Adopting healthier habits

 | January 1, 2007

Adopting healthier habits

Adopting a healthy lifestyle — which means cutting back on salt, losing excess weight, not smoking, and maintaining a diet high in fruits, vegetables, and whole grains — is the cornerstone for preventing and treating hypertension. If you don't have diabetes or damage to the heart, brain, kidneys, or eyes, lifestyle changes alone may be enough to bring a high blood pressure reading into the normal range.

The May 2003 JNC guidelines recommend lifestyle modifications as the best approach for bringing prehypertensive blood pressures (120/80–139/89 mm Hg) into a healthy range. In addition, people with stage 1 hypertension (140/90–159/99 mm Hg) who don't have any other health conditions can often try making lifestyle changes before resorting to medications. Studies have shown that by making a diligent effort to improve your diet and fitness, you can reduce your blood pressure numbers — even without popping a pill (see Table 4).

Table 4: Keeping score
In many cases, studies have documented precisely how much of a reduction in systolic blood pressure you can gain from certain lifestyle changes. Estimates are listed below. Keep in mind, too, that the more lifestyle changes you make, the greater the reduction.
Lifestyle change	What to do	Potential reduction in systolic blood pressure
Lose weight	Reach and maintain a normal body mass index	5–20 mm Hg for every 22 pounds lost
Adopt the DASH diet	Eat plenty of fruits and vegetables, choose low-fat dairy products, and reduce total fat consumption	8–14 mm Hg
Reduce salt	Consume no more than 2,300 mg of sodium a day (about 6,000 mg of salt)	2–8 mm Hg
Exercise regularly	Get at least 30 minutes of moderate aerobic exercise on all or most days of the week	4–9 mm Hg
Limit alcohol	Have no more than two drinks per day if you're male, or one drink per day if you're female	2–4 mm Hg
Quit smoking	There is no safe amount of cigarette smoking; if you smoke, try to quit	2–8 mm Hg*
Source: Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, May 2003. *Estimate based on clinical experience.

A study published in the Journal of the American Medical Association lends support to the emphasis on lifestyle changes. Researchers found that many people with hypertension were able to stop taking their blood pressure medications if they reduced their salt intake and lost weight. The trial included 975 volunteers, ages 60 to 80, who were taking blood pressure drugs. The 390 normal-weight participants received either counseling to reduce their salt intake or no dietary advice. The other 585 people, who were overweight, were divided into four equal groups. People in the first three groups were asked respectively to lose weight, reduce salt consumption, or do both. The fourth group received no special instructions. After three months, the researchers began to gradually withdraw the subjects from their blood pressure drugs.

More than two years later, the people assigned to both weight loss and salt reduction were only about half as likely to have high blood pressure, require an antihypertensive drug, or have cardiovascular problems as those who made no changes. People who only lost weight or reduced salt were each a third less likely to have high blood pressure, require an antihypertensive drug, or have cardiovascular problems than those who didn't make any lifestyle changes.

Even if you need to use antihypertensive drugs to control your blood pressure, you should still adopt healthy habits. The lifestyle changes described in the following pages can substantially improve your blood pressure. For example, diet and exercise are an essential part of treatment because they help medications control your blood pressure, making it possible for you to get good results with a lower dosage.

Tips for keeping your high blood pressure in check Take your blood pressure medication as prescribed. If you experience side effects, talk to your doctor. Try to maintain a healthy weight. Increase your physical activity. Do at least 30 minutes of moderate aerobic activity, such as walking, on most days. You can split the session into three 10-minute segments during the day. Eat foods low in sodium. Read nutrition labels to determine how much sodium is in packaged foods. Eat more fruits, vegetables, and whole grains, and choose low-fat dairy foods. Include foods rich in potassium and calcium in your diet. If you consume alcohol, do so moderately. If you smoke, quit. Reduce your stress. Tell your family and friends you have high blood pressure, especially the person who prepares the meals. Source: National Heart, Lung, and Blood Institute.

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Eat well

Hypertension, stroke, and heart disease are common in the United States and most other Western industrialized nations. Epidemiologists attribute much of their prevalence to diet. After decades of research, scientists have concluded that the typical American diet is a recipe for hypertension and cardiovascular disease: too much salt, too much saturated fat, too many calories, and not enough fruits and vegetables. But the good news is that you can take an active role in preventing and controlling high blood pressure by watching what you eat.

