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A healthy diet and healthful life- style changes play a key part in preventing and lowering high blood pressure. A healthy diet is low in total fat, saturated fat, trans fat, and cholesterol; and high in potassium, magnesium, calcium, and fiber. Follow the Eat-Right model for healthy eating. The low fat, low cholesterol, and high fiber diet (balanced by daily exercise) suggested in this model helps  not only control blood pressure, but also reduces the risk of chronic diseases. When modification of diet and life style measures alone is not enough to control high blood pressure, medication may be added.

The measures outlined below are effective in preventing and lowering high blood pressure.

Reduced Salt Intake
Salt has a direct effect on raising blood pressure. The more you reduce your salt intake, the greater will be the reduction in your blood pressure.

• When you reduce your salt-intake, your systolic blood pressure will decline even without weight loss.

• Reduced intake of salt will cut the dose of your blood pressure medication.

• People with and without diabetes should limit their daily salt intake to less than 2,300 mg of sodium (less than 1 teaspoon of salt). An average person’s daily need for salt can be met even by less than 1/4 teaspoon of salt.

• People with diabetes who are salt sensitive should especially restrict their salt intake.

Increased Potassium Intake
Potassium-rich diets reduce high blood pressure. The recommended intake of potassium for adults and adolescents is 4,700 mg per day. You should get your potassium from food sources.

Exercise
Regular physical activity has been shown to lower high blood pressure.

• Regular aerobic exercise of moderate intensity such as brisk walking for at least 30 to 60 minutes every day will reduce your high blood pressure, especially systolic blood pressure.

• Also, a brisk walk will help you cope with stress, resulting in reduction of high blood pressure.

Weight Loss
Excess weight is strongly related to high blood pressure.

• Weight loss even without salt restriction will lower high blood pressure.

• Weight reduction even by a few pounds (5 to 10 pounds) generally reduces high blood pressure, and also has a favorable effect on blood sugar and blood fat levels.

• A healthy weight range of BMI 18.5 to less than 25 is helpful in controlling blood pressure.

• Waist measurement not exceeding 40 inches in men, and not exceeding 35 inches in women help blood pressure control.

Stop Tobacco Smoking
If you smoke, you must quit smoking because:

• Tobacco smoking raises blood pressure, harms red blood cells, and is a strong risk factor for heart disease, lung disease, and stroke.

• Each cigarette you smoke raises your blood pressure.

• If you continue smoking and also take medications to control high blood pressure, you will still be exposed to the risk of heart attack and stroke.

Moderate Use of Alcohol
Excessive consumption of alcohol raises blood pressure, reduces the effect of blood pressure medications, and increases the risk for stroke. So:

• If you choose to drink alcohol, drink in moderation after consulting your doctor.

• If you drink alcohol in excess, reduce its intake gradually; abrupt reduction or withdrawal of alcohol can raise your blood pressure.

Relaxation
Sympathetic nerves are a part of your nervous system. Arousal of the sympathetic nerves causes stress, increases your heart rate, and raises your blood pressure. Relaxation techniques such as deep breathing are helpful in reducing the intensity and duration of nervous agitation, leading to improvement in blood pressure. Evidence shows that breathing exercises, over the course of 8 weeks, provide relaxation, reduce stress, and lower blood pressure in a safe manner. Include relaxation techniques in your treatment plan of high blood pressure.

TREATMENT OF HIGH BLOOD PRESSURE
To prevent and reduce the risk of organ damage, including heart attack, stroke, and kidney failure, latest research strongly recommends to have a tight control on blood pressure. The Joint National Committee (JNC) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure in its current guidelines (summarized below) provide useful insight and proven steps to treat high blood pressure:

Prehypertension
The JNC has introduced the term of prehypertension for systolic blood pressure 120 to 139 mmHg, or diastolic blood pressure 80 to 89 mmHg. Prehypertension is a condition which, though, is not high blood pressure, it is likely to change into high blood pressure if healthy lifestyle changes are not made. The JNC suggests to take prehypertension seriously. Because high blood pressure is associated with very high health risks in people with diabetes, even prehypertension in these people should straightaway be treated with drugs to prevent it from developing into high blood pressure. People without diabetes, however, should first try to control prehypertension without drugs by making healthy lifestyle changes.

Treatment Goal
The goal of blood pressure-lowering therapy is to reduce the risk for heart attack, stroke, and kidney failure by bringing down raised blood pressure to:

• Less than 130/80 mmHg in people with diabetes

• Less than 140/90 mmHg in people without diabetes

(These are not the ideal numbers, but they help reduce the risk of organ damage from high blood pressure.)

Priority Treatment of Systolic Blood Pressure
Raised systolic blood pressure (upper number) is a greater risk factor for heart attack and stroke than raised diastolic blood pressure (lower number) in people who are 50 years or older. For this reason, priority should be given to bring down raised systolic blood pressure in these people. Normally, when raised systolic blood pressure is brought down, diastolic blood pressure is also lowered.

