Hypertension

High blood pressure has been called the silent killer.  Slowly, year on year, blood vessels become thicker and hardened until they either block or rupture. 

Some simple lifestyle choices can reduce your blood pressure and the risk of disease with them. 

Have a look at these healthy lifestyle options that might help you to reduce your blood pressure.  Most of them are good for you in many other ways and can reduce your risk of heart disease and stroke even if your blood pressure does not improve.

Salt.

Salt increases blood pressure.  The more salt you eat, the more it increases the blood pressure. 

Older people and those with kidney disease are more prone to salt related problems.  Younger people can probably get away with it for a while but old habits die hard and it is a good idea to start as you mean to go on. 

A little salt can make food taste great but once you are used to it, it is easier to add more.  Local habits don't help - Canadian prepared food has much more salt than average (Canadian National Post Story) so try hard to get used to less salt in your diet.

Salt reducing tips:

• Cook your own food as convenience food often has higher levels of salt than what you cook yourself.
• Try mixed herbs to add flavour to sauces instead of salt.
• Steam or microwave vegetables as they need little or no salt cooked this way.
• Avoid foods with a high starch content (potato, rice, pasta) as these are often cooked with salt.  This is also good for your waistline too!

Evidence:  Solid.  World Health Organisation recommendation.  Long term observational studies.  Short term randomised trials.

Time: Significant changes in salt in the diet can reduce blood pressure in as little as 4 weeks. 

Exercise

Exercise is essential for healthy living.  It improves mood and directly reduces the risk of heart attack and stroke but it also reduces your blood pressure. 

People do have a tendency to make excuses for lack of exercise so to be clear, exercise is:  "being at least mildly short of breath for at least 20 minutes continuously" Sadly, though housework and aqua jogging are a little better than nothing, they do need to get you puffing for that 20 minutes to do much good.  There is a lot to be said for up to an hour of vigorous exercise at least three times a week - generally the more the merrier but if you are not used to it, take care to build up slowly and speak to your doctor first.

• Leave the car behind as often as possible.
• When you go for a walk, walk fast enough to be a little short of breath.
• Find exercise you enjoy.  Pilates, Zumba, Aerobics, Spin, Swimming, Yoga, Running, Sports - all are good for you.  If you enjoy it, it is easier to keep up.
  
• Monitor your performance - you will soon see improvements.
• Get into an exercise habit.  It is easier to keep up if you do it regularly.

Evidence:  Solid.  Randomised trials and observational studies.

Time:  Variable.  Benefits are often evident in as little as four weeks but greater benefit occurs with longer duration of activity.

Sleep

It will not surprise you to find that poor sleep, and especially sleep apnoea are associated with higher blood pressure and higher cardiovascular disease risks.

If you are waking tired then there is a good chance that your sleep is poor and measures to improve this may help your blood pressure too.  As there are more possible causes of being tired, it is always worth discussing this with your doctor.

There are loads of ways to improve your sleep so we've just listed the most commonly helpful changes:

• Cut the caffeine.  New Zealand's favourite drug disturbs sleep and itself increases blood flow.  Try decaf or at least avoid caffeine after dark.
• Cut the alcohol.  Alcohol, especially taken in the evening will reduce the quality and quantity of your sleep.  Alcohol also increases blood pressure.
• Reduce night-time fluids if you need to get up to go to the toilet.
• Go to bed when you are tired - leaving it later can make things harder.
• If you wouldn't let a three year old do it, don't do it yourself.

Evidence:  Moderate.  There are lots of studies supporting this recommendation but it is harder to generalise the advice.

Time: Instant - a poor sleep will often increase blood pressure and vice-versa.  Treatment of sleep apnoea makes rapid changes.

Alcohol

No-one wants to be told to stop drinking but really, if you have high blood pressure, it is one of the easiest changes to make to improve things.  Though there is some (disputed) evidence that small quantities of alcohol may reduce your risk of heart disease, larger quantities are proven to increase it and also to increase your blood pressure. 

Try to drink less than 10 standard drinks per week and to have at least 3 days per week when you have no alcohol at all.

Top tips for alcohol reduction:

• Try giving up altogether for a while - it is easier to quit for a reason.  FebFast, Dry July or even giving up for Lent. If you feel this would be too hard, ask yourself why.
• Avoid RTDs they are high in alcohol and easy to consume in large quantities.
• Buy less.  If you don't have it in the house, it is easier to resist.
• Have a large glass of water before going out to drink - you will need less beer and you will get fewer hangovers.