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How the DASH diet helps

Results of the first Dietary Approaches to Stop Hypertension (DASH) study, published in the New England Journal of Medicine in 1997, offered some of the most encouraging news that diet can help control blood pressure. In fact, the results were so promising that the JNC guidelines recommend that all Americans — not just those with hypertension — follow the DASH diet. Low in fat and rich in fruits, vegetables, whole grains, and low-fat dairy products, this eating plan significantly and quickly lowered blood pressure in people with hypertension enrolled in a multicenter study.

The 459 volunteers were randomly assigned one of three diets. One was based on what most Americans eat, with 37% of calories from fat. The second was a similar regimen with fruits and vegetables added. The third was a "combination" diet (the DASH diet), containing 27% of calories from fat, plus plenty of fruits and vegetables, whole grains, low-fat or nonfat dairy products, and small amounts of meat, fish, poultry, and nuts. After following the DASH plan for eight weeks, participants with hypertension enjoyed average reductions of 11.4 mm Hg in systolic pressure and 5.5 mm Hg in diastolic pressure. These results are comparable to the effects of some antihypertensive drugs. Participants with borderline high blood pressure experienced improvements as well, suggesting that the DASH diet may keep some people from developing hypertension in the first place. The second diet, which was higher in fats but also rich in fruits and vegetables, also lowered blood pressure, although not as much as the DASH plan. All reductions occurred without people changing their salt intake, alcohol consumption, or weight — factors known to influence blood pressure.

A follow-up analysis of the trial's results found that the DASH diet reduced blood pressures in virtually all groups tested regardless of such factors as age, sex, race, and hypertension status. Its effects were most pronounced, though, in African Americans and people with hypertension.

Researchers do not attribute the blood pressure reductions of the DASH trial to any single nutrient. Compared with the typical American diet, the DASH eating plan had a relatively higher calcium content and less salt, total fat, saturated fat, and cholesterol. It also had 173% more magnesium, 150% more potassium, 240% more fiber, and 30% more protein.

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Beyond DASH: OmniHeart

The OmniHeart study, which consisted of three different diets, was launched in order to take DASH a step further by replacing some of its carbohydrates with unsaturated fat or protein. Investigators wanted to assess the impact not only on blood pressure, but also on cholesterol.

In the study, researchers from Harvard and other medical institutions fed 164 people with mild hypertension three different diets in random sequence: high in carbohydrates, high in protein, or high in unsaturated fat. All of the diets were healthy in that they included lots of fruits, vegetables, and whole grains. Meats were limited to lean cuts and skinless poultry. Dairy products were nonfat or low fat. Results of this study, known as the OmniHeart trial, were published in the Journal of the American Medical Association in 2005. Investigators found that all three diets lowered blood pressure, improved cholesterol profiles, and lowered risk of heart disease, but the high-protein and the high–unsaturated fat diets were most effective.

The results of the OmniHeart diet were striking. When the participants' blood pressure and cholesterol levels were tested after six weeks on each diet, the researchers found that the high-protein diet and the high–unsaturated fat diet both delivered even greater health benefits than the high-carbohydrate DASH-like diet did by improving blood pressure and cholesterol levels even more. Here are the results:

High-carb diet. The high-carb DASH-like diet lowered systolic blood pressure (the upper number) by 13 points in those with mildly elevated blood pressure (mild hypertension) and 7 points in those with merely above-average blood pressure. The high-carb diet also lowered harmful LDL cholesterol by 12 mg/dL, but also slightly lowered good HDL cholesterol.

High–unsaturated fat diet. The diet high in unsaturated fats, dubbed the UNSAT diet, outperformed the high-carb DASH-like diet. It lowered blood pressure, increased HDL cholesterol, and lowered triglycerides, another fat that circulates in the blood and correlates with heart disease. Results showed that eating lots of unsaturated fats — primarily monounsaturated fats from vegetable oils and nuts — lowered blood pressure in people with hypertension 3 points more than the DASH-like diet, for a total drop of 16 points. The UNSAT diet also was the only diet that did not lower HDL cholesterol, but raised it slightly. That's good, because while there are a number of ways to lower LDL cholesterol, such as taking medication, it's more difficult to raise HDLs. HDLs, or high-density lipoprotein particles, sweep your blood clean of unhealthy fats, preventing the buildup of fatty plaque that narrows your arteries.

