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The best pill to control high blood pressure

BY Dr. Chamara Dalugama

High blood pressure also known as hypertension is one of the major modifiable risk factors for heart disease and a leading cause of disability and death worldwide. High blood pressure is diagnosed based on multiple readings of elevated systolic (the top number which measures the force one’s heart exerts on the walls of one’s arteries each time that it beats) blood pressure above 140 millimetres of mercury (mmHg) and diastolic (the bottom number, which is the pressure in the arteries when the heart rests between beats) blood pressure above 90 mmHg. 

Hypertension is considered a “killer in disguise” as it is largely asymptomatic and may be diagnosed for the first time with a related complication such as a heart attack or a stroke. The healthcare system is under tremendous pressure with the ever increasing burden of non-communicable diseases such as hypertension and in a recent islandwide survey in Sri Lanka, one third of the adult population was found to be hypertensive. 

Screening for largely asymptomatic hypertension, diagnosing early, looking for hypertension-related complications and acting fast to control the hypertension to meet desired treatment targets should be the way forward. The management of hypertension has two main aspects which include lifestyle modifications and anti-hypertensive medications. Both of these are equally important and complementary to each other. Mild, uncomplicated hypertension can be managed with lifestyle modification alone. 

The article on guidance for prevention, detection, evaluation and management of high blood pressure in adults in the American College of Cardiology in 2017 highlights the importance of lifestyle modifications over the “pressure pills”. It states that dietary changes (Dietary Approaches to Stop Hypertension diet) alone can bring down the blood pressure by 11 mmHg. Reduction in alcohol consumption and physical exercise can improve blood pressure by four mmHg and four to eight mmHg, respectively. According to the article, every kilogramme you lose can reduce the blood pressure by one mmHg. 

  1. Diet 

Adopting a healthy diet is the best anti hypertensive pill. Diet alone is shown to improve the blood pressure by 11 mmHg. 

What dietary modifications are shown to reduce blood pressure?

DASH is a heart healthy way of eating which will help to bring down one’s blood pressure. Importantly, this will not require any special foods or hard to follow dietary recipes. It is a dietary pattern focused on the servings of different types of food. The DASH diet includes increasing the servings of fruits, vegetables, nuts, whole grains, fish, poultry, beans, seeds, low fat milk and lean meat. It also includes micronutrients in the menu. The DASH diet advocates the reduction of the salt intake to about 1,500 milligrammes (mg) per day.  

Food rich in potassium, calcium and magnesium are included in the DASH diet. Banana, oranges, and spinach are foods rich in potassium. Daily products and green leafy vegetables have a lot of calcium and whole grains, nuts and seeds are good sources of magnesium

The reduction of salt in the diet has multiple health benefits and certainly reduces the blood pressure and improves the efficacy of pressure pills. Lowering the daily salt intake to 1,500 mg is ideal and realistic if you act smart. Follow a gradual strategy to cut down salt, always read food labels and try to choose alternative foods and beverages with a low salt content. Fast foods and processed food contain large amounts of salt. Try to avoid adding salt to meals, use spices or herbs instead to add flavour.

The DASH diet in addition to improving blood pressure is shown to have beneficial effects. It is shown to reduce blood sugar, low density lipoprotein cholesterol and insulin resistance. At the same time, it reduces the incidence of bowel malignancies and prevents chronic heart failure. It is a very effective strategy to lose weight. 

Switching to a DASH diet is not difficult. The current diet can be easily aligned with the DASH diet by simply eating more fruits and vegetables, choosing low fat products, and limiting processed high fat food and sugary food. If you want to start a DASH diet, keep a food diary at least for a week so that you can reflect on your true eating habits and make changes to align it with the DASH diet. Be a smart shopper when buying food items and learn to read food labels when shopping and stick to healthy meal plans when dining out. 

  1. Exercise

Increasing physical activity helps lower blood pressure. Regular exercise makes the heart stronger, thus a strong heart can pump blood with less effect and the force on the blood vessels decreases, leading to lower blood pressure. Regular exercise also helps in weight loss which in turn helps to bring down the blood pressure. It is important to continue to exercise on a regular basis as the benefits only last as long as you continue to exercise. 

Try to get at least 150 minutes of aerobic exercise per week, aiming for at least 30 minutes per day. You can break up the daily 30 minute session to three 10 minute sessions, keeping the same benefit. Aerobic exercises include any activity that increases the heart and breathing rate. Examples include active sports such as tennis, football, cycling, dancing, jogging, swimming or even gardening. High intensity interval training which involves alternative brief bursts of high intensity activity followed by relaxing lighter activity can also be tried. Strength training exercises on two days per week can be included in the exercise programme to reduce blood pressure. 

  1. Quitting smoking

Blood pressure remains elevated for several minutes after each cigarette you smoke. Quitting smoking will have multiple health benefits on cardiovascular health and overall health. Smokers with high blood pressure are more likely to develop complications.

  1. Limiting ethanol intake

Ethanol can be good and bad for health. Ethanol consumption in moderation (males two units and females one unit per day) is shown to reduce the blood pressure by about four mmHg. Exceeding this limit, the protective effect will be lost, and excess amounts of ethanol will in fact increase the blood pressure and will have a negative effect on the action of pressure pills. 

  1. Stress reducing strategies

Chronic stress is well known to adversely affect blood pressure. Chronic stress leads to the continuous release of stress hormones which increase the heart rate and blood pressure. Stress may lead to unhealthy dietary practices, smoking and heavy ethanol consumption which affects blood pressure. One should look for strategies to cope with stress in a healthier way. Changing the expectations and planning the day and focusing on priorities would be useful. One should try avoiding stress triggers and make time to relax and engage in activities that one enjoys. 

  1. Self-monitoring of blood pressure

The home monitoring of blood pressure will help to monitor one’s progress on blood pressure control and to ensure that one’s lifestyle changes are working. 

High blood pressure is a “killer in disguise” as it is largely asymptomatic and may present with grave complications. In the management of high blood pressure, diet, exercise, stress reduction, and lifestyle habits cannot be ignored. Lifestyle strategies can be adopted alone in mild uncomplicated high blood pressure, and it is always synergistic with anti hypertensive medications. Adopting a healthy lifestyle would benefit in many other ways to boost overall health and wellbeing. 

(The author is a Consultant Physician at the Teaching Hospital, Peradeniya, and Senior Lecturer at the Peradeniya University’s Medicine Department)