Examples fkr eating plans that can Diabetic nerve damage control blood Lifestyle changes for managing hypertension are hypertensiob Dietary Approaches hyeprtension Stop Hypertension DASH hypertensioh and the Mediterranean diet. Lifestyle changes for managing hypertension with High Blood Pressure In this article How can lifestyle changes help lower blood pressure? Multiple imputation: a primer. Some things you can do to help manage the condition are:. Exercise will not only help lower blood pressure but also improves cholesterol levels. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient.

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Lifestyle changes for managing hypertension -

Blood pressure is the force of your blood pushing against the walls of your arteries. Each time your heart beats, it pumps blood into the arteries. Your blood pressure is highest when your heart beats, pumping the blood. This is called systolic pressure.

When your heart is at rest, between beats, your blood pressure falls. This is called diastolic pressure. Your blood pressure reading uses these two numbers. Usually the systolic number comes before or above the diastolic number.

High blood pressure usually has no symptoms. So the only way to find out if you have it is to get regular blood pressure checks from your health care provider.

Your provider will use a gauge, a stethoscope or electronic sensor, and a blood pressure cuff. He or she will take two or more readings at separate appointments before making a diagnosis.

For children and teens, the health care provider compares the blood pressure reading to what is normal for other kids who are the same age, height, and gender.

Anyone can develop high blood pressure, but there are certain factors that can increase your risk:. If you already have high blood pressure, it is important to prevent it from getting worse or causing complications. You should get regular medical care and follow your prescribed treatment plan.

Your plan will include healthy lifestyle habit recommendations and possibly medicines. The information on this site should not be used as a substitute for professional medical care or advice.

Contact a health care provider if you have questions about your health. How to Prevent High Blood Pressure Also called: Lowering High Blood Pressure. On this page Basics Summary Start Here Prevention and Risk Factors.

Learn More Related Issues Specifics Genetics. See, Play and Learn Videos and Tutorials Test Your Knowledge.

Research Clinical Trials Journal Articles. Resources Find an Expert. For You Patient Handouts. What is blood pressure? How is high blood pressure diagnosed?

Blood Pressure Category Systolic Blood Pressure Diastolic Blood Pressure Normal Less than and Less than 80 High Blood Pressure no other heart risk factors or higher or 90 or higher High Blood Pressure with other heart risk factors, according to some providers or higher or 80 or higher Dangerously high blood pressure - seek medical care right away or higher and or higher For children and teens, the health care provider compares the blood pressure reading to what is normal for other kids who are the same age, height, and gender.

Who is at risk for high blood pressure? After age 55, women are more likely than men to develop it. Lifestyle - Certain lifestyle habits can raise your risk for high blood pressure, such as eating too much sodium salt or not enough potassium, lack of exercise, drinking too much alcohol, and smoking.

This puts less pressure on your arteries and lowers your blood pressure. The Centers for Disease Control and Prevention CDC recommend doing at least 2. For children and teens, the CDC recommend 1 hour of exercise per day. Why is regular exercise good for you? Having additional body weight puts a strain on the heart and the cardiovascular system.

This can raise blood pressure. If your body mass index BMI is 25 or over, losing 5—10 pounds can help reduce your blood pressure. It can also lower the risk of other health problems. Get some tips on losing weight here. Restricting sugar and refined carbohydrates may help you lose weight and lower your blood pressure.

People with overweight or obesity who followed low carb and low fat diets saw their diastolic blood pressure fall by an average of about 5 mm Hg and their systolic blood pressure by 3 mm Hg after 6 months. What is the difference between diastolic and systolic blood pressure?

Is it safe to follow a no-carb diet? Increasing your potassium intake and cutting back on salt can help lower your blood pressure. A high salt intake can increase the risk of blood pressure, while reducing salt intake lowers it.

Potassium helps the body eliminate salt and eases tension in your blood vessels. High potassium foods include:.

However, a high potassium intake may be harmful to people with kidney disease , so talk with your doctor before increasing your potassium intake. Nutrition labels can help you decide which foods to eat and which to avoid. What effects does potassium have on the body?