High-protein diet. The good news for protein lovers is that the high-protein diet also did better than the high-carb DASH-like diet. It lowered systolic blood pressure 3.5 points more than the high-carb diet in people with mild hypertension, for a total 16.5-point reduction. The high-protein diet also lowered LDL cholesterol 3 points more than the high-carb diet, but like the high-carb diet, slightly lowered healthy HDLs as well. The high-protein plan did the best of the three diets in lowering triglycerides — another good step in lowering risk of heart disease.

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Consume less salt

While it's generally accepted that salt plays a significant role in blood pressure, the question of whether everyone should reduce salt intake is the source of a longstanding, vigorous debate.

According to one study, about 26% of people with normal blood pressure and nearly 50% of people with hypertension are salt sensitive, meaning eating too much sodium elevates their blood pressure. If you're salt sensitive, a low-salt diet is likely to lower your blood pressure and reduce your subsequent risk of stroke and heart attack. A 2001 Hypertension study also demonstrated that people identified as salt sensitive faced a higher risk of death even if their blood pressure stayed within normal ranges. In addition, those who were salt sensitive and had normal blood pressure at the beginning of the study had a higher likelihood of developing hypertension as they aged.

Most experts agree that elderly, obese, and diabetic people are more sensitive to salt consumption and should consider cutting back. Many African Americans are also salt sensitive and should restrict their sodium intake.

But what if you don't fall into one of these categories? Can you reach for the salt shaker? That's where the controversy lies. Some scientists say there isn't evidence that cutting back dramatically on salt benefits healthy people. Instead, they argue that for the average American, following the DASH diet is more important than cutting back on salt and that restricting salt intake has only a modest effect on blood pressure. But before you sprinkle away, be aware that other experts argue just as vehemently that cutting back on salt is good for you, even if you don't have high blood pressure. Keep in mind that there's no easy way to determine if you're salt sensitive; even if your blood pressure is normal now, you may be salt sensitive and, therefore, have a higher risk of developing hypertension in the future.

The results of the second DASH study (the DASH-Sodium trial), which were published in the New England Journal of Medicine in 2001, suggest that reducing your salt intake may dramatically lower your blood pressure even if you don't have hypertension. More than 400 subjects followed either a typical American diet or the DASH diet for 12 weeks, but their sodium intake was randomly changed every four weeks. The sodium intake varied from 3,300 mg to 2,400 mg (the upper limit then established by the National High Blood Pressure Education Program) to a more restrictive 1,500 mg. With either diet, the researchers found that the lower the sodium intake, the lower the blood pressure. But at each sodium level, blood pressure was consistently lower for those on the DASH diet. Therefore, the largest reductions in blood pressure were found among those who followed the DASH diet and consumed just 1,500 mg of sodium per day. This combination worked best for all participants — with or without hypertension, black or white, male or female — but was most pronounced for those with hypertension.

The researchers say this proves we can all benefit from reducing our sodium intake, but the study has done little to settle the controversy. Critics charge the study didn't last long enough to make such generalizations or expose any possible health risks that might be associated with a very low-sodium diet. They also argue that cutting back on salt had only a small impact for those with normal blood pressure. Furthermore, the most relevant question — whether a reduction in salt consumption would actually reduce the risk of hypertension and its complications — wasn't tested.

Researchers will most likely continue to study and debate this issue. In the meantime, it's best to keep your sodium intake below 2,300 mg, even if your blood pressure is currently normal. Individuals who have prehypertension or hypertension, or are at high risk for high blood pressure, may benefit even more from dropping their sodium intake further — to 1,500 mg a day or less. The same is true for people who are obese, diabetic, or elderly.

Nine tips to reduce the salt in your diet Buy vegetables that are fresh, frozen, or canned "with no salt added." Use fresh poultry, fish, and lean meat, rather than canned or processed types. Use herbs, spices, and salt-free seasoning blends in cooking and at the table. Cook rice, pasta, and hot cereals without salt. Cut back on instant or flavored rice, pasta, and cereal mixes. Avoid convenience foods. Eliminate or significantly cut back on frozen dinners, packaged mixes, canned soups or broths, and bottled salad dressings. Rinse canned foods, such as tuna, to remove some sodium. When available, buy low-sodium, reduced-sodium, or no-salt-added versions of foods. Choose breakfast cereals that are lower in sodium or sodium-free. Snack on fresh fruits and vegetables instead of chips.