Treatment of Stage 1 High Blood Pressure
Thiazide-type diuretic is the drug of choice for most people having stage 1 high blood pressure (systolic blood pressure 140 to 159, or diastolic blood pressure 90 to 99). The therapy is started in a low dose. The low dose will minimize side effects, if any. If response to the low dose is good, but high blood pressure is not adequately lowered, and the diuretic is well tolerated, its dose may be increased. However, when the diuretic in a sufficient dose fails to achieve your blood pressure goal, your doctor may add a different class of drug to the diuretic. Adding a different class of drug will enhance the blood pressure-lowering effect of the combination. The other classes of drugs in the combination may include an ACE inhibitor (ACEI), angiotensin receptor blocker (ARB), beta-blocker (BB) or calcium channel blocker (CCB). Or, if the diuretic does not suit you at all, the doctor may choose any of the above different classes of blood pressure-lowering drugs.

Treatment of Stage 2 High Blood Pressure
A combination of at least two different classes of blood pressure-lowering drugs will be required to treat most people having stage 2 high blood pressure (systolic blood pressure 160 mmHg or greater, or diastolic blood pressure 100 mmHg or greater). The combination should usually consist of a thiazide-type diuretic plus ACEI, or ARB, or BB, or CCB class of blood pressure-lowering drug.

Intensifying the Treatment
If your blood pressure treatment goal is not achieved, doses of the drugs used in the combination may be increased, or additional classes of blood pressure-lowering drugs may be added.

Healthy Lifestyle
Even when high blood pressure is treated with drugs, healthy life style (laid out in boxes in this chapter) must remain in place.

Treatment of high blood pressure continues for life. If you discontinue the treatment, high blood pressure will come back. When you have successfully controlled your high blood pressure over a long period and continue to follow a healthy lifestyle, it may be possible for you to reduce the dose and number of blood pressure-lowering drugs.

HIGH BLOOD PRESSURE EMERGENCIES
Sometimes blood pressure may suddenly become very high (180/110 or higher). Very high blood pressure can cause angina and convulsions, increasing the risk for coma, heart attack, and stroke. High blood pressure emergencies are handled in the following manner:

• High blood pressure emergencies are treated in a hospital by intravenous administration of blood pressure-lowering drugs belonging to the class of vasodilators, beta-blockers, or alpha-blockers.

• Taking fast-acting blood pressure-lowering drugs by mouth and having bed rest can treat uncomplicated emergencies of high blood pressure. The fast-acting drugs include loop diuretics, betablockers, ACE inhibitors, and calcium channel blockers.

• In the emergency therapy, the first goal is to reduce high blood pressure to about 160/100 within 2 to 6 hours. Rapid fall of blood pressure is not advisable because this may decrease blood flow to the brain, heart, and kidneys, increasing the risk for stroke, heart attack, or kidney failure.

• Blood pressure should be monitored every 15 to 30 minutes in an emergency treatment. If it continues to remain greater than 180/120, a different combination of blood pressure-lowering drugs may be tried.

• If high blood pressure emergencies occur frequently, regular medical treatment and blood pressure monitoring are necessary.

DIETARY APPROACHES TO STOP HIGH BLOOD PRESSURE
A clinical study known as DASH (Dietary Approaches to Stop Hypertension) was conducted with the help of the National Heart, Lung, and Blood Institute, the National Center for Research Resources, and the Office of Research on Minority Health. The study results (1997) demonstrated that the DASH diet, a “combination” eating plan that is low in total fat, saturated fat, and cholesterol and rich in fruits and vegetables, reduces high blood pressure. The DASH eating plan based on a 2,000- calorie level comprises of:

• Grains: 7 to 8 servings

• Vegetables: 4 to 5 servings

• Fruits: 4 to 5 servings

• Low fat or fat free dairy foods: 2 to 3 servings

• Meats, poultry, and fish: 2 or less servings (All the above servings are per day)

• Nuts, seeds, and dry beans: 4 to 5 servings per week

Note: The size of servings in the DASH diet are almost the same as in the Eat-Right model noted before. Here you can find details of the DASH diet.

High blood pressure affects about 1 billion people in the world. In the United States more than 50 million people have high blood pressure, but because high blood pressure usually has no symptoms, one-third of these people are not even aware that they have this disorder. And many people who know they have high blood pressure are not treating it at all, or treating it in a loose manner. High blood pressure poses a high risk for organ damage or organ failure, including heart attack, kidney failure, sight loss, and stroke. This risk is much higher in people with diabetes than the nondiabetic people. However, a landmark study, namely, the UK Prospective Diabetes Study (UKPDS) has shown that a tight control of blood pressure in people with diabetes reduces all diabetes complications by 24 percent, strokes by 44 percent, heart failure by 56 percent, and damage to minute blood vessels by 37 percent. Recent studies have further confirmed that a strict control of blood pressure will significantly reduce these risks both in people with type 1 and type 2 diabetes. To protect yourself from the serious consequences of high blood pressure, you must lower it and keep it within the acceptable range.