NEW RECOMMENDATIONS TO PREVENT HIGH BLOOD PRESSURE ISSUED: Additional
Lifestyle Approaches Advised
The National High Blood Pressure Education Program (NHBPEP) has updated its
recommendations to prevent hypertension (high blood pressure). New
recommendations include adequate intake of potassium and an eating pattern
rich in fruits, vegetables, and low-fat dairy products and reduced in
saturated
and total fat. The advisory also reinforces earlier recommendations to limit
consumption of sodium and alcohol, reduce excess body weight, and increase
levels of physical activity.
Published in the October 16 issue of The Journal of the American Medical
Association, the report also cautions that some widely publicized approaches
have less proven or uncertain efficacy. Fish oil (omega-3 polyunsaturated
fatty acids) and calcium supplements lower blood pressure only slightly in
individuals with hypertension. In addition, the ability of herbal and
botanical supplements to safely lower blood pressure is unproven, and these
unregulated products can interact adversely with medications.
Developed by a distinguished panel of experts convened by the NHBPEP
Coordinating Committee, the advisory reflects the latest scientific evidence
and updates the first recommendations on preventing high blood pressure
released nearly a decade ago. Like the 1993 advisory, the new report
emphasizes two overall strategies to keep blood pressure from rising: a
population-based strategy and an intensive strategy for high-risk
individuals.
High blood pressure (systolic blood pressure at or above 140 mmHg or
diastolic
blood pressure at or above 90 mmHg) is associated with an increased risk of
death and disability from heart disease, stroke, congestive heart failure,
and
end-stage renal disease.
"The United States has made substantial gains over the past several decades
in
preventing high blood pressure and in detecting and controlling high blood
pressure when it does develop," said Dr. Claude Lenfant, director of the
National Heart, Lung, and Blood Institute (NHLBI), which coordinates the
NHBPEP. "However, Americans continue to be at high risk for hypertension and
related complications. These revised recommendations can help us do better."
Fifty million adults in the United States -- including more than one of every
two adults over the age of 60 -- have high blood pressure, according to the
National Center for Health Statistics. Furthermore, data from NHLBI's
landmark
Framingham Heart Study suggest that middle-aged and elderly individuals face
a
90 percent risk of developing hypertension during their remaining years.
Framingham research has also shown that the risk of cardiovascular disease
associated with high blood pressure increases gradually -- even before
hypertension occurs. The approximately 23 million adults in the U.S. with
high-normal blood pressure levels (systolic pressure of 130-139 mmHg and/or a
diastolic pressure of 85-89 mmHg) are 1.5 to 2.5 times more likely to have a
cardiovascular event or to die within 10 years, compared to those with
optimal
blood pressure (systolic pressure of less than 120 mmHg and diastolic
pressure
of less than 80 mmHg). Normal blood pressure levels are 120-129 mmHg systolic
and 80-84 mmHg diastolic.
"Epidemiological data suggest that if we could lower the average systolic
blood pressure among Americans by 5 mmHg, we'd see a 14 percent drop in
deaths
from stroke, a 9 percent drop in heart disease deaths, and a 7 percent drop
in
overall mortality," said Dr. Paul Whelton, senior vice president for health
sciences for Tulane University Health Sciences Center and co-chair of the
NHBPEP working group that developed the latest recommendations. "A reduction
as small as 2 mmHg in the average American's systolic blood pressure could
save more than 70,000 lives per year."
Proven behavioral changes can lower one's blood pressure and reduce the risk
of a cardiovascular event. The report cites one study, for example, that
found
that people with normal blood pressure levels who increased the amount of
regular physical activity lowered their systolic blood pressure by more than
4
mmHg. In another study, overweight participants with normal blood pressure
levels significantly lowered their systolic blood pressure by losing weight
(fewer than 8 lbs); in addition, the percentage of participants in this group
who had high blood pressure seven years later was less than half of the
percentage of the control group which remained overweight.
The clinical trial known as Dietary Approaches to Stop Hypertension, or DASH,
has demonstrated the critical role of nutrition in controlling blood
pressure.
Based on the results of DASH, the NHBPEP now recommends an eating plan that
is rich in fruits, vegetables, and low-fat dairy products and that has
limited
saturated and total fat.
Furthermore, limiting daily dietary sodium intake to less than 2,400 mg of
sodium (about 1 teaspoon of salt) per day helps lower or control blood
pressure. In one study, older patients with hypertension significantly
lowered
their systolic blood pressure and decreased their need for medications by
moderately reducing how much sodium they consumed. The advisory highlights
that although limiting the amount of salt added during cooking and at the
table is important, three-fourths of the average individual's total intake of
salt and sodium comes from sodium added during processing and manufacturing.
Therefore, NHBPEP urges food manufacturers to lower the amount of sodium in
the food supply -- and to offer these products at equitable prices.
Other behavioral changes for people with blood pressure above optimal levels
include consuming more than 3,500 mg of dietary potassium per day -- an
approach especially important for individuals with high sodium intake -- and
limiting alcohol consumption to no more than 1 ounce of ethanol (e.g., 24 oz
beer, 10 oz wine, or 2 oz 100-proof whiskey) per day in most men and to no
more than 0.5 ounce per day in women.
These lifestyle factors are essential for seniors and others who are more
likely to develop high blood pressure, such as those with high-normal blood
pressure or a family history of hypertension; those who are African American,
overweight or obese, or inactive; and those who consume more than the
recommended amounts of dietary sodium or alcohol, or insufficient amounts of
potassium.
The report advises, however, that efforts to prevent blood pressure from
rising in children are also important. School administrators can help by
offering heart healthy foods in their cafeterias and health education
programs
in their classrooms.
"Our society needs to better support individuals who are trying to make
healthy lifestyle changes," said Dr. Jiang He, who co-chaired the NHBPEP
working group with his Tulane colleague. For instance, reimbursement of
counseling services for hypertension prevention could help consumers adopt
healthy behaviors.
"Consumers need to be better informed about portion sizes, food content and
labeling," added NHBPEP Coordinator Dr. Edward Roccella. "Training programs
for health care providers also need to focus more on nutrition and other
lifestyle issues related to blood pressure."
Established in 1972, the NHBPEP strives to reduce death and disability
related
to high blood pressure through programs of professional, patient, and public
education. NHBPEP is a cooperative effort among professional and voluntary
health agencies, state health departments, and community groups.
To learn more, visit the NHLBI Web site at www.nhlbi.nih.gov. Click on
Special
Web Pages and Interactive Applications, then High Blood Pressure for
interactive quizzes and tools, such as a body mass index calculator; tips,
recipes and real-life examples to help control blood pressure; and other
educational materials for consumers and clinicians.
NHLBI is part of the National Institutes of Health (NIH) in Bethesda,
Maryland. NIH is an agency of the U.S. Department of Health and Human
Services.