Lifestyle Treatments for Hypertension

High blood pressure, or hypertension, goes hand in hand with diabetes and obesity, affecting about 75 percent of people with type 2 diabetes. The combination of the two increases your risk of developing eye, kidney, and heart disease and stroke. If you throw in abnormal cholesterol levels, which will be discussed later in this chapter, you have a potentially lethal combination that increases the risk of heart disease and stroke even more.

All three—hypertension, obesity, and abnormal cholesterol and other blood fats—are connected to the prediabetic and diabetic states, and all three can be improved with lifestyle changes. High blood pressure responds to the lifestyle changes that lead to weight loss and increased activity levels, as we have already discussed. For example, a weight loss of five to fifteen pounds, achieved in studies such as the Diabetes Prevention Program and Trials of Hypertension Prevention Study, can lower blood pressure by two to five points (for example, from 135/80 to 130/76).

While this may not seem like a big change, it is sufficient to decrease substantially your risk of getting hypertension and decrease your long-term risk of heart disease or stroke. Remember, at the same time, you are reducing the risk for developing diabetes or reducing your blood-sugar level if you already have diabetes, and you are reducing your risk of getting heart disease through other mechanisms. Weight loss and increased physical activity may also make you feel and look better.

Other lifestyle interventions have proved to decrease blood pressure. Reducing salt in your diet by approximately one teaspoon per day—as done in the Dietary Approaches to Stop Hypertension (DASH) study and the Trial of Nonpharmacologic Interventions in Elderly (TONE) study—will also lower blood pressure by two to five points. Combining weight loss with dietary salt reduction is even more effective and may lower your chances of developing high blood pressure or needing medications by as much as 50 percent.

The DASH diet reduces blood pressure by emphasizing an eating pattern rich in fruits, vegetables, and grains with reduced saturated fat and total fat content. The reductions in blood pressure were achieved with a sodium intake of 3,000 milligrams per day, a stable body weight, and two or fewer alcoholic beverages per day. As summarized in Table 4.3, the DASH diet recommends a certain number of servings per day from each food group.

To keep your sodium intake to fewer than three thousand milligrams per day, avoid table salt, avoid entrées containing seven hundred milligrams or more of sodium, and keep the following high-sodium foods to a minimum:

• Canned or dried soups, bouillon, bouillon cubes

• Foods with salt toppings

• Processed, smoked, dried, or cured meats, poultry, or fish (bacon, cold cuts, frankfurters, ham, salt pork, sausage, anchovies, sardines, salted cod, smoked herring, corned beef, turkey, chicken loaf or roll)

table 4.3 DASH Diet Servings

Food Group

Daily Servings

1 Serving Equals



1 slice bread; 1 cup dry cereal; V2 cup cooked rice, cereal, or pasta



1 cup raw leafy vegetable; V2 cup cooked vegetable



1 medium fruit; V2 cup mixed fruit

Low-fat/nonfat dairy


8 ounces nonfat/1% milk or yogurt; 1.5 ounces low-fat/nonfat cheese

Meats, poultry, fish

2 or fewer

3 ounces cooked lean meats, poultry, or fish (trim away visible fat)


4-5 per week

1.5 ounces or V3 cup nuts; 2 tablespoons or V2 ounce seeds; V2 cup cooked legumes

Fats and oils


1 teaspoon oil, margarine, mayo; 1 tablespoon regular or 2 tablespoons low-fat salad dressing


5 per week

1 tablespoon jelly or jam or maple syrup (may want to use sugar-free versions if you have diabetes)

Adapted from "A Clinical Trial of the Effects of Dietary Patterns on Blood Pressure," New England Journal of Medicine 336 (1997): 1117.

Adapted from "A Clinical Trial of the Effects of Dietary Patterns on Blood Pressure," New England Journal of Medicine 336 (1997): 1117.

• Processed cheese, Parmesan, Romano, Roquefort, feta, blue cheese, cheese spreads

• Canned vegetables, sauerkraut, any vegetable prepared in brine, pickles, olives, pickled beets, tomato or vegetable juice

• Salted snack foods, salted popcorn, cheese curls, potato chips, corn chips, salted nuts, pretzels

• Garlic salt, celery salt, onion salt, chili sauce, sea salt, soy sauce, meat tenderizers, monosodium glutamate, steak sauce, stuffing mixes, package mixes for sauces and gravies, some salad dressings

If you increase your activity level and eat the fewest number of servings in each food category, then you will also lose weight and maximize your blood pressure-lowering potential with lifestyle changes.

The reductions in blood pressure with lifestyle changes may seem small compared with the results that are achieved with some of the powerful medications that are available today; however, for many people with only modestly elevated blood pressure, the lifestyle changes will achieve blood pressure reductions that have a demonstrable benefit on long-term health. Making a lifestyle change is also much less expensive than taking pills. In addition, although there may be side effects of lifestyle changes, such as orthopedic injuries associated with increased activity levels, they are generally infrequent, minor, and temporary.

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