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Keep an eye on fat

A diet low in saturated fat can reduce cholesterol levels, but its effect on blood pressure is not well established. In the early 1970s, researchers observed that vegetarians tended to have lower blood pressures than people who ate meat. Vegetarian diets tend to be lower in fat, particularly saturated fat, but there are many other differences. Vegetarians generally consume more fiber and minerals and less protein than meat-eaters. Furthermore, vegetables, fruits, grains, and dairy products are rich sources of potassium, magnesium, and calcium. Diets high in these minerals are associated with low blood pressure. The DASH diet, for instance, is a low-fat, high-mineral eating plan.

It's important to remember, though, that not all fats are bad. Particularly heart-healthy are omega-3 fatty acids, which are found in fatty fish like mackerel and salmon, some oils such as canola oil, and some nuts and grains such as flaxseed. Large amounts of these fatty acids may help reduce high blood pressure, but their role in preventing hypertension is unclear. What is apparent is their effect on heart disease. A number of studies have linked modest levels of fish consumption with a reduced risk of heart attack and sudden death.

Salt and salt substitutes Despite the controversy over how much salt the average person should consume, it's clear that many people, especially African Americans, are salt sensitive and should curtail their salt intake to control their blood pressure. But many people love salt. An adult requires just one-eighth of a teaspoon of salt, or about 300 mg of sodium, a day, but most Americans consume 1 to 3 teaspoons a day — even though federal guidelines now recommend that people keep their intake below 2,300 mg of sodium, the amount in about 1 teaspoon of salt. The bulk of most people's sodium intake — as much as 75% — comes from processed foods, including soups (canned, dried, or frozen), lunch meats, cold cereals, frozen dinners, salad dressings, cheese, pizza, bread and rolls, crackers, olives, pickles, cured meats, kosher meats, hot dogs, potato chips, corn chips, pretzels, and nuts. Another 15% of sodium in the typical American diet is added during cooking. Some comes as table salt, which consists of about 40% sodium and 60% chloride. Other sources include seasoned salt (garlic, onion, and celery salts, for example), baking powder, baking soda, soy sauce, steak sauce, Worcestershire sauce, and monosodium glutamate. Sodium is also found naturally in some foods: One cup of skim or low-fat milk contains 120 mg of sodium; 3 ounces of meat, fish, or poultry has 75 mg; and half a cup of fresh vegetables may have anywhere from 5 to 25 mg of sodium. If you're trying to cut back on salt, you'll find tasty alternatives on your grocer's shelves. Adventurous cooks often rely on herbs and spices to beef up flavor while cutting down on sodium. For more timid souls, the answer may be ready-made salt-free mixtures, such as Spike and Mrs. Dash. Another option is "lite" salt, which substitutes potassium chloride for about half the sodium chloride found in regular salt. Many doctors advise their hypertensive patients not just to cut back on sodium but also to switch to this type of salt, because it helps replace potassium, which gets washed out of the body by some diuretics prescribed to treat hypertension. However, even "lite" salt contains too much sodium for many people who have been advised to limit their salt intake. While one-fourth of a teaspoon of "lite" salt contains 244 mg of sodium, some people tend to use more of it at the table to compensate for its light taste. Also, it's not recommended for use in cooking because potassium chloride gives food a bitter taste when heated to high temperatures. Before using a salt substitute with extra potassium, be sure to check with your doctor. Some people — for example, those with kidney disease — may need to avoid potassium as well as salt.

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Boost your potassium intake

Consuming too little potassium can raise your blood pressure and your risk of stroke. A 12-year study determined that men who consumed low amounts of potassium were 2.6 times more likely to die from stroke than men who consumed moderate to high amounts of it. The results were even more sobering for women. Women with the lowest potassium intake had a nearly fivefold increase in risk. In other studies, researchers induced a rise in blood pressure in both normal and hypertensive people simply by restricting potassium.

Increasing dietary potassium may allow some people to reduce the dose of their blood pressure medication (see "Foods to help reduce your blood pressure"). In a study in Italy, 27 people with hypertension increased their potassium intake while another 27 followed their usual diets. After one year, 81% of people on the high-potassium diet were able to cut their medications by more than half, while only 29% of the people who followed their usual diets could cut back that far.

Before increasing your intake of potassium, check with your doctor. Some people — for example, those with kidney disease — may need to avoid both potassium and salt.

