Pressure Points

6 lifestyle changes that can improve your numbers

Matthew Solan | Harvard Health Publishing

   Taking medication to lower high blood pressure is a proven way to reduce your risk for heart disease. But adopting lifestyle changes may let you maintain healthy readings and perhaps even avoid drug therapy.

  “Unless a person’s blood pressure is very high, medication most often does not start immediately,” says Dr. Howard LeWine, editor in chief of Harvard Men’s Health Watch. “For people with elevated blood pressure or stage 1 hypertension, the first order of business is to get serious about modifying their lifestyle.”

By the numbers

   Normal blood pressure is defined as a reading of less than 120/80 millimeters of mercury (mm Hg). Elevated pressure means systolic blood pressure (the first number in a reading) is 120 to 129 mm Hg with a diastolic pressure (the second number) of less than 80 mm Hg. People who have consistent readings of 130 to 139 for systolic pressure or 80 to 89 for diastolic pressure are said to have high blood pressure (stage 1 hypertension).

   “But your target numbers may differ based on your health and individual goals, as determined in consultation with your doctor,” says LeWine.

   Healthy lifestyle habits are the cornerstone of managing blood pressure, whether or not you require medication. A lifestyle approach to management also helps people feel more in control of their health.

   “Understandable, sometimes people are reluctant to start a drug because they don’t want to be dependent on medication,” says LeWine. “And this resistance can provide extra motivation for making the necessary changes.”

   Still, don’t be discouraged if your doctor wants you to begin taking a low dose of medication. Once you reach your blood pressure goals, maintaining a healthy lifestyle may mean you can take a drug holiday (with your doctor’s approval).

   “And even if you still need medication, your healthy lifestyle changes can help prevent dose increases or additional blood pressure drugs,” says LeWine.

The big six

   Six lifestyle changes have the most significant influence on blood pressure, according to LeWine. They include the foundation for healthy living — diet, exercise and weight control — as well as limiting sodium and alcohol and managing stress.

   “While all of these are important, don’t try to change them all at once,” LeWine says. “In consultation with your doctor, you first want to concentrate on the one or two most important modifications, based on what’s likely to have the greatest impact.”

1 Diet

   While most experts advocate plant-based diets to help lower blood pressure numbers, a recent study found that the Dietary Approaches to Stop Hypertension (DASH) diet may have the most significant impact. The researchers found that adopting the DASH diet could prevent an estimated 15,000 annual heart attacks and strokes among men with high blood pressure. DASH emphasizes fruits, vegetables, lean proteins, nuts, seeds and grains and limits consumption of red meat, sodium, and sugar-sweetened foods and drinks.

2 Exercise

   Guidelines call for a minimum of 150 minutes of moderate-intensity exercise per week. A reasonable starting goal is 20 to 30 minutes every other day. Any kind of exercise is always better than nothing. But if you need motivation, join a walking club or sports league (like golf, bowling, basketball or pickleball), hire a personal trainer, or sign up for fitness classes at a gym or community center. You can also increase your daily movements, like walking for five minutes every hour, doing two sets of five to 10 push-ups on the floor or against the kitchen counter or 20 minutes of yoga or stretching.

3 Weight

   While it’s natural for weight to increase somewhat with age, even five to 10 pounds over one’s ideal number can raise blood pressure. Your doctor can determine your target weight for your age and body type. Investing in a healthy diet and increasing exercise can help reduce weight.

4 Sodium

   “People with high blood pressure sometimes have a significant improvement by avoiding sodium,” says LeWine. Processed foods account for much of the sodium that people consume. These include foods such as canned vegetables and soups, frozen dinners, lunch meats, instant and ready-toeat cereals, salty chips and other packaged snacks. Cut back on these items, or select low-sodium options.

5 Alcohol

   Drinking more than moderate amounts of alcohol can raise blood pressure. Guidelines says men should consume no more than two standard drinks per day and women no more than one per day, with a single drink defined as 12 ounces of beer, 5 ounces of wine or 1.5 ounces of distilled spirits. However, cutting back on alcohol as much as possible is ideal.

6 Stress

   Reducing stress is also a priority. Stress can lead to chronic inflammation that damages artery walls, making them less elastic. In addition, ongoing stress can trigger the adrenal glands to release hormones that raise blood pressure. “Uncontrolled stress often manifests as poor sleep, overeating and physical inactivity,” says LeWine. To manage stress, practice relaxation breathing and meditation, or perhaps just set aside time every day to do whatever you wish, even if it’s nothing at all.

Headache at temples could be serious

Dr. Howard Lewine
Harvard Health Publishing

   Q: How would a person know if a one-sided headache around the temples is just a migraine or something more serious, like temporal arteritis?

   A: Throbbing pain in the temples, especially on just one side of your head, is a common symptom of migraine pain. But when throbbing turns into a constant headache, and it’s accompanied by pain when you touch your temples, you need immediate medical evaluation. It may be a sign of temporal arteritis.

   Temporal arteritis is a condition caused by inflammation of one or more large arteries. It typically strikes either or both large temporal arteries located on the side of the head. Also known as cranial or giant-cell arteritis, this painful condition almost always occurs in people ages 50 or older.

   People with temporal arteritis describe the pain as severe, throbbing and burning — most often at the temple on one side of the head. Other symptoms, such as a low-grade fever, fatigue, loss of weight or appetite, or a tender scalp or temple may also occur. Chewing may cause aching in the jaw muscles.

   Doctors don’t know what triggers the problem, but it involves a misguided immune response causing inflammation of artery walls. The resulting swelling can progressively narrow the affected vessels, reducing blood flow. In severe cases, arteries become totally blocked. If this happens in the artery supplying the retina, it threatens the vision in that eye. However, when caught and treated early, temporal arteritis responds well to medication.

   A doctor who suspects temporal arteritis will check your blood’s erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP). A high level of one or both suggests there’s inflammation in your body. In some centers, ultrasound of the temporal arteries can confirm the diagnosis.

   But the surest way to diagnose the condition, however, is to remove part of the blood vessel and examine it under a microscope for changes in the artery wall. Confirming temporal arteritis is crucial because the condition requires long-term treatment with drugs to reduce inflammation.

   If your symptoms, exam and blood test strongly suggest temporal arteritis, therapy with highdose corticosteroids needs to start as soon as possible. Most doctors will begin corticosteroid therapy as a precautionary measure before having an ultrasound or taking the blood vessel biopsy.

   If the diagnosis is confirmed, you will need to take prednisone or other corticosteroid at a high dose until symptoms have disappeared and the results of further laboratory tests are close to normal. This usually takes at least a month. The dosage is then gradually decreased.

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