Lifestyle Medicine approach to Hypertension:

These recommendations are the starting point but if blood pressures persistently remain over 135/85 then medication or some other intervention will, at least temporarily, be necessary.

  1. Modest but consistent physical activity such as a 30 minute walk at least 5 days a week raises good HDL cholesterol, lowers blood pressure, improves glucose metabolism, boosts the immune system and long term, lowers overall mortality rates 30%. The “30 minute a day “ formula comes out to 150 minute average a week. It turns out that benefits are conferred with any time combinations per week. For example, two walks each day on the weekend, each 75 minutes would give you the same 150 minute a week benefit! If we have discussed more intensive “moderately vigorous physical activity” in the office, such as bicycling, then 3 times weekly has been shown to achieve these benefits- half the time is needed which comes out to 75 minutes a week, and yes, two 35-40 minute bike rides each day on the weekend would confer the same benefits! Remember though, long term consistency is the key, not the intensity. The long term benefits confers a myriad of health benefits including lower cancer rates, maintaining cognitive function later into life and psychological benefits. When we say 30% lower mortality rates; that’s “All Cause Mortality” meaning the individual is benefitting from the ripple effect into all these areas! See physical activity National Guidelines at link.

  2. Be aware that caffeine consumption in a 24 hour period has a cumulative effect. So if you drink 2 mugs of coffee in the morning, two iced teas in the afternoon and a caffeinated soda or energy drink, all that caffeine effect adds up. Green tea is less potent than black tea. Coffee can be brewed half-decaffeinated so that 2 mugs of “half-caff” is really “one mug of caffeine.” Sodas in general are a bad choice for multiple reasons, caffeine probably the least problematic. The sugar load, often as “fructose corn syrup” wreaks metabolic havoc on the body. If you need something “bubbly” (carbonated), try a “naturally flavored” 0 calorie mineral water, and add a little something extra to add more taste. Your taste buds adjust over several weeks to the “new you” so stick with it!

  3. Avoid allergy/cold preparations that contain the decongestants phenylephrine or pseudoephedrine. They are stimulants that add little to alleviate upper airway congestion but wreak havoc on patients with hypertension, putting cardiac patients at undue risk. The other "cold/allergy formula" ingredients (guanefisin, dextromethorphan, antihistamines) do not have the stimulant effect.

  4. Tobacco vasoconstricts the blood vessels, raising the blood pressure, putting cardiac patients at increased risk. Longer term, tobacco accelerates atherosclerotic vascular damage. If you need help substituting a need that tobacco is filling such as lessening chronic anxiety symptoms, for example, please bring that to my attention at our next meeting. Nicotine patches, gum, lozenges are an acceptable substitute for 4-8 weeks. I do not recommend “vaping” as it reinforces the whole social “ritual” of holding something in your hand and putting something in your mouth; yes it’s psychological, but that doesn’t make it easier. (I am an ex-smoker).

  5. Flaxseed has been shown to have an antihypertensive effect as documented in the link to the article “Potent Antihypertensive Action of Dietary Flaxseedfrom the American Heart Association 2013 Hypertension journal article. The bioactive component appears to be in the shell (lignans and fiber) as the pure oil or capsule forms do not have as potent an effect. Therefore buy the ground flax seed from the supermarket and add 2 tablespoons a day to foods such as your cereal or yogurt, wherever you might have used wheat germ. Flax is a rich source of omega fatty acids which provides multiple other benefits - anti-inflammatory and neurological (DHA is an important omega fatty acid in the brain).

  6. Salt: Minimize salt consumption to under 2000 mg, ideally 1700mg or less. Try substituting herbs/spices for different flavor profiles; some such as oregano, clove and thyme are potent antioxidants and confer healthful benefits. See the NIH article “ Antioxidant Activity of Spices and Their Impact on Human Health: A Review” for a comprehensive look at at these under appreciated sources of health.