Foods to help reduce your blood pressure

Foods high in potassium Bananas, citrus fruit, dried apricots, fish (especially salmon, flounder, and tuna), green leafy vegetables, legumes, melons, potato skins, poultry, raisins, tomatoes, whole-grain cereals, yogurt

Foods high in fiber Apples, barley, brown rice, corn, legumes, nuts, potatoes with skin, prunes, whole-grain cereal and bread, yams

Foods high in calcium Blackstrap molasses, broccoli, canned sardines and salmon (with bones), dairy products (milk, cheese, and yogurt), kale, tofu

Foods high in magnesium Fish, green leafy vegetables, legumes, meat, nuts, poultry, whole grains

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Get enough calcium

Some research suggests a low calcium intake may contribute to high blood pressure, but calcium's exact role in hypertension is unknown. One theory holds that a lack of calcium in the diet predisposes your body to retain sodium, which raises blood pressure. For this reason, it may be especially important that salt-sensitive people with hypertension get enough calcium.

While there's evidence that consuming plenty of calcium-rich foods and beverages may help prevent hypertension, efforts to control blood pressure with calcium supplements have had mixed results. Studies found that supplements successfully reduced both systolic and diastolic pressures in pregnant hypertensive women. But clinical trials involving patients with essential hypertension have been largely disappointing. For most people, calcium supplements either made no difference or reduced blood pressure only slightly — by an average of 1 to 2 mm Hg in systolic readings. Although some people experienced dramatic reductions in blood pressure with the supplements, there seems to be no common denominator, such as race or sex, among those who achieved such gains.

At this point, experts are reluctant to recommend calcium supplements solely to lower blood pressure. But since many Americans simply don't get enough calcium in their diets, and calcium is vital for preventing osteoporosis, few would argue against the use of supplements to boost your calcium intake (see Table 5).

Table 5: How much calcium do you need?
Age	National Academy of Sciences recommended daily calcium intake
Birth–6 months	210 mg
7–12 months	270 mg
1–3 years	500 mg
4–8 years	800 mg
9–18 years	1,300 mg
19–50 years	1,000 mg
51 years or older	1,200 mg

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Other nutritional factors

In addition to the factors described above, the following elements of your diet may affect blood pressure as well.

Magnesium. Some evidence links a low amount of dietary magnesium with hypertension, but experts aren't sure whether this mineral alone affects blood pressure or if the effect comes from other nutrients, such as calcium and potassium, often found in foods containing magnesium.

Fiber. Dietary fiber helps reduce cholesterol and, according to some studies, may help lower blood pressure.

Caffeine. Generally, most experts believe that caffeine may raise blood pressure in people who are unaccustomed to consuming it, but not in regular users. Unless you are consuming large amounts of caffeine, its effect on your blood pressure is likely to be negligible.

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Quit smoking

When it comes to heart disease and blood pressure, smoking packs a devastating wallop. Nicotine raises your blood pressure, lowers "good" HDL cholesterol, reduces your body's supply of oxygen, and makes blood clots more likely.

It is difficult to quit smoking, despite all the health reasons to do so, because this habit is psychologically and physically addictive. Smoking cessation programs primarily address the psychological facets of addiction by helping participants change ingrained behaviors. Nicotine replacement systems — such as patches, chewing gum, and nasal sprays — target physical craving by delivering the addictive substance in another form, allowing the user to taper off gradually and minimizing withdrawal symptoms. According to the American Lung Association, research has found that using a nicotine replacement product and participating in a smoking cessation program doubles your chances of successfully quitting.

Quitting isn't easy, but it offers enormous benefits. Within hours of stopping smoking, your heart rate and blood pressure decrease. Within a year of quitting, your heart disease risk is cut in half. Within 15 years of giving up smoking, your risk of heart disease is close to that of nonsmokers.

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Cut back on alcohol

Heavy drinking increases blood pressure and interferes with blood pressure medication. Drinking has dietary drawbacks, too. For people battling their weight, alcohol adds "empty" calories with no nutritional value. A bottle of beer contains 146 calories (100 calories if it's light beer), and a glass of wine has 123 calories. Some mixed drinks add fat and cholesterol, too. Eggnog with brandy, for example, serves up 288 calories with 6 grams of saturated fat, 11 grams of total fat, and 84 mg of cholesterol.

On the other hand, modest alcohol consumption has different effects. Numerous studies have shown that people who drink in moderation are at significantly lower risk for coronary artery disease than those who don't drink. Moderate alcohol use for men is defined as no more than 1 ounce of alcohol (two drinks) a day. However, women absorb more alcohol than men and should limit their daily intake to half an ounce (one drink). Small or underweight people are more susceptible to the effects of alcohol than heavier people and should consume no more than half an ounce daily (see "How much alcohol is in your drink?").

