High Blood Pressure

About one in four Americans has high blood pressure, or hypertension. But only two-thirds of these people actually know about it, and only half are taking steps to control it. The main reason people ignore high blood pressure is that it causes no symptoms-until they collapse from a stroke or find out they have heart disease. No wonder that it's called a silent killer.

To understand how blood pressure works, imagine that your blood vessels are a closed system of interlocking garden hoses. The water flowing through the hoses is your blood, and it's circulated by a pump, your heart. Just as water pushes against the inside of a hose, your blood pushes against the inside of your blood vessels, exerting pressure.

Every time your heart beats, blood exerts extra pressure on your blood vessels. That's systolic pressure, the first, or top, number in a blood pressure reading. When your heart rests between beats, there's residual pressure inside your vessels. That's diastolic pressure, the second, or bottom, number in a blood pressure reading. These numbers are expressed as millimeters of mercury (rom Hg).

"Normal" blood pressure is 120/80. But that's misleading, says Anne Simons, M.D. Your blood pressure varies over the course of the day. When you wake up in the morning, it's on the low side. Then it rises as the day goes on. And if you exert yourself-say, running to catch an elevator or a bus-it spikes sharply.

Because blood pressure varies so much, the term high blood pressure refers to persistently high readings. One high reading is meaningless, especially if it shows up during a doctor visit. (Doctor visits make many people anxious and can raise their blood pressures significantly.)

Until recently, physicians diagnosed blood pressure as high if it remained above 140/90 for a month or two. Now researchers have discovered that even readings in the high-normal range-from 130/85 to 139/89-can cause problems.

If you have high blood pressure but don't treat it for many years, it can contribute to a number of serious conditions, including atherosclerosis (hardening of the arteries), stroke, congestive heart failure, and kidney disease.

Anyone can develop high blood pressure, but some people are more susceptible to the condition than others. Men are more likely than women to develop high blood pressure, and a higher percentage of African­ Americans than Whites have this problem.

You've probably heard that consuming too much sodium can raise your blood pressure. But you may not realize that consuming too little vitamin C, potassium, magnesium, or calcium can have the same effect.

"High blood pressure is one of the many diseases associated with our Western diet," says Joseph Pizzorno Jr., N.D. "The condition exists almost exclusively in developed countries. People living in remote areas of China, New Guinea, Brazil, and Mrica show virtually no evidence of high blood pressure, nor do they experience a rise in blood pressure as they age. What's more, when members of these societies emigrate to less remote areas and adopt more 'civilized' diets, their risk of high blood pressure rises dramatically:"

Researchers note that you have a higher risk if your family has a history of stroke or high blood pressure. You also have elevated risk if you are obese, if you drink excessively, or if you smoke. To treat high blood pressure, mainstream doctors tend to rely on prescription medications. But many studies have shown that in cases where blood pressure is only mildly elevated (140/90 or lower), nondrug therapies work just as well.

"Few patients with (mild) high blood pressure require drug treatment," writes Edward D. Freis, M.D., of the Hypertension Clinic at the Veterans Administration Medical Center in Washington, D.C., in the American Journal of Cardiology. "There is little evidence that they will achieve enough benefit to justify the costs and adverse effects of drug treatment."

If you're diagnosed with high blood pressure and your doctor advises drug therapy, ask whether you could first try a nondrug approach combining dietary changes, exercise, and alternative remedies like those recommended below.

Best Choices

Nutrition

DASH to a healthy diet. Throughout the 1980s and early 1990s, several studies found that vegetarians have lower blood pressure than meat eaters. Such research prompted Thomas Moore, M.D., associate clinical professor of medicine at Brigham and Women's Hospital in Boston, to launch a study called DASH, Dietary Approaches to Stop Hypertension.

Dr. Moore and other researchers around the Gountry instructed 459 people with mildly high pressure to follow one of three diets. None of those eating high-fat diets showed decreases in their readings. But the people who followed near-vegetarian diets saw their systolic pressures drop by an average of six points, and their diastolic pressures by three points.

