltshaker, which contributes just 15% of the sodium in the typical American diet. In addition to seasoning the foods you cook with spices, herbs, lemon, and salt-free seasoning blends, watch for sodium in processed foods, Dr. Obarzanek warns. Most of the sodium in your diet comes from processed foods, she says.

5. Flag Yourself at One or Two Drinks
According to a recent analysis of 15 studies, the less you drink, the lower your blood pressure will drop--to a point. A study of women at Boston's Brigham and Women's Hospital, for example, found that light drinking--defined as one-quarter to one-half a drink per day for a woman--may actually reduce blood pressure more than no drinks per day. One "drink" is 12 oz of beer, 5 oz of wine, or 1.5 oz of spirits.

Other studies have also found that moderate drinking--up to one drink a day for a woman, two for a man-can lower risks of heart disease. "High levels of alcohol are clearly detrimental," says Dr. Obarzanek. "But moderate alcohol is protective of the heart. If you are going to drink, drink moderately."

6. Stay Out of Café Nervosa
Scientists have long debated the effects of caffeine on blood pressure. Some studies have shown no effect, but a recent study at the Duke University Medical Center found that caffeine consumption of 500 mg-roughly three 8-oz cups of coffee-increased blood pressure by 4 mm/Hg, and that effect lasted until bedtime. For reference, 8 oz of drip coffee contains 100 to 125 mg; the same amount of tea, 50 mg; an equal quantity of cola, about 40 mg.

Caffeine can raise blood pressure by tightening blood vessels and by magnifying the effects of stress, says Jim Lane, PhD, associate research professor at Duke and the lead author of the study. "When you're under stress, your heart starts pumping a lot more blood, boosting blood pressure," he says. "And caffeine exaggerates that effect." Can't live without your morning cup? Look around for decaf versions.

7. Learn to Chill
Meditation and other relaxation techniques such as yoga and tai chi can help lower blood pressure significantly, says Richard Liebowitz, MD, medical director of the Duke Center for Integrative Medicine. In a study of 62 sedentary seniors, in fact, those who started doing tai chi saw their blood pressure drop nearly as much as those who began a moderate-intensity aerobic exercise program.

Relaxation techniques trigger what Herbert Benson, MD, of Harvard Medical School, has dubbed the "relaxation response," a calming of the nervous system that can lower blood pressure and slow breathing rate.

For a quick, at-home course in meditation, see "The 5-Minute Meditation" at www.prevention.com/links. While you can learn yoga and tai chi from videos, says Dr. Shapiro, many people find it easier to learn from an instructor and regular classes. To find out more about yoga and how to select an instructor, contact the American Yoga Association, PO Box 19986, Sarasota, FL 34276, or visit www.prevention.com/linksfor a link to its Web site. To find out more about tai chi, go to www.prevention.com/links to link to a Web site with lots of tai chi resources.

What Is High Blood Pressure?
Your blood pressure readings--always two numbers, one over the other--gauge the force your circulating blood exerts against the walls of your blood vessels. Systolic pressure, the top number in a reading, indicates the pressure as your heart beats or contracts. The bottom number, your diastolic reading, indicates the pressure between contractions. You have high blood pressure when you have a systolic blood pressure of 130 millimeters of mercury (mm/Hg) or higher and a diastolic blood pressure of 85 mm/Hg or higher, or 130/85. But most experts now agree that your optimal pressure is 120/80 or lower, as low as you can go without fainting when you stand up.

Good news, no matter your readings: Just a tiny drop in blood pressure, 2 mm/Hg, could reduce strokes by 14% and heart disease by 6%, potentially saving 70,000 lives a year.

Are You at Risk?
An estimated one in four American adults has high blood pressure. That's more of us than have high cholesterol. Why so many? In some cases, medical problems, such as kidney disease or narrowing of the arteries, are the culprit. But in most cases, it's not clear what's to blame. Certain risk factors, however, seem to boost your odds of developing high blood pressure.

Age. As you get older, you're more likely to develop high blood pressure.

Excess weight.

Ethnicity. High blood pressure is particularly common among African-Americans.

A family history of high blood pressure.

PHOTO (COLOR): You and your pressure can stay calm-all without drugs.

PHOTO (COLOR): Perk up the flavor with herbs, no salt.

PHOTO (COLOR): If you're African-American, you're at higher risk.

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By Michael Tennesen and Barbara Loecher

Michael Tennesen is a California-based freelance writer. Senior Editor Barbara Loecher also contributed to this article.

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