How much alcohol is in your drink? The following drinks each contain about an ounce of alcohol: 1 ounce of 100-proof liquor 1½ ounces (a jigger) of 80-proof liquor (bourbon, gin, rum, scotch, tequila, vodka, or whiskey) 3 ounces of fortified wine (sherry, port, marsala, or Madeira) 4 to 5 ounces of table wine 12 ounces of regular or light beer

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Be active

Not only does regular exercise help prevent high blood pressure (see "Sedentary lifestyle"), but it's also a proven treatment for existing hypertension.

The American College of Sports Medicine reviewed 40 studies on the effect of exercise on blood pressure. With regular aerobic exercise, participants were able to reduce their systolic and diastolic pressures an average of 11 and 9 mm Hg, respectively. Although many studies focused on high-intensity exercises like running, several evaluated the impact of moderate activities such as walking. Surprisingly, moderate-intensity training provided the same or even better blood pressure–lowering benefits. Exercise is also beneficial to people with hypertension because it may prevent plaque buildup in the arteries and makes clots less likely. Furthermore, exercise helps strengthen muscles and bones, control weight, and improve mood and mental functioning.

Need more reasons to get up and moving? In a study of severely hypertensive African American men, 10 of the 14 who rode a stationary bike for 45 minutes three times a week were able to lower their dosage of antihypertensive drugs at the end of the 32-week trial. In addition, echocardiograms showed that thickness of the heart wall had diminished in all the men who exercised. A thickened heart wall, known as left ventricular hypertrophy, raises your risk of stroke, abnormal heart rhythm, and heart attack.

Study after study has shown that aerobic exercise — walking briskly, running, or cycling — provides a host of other health benefits, including weight loss and reduced cholesterol levels.

While aerobic activity is most commonly associated with cardiovascular health, strength training exercises, such as lifting weights and doing resistance-band workouts, is also great for your heart and overall health. In the past, doctors were hesitant to recommend strength training for hypertensive patients because this type of exercise elicits a short-term spike in blood pressure. But information from the American Heart Association suggests that moderate, comfortable resistance exercises are safe and beneficial.

You can start to do strength training exercises by using resistance bands, small hand weights, weight machines, or even your body's own weight. Generally speaking, you should aim to perform one or two sets of 8 to 12 repetitions of each exercise — find a weight that's challenging but manageable.

Experts recommend that you get at least 30 minutes of moderate physical activity on all or most days of the week. Longer sessions can yield even greater health rewards. But it's important to start any exercise program slowly and to gradually build up the intensity level and length of sessions. People with heart disease or other health problems should consult their doctors before starting an exercise program.

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Attain a healthy weight

Not only can being overweight raise your blood pressure (see "Obesity"), but it can also increase your risk for diabetes, arthritis, sleep apnea, and some cancers. Achieving and maintaining a healthy weight is an important step in fighting these and many other illnesses.

People with hypertension who are more than 10% over their ideal weight may be able to reduce their blood pressure by weight loss alone. According to the JNC report, you can reduce your systolic blood pressure by 5 to 20 mm Hg for every 22 pounds you lose (see Table 4). A smaller weight loss can have an effect, too. Losing as few as 10 pounds can reduce your blood pressure.

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Calories count

How do you go about attaining a healthy weight? It seems that every month brings a new book on the subject boasting some surefire method and professing to debunk its predecessors' claims. Eat fewer carbohydrates, claims one. Limit fat, counters another. Become a vegetarian, advocates yet another (see "Weighing in on weight-loss diets," below). But for all the hype, the simple truth is this: Your body weight is a matter of calories in versus calories out — always has been, always will be. To lose weight, you need to burn more calories than you consume. You can do so either by reducing your caloric intake or by increasing your physical activity. It's a good idea to do a little of both.

Weighing in on weight-loss diets Consider this choice: Eat 500 calories worth of potato chips or 500 calories worth of lettuce. It'll have the same effect on your weight, but it won't have the same effect on your blood pressure and overall health. People with high blood pressure should limit foods such as potato chips that are high in salt, fat, and cholesterol. But some popular weight-loss plans, like the Atkins diet, involve eating foods high in fat and cholesterol, including butter, bacon, and cheese. Which is more important — to avoid fatty foods, or to get your body weight down? The ideal is to reduce your body weight and avoid fatty foods, but diets like Atkins may be acceptable in the short term to help you lose weight. Over the long term, though, all that fat and cholesterol will do you more harm than good. Always check with your doctor before beginning any new diet program — especially if you have high blood pressure.