The results produced by the DASH diet rival those produced by any blood pressure medication. And there's a lot to be said for this near-vegetarian low-fat diet: In addition to lowering blood pressure, it can reduce your risk of heart disease, diabetes, osteoporosis, and several cancers.

Skimp on salt. Salt is sodium chloride. The more salt-actually, the more sodium­you consume, the more water your body retains, and the more fluid circulates in your blood vessels. This extra fluid raises your blood pressure.

Based on many studies, the National High Blood Pressure Education Program, an organization of researchers, recommends that Americans limit their sodium intakes to control their blood pressures. Your body needs no more than 2,000 milligrams of sodium a day. But most Americans consume twice that much.

In addition, some people with high blood pressure are salt-sensitive. This means that their blood pressure rises considerably when they consume even a small amount of sodium. These people should limit their sodium intakes to even less than 2,000 milligrams a day. Your doctor can help determine whether or not you're salt-sensitive.

To reduce your intake, read nutrition labels and steer clear of processed foods that are often high in sodium-especially canned soups, frozen dinners, and snack foods. And taste your food before you reach for the salt­shaker. Your meal may not need as much salt as you think.

Pick foods with a proper sodium­potassium ratio. Sodium is only one of several minerals that affect your blood pressure. Another biggie is potassium, primarily because your body's sodium-potassium balance is crucial to blood pressure control. According to Michael T. Murray, N.D., a naturopath in Seattle, you should consume five times as much potassium as sodium to maintain normal blood pressure. Unfortunately, the typical American has that ratio reversed, consuming twice as much sodium as potassium.

Among the foods with the best potassium-to-sodium ratios are bananas (440:1), oranges (260:1), potatoes (110:1), apples (90:1), and carrots (75:1). If you want to control your blood pressure, eat more of these foods-and other fruits and vegetables as well.

"C" the difference. Another reason fruits and vegetables help reduce blood pressure is that they're high in vitamin C. To ensure that you're getting enough vitamin C, clinical nutritionist Shari lieberman, Ph.D., recommends eating more C-rich foods: broccoli, bell peppers, cabbage, cauliflower, spinach, strawberries, and citrus fruits.

Go on a calcium kick. Calcium has complicated effects on your hormones, nervous system, and blood vessels, according to blood pressure specialists D. C. Hatton and D. A. McCarron of Oregon Health Sciences University in Portland. If you get enough of the mineral, your blood pressure stays low. lf you don't, you risk developing high blood pressure.

To get more calcium in your diet, feast on low-fat and nonfat dairy products, salmon, sardines, shrimp, green leafy vegetables, and tofu.

Mind your magnesium intake. Magnesium plays a key role in the muscle tone of your blood vessels. If you get enough of the mineral, your blood vessels relax, which helps reduce your blood pressure, Dr. Lieberman explains. If your intake is low, your blood vessels can constrict or even go into spasm, which raises your blood pressure. Good food sources of magnesium include nuts, seeds, wheat germ, soybeans, seafood, dairy foods, and whole grains.

Make salmon your favorite fish. In addition to being a good source of calcium, salmon is rich in omega-3 fatty acids. Omega-3's may be known for cutting cholesterol, but they also help lower blood pressure, according to a review of more than 20 studies by Howard R. Knapp, M.D., Ph.D., assistant professor of medicine at Vanderbilt University in Nashville.

Dr. Simons suggests eating salmon or other cold-water fish such as mackerel or herring once or twice a week.

Crunch bunches of celery. Celery contains a compound called 3-n-butyl phthalide, which can lower blood pressure considerably. A very small amount does the trick in laboratory animals, reducing blood pressure by about 12 percent (and lowering cholesterol a bit as well). "I'm not surprised," says James A. Duke, Ph.D. "You can get the equivalent amount of the compound by munching about four average celery stalks."

