Diet for people with high blood pressure

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THE CHANGING APPROACH TO EVALUATING BLOOD PRESSURE

(APRIL 2003)

An elevated blood pressure is the major risk factor for stroke, one of the major risk factors for heart attack, and an important cause of kidney failure.

A few decades ago, the accepted viewpoint was that the diastolic pressure (the bottom value, preferably not over 80 millimeters of mercury), was the more important value. The systolic pressure (the top value, normal less than 140 millimeters of mercury, preferably not over 120) was thought to be less important. Additionally, as people age, their blood vessels stiffen; that was thought to be “normal” and the dictum was that the acceptable systolic blood pressure was 100 plus the persons age (so for a 50-year-old person, it was 150, a 60-year-old person, 160 millimeters of mercury, etc).

Those old concepts are now completely reversed. The evidence from multiple studies now indicates that:

1. Under age 50, the diastolic blood pressure better predicts the risks for heart attack or stroke. Every 10 millimeter increase above 80 millimeters of mercury increases risk of heart attack or stroke by about 35 percent.

The systolic pressure is also important; every 10 millimeter increase above 130 millimeters of mercury increases risk by about 14 percent.

2. After age 50, the systolic blood pressure predicts heart attack or stroke better.

3. By age 60, the systolic blood pressure is a much better predictor of risk. Every 10 millimeter increase above 130 millimeters of mercury increases risk by about 17 percent.

4. Two-thirds of all high blood pressure over age 60 is isolated systolic hypertension.

Blood pressure is on a continuum; optimal is less than 120 systolic / 80 diastolic; normal is 120 to 129 systolic / 80 to 84 diastolic; high normal is 130 to 139 systolic / 85 to 89 diastolic; anything equal to or above 140 systolic / 90 diastolic is high blood pressure. To determine the category, use the value that puts you in the higher category. For example, 120/86 is high normal because of the diastolic value; 134/80 is high normal because of the systolic value (see table below).

Healthful Life has always pointed out that it is much better to have your blood pressure in the low normal range (less than 120/80) and ideally probably to have it no more than 110 systolic / 70 diastolic (we do know the optimal range [less than 120 systolic / 80 diastolic]; we do not know for sure the “ideal range”). For those in the high normal range (systolic 130 to 139, diastolic 85 to 89), there is a small, but very real, increased risk of heart attack or stroke. For persons with high normal blood pressure, weight loss, diet, and exercise are recommend to get the blood pressure in the lower part of the normal range. The same is true of those in the normal range; they should try to get into the optimal range.

It is important at any adult age to keep the blood pressure under 140 systolic, 90 diastolic. Anything above that, either systolic or diastolic, is hypertension and should be under the care of a physician. The risk from a systolic between 140 and 150 for those over age 60 is small and should ordinarily be treated with diet, weight loss, and exercise, not drugs, turning to drug treatment only if all else fails to lower the blood pressure.

There are multiple non-drug approaches to getting into the normal range if you have high normal blood pressure or into the optimal range if you have normal blood pressure. These include:

– taking off some weight; five or ten pounds can often make a huge difference

– increasing your physical activities (if you are over age 40 or if you have or think you might have an underlying condition that might be harmed by increased physical activity, check with your health care provider)

– go on a high vegetable, high fruit, high low fat dairy food diet (also high in poultry, fish, nuts)

– if necessary, reduce salt intake

(see Archives “Fruits, vegetables, dairy foods, salt and high blood pressure – your diet can make a difference”; and “Diet with or without salt restriction can keep your blood pressure lower or can treat mild hypertension”)

Keeping the blood pressure in a desirable range is a major component of health promotion.

Blood Pressure Categories

(In millimeters of mercury)

Ideal ? Less than 110 systolic / 70 diastolic

Optimal Less than 120 systolic / 80 diastolic

Normal 120 to 129 systolic / 80 to 84 diastolic

High Normal 130 to 139 systolic and/or 85 to 89 diastolic

Hypertension 140 and over systolic and/or 90 and over diastolic