Eating fewer calories doesn't necessarily mean eating less. "Caloric density" is a way to describe the number of calories contained in a food when its portion size is taken into consideration. A cookie, for example, can pack a lot of calories into a very small amount of food, and therefore has a high caloric density. On the other hand, you might have to eat an entire plate of steamed vegetables to equal the calorie count of that one cookie. Vegetables have a low caloric density. In general, fresh, whole, natural foods have a low caloric density, which means that you can fill up on them without consuming too many calories. Snack on carrot sticks or air-popped popcorn instead of potato chips or crackers. Choose water or unsweetened iced tea over sugary soft drinks. Cut a little here and a little there — you may hardly know you're dieting.

The first important step to losing weight is to figure out how many calories your body requires to maintain its current weight. To do so, do a simple calculation: Multiply your current weight in pounds by 15 — that's roughly the number of calories per pound of body weight needed to maintain your current weight if you are moderately active. Moderately active means getting at least 30 minutes of physical activity a day in the form of exercise (walking at a brisk pace, climbing stairs, or active gardening).

The following examples may make this clearer:

If you weigh 150 pounds, 150 x 15 = 2,250 calories for weight maintenance

If you weigh 200 pounds, 200 x 15 = 3,000 calories for weight maintenance.

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Losing the weight

One pound of body fat is equal to 3,500 calories that you consumed but didn't burn. To lose weight, you'll need to create a "calorie deficit": by eating fewer calories than you require, by burning more calories than you usually do, or some combination of the two. For example, if it takes 2,365 calories a day to maintain your weight, you might consume 1,865 a day, a 500-calorie reduction. After seven days, you'll have lost a total of 3,500 calories, and should be a pound lighter. Or if you want to be less aggressive, you can reduce an average of 250 calories a day and lose that pound after two weeks. (As your weight changes, you'll need to continually re-evaluate your calorie needs.)

Or maybe you don't want to restrict your calories quite so much. If that's the case, you can reduce your daily calories by only 100 and increase your physical activity in order to burn an extra 150 calories (see Table 6). The result is the same: You will have created an overall 250-calorie daily deficit, and lose a pound after two weeks.

As you can see, losing weight involves a little bit of math and a little bit of will power. Small, consistent steps, taken at a pace that's right for you, are the key to achieving your goal.

Table 6: Fifteen ways to burn 150 calories This chart lists some activities you can do to burn 150 calories. These are approximate figures, based on a body weight of 150 pounds. If you weigh less than 150 pounds, it'll take you longer to burn the same number of calories. The opposite is true if you weigh more than 150 pounds.
Activity	Time
Biking, 6 mph	38 minutes
Biking, 12 mph	22 minutes
Jogging, 5.5 mph	12 minutes
Running, 10 mph	7 minutes
Walking, 2 mph	38 minutes
Walking, 3 mph	28 minutes
Walking, 4.5 mph	20 minutes
Tennis, singles	23 minutes
Gardening	30–45 minutes
Washing windows or floor	60 minutes
Water aerobics	35 minutes
Swimming, 25 yards/minute	33 minutes
Swimming, 50 yards/minute	18 minutes
Raking leaves	35 minutes
Shooting basketballs	35 minutes

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Stress less

Even though it's vital to survival, stress has a bad reputation. When you perceive stress, your sympathetic nervous system triggers the "fight or flight" response to prepare your body for action. A release of hormones quickens your heart rate and breathing, and extra blood is pumped to your muscles and organs to provide them with a burst of energy. Stress keeps drivers alert, helps students excel, and spurs competitors to win. But ongoing stress has harmful long-term effects, including raising your blood pressure.

If you are often tense, the following stress reduction strategies can help.

Get enough sleep. Lack of sound sleep can affect your mood, mental alertness, energy level, and physical health.

Exercise. Physical activity alleviates stress and reduces your risk of becoming depressed.

Learn relaxation techniques. Meditation, progressive muscle relaxation, guided imagery, deep breathing exercises, and yoga are the mainstays of stress relief. Your local hospital may offer meditation or yoga classes, or you can learn about these techniques from books or videotapes. To get started, try a quick relaxation exercise (see "Quick stress relief exercises").

