Patient education: High blood pressure, diet, and weight (Beyond the Basics)
- Norman M Kaplan, MD
Norman M Kaplan, MD
- Editor-in-Chief — Nephrology
- Section Editor — Hypertension
- Clinical Professor of Internal Medicine
- University of Texas Southwestern Medical Center
HIGH BLOOD PRESSURE OVERVIEW
Hypertension (high blood pressure) is a common condition that can lead to serious complications if untreated. 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.
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 — The main source of sodium in the diet is the salt contained in packaged and processed foods and in foods from restaurants. 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".)
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 (2,000 milligrams) of sodium each day.
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 to nondrinkers; the risk is greatest when you drink more than five drinks per day.
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 — Eating a vegetarian diet may reduce high blood pressure and protect against developing high blood pressure. A strict vegetarian diet may not be necessary; eating more fruits and vegetables and low-fat dairy products may also lower blood pressure. (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 1).
Regular aerobic exercise (walking, running) for 20 to 30 minutes most days of the week can lower your blood pressure, although the effect is not as pronounced among older adults. 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). You are said to be overweight if your BMI is greater than 25, while a person with a BMI of 30 or greater is said to be obese. People who are overweight or obese can benefit from losing weight.
To lose weight you must eat less and exercise more. (See "Patient education: Weight loss treatments (Beyond the Basics)".)
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 healthcare 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 web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for healthcare 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 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
Hypertension: Who should be treated?
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
- 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.