Treatment of primary hypertension involves both lifestyle modifications and antihypertensive medications. The goal of treatment is to lower blood pressure and reduce the risk of complications from hypertension—specifically strokes, heart attacks, heart failure, and kidney disease. Most people with hypertension should aim to lower their blood pressure to less than 140/90 mm Hg. Those with diabetes or kidney disease have an even lower blood pressure goal—less than 130/80 mm Hg.
The same blood pressure goals apply to people with secondary hypertension. In these individuals, however, doctors often try to treat the underlying disorder, especially if blood pressure is difficult to control with lifestyle modifications and medications.
People experiencing a hypertensive emergency must seek immediate medical attention and have their blood pressure lowered with intravenous antihypertensive medication in the hospital. Blood pressure is lowered gradually to avoid precipitous drops in pressure that could lead to a stroke.
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Lifestyle modifications proven to lower blood pressure include weight loss in people who are overweight, the Dietary Approaches to Stop Hypertension (DASH) diet, reduced salt intake, increased potassium intake, regular physical activity, and moderation of alcohol consumption.
These lifestyle modifications not only help lower blood pressure, but also improve the effectiveness of antihypertensive medication and lower the risk of cardiovascular disease. Studies show that the effects of these lifestyle changes are additive, and people who adopt more of them reap the most benefits.
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All people—whether or not they have hypertension—should aim for a body mass index (BMI) between 18.5 and 24.9. People with a BMI of 25 or more are considered overweight. BMI is a measure of weight in relation to height; it can be determined by multiplying weight in pounds by 704 and dividing the result by the square of height in inches. Studies show that for every 2.2 pounds of weight lost, blood pressure drops by about 1/1 mm Hg.
The Dietary Approaches to Stop Hypertension (DASH) diet is an eating plan that is rich in fruits, vegetables, and low-fat dairy products and low in saturated fat, cholesterol, and total fat. The diet also includes whole-grain products, fish, poultry, and nuts. Red meat, sweets, and sugar-containing beverages are kept to a minimum, however.
Two major trials have evaluated the DASH diet. In the first trial, people who followed the DASH diet for eight weeks reduced their blood pressure by an average of 5.5/3.0 mm Hg, compared with people who ate a typical American diet (low in fruits and vegetables and high in fat). The benefits of the DASH diet were most pronounced in people with hypertension. In these individuals, the DASH diet lowered systolic pressure by 11 mm Hg, which is similar to the level of blood pressure reduction typically achieved with a single antihypertensive drug.
In the second trial, people who combined the DASH diet with a low salt intake (1,500 mg of sodium per day) for four weeks had an average blood pressure reduction of 9/5 mm Hg, compared with people who followed a typical American diet with a high salt intake. As in the first study, the benefits were greater in people with hypertension—their systolic blood pressure dropped by an average of 12 mm Hg.
Research indicates that, on average, blood pressure levels rise with higher intakes of salt, and limiting salt may lower systolic blood pressure by 2 to 8 mm Hg. The effects of dietary salt on blood pressure tend to be greater in blacks, middle-aged and older adults, and people with hypertension or diabetes.
The Institute of Medicine recently issued new guidelines for salt intake in adults. They set an upper limit of 2,300 mg of sodiumdaily, and the following minimum requirements: 1,500 mg of sodium for adults under age 50; 1,300 mg for people age 50 to 70; and 1,200 mg for those above age 70. Reducing salt intake means not only avoiding the salt shaker while cooking and at meals but also reading nutrition labels and choosing foods that contain less than 140 mg of sodium per serving.