Quick stress relief exercises When you've got one minute. Place your hand just beneath your navel so you can feel the gentle rise and fall of your belly as you breathe. Breathe in. Pause for a count of three. Breathe out. Pause for a count of three. Continue to breathe deeply for one minute, pausing for a count of three after each inhalation and exhalation. When you've got three minutes. While sitting down, take a break from whatever you're doing and check your body for tension. Relax your facial muscles and allow your jaw to fall open slightly. Let your shoulders drop. Let your arms fall to your sides. Allow your hands to loosen so that there are spaces between your fingers. Uncross your legs or ankles. Feel your thighs sink into your chair, letting your legs fall comfortably apart. Feel your shins and calves become heavier and your feet grow roots into the floor. Now breathe in slowly and breathe out slowly. Each time you breathe out, try to relax even more. When you've got 10 minutes. Try imagery. Start by sitting comfortably in a quiet room. Breathe deeply and evenly for a few minutes. Now picture yourself in a special place. Choose an image that conjures up good memories. What do you smell — the heavy scent of roses on a hot day, crisp fall air, the aroma of baking bread? What do you hear? Drink in the colors and shapes that surround you. Focus on sensory pleasures: the swoosh of a gentle wind, the soft cool grass tickling your feet. Passively observe intrusive thoughts and then gently disengage from them to return to the world you've created.

You may also want to explore a more integrative approach to stress management known as the "relaxation response," a term coined by Dr. Herbert Benson of the Mind/Body Medical Institute. The relaxation response is the opposite of the stress-induced fight or flight response, and it is elicited by daily practice of relaxation and meditation. As its name implies, the relaxation response is characterized by a slowing of the breathing and heart rates, lowering of blood pressure, and a calm state of mind. It is so effective at reducing blood pressure over the long term that a one study even suggests that it may help some patients reduce or even eliminate their need for antihypertensive medications (see "Can you reduce your need for medication?"). For more information on the relaxation response, refer to the Harvard Medical School Guide to Lowering Your Blood Pressure (see "Resources").

Strengthen your social network. Studies show that social ties significantly protect health and well-being. Try to connect with others by taking a class, joining an organization, or participating in a support group.

Learn time-management skills. These skills can help you juggle work and family demands.

Confront stressful situations head-on. Don't let stressful situations fester. Hold family problem-solving sessions and use negotiation skills at work.

Nurture yourself. Treat yourself to a massage. Truly savor an experience: Eat slowly, focusing on each bite of that orange, or soak up the warm rays of the sun or the scent of blooming flowers during a walk outdoors. Take a nap. Enjoy the sounds of music you find calming.

Talk to your doctor. If stress and anxiety persist, talk to your doctor about whether anti-anxiety medications could be helpful.

Acupuncture for hypertension? Acupuncture is one of the oldest known forms of health treatment. Believed to have originated in Asia more than 2,500 years ago, acupuncture involves inserting fine needles into the skin at various points along what are believed to be pathways ("meridians") for a form of energy known as "chi." According to acupuncture theory, health problems are the result of blocked chi flow, and inserting the acupuncture needles helps to restore the flow and restore health. Some small studies and anecdotal reports have suggested that acupuncture might be helpful for people with hypertension. Now the results of a pilot clinical trial are in — and the outcome may disappoint proponents of acupuncture. The SHARP (Stop Hypertension with the Acupuncture Research Program) trial involved 192 participants whose untreated blood pressure was between 140/90 mm Hg and 179/109 mm Hg. Participants first had their medications reduced and eliminated, and were then randomly assigned to one of three groups: two that received different forms of acupuncture treatment, and one that received the acupuncture equivalent of a placebo ("sham acupuncture"). The participants received up to 12 treatments over six to eight weeks. At the end of that time, reported the investigators in 2006 in the journal Hypertension, there was no significant change in blood pressure between those who received sham acupuncture and those who received the real version. Even so, there may be a role for acupuncture in helping some people with hypertension. Studies have shown that acupuncture is effective for treating some forms of chronic pain and depression, both of which can have a negative effect on blood pressure and overall health. In this way acupuncture may be an effective "back-door" treatment. Before you consider integrating acupuncture, make sure you find a qualified, experienced practitioner. The American Academy of Medical Acupuncture (

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Review Date: 2007-01-01

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