One of the leading causes of blood pressure is our lifestyle; the changes that we have brought over time have considerably damaged our health in terms of our food choices and eating time. The dependency on eating out has increased. The entrance of convenience foods on our kitchen racks has replaced the old traditional food ingredients naturally added to food and was silently benefiting us. These changes have given way to diseases that have impacted the health in a big way

Therefore Lifestyle management is one of the cornerstones of the management of these lifestyle diseases. Blood pressure is one of them.

High BP is a chronic medical condition in which BP in the arteries is elevated. Hypertension is usually classified based on systolic and diastolic blood pressure. Systolic BP is the BP in vessels during a heartbeat. Diastolic BP is the pressure between the heartbeats. A systolic and diastolic blood pressure measurement higher than the expected normal values for an individual’s age is classified as pre- HTN or HTN.

The normal blood pressure range should be less than 120 /80 mmHg. The blood pressure levels between 121-139 mm Hg of systolic and 81-89 mm Hg of diastolic blood pressure is a measure of Prehypertension. The blood pressure levels of 140 mm Hg or more of and diastolic blood pressure of 90 mm Hg or more or diastolic is defined as Hypertension. Hypertension is also classified as resistant if the medication does not reduce BP to normal. Exercise Hypertension is an excessive elevation of blood pressure during exercise.

Hypertension or high blood pressure is an emerging problem all around the world. Reports have been found that about 8 million deaths occur annually due to hypertension. In India, the overall prevalence of hypertension is about 30.7 % (as of 2019). The majority of hypertension is 25 percent in urban India and 10 percent in rural India. (ACCORDING TO CENSUS 2011). That is almost one in every three Indian adults is affected. Hypertension is often called the silent killer and is mainly asymptomatic, putting us at high risk of morbidity and mortality due to other comorbidities.

 

High blood pressure is a risk factor for various diseases and conditions like – chronic heart disease, stroke, and coronary heart disease. Studies have found that there is a Direct correlation between elevated blood pressure and the chances of stroke. Many other comorbidities are involved, like heart failure, peripheral vascular disease, renal impairment, retinal hemorrhage, visual impairment, and much more.

CAUSES

  • Essential hypertension
  • Secondary hypertension
  • Whitecoat hypertension

How to Monitor Blood Pressure

The average of patients resting bp is taken two or more times

IMPACT OF NUTRITION ON HYPERTENSION

Diet and lifestyle change plays an essential role in managing blood pressure. One of the most known diets that are said to make a difference in BP management is DASH DIET.

DASH DIET

DASH diet is a culmination of the ancient and modern world. Scientists have derived it based on certain ancient dietary principles and have been tailored to target modern society’s leading killers. DASH diet advocates the consumption of whole-grain products, fresh fruits and vegetables, and avoiding processed foods. Eat at least five servings of fruit and vegetables every day while reducing saturated and total fat intake and incorporating healthy fats in moderation, such as those in olive oil, nuts, and seeds, lean meats, and dairy, and the reduction of sodium in the diet to about 1500 mg/day. Following such a diet reduces systolic blood pressure on average by 8 to 14 mm Hg.

 

Dash Diet Includes healthy Carbohydrates – in the form of Green leafy vegetables: kale, broccoli, spinach, collards, mustards.

Whole grains: cracked wheat, millets, oats, wheat bran, Rice Millets

Low glycemic index fruits

Legumes and beans

Inclusion of good fats is of crucial importance- for example- cold-pressed oils (groundnut, sesame oil), Avocados, Nuts, Hemp Seeds, Flax seeds.

Fish rich in omega-3 fatty acids

DASH focuses more on plant-based proteins like legumes, soy products, nuts, and seeds. Low-fat dairy, eggs, fish, and lean cut meats can be included.

DASH diet also talks about the inclusion of certain foods rich in potassium, calcium, and magnesium as these prevent endothelial dysfunction and promote endothelial, smooth muscle relaxation. Some of the foods rich in potassium include bananas, oranges, and spinach. Calcium is rich in dairy products and green leafy vegetables. Magnesium is present in a variety of whole grains, leafy vegetables, nuts, and seeds.

POTASSIUM

Foods rich in potassium are essential in managing high blood pressure (HBP or hypertension) because potassium lessens sodium. The more potassium you eat, the more sodium you lose through urine. Potassium also helps to ease tension in your blood vessel walls, which helps further lower blood pressure. Normal body levels of potassium are essential for muscle function, including relaxing the blood vessels’ walls. The recommended potassium intake for an average adult is 4,700 milligrams (mg) per day.

