One of the most important aspects of treating hypertension is lifestyle changes. These are not temporary short term changes but rather changing habits to be healthier long term. Some of the lifestyle changes that will improve high blood pressure include weight loss, exercise, smoking cessation, decreased alcohol intake, and managing other disease entities well. These changes are not easy but they are a crucial part to treating hypertension and allowing a longer healthier life.
Obesity is a strong risk factor for hypertension. Many overweight patients with hypertension can solve the high blood pressure problems with weight loss alone. We often measure obesity with body mass index (BMI). This is a scale that takes into account the patients weight as well as height and has been shown to be a good predictor of body fat. BMI over 25 is considered overweight and BMI over 30 is considered obese. BMI over 35 is considered severely obese. Although the goal of weight loss is to have a BMI under 25, there is good data that losing 10% of body weight can make a large difference in health even if the 10% does not bring the BMI down to ideal weight. This is an excellent initial goal for weight loss, 10% of current weight. Weight loss generally requires a combination of dietary modifications and exercise. Eating a low fat, low carbohydrate, high fiber diet is key to healthy weight loss. A goal of 1-2 pounds per week is a healthy sustainable rate of losing weight. Remember, you are in this for the long run, a slow but steady rate of weight loss is the best way to maintain this important lifestyle change. Many patients will benefit from a meeting with a trained dietician to help tailor dietary modifications that are sustainable for the long term.
Exercise is a key ingredient to treating hypertension. You do not have to run a marathon or train like a professional athlete to gain benefits from exercise. Walking 30 minutes per day is an easy and often enjoyable way to stay active. If the weather is not conducive to walking I recommend that y patients walk in an indoor shopping mall (just avoid the food court). Walking is only one form of exercise, anything that keeps you active and raises your heart rate will give you benefit. Aerobics, yoga, sports, jogging, sprints, bicycling, and swimming are all great examples of ways to stay active. For people with joint problems, swimming and water aerobics are excellent forms of exercise as they avoid weight bearing yet still give the benefits of activity.
Smoking can worsen the health risks associated with hypertension. Smoking cessation is a key part of lifestyle changes that can improve long term health in anyone but especially in a patient with high blood pressure. There are many methods to help with smoking cessation. There are medications that can be prescribed by your doctor, there are also strategies that can be employed to help making quitting easier. One common ingredient is the need for the patient to strongly desire to quit. Here is one method to help people quit smoking.
Excessive consumption of alcohol can also lead to increase problems in the hypertensive patient. Alcohol has been shown to raise blood pressure in a dose dependent manner. This means the more you drink the more it will effect your blood pressure. Alcoholic beverages also have a lot of calories, lowering alcohol use can also help with weight loss. It is recommended to reduce alcohol consumption to less than 4 drinks per day.
It is common for people with hypertension to have other medical problems as well. Many of these other problems, called co-morbidities, can either raise blood pressure directly or amplify the risks associated with hypertension such as heart disease and stroke. Examples of common co-morbid conditions include diabetes, high cholesterol, and heart disease. It is very important for the hypertensive patient to control other diseases well to help reduce the long term consequences of both hypertension and the other disease entities.