1. Diet and Health Guidelines to Lower Risk of High Blood Pressure Presented by Janice Hermann, PhD, RD/LD OCES Adult and Older Adult Nutrition Specialist

2. What Is Blood Pressure Blood pressure is the pressure on the blood vessel walls A blood pressure reading consists of two numbers, for example 120/80 The first number is called systolic Pressure when the heart contracts The second number is called diastolic Pressure when the heart is resting between contractions

3. How is Blood Pressure Classified Systolic mm HgDiastolic mm Hg Recommended Blood Pressure < 120< 80 Borderline-high Blood Pressure 120-13980-89 High Blood Pressure ≥ 140≥ 90

4. Diagnosing High Blood Pressure To diagnose high blood pressure you need two high blood pressure readings, taken several weeks apart, with either the systolic or diastolic or both consistently above 140/90 Blood pressure changes throughout the day Just going to the doctor may make some people’s blood pressure rise

5. Diagnosing High Blood Pressure High blood pressure can progress silently and without symptoms Estimated 1/3 of people with high blood pressure and are unaware However, with detection and proper treatment high blood pressure can be controlled People need to have their blood pressure checked regularly, at least every two years

6. Children Should Have Blood Pressure Checked Too Children should have blood pressure checked regularly too High blood pressure in children may signal an underlying disease or early onset of high blood pressure

7. Effect of High Blood Pressure High blood pressure is a serious health problem High blood pressure causes the heart to work harder, and over time may damage blood vessels Damage to blood vessels in the heart may increase the risk of heart disease Damage to blood vessels in the brain may increase the risk of stroke Damage to blood vessels in the kidney may increase the risk of kidney damage

8. Causes of High Blood Pressure Blood pressure arises from: Contractions of the heart muscle that pump blood away from the heart (cardiac output) and Resistance that blood encounters as it moves through the arteries (peripheral resistance) When either cardiac output or peripheral resistance increases, blood pressure rises

9. Causes of High Blood Pressure Cardiac output is raised when: Heart rate increases Blood volume increases Sodium retention Fluid retention

10. Causes of High Blood Pressure Peripheral resistance is mostly affected by physical and chemical signals that alter the blood vessel diameter Signals from the nervous system influence the heart’s pumping activity and blood vessel diameter Signals from hormones promote fluid retention and blood vessel constriction The kidneys also control section of hormones involved in sodium and water retention and blood vessel constriction

11. Causes of High Blood Pressure High blood pressure is a very complex condition Primary or essential hypertension develops without an identifiable cause (95%) Most cases of high blood pressure have no identifiable cause Secondary hypertension is caused by a specific disorder (5%) Usually due to abnormalities in organs or hormones involved in regulating blood pressure

12. Causes of High Blood Pressure Causes of secondary hypertension Chronic kidney disease interferes with the removal of sodium and water from the blood, thus increasing blood volume and blood pressure Atherosclerosis in the renal blood vessels may cause increased production of hormones that stimulate water retention and blood vessel constriction

13. Causes of High Blood Pressure Causes of secondary hypertension Artery stiffness and thickening due to age, diabetes, atherosclerosis and other reasons can increase resistance to blood flow, increasing blood pressure Hormonal disorders, including some thyroid diseases and adrenal disorders, can also cause high blood pressure

14. Risk Factors There are factors that may affect high blood pressure Family history of high blood pressure Being overweight Increasing age Physical inactivity Smoking Diabetes High sodium intake (sodium sensitive people) High alcohol intake High fat diet Low potassium, calcium and magnesium intake

15. Family History High blood pressure tends to run in families People in the same family may have similar lifestyle and dietary habits that increase their risk of developing high blood pressure High blood pressure is more prevalent and severe among African Americans

16. Overweight Being overweight is a risk for high blood pressure Carrying excess weight in the abdomen is a greater risk for high blood pressure than carrying excess weight in the hips and thighs Bringing weight down may be all some people need to do to control their blood pressure

17. Obesity Rate of high blood pressure increases with overweight Rate of High Blood Pressure MenWomen Obese38%32% Healthy weight18%16%

18. Weight Management Weight management recommendations are: To maintain body weight in a healthy range, balance calories from foods and beverages with calories expended To prevent gradual weight gain over time, make small decreases in food and beverage calories and increase physical activity

19. Age Blood pressure tends to increase with age Men typically begin having an increase in blood pressure by age 45 to 50 Women typically begin having an increase in blood pressure after menopause However, just because you get older doesn’t mean you will develop high blood pressure

20. Physical Activity Physical activity can help you: Lose weight Lower total cholesterol Lower LDL-cholesterol Lower triglycerides Increase HDL-cholesterol All of which can lower the risk of: High blood pressure Heart disease Stroke Diabetes Obesity

21. Physical Activity Engage in regular physical activity and reduce sedentary activities to promote health, psychological well-being, and a healthy body weight Physical activity recommendations are: 150 minutes of moderate-intensity per week or 75 minutes of vigorous-intensity per week

