Patient education: High blood pressure, diet, and weight (Beyond the Basics)
- Michael J Bloch, MD, FACP, FASH, FSVM, FNLA
Michael J Bloch, MD, FACP, FASH, FSVM, FNLA
- Associate Professor, University of Nevada School of Medicine
- Medical Director, Vascular Care, Renown Regional Medical Center
- Jan Basile, MD
Jan Basile, MD
- Professor of Medicine
- Medical University of South Carolina
- Ralph H Johnson Veterans Affairs Medical Center
Contents of this article
- Section Editor
- George L Bakris, MD
George L Bakris, MD
- Editor-in-Chief — Nephrology
- Section Editor — Hypertension
- Professor of Medicine
- The University of Chicago
- Deputy Editors
- Daniel J Sullivan, MD, MPH
Daniel J Sullivan, MD, MPH
- Deputy Editor — Primary Care (Adult)
- Assistant Professor of Medicine
- Harvard Medical School
- John P Forman, MD, MSc
John P Forman, MD, MSc
- Senior Deputy Editor — UpToDate
- Deputy Editor — Nephrology
- Assistant Professor of Medicine
- Harvard Medical School
HIGH BLOOD PRESSURE OVERVIEW
Hypertension (high blood pressure) is a common condition that can lead to serious complications if untreated. These complications can include stroke, heart failure, heart attack, and kidney damage. Making dietary changes and losing weight are effective treatments for reducing blood pressure . Other lifestyle changes that can help to reduce blood pressure include stopping smoking, reducing stress, reducing alcohol consumption, and exercising regularly. These changes are effective when used alone but often have the greatest benefit when used together (table 1). Many patients with hypertension will also require medications to lower their blood pressure to safe levels.
An overview of hypertension and a discussion of treatments can be found elsewhere (see "Patient education: High blood pressure in adults (Beyond the Basics)" and "Patient education: High blood pressure treatment in adults (Beyond the Basics)"). More detailed information is available by subscription. (See "Salt intake, salt restriction, and primary (essential) hypertension" and "Diet in the treatment and prevention of hypertension".)
DIETARY CHANGES AND BLOOD PRESSURE
Making changes in what you eat can help to control high blood pressure .
Reduce sodium (salt) — The main source of sodium in the diet is the salt contained in packaged and processed foods and in foods from restaurants.
The body requires a small amount of sodium in the diet. However, most people consume more sodium than they need. A low-sodium diet contains fewer than 2 grams (2000 milligrams) of sodium each day.
Reducing the amount of sodium you consume can lower blood pressure if you have high or borderline-high blood pressure. (See "Salt intake, salt restriction, and primary (essential) hypertension".)
A detailed discussion of low-sodium diets is available separately. (See "Patient education: Low-sodium diet (Beyond the Basics)".)
Reduce alcohol — Drinking an excessive amount of alcohol increases your risk of developing high blood pressure. People who have more than two drinks per day have an increased risk of high blood pressure compared with nondrinkers.
On the other hand, drinking one (for women) or two (for men) alcoholic beverages per day appears to benefit the heart in people greater than 40 years old. This protective effect applies to people with preexisting high blood pressure. (See "Patient education: Risks and benefits of alcohol (Beyond the Basics)".)
Eat more fruits and vegetables — Adding more fruits and vegetables to your diet may reduce high blood pressure or protect against developing high blood pressure. A strict vegetarian diet may not be necessary. (See "Diet in the treatment and prevention of hypertension".)
Eat more fiber — Eating an increased amount of fiber may decrease blood pressure. The recommended amount of dietary fiber is 20 to 35 grams of fiber per day. Many breakfast cereals are excellent sources of dietary fiber. More information about increasing fiber is available separately. (See "Patient education: High-fiber diet (Beyond the Basics)".)
Eat more fish — Eating more fish may help to lower blood pressure, especially when combined with weight loss .
Caffeine — Caffeine may cause a small rise in blood pressure, although this effect is usually temporary. Drinking a moderate amount of caffeine (less than 2 cups of coffee per day) does not increase the risk of high blood pressure in most people (table 2).
Dietary Approaches to Stop Hypertension (DASH) eating plan — The DASH eating plan combines many of the interventions noted above. It is high in fruits and vegetables, low-fat dairy, and fiber. Patients who strictly follow the DASH eating plan can also have fairly significant reductions in weight, particularly when combined with a low-sodium diet. (See "Diet in the treatment and prevention of hypertension".)
Regular exercise (walking, running) for 20 to 30 minutes most days of the week can lower your blood pressure, even if you don't lose weight. To maintain this benefit, you must continue to exercise; stopping exercise will allow your blood pressure to become high again. (See "Patient education: Exercise (Beyond the Basics)".)