The National Institutes of Health recommend the DASH Dietary Approaches to Stop Hypertension as a heart-healthy option.

The DASH diet emphasizes:. What are some heart-healthy foods? Processed foods are often high in salt, added sugar, and unhealthy fats. They may lead to weight gain. All these factors can contribute high blood pressure. Foods labeled low fat may be high in salt and sugar to compensate for the loss of fat.

Fat is what gives food taste and makes you feel full. Eating less processed food will help you eat less salt, less sugar, and fewer refined carbohydrates. All of this can result in lower blood pressure. Smoking can affect your all-around health, including your blood pressure.

One study showed that nonsmokers in areas with smoke-free restaurants, bars, and workplaces had lower blood pressure than nonsmokers in areas without smoke-free policies.

Get some tips here for stopping smoking. Finding ways to manage stress is important for your health and your blood pressure.

Ways of relieving stress depend on the individual but can include:. Get some tips here for relieving stress. Cacao contains flavonoids, an antioxidant that may help lower blood pressure. These flavonoids may help dilate, or widen, your blood vessels. However, the American Heart Association notes that while eating a little dark chocolate is unlikely to be harmful, the amount a person is likely to eat per day will probably not provide enough flavonoids to produce health benefits.

Does dark chocolate have other benefits? Some herbal medicines may help lower blood pressure. However, more research is needed to identify the doses and components in the herbs that are most useful. Always check with your doctor or pharmacist before taking herbal supplements.

They may interfere with your prescription medications. Learn more about herbal remedies for high blood pressure. Sleep deprivation may increase the risk of high blood pressure. Tips for sleeping well include :.

Get some tips on sleeping well. Fresh garlic or garlic extract may help lower blood pressure. One review found that for people with high blood pressure, garlic supplements reduced their systolic blood pressure by up to about 5 mm Hg and their diastolic blood pressure by up to 2. Can you eat raw garlic?

As such, the DASH diet has reduced levels of total fat, saturated fat, and cholesterol and increased levels of potassium, calcium, magnesium, fiber, and protein. These lifestyle modifications are recommended in nonhypertensive individuals with above-optimal BP.

Lifestyle modification is also recommended as initial therapy in stage 1 hypertension for up to 12 months in those without other risk factors [risk class A] or for up to 6 months in those with other risk factors [risk class B].

Although lifestyle therapies are generally recommended as a group, no previous trial has evaluated the effects of implementing these recommendations simultaneously, and no trial has tested the feasibility of implementing the DASH diet in free-living persons.

The rationale for the PREMIER clinical trial 10 has been published. Participating institutions included the National Heart, Lung, and Blood Institute Project Office Bethesda, Md , the coordinating center Kaiser Permanente Center for Health Research in Portland, Ore , and 4 clinical centers Johns Hopkins University, Baltimore, Md; Pennington Biomedical Research Center, Baton Rouge, La; Duke University Medical Center, Durham, NC; and Kaiser Permanente Center for Health Research, Portland, Ore.

Institutional review boards at each center and an external protocol review committee approved the protocol. Each participant provided written consent.

The target population consisted of generally healthy adults with above optimal BP including individuals with stage 1 hypertension who met Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure JNC-VI criteria for at least a 6-month trial of nonpharmacological therapy.

Other inclusion criteria were 25 years of age or older and body mass index BMI of Although individuals with diabetes were excluded, persons with other cardiovascular risk factors ie, cigarette smoking and dyslipidemia could enroll. Vitamin and mineral supplement use was not an exclusion.

Participants were recruited using mass mailings, community-based screening, and mass-media announcements. Enrollment began in January and ended in June For logistical purposes, participants were enrolled in 3 or 4 cohorts at each center.

Baseline data were collected during 3 screening visits and a randomization visit, each scheduled at least 7 days apart. Follow-up data were collected at 1 visit 3 months after randomization and at 3 visits 6 months after randomization.

