Blood Pressure monitor |
Doctors have long known that systolic blood pressure below 120 was considered normal and meant a lower risk of heart disease and kidney problems.
But they would often only treat patients if that top number crept above 140, the threshold for officially having high blood pressure.
Recent findings from a large National Institutes of Health study now
suggest that it's worth treating patients in that prehypertension gray
area of 120 to 140, in order to bring them down into the normal range.
So how can patients take their blood pressure down to 120?
If
that becomes the new goal, many people will probably need to start a
blood pressure medication or add another to their current regimen,
Bisognano said. But there are also a number of lifestyle interventions
they may be able to tap into instead of taking a new drug. Here are
their options:
Medicate
Many people have
to take blood pressure medication just to stay close to the 140 mark,
Bisognano said. Some may even run marathons and lead otherwise healthy
lives, but just can't get down in the normal range, possibly because
they are genetically predisposed to high blood pressure.
To
get down to 120, these people may have to take more blood pressure
medication. The most common, Bisognano said, are the "ABCDs": ACE
inhibitors, beta blockers, calcium channel blockers and diuretics.
Typically, patients who need more than one medication would take one
from each of these classes.
Although
the ABCDs can lead to side effects, such as dehydration, headache and
weakness, most people can tolerate them and the problems are usually not
severe, Bisognano said. In addition, "we are in a golden age of
hypertension treatment, where almost all of the drugs are cheap," he
said.
Lose weight
Weight loss can lower blood pressure about as much as taking a single blood pressure medication, Margolis said. Research suggests that losing about 9 pounds could reduce systolic blood pressure by 4.5 points, and one study found that maintaining weight loss of about 7 pounds for a year could even bring it down by 11 points.
It is not clear
why weight loos is so beneficialfor blood pressure, Bisognano said. It may lead to changes in
circulation, or it may be because of the dietary changes that can
accompany weight loss, such as eating less salt. "(However) we have to
appreciate how difficult it is to lose weight," especially if you are
busy, Bisognano said. "Sometimes you can do it and sometimes you
cannot."
Exercise
Along with weight
loss, exercise is probably the best way to lower blood pressure without
the possible side effects of medication, Bisognano said. It makes
arteries more flexible and better able to dilate, which directly reduces
systolic blood pressure, he said.
Eat more fruits and vegetables
If reducing salt is not enough, people with high blood pressure have an entire diet designed for them. Dietary Approaches to Stop Hypertension or DASH, was developed by the National Institutes of Health and has been voted one of the best overall diets. .
The
DASH diet is high in fruits, vegetables and fiber, and low in sodium.
It may further reduce systolic blood pressure by about 3 points compared
with a regular low-sodium diet, according to a trial of DASH.
Scale back the salt
One of the most important dietary changes some people can make to lower blood pressure is reducing salt intake,
Bisognano said. Many of us consume 9 to 12 grams of salt a day, but the
American Heart Association recommendation is 3 or 4 grams. In one study scaling back daily salt levels from 8 grams to 4 grams was associated with a drop of 6.7 points in systolic blood pressure.
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