Skimp on sugar. Several studies have shown that table sugar, or sucrose, raises blood pressure. If you have high blood pressure, avoid sugar as much as possible, recommends naturopath Enrico Liva, N.D., director of the Connecticut Center for Health in Middletown. Instead, satisfy your sweet tooth with fruit, which contains a different type of sugar called fructose.

Supplements

Take potassium in pills. Potassium supplementation is especially important if you're on diuretic blood pressure medications, because these drugs deplete your potassium supply. Because of potential side effects, speak with your doctor to see if potassium supplementation is necessary for your condition.

Add magnesium to the mix. At Erasmus University in Rotterdam, Netherlands, researchers gave 91 women with high blood pressure either a magnesium supplement or a placebo (a fake pill) for 6 months. Compared with the placebo takers, the magnesium takers' blood pressure readings fell by an average of three points systolic and three points diastolic. Dr. Lieberman recommends taking between 500 and 750 milligrams of magnesium a day.

Include calcium, too. In studies, calcium helped to reduce the systolic reading by 10 points and the diastolic reading by 25 points. Dr. Pizzorno recommends taking up to 1,500 milligrams of calcium a day.

Don't forget fish oil. If you don't care for salmon or other cold-water fish, you can get your omega-3 fatty acids by taking fish oil. Dr. Murray suggests taking one tablespoon (about 4 grams) of fish oil a day.

Exercise

Get fit to defeat high blood pressure.

According to Stephen Fortmann, M.D., deputy director of the Center for Research in Disease Prevention at Stanford University, exercise can help lower your blood pressure mainly by helping you slim down. But even if you don't lose weight, exercise can lower your blood pressure. That's what investigators at the Cooper Institute for Aerobics Research in Dallas discovered when they studied 56 sedentary people with mild high blood pressure. Twelve of these people remained sedentary, while the rest began walking for an hour three times a week. After 16 weeks, the non exercisers showed no change in their blood pressure readings. But the exercisers' average reading dropped from 146/94 to 134/87, even though they didn't lose weight.

Exercise also helps reduce stress, which often contributes to high blood pressure. By engaging in regular physical activity, such as brisk walking, you stimulate the release of your body's natural tranquilizers, called endorphins. That's why exercise feels calming. And if you're already taking blood pressure medication, exercise can help you reduce your dosage-and maybe even help you get off the drugs completely.

If you have high blood pressure, do at least a daily half-hour of endurance-building exercise at least three times a week, recommends Alfred Bove, M.D., chief of cardiology at Temple University School of Medicine in Philadelphia.

Tai Chi and Qigong

Try tai chi. At Johns Hopkins School of Medicine in Baltimore, Deborah Young, Ph.D., assistant professor of internal medicine, enrolled 62 older people with high blood pressure in either a brisk walking program or a less strenuous tai chi class.

Tai chi lowered blood pressure almost as much as brisk walking, even though tai chi feels like less of a workout.

Consider qigong. Chinese researchers taught a qigong routine to 244 people with very high blood pressure-average reading, 175/108 mm Hg. Some ofthe people made qigong practice a regular ritual. Some practiced the exercises only from time to time. And some gave up qigong completely.

Twenty years later, the researchers counted how many of the study participants had died from stroke, whose major risk factor is high blood pressure. Among the qigong dropouts, 42 percent had died of stroke. Among those who practiced qigong occasionally, 29 percent had died of stroke. But among people who practiced qigong regularly, only 11 percent had died of stroke.

Yoga

Strike a pose for low pressure. Indian researchers taught a yoga routine to 25 people with high blood pressure. The participants were encouraged to practice the routine two or three times a day. After 6 months, their average blood pressure fell from 153/103 mm Hg to 139/90 mm Hg.

Meditation

Before you medicate, meditate. Stress constricts your blood vessels and simultaneously makes your heart beat harder. This sends your blood pressure soaring. But relaxation dilates your blood vessels, calms your heart, and decreases your levels of stress hormones. In this way, it helps bring your blood pressure back to normal.

