Risk factors you can control
Recommended action or lifestyle modification
Overweight or obesity
A Body Mass Index (BMI) > 25 is considered as overweight. Abdominal obesity is also important and men should have a waist circumference < 94 cm and women < 80 cm.
Lose weight. This is the most effective non-drug method of lowering blood pressure. Losing as little as 4,5 kg can lead to a meaningful drop in blood pressure. In fact, some studies find that for every kilogram of weight lost, blood pressure drops 2,5mm Hg systolic and 1,5 mm Hg diastolic. Weight loss can also enhance the blood pressure lowering effect of anti-hypertensive drugs.
If you exercise less than two hours per week, your lifestyle can be described as inactive.
Even people with normal blood pressure who do not exercise and are "out of shape" have a 20 to 50% higher risk of developing hypertension than more active people.
Exercise. Aim to exercise about 2 hours per week. Twenty minutes of brisk walking 4 times a week, is a good start. Thirty to 45 minutes of mild to moderate aerobic exercise such as brisk walking or cycling four times a week can nudge your blood pressure down a few points, particularly if you're also losing weight. Vigorous exercise, such as riding a stationary bike for 40 minutes at high intensity, can lower blood pressure by more than 10 mmHg.A high activity level lowers your blood pressure, strengthens your heart and lungs and tones your muscles. As a bonus it is also a powerful stress-reducing tool. Exercise should be regular and dynamic, and should be determined by both your ability and by what your doctor advises. RED FLAG: Exercise should be avoided in severe hypertension (blood pressure > 180/110 mmHg) until it is better controlled. In high risk patients assessment by a cardiologist or specialist physician may be advised, as exercise may unmask underlying heart disease.
Unhealthy food choices
You are at increased risk if you: Drink more than two drinks per day
* Eat less than five fruits and vegetables per day
* Consume more than 3 g (half a teaspoon) of salt per day, including salt in preserved foods
* Your diet contains a lot of pastries, pies, or deep fried foods
* You love loads of oil and fatty food.
Opt for healthy eating and drinking habits
A recent study found people with hypertension lowered their blood pressure by 11.5 mm Hg systolic and 5.5 mm Hg diastolic through diet alone. 40% of these people were able to stop their medication completely. The diet may have worked because it promoted weight loss and was high in the minerals calcium, potassium and magnesium, which are associated with lower blood pressure.
* Opt for low fat, high fibre food including whole grains and legumes. Choose low-fat dairy products and lean meat like ostrich. Fatty fish, like salmon and tuna, contains omega-3 oils that protect your heart.
* Less Salt: Everyone should reduce salt intake, but this has more benefits in black people. Those with kidney problems and those older than 65 seem to benefit when they lower their daily sodium intake to no more than 2,4 g per day – (about half a teaspoon) of salt. (More than 82% of SA people consume too much salt - about 9 g of salt daily.) Individual response of blood pressure to salt intake differs widely and is difficult to measure. Most of the salt you eat daily is already added during the preparation of processed foods. Read food labels carefully for sodium amounts. Even a salad in a restaurant may contain half your allowed salt intake through addition of salad dressings. Don’t add salt to food at the table. The most important thing is to avoid processed foods, which is full of sodium, in many forms. Salt is also bad news for your kidneys, one of the target organs that can be damaged by hypertension and vascular disease.
* Eat plenty of fresh fruit and vegetables to supply potassium and other crucial nutrients. 100% of South Africans are “potassium deficient”. Potassium seems to replace and eliminate excess sodium from the body, which reduces blood pressure in salt-sensitive people.
* Limit your alcohol intake: Alcohol raises your blood pressure even if you don't have hypertension and reduces your heart's pumping ability. It can also interfere with the effectiveness of blood pressure medications. If you are female, limit your alcohol intake to less than one drink per day; if you are male, limit your intake to two drinks per day. One drink is 360 ml beer, 150 ml wine or 30 ml distilled liquor.
* Coffee: Although still much debated, coffee produces a temporary increase in heart rate and blood pressure, also in people who do not suffer from hypertension. It would be wise for hypertensive people to avoid the repeated elevations in blood pressure by drinking less coffee.
See the DASH eating plan for a user-friendly guide.
Active and passive smoking is a major culprit, causing damage to the heart and blood vessels, and raising blood pressure by constricting and therefore narrowing the vessels. A disaster triangle of disease is formed when people with hypertension and high cholesterol opt to smoke.
Smoking is the most preventable cause of premature death in the Western world and is the most important lifestyle change that will reduce your risk of complications due to both hypertension and heart and blood vessel disease. If you're a smoker, especially one with hypertension, you must stop. And if you're not a smoker, don't start. If people smoke in your home or work environment, this may also harm your health.
The contraceptive Pill and over-the-counter medication
Certain drugs can affect blood pressure.
These include the contraceptive Pill and over-the-counter drugs like some diet pills, anti-inflammatories, antidepressants, cortisone and decongestants, and liquorice.
*Using the contraceptive pill can raise the blood pressure of some women, especially if they smoke, and increase their risk for stroke and a heart attack. This is of even greater importance after the age of 35. The solution: stop smoking or change your method of contraception to a progesterone-only pill.
* Discuss your over-the-counter medication with your health professional
Many drugs like Ecstasy, “tik” or cocaine.
* Stop taking recreational drugs
* Inform your health professional about your dug habits.