High blood pressure (hypertension) is estimated to affect 20% of adults in industrialised countries and is even more prevalent in developing countries. Despite billions of dollars spent on blood pressure lowering medications, blood pressure is poorly controlled in many people. The World Health organisation (WHO) reports that the problem is further compounded by poor compliance to prescribed anti-hypertensive medication.
Blood pressure is the measurement of the force of blood pushing against the walls of arteries. The more force, the higher the blood pressure. When the heart contracts to push blood out into the arteries, the force is at its highest and this is termed the systolic pressure. When the heart relaxes to fill with blood again, the pressure is at its lowest point, and this is referred to as the diastolic pressure.
Blood pressure is measured in millimetres of mercury (mm Hg) and measurements less than 120/80 mm Hg are considered ideal, a reading of less than 140/90 mm Hg is considered normal, but blood pressure over 140/90 is diagnosed as hypertension.
Hypertension is one of the leading causes of death or disability, due to stroke, heart attack and kidney failure. There are two types of high blood pressure – 90% of all cases are primary or essential hypertension where the cause is unknown, unlike secondary hypertension with identifiable causes that are treatable or reversible. The good news is that diet modifications, exercise, stress management and the use of nutritional supplements can help control essential hypertension.
Diet lowers blood pressure
The Dietary Approaches to Stop Hypertension (DASH) trial evaluated the effect of three dietary patterns on blood pressure in persons with untreated systolic blood pressure of 140-160 mm Hg and diastolic blood pressure of 80-95 mm Hg. A total of 459 adults participated and were randomly placed in three groups to receive either one or the following:
All participants ate the control diet for three weeks before being randomised to receive either diet 1, 2 or 3 for another eight weeks. During the eight-week study, sodium intake, physical activity, and body weight remained constant and the outcome showed that the DASH diet has a much greater blood pressure lowering effect than diets 1and 2.
The DASH diet is easy and simple to follow and can be modified to the Malaysian palette. The diet is based on a daily intake of 2000 calories and you will need to reduce the serving size according to your daily calorie needs.
A diet low in saturated fat, high in complex carbohydrate and restricted in salt is recommended. Such a diet includes whole grains, unpolished rice, vegetables, lentils, legumes, nuts, seeds, fish, soy products, onions, garlic, foods rich in potassium, calcium, and magnesium (Chinese cabbage, carrots, cucumber, spinach, celery, sprouts, mushrooms, mung beans, potatoes, avocados, broccoli, and most fruits).
Lifestyle factors to reduce blood pressure
Research indicates that if you are physically inactive, you have a 35% chance of developing high blood pressure compared to an athletic person. Well the welcoming news is that you need not huff and puff and be all sweaty to reap the benefits of exercise. Published in the American Journal of Hypertension, researchers looked at 207 people with high blood pressure not on anti-hypertensive drugs and randomly divided them into four groups based on the duration and frequency of exercise per week, ranging from 30 to 60 minutes per week to more than 120 minutes per week. The exercise programme consisted of: A brief warm-up period; aerobic exercise (such as brisk walking, jogging, swimming, or cycling); and conditioning exercise (such as sit-ups and stretching).
After eight weeks on the programme, the researchers found that the ability to lower blood pressure was greatest among those who exercised 60 to 90 minutes per week and there were no further reductions in systolic blood pressure among those who exercised more than 90 minutes a week. It seems that the benefit was seen based on the total amount of time one exercises rather than the frequency.
Chronic stress can raise normal blood pressure. The first step to combat stress and reduce blood pressure is to identify the things that stress you and eliminating them if possible. If the stressors are things that can’t be changed, then one needs the help of stress-reducing techniques.
In one study, researchers found nearly 70% of patients with mild to moderate hypertension using techniques (meditation, exercises, yoga ) to reduce stress were able to reduce their medication after six weeks and after one year, 55% could stop medication.
Several studies on small patient numbers have clearly shown the potential benefit of coenzyme Q10 in the treatment of hypertension. In one cohort study of 109 patients with essential hypertension for an average of nine years and on anti-hypertensive medication, they were supplemented with coenzyme Q10 between 75mg to 360mg daily. Patients were able to gradually decrease their medication during the first one to six months with 51% of patients able to cease their drugs completely after four months of starting on coenzyme Q10. Even with so many studies, the mechanism by which coenzyme Q10 works to reduce blood pressure remains unclear. Long-term studies on the safety of coenzyme Q10 have shown it to be a safe supplement.
·Omega-3 fatty acids and GLA
A review of 31 studies on 1,356 hypertensive subjects showed that omega-3 fatty acids contributed to the blood pressure lowering effect due to the two main fatty acids found in fish oil: eicosapentaenoic acid and docosahexaenoic acid.
Another fatty acid, GLA (gammalinolenic acid), richly available from evening primrose oil, is associated with a beneficial reduction of cardiovascular risk factors and also lowering of blood pressure and total cholesterol in those over 80 years old.
Other nutritional supplements that are known to play a role in lowering blood pressure are calcium, magnesium, potassium, vitamin B6 and vitamin C.
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2. Jamy D. Ard, MD, Laura P. Svetkey, MD, MHS. Lowering Blood Pressure Using a Dietary Pattern: A Review of the Dietary Approaches to Stop Hypertension (DASH) Trial. J Clin Hypertens 2(6):387-391, 2000
3. Mongthuong T. Tran et al. Role of Coenzyme Q10 in Chronic Heart Failure, Angina, and Hypertension. Pharmacotherapy 21(7):797-806, 2001
4. Morris MC, Sacks F, Rosner B. Does fish oil lower blood pressure? A meta-analysis of controlled trials. Circulation. 1993 Aug;88(2):523-33.
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