WEIGHT LOSS AND BLOOD PRESSURE
Being overweight or obese increases your risk of having high blood pressure, diabetes, and cardiovascular disease. The definition of overweight and obese are based upon a calculation called body mass index (BMI) (calculator 1 and calculator 2). A patient is said to be overweight if his or her BMI is greater than 25, while a patient with a BMI of 30 or greater is said to be obese. People who are overweight or obese can see significant reductions in blood pressure with even modest weight loss.
To lose weight, you must eat less and exercise more. (See "Patient education: Weight loss treatments (Beyond the Basics)".)
AVOID TAKING MEDICATIONS AND SUPPLEMENTS THAT INCREASE BLOOD PRESSURE
In susceptible individuals, nonsteroidal anti-inflammatory medications, otherwise known as NSAIDs (ibuprofen, naprosyn, etc), can increase blood pressure. Oral contraceptive pills (OCPs) may increase blood pressure in some women. Additionally, any stimulant, including those found in some decongestants, weight loss products, and illicit drugs, can increase blood pressure. If you are regularly consuming any of these substances, you can talk to your health care provider about potential substitutions.
WHAT IF I STILL HAVE HIGH BLOOD PRESSURE?
If you continue to have high blood pressure despite making changes in your diet, exercising more, and losing weight, you may need a medication to reduce your blood pressure. Medications for high blood pressure are discussed separately. (See "Patient education: High blood pressure treatment in adults (Beyond the Basics)" and "Choice of drug therapy in primary (essential) hypertension".)
WHERE TO GET MORE INFORMATION
Your health care provider is the best source of information for questions and concerns related to your medical problem.
This article will be updated as needed on our website (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for health care professionals, are also available. Some of the most relevant are listed below.
Patient level information — UpToDate offers two types of patient education materials.
The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.
Patient education: High blood pressure in adults (The Basics)
Patient education: Controlling your blood pressure through lifestyle (The Basics)
Patient education: Diabetes and diet (The Basics)
Patient education: Renovascular hypertension (The Basics)
Patient education: High blood pressure emergencies (The Basics)
Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.
Patient education: High blood pressure in adults (Beyond the Basics)
Patient education: High blood pressure treatment in adults (Beyond the Basics)
Patient education: Low-sodium diet (Beyond the Basics)
Patient education: Risks and benefits of alcohol (Beyond the Basics)
Patient education: High-fiber diet (Beyond the Basics)
Patient education: Exercise (Beyond the Basics)
Patient education: Weight loss treatments (Beyond the Basics)
Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research upon which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.
Ambulatory and home blood pressure monitoring and white coat hypertension in adults
Can drug therapy be discontinued in well-controlled hypertension?
Cardiovascular risks of hypertension
Choice of drug therapy in primary (essential) hypertension
Definition, risk factors, and evaluation of resistant hypertension
Diet in the treatment and prevention of hypertension
Initial evaluation of the hypertensive adult
Overview of hypertension in adults
Patient adherence and the treatment of hypertension
Renin-angiotensin system inhibition in the treatment of hypertension
Salt intake, salt restriction, and primary (essential) hypertension
Blood pressure measurement in the diagnosis and management of hypertension in adults
Treatment of hypertension in blacks
Antihypertensive therapy to prevent recurrent stroke or transient ischemic attack
Treatment of hypertension in patients with diabetes mellitus
Treatment of hypertension in patients with heart failure
Treatment of hypertension in the elderly patient, particularly isolated systolic hypertension
Treatment of resistant hypertension
What is goal blood pressure in the treatment of hypertension?
Evaluation of secondary hypertension
The following organizations also provide reliable health information:
●National Library of Medicine
●National Heart, Lung, & Blood Institute (NHLBI)
●American Heart Association
- Appel LJ. Lifestyle modification as a means to prevent and treat high blood pressure. J Am Soc Nephrol 2003; 14:S99.
- Mori TA, Burke V, Puddey IB, et al. Effect of fish diets and weight loss on serum leptin concentration in overweight, treated-hypertensive subjects. J Hypertens 2004; 22:1983.
- Streppel MT, Arends LR, van 't Veer P, et al. Dietary fiber and blood pressure: a meta-analysis of randomized placebo-controlled trials. Arch Intern Med 2005; 165:150.
- Noordzij M, Uiterwaal CS, Arends LR, et al. Blood pressure response to chronic intake of coffee and caffeine: a meta-analysis of randomized controlled trials. J Hypertens 2005; 23:921.
- Sacks FM, Svetkey LP, Vollmer WM, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med 2001; 344:3.
- Elmer PJ, Obarzanek E, Vollmer WM, et al. Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: 18-month results of a randomized trial. Ann Intern Med 2006; 144:485.
- Mancia G, De Backer G, Dominiczak A, et al. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007; 25:1105.
All topics are updated as new information becomes available. Our peer review process typically takes one to six weeks depending on the issue.