22. Smoking Smoking increases your risk of high blood pressure Smoking raises blood pressure level and heart rate Smoking lowers HDL-cholesterol Smoking increases the tendency of blood to clot

23. Diabetes High blood pressure is more common in people who have uncontrolled diabetes Insulin resistance, commonly associated with obesity, signals the pancreas to produce more insulin High insulin signals the kidneys to retain sodium and thus may increase the risk of developing high blood pressure

24. Sodium Your kidneys regulate the sodium level in your body Most people aren't affected by excess dietary sodium because their bodies just get rid of excess sodium in the urine

25. Sodium Sensitive People However, some people are sodium-sensitive For sodium-sensitive individuals, too much sodium in the diet can increase blood pressure

26. Sodium Sensitive People For sodium-sensitive people, lowering sodium intake may help lower blood pressure 55% white 73% African Americans Unfortunately, there’s no easy way to know who may be a sodium-sensitive individual

27. Sodium Sensitive People People most likely to be sodium-sensitive: Family history of high blood pressure Chronic kidney disease Diabetes African American Over 50 years of age Overweight

28. How Much Sodium Dietary Guidelines recommend People reduce daily sodium intake to less than 2,300 mg (approximately 1 teaspoon of salt) and Further reduce sodium intake to less than 1,500 mg sodium among those: 51 years of age or older of any age who are African American or have hypertension, diabetes or chronic kidney disease

29. How Much Sodium The DRI for sodium is: 1,500 mg/day for people 19-50 years of age 1,300 mg/day for people 51-70 years of age 1,200 mg/day for people >70 years of age The Upper Level for sodium intake for adults is 2,300 mg/day On average, most adults consume significantly more, 4,000 to 6,000 milligrams of sodium daily

30. Where Is Sodium As much as 75% of the sodium in your diet comes from salt added to foods during processing About 15% comes from salt added during cooking and at the table Only 10% comes from the natural content in foods

31. Replacing Sodium Losses Although you lose sodium and some other minerals in perspiration, the amount lost is usually small Regular meals and snacks eaten after physical activity will normally replace electrolytes (sodium and potassium) lost in perspiration In extreme heat beverages containing electrolytes such as Gatorade or Powerade help replace fluids and electrolytes lost in perspiration

32. Alcohol Heavy alcohol consumption, 3 or more drinks daily, is strongly associated with increased risk of high blood pressure Effect of moderate alcohol intake on blood pressure unknown Recommended alcohol intake is: Not more than one alcoholic drink a day for women Not more than two alcoholic drinks a day for men

33. Alcohol Role of alcohol with high blood pressure is unclear May contribute extra calories which may increase body weight

34. Fat, Trans Fat, Saturated Fat & Cholesterol High fat, trans fat, saturated fat and cholesterol intakes are linked to high cholesterol, LDL-cholesterol, and triglycerides which contributes to atherosclerosis and high blood pressure Atherosclerosis narrows the blood vessels and decreases blood flow to the kidneys

35. Fat, Trans Fat, Saturated Fat & Cholesterol The kidneys try to increase blood flow to the kidneys by expanding blood volume and constricting smaller blood vessels However, blood pressure increases not only in the kidneys, but all over the body, which further damages blood vessels and increases atherosclerosis

36. Fat, Trans Fat, Saturated Fat & Cholesterol Lowering total fat, saturated fat, cholesterol and trans fat helps lower blood cholesterol and triglycerides, which may lower atherosclerosis Reducing fat helps with weight loss, which may lower blood pressure

37. Fat, Trans Fat, Saturated Fat & Cholesterol Recommendations are: Keep total fat intake between 20 to 35 % of calories, with most fats coming from polyunsaturated and monounsaturated fats Consume less than 10 percent of calories from saturated fatty acids Consume less than 300 mg/day of cholesterol Keep trans fatty acid consumption as low as possible

38. Other Dietary Factors Too little of some other nutrients including potassium, calcium and magnesium, may have an important link to high blood pressure Adequate intakes of these minerals may have a protective effect against high blood pressure

39. Other Dietary Factors Potassium has roles with: Maintaining fluid balance Muscle contraction Calcium has roles with: Activating messengers that help maintain normal blood pressure Magnesium has roles with: Heart function Lessening blood vessel constriction

40. Other Dietary Factors Fruits and vegetables are good sources of potassium Milk and dairy products are a good source of all three nutrients The best guideline is to follow the USDA Daily Food Plan

41. Other Dietary Factors For some individuals potassium may be beneficial, but for individuals with kidney problems potassium may be restricted. Check with your doctor before using a potassium chloride salt substitute.

42. Emotional Stress For some people, stress may be a factor for high blood pressure Learning how to relieve stress improves the overall quality of one's life

43. Lower Risk of High Blood Pressure Follow Dietary Guidelines Maintain a healthy weight Be physically active each day Consume ample fruits, vegetables or dairy products to provide calcium, potassium, and magnesium Keep total fat, saturated fat, trans fat, and cholesterol intakes within recommended levels Keep sodium intake below 2,300 mg or 1,500 mg Use alcohol in moderation Abstain from smoking Keep diabetes in control