Evidence:  Solid.  World Health Organisation recommendation. Randomised trials and observational studies.

Time:  1-2 weeks after quitting alcohol you are likely to be able to see a benefit.

Smoking

Quitting smoking sometimes reduces blood pressure significantly, but its main benefit is in preventing ongoing harm.  The longer you smoke and the more you smoke, the more likely your arteries are to thicken and harden.  If you quit, this process slows down and may even reverse itself.

We love to help you quit - our nurses are experts in supporting you and of course we have a good range of cessation support products available.

Evidence:  Solid.  World Health Organisation recommendation. Randomised trials and observational studies.

Time:  Slow.  It can take years for the full benefits of smoking cessation to be seen on blood pressure.  That is why you need to do it NOW.

Vegetables

This is a controversial one as there are many reasons why a diet richer in vegetables is often associated with better health outcomes but it has been included here as it may help and is certainly good for you anyway.

Try to eat plenty of non-starchy vegetables.  An ideal diet contains at least half of your daily intake of calories from such sources.  This sort of diet will often also be lower in fat and salt and might even reduce your risk of cancer too though it is easier to prove unhealthy diets increase the risk than changes reduce it.

Top veg-up tips:

• Try doing without potatoes or rice - consider cauliflower, swede, carrots or broccoli as an alternative. 
• Consider an apple for breakfast instead of cereal or toast.
• Try having only 2 slices of bread as sandwiches - fill up on tomatoes, carrot or fruit.
• Try to have at least 3 portions of vegetables daily (smokers need 7!)

Evidence:  Weak.   Large scale observational studies have shown a lower risk of heart disease and stroke associated with non-starchy vegetable consumption.

Time:  Uncertain.  This is a preventative measure more than a treatment.

Lose weight

Losing weight has been proven to reduce blood pressure.  If you are obese (BMI over 30) or weigh over 100Kg, then weight reduction is essential.  People weighing less may still benefit but if you are not overweight, then dieting may be harmful.

There is no easy way to reduce weight, though following the exercise and vegetables tips above will make a big difference to how easy you find it.  Our nurses are really good at helping you make healthy lifestyle choices and are trained in helping you to lose weight - it's the cheapest support you'll get too! 

Even if you don't lose any weight, healthy lifestyle changes can still make a big difference to your blood pressure and other risks so it is well worth a go - we can help you be healthier, even if you are still larger than life.

We do recommend that you seek professional support for weight loss - you are more likely to succeed, we can tell you how likely it is to make a difference and can help you to monitor improvements.  We can even loan you a blood pressure machine free of charge!

Evidence:  Solid.  World Health Organisation recommendation. Randomised trials and observational studies.

Time:  Depends on speed of weight loss.  You can expect up to 2mmHg reduction in systolic blood pressure per Kg of weight lost though people do vary a lot.

Cut the stress.

Stress puts your blood pressure up.  Sometimes a high blood pressure is just a sign that you are overdoing it and need to accept that there is a limit to what one person can do.  Often the amount you are capable of doing fluctuates through your life so it can be hard to realise that this is the cause of problems.

Stress reduction is a good way not only to reduce your blood pressure but also to improve your life in general, and usually that of those around you.  We are not going to give you top stress reduction tips here as most people who are stressed find reading them stressful!  You know who you are, you know what you need to do and if you don't, come and talk to us - believe it or not we can almost always help.

So that about wraps it up for the drug-free ways to reduce blood pressure.  Almost everyone who follows all of this advice will achieve significant gains by reducing blood pressure, losing weight and feeling better in themselves and most who manage one will still be better for it.  None of it is rocket science it is just plain, simple, healthy living and it's not as hard as you think, especially if you do it one thing at a time. 

Don't forget that we are here to help you.  This page is an aide-memoir intended to help you to make the most of a consultation and to help yourself.  It is not a substitute for a consultation with a trained healthcare professional and we recommend that all healthcare activity should take place in conjunction with the support of your doctor.

Evidence: Moderate.  Observational studies show increased risk with chronic stress and short term interventional studies have shown stress reduction can improve blood pressure.

Time:  Immediate.  Meditation and stress reduction can have an instant benefit on blood pressure.

Credits:

The following images are used with the kind permission of their creators under the Creative Commons Licence.

Blood Pressure Machine: Pete

Salt Crystals: Kevin Dooley

Exercise: Ron Sombilon

Smoke: Duc Digital

Belly: FBellon

Cracking up under stress?: Bernard Goldbach