Lower Your Blood Pressure

by Maren Sederquist, MES, CSCS, PES, CPT

Heart disease is the number one preventable killer in the United States. Risk factors include:

High blood pressure
Elevated cholesterol and/or triglycerides
Smoking
Diabetes
Being overweight
Being sedentary
Being over 55 for men, or 65 for women
Having family history of heart disease at an early age

The last two factors are hereditary, so there's nothing you can do about it, but high blood pressure is largely preventable, and often without medication! High blood pressure is called the "silent killer" because nearly one-third of people who have it, don't know they do. Since there are no overt symptoms, you have to get your blood pressure checked to find out that it's high. One in three U.S. adults are thought to have high blood pressure, and if you're over 55, you have a 90% chance of developing it within your lifetime.

What Is High Blood Pressure?

Your blood pressure reading is given in two numbers: The top number is called the systolic number, and it's the amount of pressure exerted against your arteries when your heart pumps blood out. The bottom number is called the diastolic number, and it's the amount of pressure exerted on your arteries in between beats.

The higher your blood pressure, the greater your chance of heart attack, heart failure, stroke, and kidney disease. If you have long standing hypertension, over a period of 10 or more years, it can lead to left ventricular hypertrophy (LVH).

In persons older than 50 years, systolic blood pressure greater than 140 mmHg is a much more important cardiovascular disease (CVD) risk factor than diastolic blood pressure. Check the chart below to see what classification your blood pressure falls under.

Blood Pressure Classification	Systolic BP (mmHg)	Diastolic BP (mmHg)

Normal	< 120	and < 80

Prehypertension	120 – 139	or 80 – 89

Stage 1 Hypertension	140 – 159	or 90 – 99

Stage 2 Hypertension	≥ 160	or ≥ 100

Taking Your Blood Pressure

Health care providers should give you the best possibility for accurate results. That means being seated in a comfortable chair for 5 minutes before taking a reading. At least two measurements should be taken, and three separate readings on three separate weeks should be confirmed before medication is prescribed. Be aware of factors that can temporarily rise your blood pressure such as "white coat syndrome" (when you're nervous about the possible outcome), being too cold, or needing to urinate badly. If you're still uncertain the environment is comfortable enough for you to get an accurate reading, there are many home measurement devices. I've had good experiences with Omron Models.

Ways To Lower Your Blood Pressure

There are many things you can do to reduce your blood pressure:

Maintain a healthy weight.
Be physically active.
Follow a healthy, low sodium eating plan like DASH.
Only drink alcohol in moderation.
Reduce stress.
Take medication if prescribed.

Prehypertension should be treated with lifestyle modifications. Stage I hypertension usually has to be treated with one medication in addition to lifestyle modifications. Stage II is usually treated with 2 different medications in addition to lifestyle modification. Notice that recommendations for all stages of hypertension include lifestyle modifications!

Every lifestyle change you make adds up. Check the chart below!

Effect of Lifestyle Modifications on Hypertension
Modification	Recommendation	Approximate Systolic BP Reduction Range (mmHg)

Weight reduction	Maintain normal body weight (Body Mass Index of 18.5–24.9 kg/m2 and Waist Measurements of <35" in women, 40" in men)	5 – 20 / 10 kg weight loss

Adopt DASH eating plan	Consume a diet rich in fruits, vegetables, and low fat dairy products with a reduced content of saturated and total fat.	8 – 14

Dietary sodium reduction	Reduce dietary sodium intake to no more than 2400 mg sodium per day.	2 – 8

Physical activity	Engage in regular aerobic physical activity such as brisk walking for at least 30 min per day, most days of the week.	4 – 9

Moderation of alcohol	Limit consumption to no more than 2 drinks per day for men, 1 drink per day for women.	2 – 4

It's harder to measure how much impact stress reduction has on blood pressure, since individual personalities vary so much. If you know stress may be a factor (yes you probably know who you are), practice mind / body techniques like mindfulness based stress reduction, meditation, autogenic training, progressive relaxation, visualization, breathing techniques, yoga or biofeedback. It's also important to make sure you remove stressors in your life, have a supportive social network, work on lessening feelings of despair and hopelessness, and find constructive outlets for emotional responses like talk therapy or writing. There are more resources for you at the bottom of the page.

Recommendations for exercise if you have hypertension:

Check with your physician for clearance to exercise first, and make sure they rule out LVH and other ECG abnormalities.
Monitor blood pressure before, during and after exercise.
Stop exercise immediately if your diastolic blood pressure increases more than 20 mmHg.
Always warm up and cool down to avoid a sudden change in heart rate.
Use caution exercising in other situations that cause sudden increase in blood pressure: cold environments, and within 90 minutes after a large meal.
Cardiovascular exercise should be done at an intensity level of 40-65%, 4-5 times per week for 30-60 minutes.
Use Rate of Perceived Exertion and the Talk Test, rather than Heart Rate to determine safe exercise limits. Many blood pressure-reducing medications also lower heart rate, so it's not a good indicator.
30-60 minutes should be worked up to, with an increase of no more than 10% per week, from what you're able to do easily when beginning an exercise program.
Resistance exercise should be done at an intensity level of 30-50% of 1 repetition maximum, so you're able to complete 12-15 repetitions.
Resistance training is not recommended if your blood pressure is above 180/105, or if you have congestive heart failure, uncontrolled arrrythmias or unstable angina.
Make sure you breathe through any resistance exercises. Holding your breath causes a sudden increase in blood pressure.
Include mindfull exercise like Yoga, since stress also increases blood pressure.