Sources of  Potassium – Banana/ coconut water/ beetroot / pomegranate juice

 

MAGNESIUM AND HYPERTENSION

Magnesium (Mg), an essential element in the human body, may have beneficial health effects for the primary prevention of hypertension. Mg may play a critical role in BP regulation by directly stimulating prostacyclin and nitric oxide formation,1 modulating endothelium-dependent and endothelium-independent vasodilation,2,3 reducing vascular tone and reactivity, four and preventing vascular injury via its antioxidant and anti-inflammatory functions.

The RDA of magnesium is 420 milligrams (mg) per day for men ages 50 and older; 320 mg/day for women ages 50 and older.

 

Foods that help in lower Blood Pressure

Foods Function How to use
Garlic Endowed with the substance Allicin, it effectively brings down blood pressure, it works by helping the blood vessels relax and dilate, facilitating easy blood flow through the body. Some research suggests that garlic increases the body’s nitric oxide production, which helps the smooth muscles relax and the blood vessels to dilate. These changes can reduce hypertension -3-4 cloves of garlic can be taken with water on an empty stomach
– garlic can be added in vegetables
Cinnamon According to the national library of medicine – national Institute of Health (US), eating cinnamon can help reduce systolic BP by 5.39mmHg and diastolic by 2.6mmhg – Cinnamon concoctions can be made.
– Cinnamon powder can be added in chapatis/vegetables
– Sprinkled over fruits
– Can be sprinkled over oats porridge
Cardamom Due to its antioxidants and diuretic properties, it shows promising results against hypertension.

 

 – Cardamom infused water
– As a part of garam masala
– Added to milk/latte
Ginger ginger helps lower blood pressure through its blockade of voltage-dependent calcium channels. It also effectively decreases muscle contraction and arterial bp. – Can be used for making herbal teas
– In regular cooking of vegetables
– Candid gingers can be had after meals
Black pepper rich in potassium, and iron helps control heart rate and bp. – Pepper can be part of herbal teas
– Pepper powder can practically replace red chili powder for many dishes
– Goes well with eggs and raw salad
Turmeric Curcuma longa  could reduce BPbecause of its antioxidant and anti-inflammatory activity – And be added to milk
– Making of vegetables or any Indian Preparation
– Can be a part of herbal teas
Coriander – Coriander water
– Coriander powder add to vegetables
– Part of garam masalas
Beetroot High in nitric oxide, helps to open blood vessels and lower blood pressure – Salad
– Juices
– Parathas / Rotis
Banana According to the American Heart Association, potassium reduces the effects of sodium and alleviates tension in the walls of the blood vessels. The mineral helps balance the effects of salt on the body and helps the kidneys function properly. Studies have shown that daily banana consumption can help lower blood pressure. One study, in particular, said just two bananas a day can reduce your blood pressure by 10 percent – Eaten as it is
– Add to smoothies
Pomegranate Rich in phytochemicals  shown to possess antioxidant and anti-inflammatory properties plus additional biological activities has beneficial in reducing BP – Pomegranate juice
– Added to salads
– As a fruit
Oats Weight loss with the inclusion of soluble fiber helps in lowering BP – Oats dosa, idli, upma
– Oats roti
– Oats porridge
– Soup thickening agent
Coconut water excellent source of potassium mineral – As it is
– Can be added to mocktails/cocktails

  
Other Tips to manage High Blood Pressure

  • STAY ACTIVE AND DO REGULAR PHYSICAL ACTIVITY TO MANAGE HYPERTENSION

Physical activity helps control high blood pressure . It also helps you manage your weight, strengthen your heart, and lower your stress level. A healthy weight, a strong core, and general emotional health are all good for your blood pressure. Plan an exercise routine that includes strength and flexibility goals (using weights, resistance bands, yoga, and stretching exercises.

  • Meditation and Sleep to decrease stress

It has been shown that chronic stress can cause Hypertension.  You can use stress managing strategies like practicing mindfulness, gratitude, exercising, meditating, and relaxing.

Rest is essential to manage stress .Even if you are busy, it takes 15 to 20 minutes a day to sit quietly, breathe deeply. A good sleep cycle can help in managing hypertension. Get at least 7 hours of sleep daily.

  • Avoid alcohol/smoking.

Tobacco use increases your risk of high blood pressure. Smoking can damage the heart and blood vessels. Nicotine raises blood pressure, and breathing in carbon monoxide produced from smoking tobacco—reduces the amount of oxygen that your blood can carry.

  • Say No to tea and coffee
  • Decrease salt intake switch to better options

Salt is an essential electrolyte to the living of human beings and is used universally in cooking, seasoning, and preserving manufactured foodstuffs worldwide. For several million years, human ancestors ate a diet that contained less than 1 g of salt per day. With the recent massive increase of dietary salt intake in most developed countries in the world, the prevalence of hypertension increases tremendously which is about 30% of the world population. If salt intake exceeds the kidney’s ability to excrete salt, then it is accumulated in the body. Excessive salt intake can also be attributed to hypertension.