In the late 1960s, Harvard cardiologist Herbert Benson, M.D., was intrigued when people who practiced transcendental meditation (TM) claimed they could lower their blood pressures at will by meditating. In a series of studies, Dr. Benson proved the claims to be true.

His research eventually led him to develop a version of meditation called the relaxation response. This relaxation technique involves 20 minutes of deep breathing, during which you close your eyes, empty your mind, and focus on a single word or phrase (what practitioners of classic Indian meditation and TM call a mantra). Dr. Benson has found that when people with stress-induced high blood pressure practice the relaxation response, they can lower their blood pressures significantly.

Visualization

See your blood pressure falling. Visualization exercises are another relaxation technique that can lower your blood pressure. Gerald N. Epstein, M.D., director of the Academy of Integrative Medicine and Mental Imagery in New York City, suggests this exercise: Close your eyes and breathe deeply. Imagine opening your freezer and removing several ice cubes. Imagine slowly rubbing your head, face, and neck with the ice. Feel the coolness seeping through your skin and into your bloodstream. Envision an icy feeling tumbling from your head to your toes. Open your eyes. Practice this exercise two or three times a day.

Biofeedback

Dial down your pressure. Biofeedback can teach you to lower your blood pressure quickly and easily in just a few months. The biofeedback trainer attaches electrodes to various parts of your body and hooks them up to a visual meter. As you tense your muscles, the meter dial moves in one direction; as you relax your muscles, the dial moves the other way. You breathe deeply and focus on moving the needle into the deep relaxation zone.

Music Therapy

Mellow out with music. As long ago as 1929, when radio and phonographs were still novelties, two researchers showed that listening to music could help reduce blood pressure. In a more recent study, researchers found that those who listened to music were less stressed than those who practiced the relaxation response, suggesting that music may be even more relaxing than meditation.

What sort of music should you listen to? Whatever you like that's light, soft, and not too rhythmic, according to Andrew T. Weil, M.D., director of the program in integrative medicine at the University of Arizona College of Medicine in Tucson.

Social Support

Talk to the animals. Many studies have shown that human-pet interactions-playing with a dog, holding a cat, gazing at fish in a tank-can have a profoundly positive effect on blood pressure.

Of course, some people don't care for dogs or are allergic to them. But if a dog or another animal holds a special place in your heart, your pet may be helping you in ways you may not have imagined.

Herbal Medicine

Root for garlic. You may already know about garlic's cholesterol-lowering properties. As it turns out, this odoriferous bulb can also lower blood pressure. Dr. Duke recommends consuming the equivalent of one clove of garlic a day. "If you cook with garlic, getting that much should be a snap," he says. Garlic's close botanical relatives­onions, scallions, leeks, chives, and shal­lots-can also lower blood pressure. They don't pack garlic's punch, but they help.

Seek help from hawthorn. Hawthorn helps reduce blood pressure by dilating the coronary arteries, the ones that feed your heart. Dr. Liva recommends taking 100 to 240 milligrams of a standardized hawthorn extract three times a day.

If you are currently on medication for high blood pressure, check with your doctor before taking hawthorn. You may need your medication dosage adjusted.

Chiropractic

Adjust to lower blood pressure. At the Canadian Memorial Chiropractic College in Toronto, R. G. Yates, D.C., and colleagues divided 21 people with high blood pressure into three groups. One group received chiropractic adjustment. Another group received treatment that mimicked chiropractic adjustment but wasn't the real thing. The third group received no treatment at all. Among those who got sham treatment or no treatment, blood pressure did not change. But among those who got chiropractic, blood pressure decreased significantly.

Home Remedies

Maintain a healthy weight. Studies have shown that to reduce blood pressure quickly without drugs, nothing beats weight loss. In these studies, the people who lost 10 pounds saw their diastolic pressures drop as much as three points. No wonder the National High Blood Pressure Education Program urges people with high blood pressure to lose weight by eating a low-fat diet and engaging in regular moderate exercise.

