Multiple Lifestyle Changes Help Lower Blood Pressure

People who make healthy lifestyle changes and stick to them can lower their high blood pressure significantly and slash their risks of potentially killer heart attacks.

What's more, middle-aged people who sleep five hours or less a night may stand a greater likelihood of developing high blood pressure.

Health experts with the National Heart, Lung, and Blood Institute say behavioral counseling, physical activity and a healthy eating plan called DASH leads to significant drops in blood pressure readings, which they contend underscores the value of healthy diets and exercise.

"For the millions of Americans with prehypertension and hypertension, this shows that individuals can make healthy lifestyle changes to keep blood pressure under control without the use of medications," says Dr. Elizabeth Nabel, the institute's director.

High blood pressure: culprit for heart disease, strokes

High blood pressure is a major risk factor for heart disease and the chief risk factor for stroke. About 65 million American adults - about one in three - have high blood pressure, and many of them don't know it. What's more, 59 million other adults have "prehypertension," which are blood pressure readings above normal but not in the "high" range.

Nabel bases her thinking on a federal study involving more than 800 people 25 and older with either prehypertension or actual high blood pressure who weren't taking prescription medications to control their conditions. Two groups attended 33 group and individual counseling sessions throughout the one-and-a-half year project.

The groups who received the most extensive counseling were required to lose 15 pounds, engage in three hours a week of moderate physical activity, and limit their salt to one daily teaspoon, or no more than 2,300 milligrams. Women and men were limited to one and two alcoholic drink a day respectively.

One group also received guidance on starting the Dietary Approaches to Stop Hypertension, or DASH, an eating plan rich in fruits, vegetables and low-fat dairy products, and low in saturated, total fat and dietary cholesterol. Previous institute studies have shown DASH lowers blood pressure.

The people on DASH‚ were asked to increase their consumption of fruits and vegetables to nine to 12 daily servings, consume two to three servings of low-dairy products, and keep total fat to no more than 25 percent of total daily calories. To keep track, participants kept food diaries, monitored calories and sodium intakes, and recorded minutes of physical activity.

For comparison's sake, a third group received only two 30-minute sessions of advice to follow standard recommendations for blood pressure control.

Consult with doctors first

At the start, 37 percent of the people in all three groups had high blood pressure. But by the end of the study 1 1/2 years later, rates of high blood pressure declined in all three groups, but the reduction was greater in groups that received counseling, and particularly the group that also obeyed the DASH eating plan.

Only 22 percent of the people in the group that received counseling and DASH diets had high blood pressure, compared to 24 percent in the group that received just the counseling. In the comparison group, high blood pressure rates dropped to only 32 percent, according to the survey.

"The other good news is people can make and sustain these lifestyle changes over a fairly long time period," says Dr. William Vollmer, senior investigator at Kaiser Permanente's Center for Health Research, who co-authored the study. "However, we strongly advise patients taking hypertension drugs to consult with their physicians before trying to substitute lifestyle changes for their prescribed drugs."

Sleep slows the heart

In addition, researchers with Columbia University's School of Public Health and College of Physicians and Surgeons say their study shows 24 percent of people ages 32 to 59 who slept for five or fewer hours a night developed high blood pressure compared to 12 percent of those who got seven or eight hours of sleep.

"Sleep allows the heart to slow down and blood pressure to drop for a significant part of the day," says Dr. James E. Gangwisch, the study's lead author. "However, people who sleep for only short durations raise their average 24-hour blood pressure and heart rate. We need to investigate the biological mechanisms and, if confirmed, design interventions that will help people modify sleep behavior."

Subjects who slept five or fewer hours per night continued to be significantly more likely to be diagnosed with high blood pressure even‚ after researchers figured into their findings such culprits as obesity, diabetes, lack of physical activity, salt and alcohol consumption, smoking, depression, age, education, gender, and ethnicity.

Their findings are based on analyzing information from 4,810 people 32 to 86 who didn't have high blood pressure at the start of a national health and nutrition study. Eight to 10 years later, 647 of them had high-blood pressure.

Compared to people in the on study who slept seven or eight hours a night, people who slept five or fewer hours also exercised less and were more likely to have‚ higher body mass indexes, an equation that measures the amount of body fat. They were also more likely to have diabetes, depression and daytime sleepiness.

Equally troubling to researchers: their analysis of the health and nutrition study found that 30 percent of the people didn't know they had high blood pressure because they had not received physical exams that would have picked it up.