Participant flow during the trial is shown in Figure 1. Randomization assignments were made centrally by a computer program. Clinical center staff then notified participants of their assigned group. Assignments were stratified by clinic and hypertension status; the randomization block size was Eligible participants were randomly assigned to 1 of 3 groups: 1 an "advice only" comparison group; 2 a behavioral intervention, termed "established" that implemented traditional lifestyle recommendations, 11 ie, weight loss among those who were overweight, reduced sodium intake, increased physical activity, and limited alcohol intake among those who drank alcohol; or 3 a behavioral intervention, termed "established plus DASH" that implemented the same traditional recommendations plus the DASH diet.

An interventionist, typically a registered dietitian, discussed nonpharmacological factors that affect BP weight, sodium intake, physical activity, and the DASH diet and provided printed educational materials. This advice was provided in a single minute individual session immediately following randomization.

Counseling on behavior change was not provided. No further contact with the interventionist occurred until after completion of the data collection visits at 6 months. Participant goals for both the established and established plus DASH interventions were as follows: 1 weight loss of at least 15 lb 6.

The established and the established plus DASH interventions differed from each other with respect to certain dietary goals and the strategies to achieve weight loss. Only the participants in the established plus DASH intervention received instruction and counseling on the DASH diet.

To achieve weight loss, both interventions emphasized increased physical activity and reduced total energy intake; in addition to these strategies, the established plus DASH intervention also emphasized substitution of fruits and vegetables for high-fat, high-calorie foods.

The format and contact pattern of the established and established plus DASH interventions were identical. During the initial 6 months, there were 18 face-to-face intervention contacts 14 group meetings and 4 individual counseling sessions.

Participants in both interventions kept food diaries, recorded physical activity, and monitored calorie and sodium intake. Participants in the established plus DASH group also monitored intake of fruits, vegetables, and dairy products and monitored their intake of fat.

Staff who were masked to randomization assignment collected measurements. Blood pressure measurements were obtained by trained, certified individuals who used a random zero sphygmomanometer. The BP measurement protocol was similar to protocols used in prior studies.

At each visit, 2 BP measurements separated by at least 30 seconds were obtained. Systolic BP was the appearance of the first Korotkoff sound, and diastolic BP was the disappearance of Korotkoff sounds.

At each assessment point, BP was the mean of all available measurements baseline [8 BP measurements across 4 visits], 3-month assessment [2 BP measurements at 1 visit], and 6-month assessment [6 BP measurements across 3 visits].

Weight was measured using a calibrated scale, and height was measured using a wall-mounted stadiometer. Each of these measurements was obtained at baseline and 6 months after randomization. Intake of nutrients and food groups was assessed from unannounced hour dietary recalls conducted by telephone interviewers.

Nutrient and food group intakes were then calculated using the Nutrition Data System Version NDS-R University of Minnesota. Biomarkers of dietary intake were hour urinary excretion of sodium, potassium reflecting fruit and vegetable intake , phosphorus reflecting dairy intake , and urea nitrogen reflecting protein intake.

Alcohol intake was obtained from questionnaire. Cardiorespiratory fitness was assessed using a submaximal treadmill exercise test developed for the PREMIER trial.

This 2-stage, minute protocol was designed to achieve an age- and sex-specific effort of moderate intensity. The main fitness outcome was heart rate at the end of stage 2 or the last available heart rate from stage 1 for participants who did not complete stage 2.

A 7-day physical activity recall was used to assess physical activity. The specific aims of the trial were to test the effects of the established intervention compared with the advice only intervention; the effects of the established plus DASH intervention compared with the advice only intervention; and the effects of the established plus DASH intervention compared with the established intervention.

The primary outcome was change in systolic BP from baseline to 6 months. Hypertension status and change in diastolic BP at 6 months were secondary outcomes. Blood pressure measurements were censored if the participant reported taking any antihypertensive medication or other medications known to have major BP effects eg, oral steroids.

Defining the primary outcome at 6 months reduced the risk of bias and ensured that we would have a maximum number of BP measurements for analysis.

In prespecified subgroup analyses hypertensive and nonhypertensive , the models also included a main effect for the subgroup indicator and interactions between this indicator and the 2 treatment group indicators.

