Patient information: High blood pressure, diet, and weight

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 information: High blood pressure in adults" and "Patient information: High blood pressure treatment in adults".) More detailed information is available by subscription. (See "Salt intake, salt restriction, and 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 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 information: Low sodium diet".)

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 information: Risks and benefits of alcohol".)

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 information: High fiber diet".)

Eat more fish — Eating more fish may help to lower blood pressure, especially when combined with weight loss [1].

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).

EXERCISE

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 information: Exercise".)

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). You are said to be overweight if your BMI is greater than 25, while a person with a BMI greater than 30 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 information: Weight loss treatments".)

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 information: High blood pressure treatment in adults" and "Choice of therapy in essential hypertension: Recommendations".)

WHERE TO GET MORE INFORMATION

Your healthcare provider is the best source of information for questions and concerns related to your medical problem. Because no two people are exactly alike and recommendations can vary from one person to another, it is important to seek guidance from a provider who is familiar with your individual situation.

This discussion will be updated as needed every four months on our web site (www.uptodate.com/patients). Additional topics as well as selected discussions written for healthcare professionals are also available for those who would like more detailed information.

Some of the most pertinent include:

Patient Level Information:
Patient information: High blood pressure in adults
Patient information: High blood pressure treatment in adults
Patient information: Low sodium diet
Patient information: Risks and benefits of alcohol
Patient information: High fiber diet
Patient information: Exercise
Patient information: Weight loss treatments

Professional Level Information:
Ambulatory blood pressure monitoring and white coat hypertension in adults
Can therapy be discontinued in well-controlled hypertension?
Cardiovascular risks of hypertension
Choice of therapy in essential hypertension: Recommendations
Diet in the treatment and prevention of hypertension
Hypertension: Who should be treated?
Indications for use of and contraindications to specific antihypertensive drugs
Initial evaluation of the hypertensive adult
Overview of hypertension in adults
Patient adherence and the treatment of hypertension
Prehypertension and borderline hypertension
Renin-angiotensin system inhibition in the treatment of hypertension
Resistant hypertension
Salt intake, salt restriction, and essential hypertension
Technique of blood pressure measurement in the diagnosis of hypertension
Treatment of hypertension following a stroke
Treatment of hypertension in blacks
Treatment of hypertension in diabetes mellitus
Treatment of hypertension in heart failure
Treatment of hypertension in the elderly, particularly isolated systolic hypertension
What is goal blood pressure in treatment of hypertension?
Who should be screened for renovascular or secondary hypertension?

A number of web sites have information about medical problems and treatments, although it can be difficult to know which sites are reputable. Information provided by the National Institutes of Health, national medical societies and some other well-established organizations are often reliable sources of information, although the frequency with which they are updated is variable.

• National Library of Medicine

      (www.nlm.nih.gov/medlineplus/healthtopics.html)

• National Heart, Lung & Blood Institute (NHLBI)

      (www.nhlbi.nih.gov)

• American Heart Association

      (www.americanheart.org)

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