Snuff out the butts. The nicotine in cigarettes constricts your blood vessels, which in turn elevates your blood pressure. So if you smoke, quit.

Drink in moderation. Research has shown that a little alcohol-up to two drinks a day for men and one for women­can reduce heart attack risk by raising levels of high-density lipoproteins (HDL), the "good" cholesterol. But if you drink more than that, you're more likely to develop high blood pressure and, eventually, heart disease. The National High Blood Pressure Education Program recommends limiting alcohol consumption to no more than one drink a day. A drink equals 12 ounces of beer, 5 ounces of wine, or a cocktail made with 1 1/2 ounces of 80-proof distilled spirits.

Go easy on caffeine. As every java junkie knows, caffeine is a powerful stimulant. Shortly after drinking a cup or two, your blood pressure rises. But there's conflicting evidence on the long-term effects of regular coffee consumption. Most studies show that if you habitually drink up to a few cups of coffee a day, you become tolerant of the caffeine, and your blood pressure returns to normal.

But many people with high blood pressure seem particularly sensitive to the pressure-raising effects of caffeine. If you have high blood pressure, many alternative practitioners, including Dr. Liva, recommend reducing your intake of caffeine by minimizing your consumption of coffee, tea, cola, cocoa, and chocolate.

Other Good Choices

Chinese Medicine

Nourish your yin. Efrem Korngold, O.M.D., L.Ac., treats high blood pressure with formulas that contain yin-nourishing, Liverregulating herbs. These include gastrodia rhizome, polygonum, and leonurus leaf.

Direct pressure downward. You can also lower your blood pressure with acupressure. Simply apply steady, penetrating finger pressure to each of the following points for 3 minutes.

• Liver 3, situated on top of your foot in the webbing between your big toe and second toe
• Governing Vessel 20, located on top of your head, where a line drawn from ear to ear would intersect with the midline of your body
• Spleen 6, located four finger-widths above your inner anklebone on the back inner border of your shinbone

Ayurvedic Medicine

Rebalance your Vata. Ayurvedic practitioners view high blood pressure as primarily a Vata disorder, according to Virender Sodhi, M.D. (Ayurveda), N.D., professor at Bastyr University in Kenmore, Washington.

To treat high blood pressure, Dr. Sodhi recommends daily meditation. He also advocates dietary changes that include eating more fruits and vegetables, especially garlic and onions, and less salt and saturated fat. And he prescribes an array of Ayurvedic herbs, such as sarpagandha, arjuna, and ashwagandha.

Medical Measures

If nondrug approaches don't reduce your blood pressure sufficiently, your doctor may prescribe blood pressure medication. There are many different kinds of antihypertensive drugs. They all lower blood pressure, but they also cause side effects-and you may have to take them for life. The most widely prescribed blood pressure medications are diuretics, beta-blockers, calcium channel blockers, and ACE inhibitors.

Diuretics. These drugs work by speeding the elimination of water from your body. Less water means less fluid in your blood vessels, which lowers your blood pressure. Diuretics also promote the elimination of salt in your urine.

Beta-blockers. These medications slow your heart so that it beats less forcefully. Less force means lower blood pressure.

Calcium channel blockers. By stopping calcium from entering your cells, these drugs open your blood vessels and reduce the force of your heart's contractions.

ACE inhibitors. These medications keep your body from making angiotensin, a compound that increases the fluid volume of your blood and constricts your blood vessels. ACE inhibitors reduce your blood volume and dilate your blood vessels.

All of these drugs may produce side effects, though calcium channel blockers and ACE inhibitors cause fewer side effects than diuretics or beta-blockers.

Keep in mind that while medications can control high blood pressure, they don't cure it. Whichever drug you're prescribed, you may have to take it for life. If you stop taking it, your blood pressure may soar.

"Even if you must take blood pressure medication, don't stop using the nondrug approaches," urges Alan Gaby, M.D. "Drugs are no substitute for the diet and lifestyle therapies that control blood pressure."