The ultimate high-blood-pressure prevention plan

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UPDATE: NINTH SUPPLEMENT: A LIVE LONGER LIFESTYLE PLAN

How to beat the odds if hypertension runs in your family

Are you one of the 69 percent of our Prevention Program participants who have high blood pressure in their family trees? That puts you at increased risk of developing hypertension yourself--which could mean going on blood-pressure-lowering drugs to control it. And high blood pressure, in turn, ups your risk of heart disease and is the prime risk factor in cases of stroke.

Now, you can't rewrite your family history. "But even if both your parents have hypertension, that doesn't necessarily mean you're going to develop it," says Marvin Moser, M.D., clinical professor of medicine at Yale University School of Medicine and senior advisor to the National High Blood Pressure Education Program. That's because there may be simple strategies you can use to protect yourself from high blood pressure and its dangerous fallout.

Experts aren't quite sure how high blood pressure is linked to heart disease. They think, though, that the force of the blood moving through your blood vessels and arteries somehow damages them, making them more likely to develop hardening of the arteries. Even slightly elevated blood pressure--a systolic (top) number of 130 to 140 or a diastolic (bottom) number of 85 to 89--can increase your risk, especially if that's combined with other risk factors, like being overweight or sedentary, eating too much salt or too little potassium, or possibly experiencing high levels of stress.

Following the basic Prevention Program will go a long way toward helping you keep your blood pressure in normal range (around 120 systolic and 80 diastolic). But here are some extra measures you can take to help beat the odds if you're at increased risk. "In many people, such measures can lower high blood pressure in 30 days," says Prevention advisor William Castelli, M.D., medical director of the Framing-ham Heart Study.

Lose 10 pounds (if you're overweight). Those extra pounds you're sporting on your hips aren't just unattractive--experts say excess weight can cause a two- to sixfold increase in your risk of developing high blood pressure. In fact, it's estimated that 20 to 30 percent of all cases of hypertension are caused by being overweight.

"Research indicates that losing weight is probably the most effective nondrug method of lowering blood pressure," says Dr. Moser, author of Week by Week to a Strong Heart (Rodale Press, 1992). "In some cases, weight loss of 10 to 15 pounds may be enough to lower slightly elevated blood pressures to normal and help you avoid medication."

To help you lose those high-risk pounds, see "The `No-Hunger' Weight-Loss Plan" in our September 1993 issue.

Toss a teaspoon of salt over your shoulder. Instead of on your food, that is. One to 1 1/2 teaspoons of salt represents about half of most people's intake of salt each day. "Reducing salt intake by half will probably lower blood pressure an average of 3 to 5 points systolic and 3 to 4 points diastolic in some people," Dr. Moser says. You cut it in half by swapping the saltshaker in your kitchen and on your dinner table for spicy, no-salt herb blends. Then, opt for no-salt or low-salt versions of processed foods, like sauces, low-fat lunch meats and dairy items like cottage cheese and low-fat cheeses, whenever they're available. How much that affects your risk of developing high blood pressure depends on how "sodium-sensitive" you are. (Certain people are genetically more likely to have blood-pressure responses to sodium, the main ingredient in salt, than others.) There's no good test for sodium sensitivity, yet--so it's a good idea for everyone to try to cut back, and it can't hurt, Dr. Moser says.

Go easy on the hard stuff. It's well-established that if you're a heavy drinker--you drink three or more alcoholic beverages each day--you're more likely to develop high blood pressure than people who drink less. Experts suggest that you should limit yourself to an absolute maximum of two drinks a day. But you may reap even more blood pressure benefits by drinking even less.

Get a morning or midday workout. That may help ward off the effects of daytime stress on your blood pressure, according to a recently published study.

Researchers at Wake Forest University, Winston-Salem, North Carolina, exposed a group of 48 women to two stress-producing tasks as they monitored the women's blood pressure. One day, the women simply rested before the stresses; on the other day, those same women rode stationary bicycles for 40 minutes at 70 percent of their heart-rate reserve (moderate work intensity). Then, after 30 minutes of rest, they were exposed to the stressful situations a second time.

The women's blood pressures during the stressful experiences were significantly lower after they exercised than on the day they didn't exercise. Data from another study suggests that these effects may last up to four or five hours after exercise.

"Our study suggests that exercise may actually buffer responses tostressors that occur after exercise," says Jack Rejeski, Ph.D., professor in the department of health and sport science at Wake Forest University. That could have wide-ranging implications, he says. "One theory argues that the spikes in blood pressure from repeated stress are a cause of hypertension." Brisk walking, stationary cycling, running or any other aerobic exercise lasting 30 minutes or more may yield similar results, Dr. Rejeski says. Exercise has long been part of the prescription for high blood pressure--experts estimate that a regular moderate-exercise program, like the Prevention Program Activity Plan (see Prevention, February 1993), produces a drop of about 10 points in elevated systolic and diastolic levels.

Go bananas. They're packed with potassium--a mineral some studies suggest may help prevent high blood pressure. Some people with hypertension have low potassium intakes. And some unconfirmed pilot studies have suggested that increasing potassium intake lowers blood pressure slightly in both hypertensives and people with normal blood pressure levels. Potassium may dilate your blood vessels, allowing your blood to flow more freely through them. Now, potassium isn't as powerful a tool against high blood pressure as losing weight and salt restriction. And studies of potassium supplements are too small and short-term to justify taking potassium pills to lower or prevent high blood pressure. But there is enough evidence right now that you should make sure you're eating potassium-rich foods. You can find plenty of potassium in many of the foods included in the Prevention 3-2-1 Eating Plan (see February 1993)--especially bananas, potatoes with skins, apricots, prunes, tomatoes and broccoli.

Small studies have also linked calcium, magnesium, fiber and omega-3 fatty acids (found mainly in fish) with lower blood pressure. Again, the evidence underscores the importance of following the 3-2-1 Eating Plan, which is well stocked with foods containing those nutrients.

Learn to relax. According to research, job stress, public speaking--even the stress of arguing and lying--have been shown to cause temporary spikes in blood pressure that may, if experienced long-term, result in high blood pressure, some experts theorize. Exercise is only one way to ward off the effects of stress. Small, preliminary studies have hinted that relaxation methods--like meditation, progressive relaxation (where you tense and then relax the muscles in your body in succession) and biofeedback--may help lower blood pressure in people with hypertension. While larger, better-controlled long-term studies are needed to confirm that evidence, there's a reasonable chance that coping with stress may help you control high blood pressure. "Relaxation can help break the adrenaline cycle--the release of hormones during stress that make your blood vessels constrict or narrow. This increases blood pressure," Dr. Moser says.

ILLUSTRATIONS (5): (MERLE NACHT)

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By Lisa Delaney

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