Some people can effectively excrete high dietary salt intake without an increase in arterial BP, and other people cannot excrete effectively without an increase in arterial BP. Former individuals who can excrete salt intake effectively are called “salt-sensitive,” and latter individuals who cannot are called “salt insensitive.” Salt sensitivity of BP refers to the BP responses for dietary salt intake changes to produce meaningful BP increases or decreases. Excess salt intake has functional and pathological effects on the vasculature that is independent of blood pressure.

Do not add salt on top of cooked food. Do not have a salt shaker on the table.

Limit the consumption of salty snacks;

Choose products with lower sodium content.

WHO recommends that adults consume less than 5 g (just under a teaspoon) of salt per day.

For children: WHO recommends that the recommended maximum intake of salt for adults be adjusted downward for children aged two to 15 years based on their energy requirements relative to adults. This recommendation for children does not address the period of exclusive breastfeeding (0–6 months) or the period of complementary feeding with continued breastfeeding (6–24 months).

WALKING

Hypertension is also caused by obesity. Excessive fat deposition in obese people can cause narrowing of arteries, and there is obstruction of blood flow. The most effective way of managing hypertension is by losing weight.  Even slight changes in value can cause a reduction in blood pressure. Thus having an active lifestyle with a well-balanced diet is essential for managing hypertension. WALKING REDUCES HTHabitual walking can, therefore, safely and effectively contribute to the blood pressure-lowering in hypertensive subjects without exposing the patients to potential adverse effects of drug therapy.

Given that moderate physical activity such as walking effectively lowers blood pressure and is associated with numerous other health benefits, walking should be included as standard adjunctive therapy for hypertension.

Getting regular physical activity helps your heart and blood vessels stay strong and healthy, which may lower your blood pressure. Regular physical activity can also help you keep a healthy weight, which may lower your blood pressure.

Lose Weight (obesity)& maintain a healthy weight

Having obesity or being overweight also means your heart must work harder to pump blood and oxygen around your body. Over time, this can add stress to your heart and blood vessels. Although both have their risk factors, Research shows a Weight loss of 5 kgs has been shown to significantly reduce systolic and diastolic blood pressure by an average of 4.44 and 3.57mmhg, respectively. There is an estimated average decrease of 1.05mmhg (systolic)and 0.92mmhg ( diastolic) per kilogram of weight loss for smaller weight reduction. ( oxford journals-American Journal of Hypertension -2016 Aug; 29(8): 894-991)

Read labels carefully before buying ready foods

Some food labels may only state the sodium content. Don’t confuse salt and sodium figures.

To convert sodium to salt, you need to multiply the sodium amount by 2.5. For example, 1g of sodium per 100g is 2.5 grams of salt per 100g.

Adults should eat no more than 2.4g of sodium per day, equal to 6g of salt.

The primary sodium source in our diet is salt, although it can come from sodium glutamate, used as a condiment in many parts of the world.

Most people consume too much salt—on average, 9–12 grams per day or around twice the recommended maximum intake level.

Salt intake of fewer than 5 grams per day for adults reduces blood pressure and risk of cardiovascular disease, stroke, and coronary heart attack. The principal benefit of lowering salt intake is a corresponding reduction in high blood pressure.

 

REFERENCES 

  • Dietary Approaches to Prevent Hypertension

Lydia A. Bazzano, Torrance Green, Teresa N. Harrison, and Kristi Reynolds

  • Krousel-Wood MA, Muntner P, He J, Whelton PK. Primary prevention of essential hypertension. Med Clin North Am. 2004;88(1):223–38.
  • Whelton PK, He J, Appel LJ, Cutler JA, Havas S, Kotchen TA, et al. Primary prevention of hypertension: clinical and public health advisory from The National High Blood Pressure Education Program. JAMA. 2002;288(15):1882–8. 5. Cook NR, Cohen J, Hebert PR, Taylor JO, Hennekens CH.
  • Implications of small reductions in diastolic blood pressure for primary prevention. Arch Int Med. 1995;155(7):701–9.
  • Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. NEJM. 1997;336(16):1117–24.
  • Svetkey LP, Simons-Morton D, Vollmer WM, Appel LJ, Conlin PR, Ryan DH, et al. Effects of dietary patterns on blood pressure: subgroup analysis of the Dietary Approaches to Stop Hypertension
  • https://www.nhs.uk/live-well/eat-well/salt-nutrition/