Primary analyses of BP change are based on intention to treat. For individuals without BP at the 6-month assessment and for those who had been taking antihypertensive medication, 3-month BP measurements were carried forward; if a 3-month BP measurement was unavailable, values were imputed using a "hot deck" procedure that drew values from participants in the advice only group.

For all other variables, including hypertension status, we used available data and did not impute values for missing data. To analyze continuous indicators of intervention effects, such as change in body weight, we used a similar analytic model.

We used the Mantel-Haenszel χ 2 test for 2 × 2 tables to compare the proportion of individuals meeting intervention targets at 6 months. Hypertension status at 6 months was assessed separately for those who were and were not hypertensive at baseline, reflecting persistent and incident hypertension, respectively.

We also compared the prevalence of hypertension in all participants. Pairwise differences in the incidence, persistence, and overall prevalence of hypertension between treatment groups were also assessed using the Mantel-Haenszel test.

All analyses were performed using SAS version 8 SAS Institute Inc, Cary, NC. Nominal P values are presented. A total of participants were enrolled in the trial Figure 1. Baseline characteristics were similar in the randomized groups Table 1. The mean SD age was The participants were generally overweight and sedentary.

Mean SD systolic and diastolic BP were Mean SD attendance was Differences in weight, physical fitness, and diet among the randomized groups were achieved. Table 2 displays intervention outcomes, and Table 3 lists the number of individuals who reached the intervention goals.

Weight loss occurred in each group, including the advice only group. While changes in physical activity did not differ among the groups, fitness significantly improved in both behavioral interventions. Alcohol intake was low and did not change in any group.

Mean reductions in urinary sodium excretion occurred in both behavioral interventions, but only the reduction in the established group differed significantly from that of advice only group. Also, based on hour dietary recall data, both behavioral interventions significantly reduced sodium intake in comparison with the advice only group data not shown.

In the established plus DASH group, fruit and vegetable intake increased significantly compared with the other 2 groups; parallel changes in urinary potassium excretion occurred.

Compared with the advice only and established groups, consumption of dairy products increased significantly in the established plus DASH group as did dietary calcium intake and net urinary phosphorus excretion. Saturated and total fat consumption significantly decreased in both intervention groups.

Blood pressure declined progressively over time in each group Figure 2. From baseline to 6 months, mean SD reductions in systolic BP were 6. Corresponding diastolic BP reductions were 3.

In hypertensive participants, mean SD reductions in systolic BP were 7. In nonhypertensive participants, mean SD reductions in systolic BP were 5.

Table 4 displays pairwise differences in BP. In all participants, nonhypertensive participants, and hypertensive participants, the established and established plus DASH interventions significantly reduced systolic and diastolic BP in comparison with the advice only group.

Although BP change in the established plus DASH group was consistently greater than corresponding BP change in the established group, none of the pairwise differences was statistically significant.

Figure 3 displays the percentage of nonhypertensive participants who became hypertensive, the percentage of hypertensive participants who remained hypertensive, and the percentage of all participants who were hypertensive at 6 months.

In each instance, there was a gradient in hypertensive status across the 3 groups. By 6 months, antihypertensive medication had been started in 19 participants in the advice only group, 2 participants in the established group, and 5 participants in the established plus DASH group.

A serious musculoskeletal injury occurred in 20 participants in the advice only group, 17 in the established group, and 16 in the established plus DASH group.

One stroke, 1 transient ischemic attack, and 1 myocardial infarction occurred in the advice only group. No cardiovascular event occurred in the established group, and 1 myocardial infarction occurred in the established plus DASH group.

The PREMIER trial documented that individuals with above-optimal BP, including stage 1 hypertension, can make multiple lifestyle changes that lower BP and control hypertension. Both of the PREMIER behavioral interventions accomplished substantial weight loss, reduced sodium intake, and increased physical fitness.

Individuals assigned to the established plus DASH intervention also made dietary changes consistent with the DASH diet, ie, increased their intake of fruits, vegetables, and dairy products. In aggregate, these lifestyle changes should substantially lower the risk of CVD as well as the risk of other chronic diseases, including diabetes, osteoporosis, and perhaps cancer.

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