Do you cringe a bit when your clients say their blood pressure is a little high, but they’re “not too worried about it”? It’s not called the “silent killer” for nothing. The American Heart Association states blood pressure is absolutely the most important risk factor for stroke. 1 Lifestyle changes matter. How can we convince our clients to manage it?
For starters, there are new guidelines regarding acceptable blood pressure numbers. For years, a blood pressure of 140/90 was considered safe. Now, the Heart Association, American College of Cardiology and nine other health care boards advise a level below 130/80 mm Hg. Elevated blood pressure is defined as a systolic blood pressure of 120-129 mm Hg over diastolic above 80 mm Hg. Stage 1 hypertension means a persons’ blood pressure is consistently running 130-139 mm Hg systolic or diastolic of 80-89 mm Hg. Medication for high blood pressure may be advised at Stage 2. Stage 2 is where blood pressure is running regularly at 140/90 mm Hg. Hypertensive crisis is scary and requires immediate medical attention. This occurs when blood pressure is above 180/120 mm Hg. Left untreated, blood pressure this high can cause organ damage to the heart, brain and kidneys. 1
The changes to blood pressure numbers were decided after a 2017 study called SPRINT (the Systolic Blood Pressure Intervention Trial). This study evaluated over 9,000 people aged 50 and up with blood pressure of 130 mm Hg and up and at least one cardiovascular risk factor. The study meant to assess whether reducing blood pressure to 130 mm Hg or less was better than the traditional 140 mm Hg. The research showed that lowering blood pressure below 120 mm Hg lowered risk of cardiovascular events over a 3-year period. 2 The numbers are no longer specific to younger people or those over the age of 65.
Several lifestyle factors impact blood pressure and many are diet-related. One of the best treatments of blood pressure is mild weight loss. According to the National Heart Lung and Blood Institute (the people that developed the DASH diet), a 10 lb weight loss result in blood pressure reduction. For many clients, this is a more realistic weight loss target even if their BMI is still elevated. 3
Reducing sodium intake also impacts blood pressure, though clients may think giving up the salt shaker is enough. In reality, the majority of dietary sodium is in processed foods like frozen meals, fast food, lunch meat, snack foods, sauces and condiments and breakfast meats like bacon and sausage. Teach clients simple cooking methods so they rely less on already prepared food. Foods should have less than 140 mg sodium per serving to be considered low sodium.
Push produce! Fruits and vegetables are a big part of the DASH diet given their potassium content, which lowers blood pressure. Encourage more dark, green leafy vegetables and deep orange fruits and vegetables like melon, mango, citrus fruit, squash and sweet potatoes. Don't forget about kiwi, bananas and tomatoes. Nuts, seeds and beans are also good sources of potassium. Once new food labels are uniformly enforced, potassium will be listed to make things easier for consumers.
Encourage low-fat dairy products. Dairy products like low-fat yogurt, skim milk and low-fat cheese are the best sources of calcium, which has been found to reduce blood pressure. For clients with lactose intolerance, calcium-fortified, plant-based milks such as soy or almond milk are good substitutes. Dark green leafy vegetables like kale, collard greens, Brussels sprouts and broccoli also sources of calcium, though consumers would need to consume big quantities to meet calcium needs, which is not necessarily a bad thing.
Teach the difference between unhealthy and healthy fats. Healthy fats are beneficial to blood pressure reduction and include olive and canola oil, fatty fish such as salmon, avocado and low salt nuts and seeds. Reduce intake of saturated fats from full fat dairy, beef, bacon, butter, lamb, pork and other animal products. Limit consumption of processed/trans fats found in snack foods, commercial baked goods and fast foods.
Clients need to know the risks of alcohol intake. While a drink now and then (1/day for women, 2/day for men) is considered moderate, excessive alcohol consumption is inked with elevated blood pressure. According to previous studies, blood pressure increases about 1 mmHg for each 10 g alcohol consumed and can be reversed within 2-4 weeks of abstinence or reduction in alcohol consumption. 4 Have clients try a “mocktail” of flavored seltzer water with a twist of lemon or lime.
- Dharam J. Kumbhani, MD, SM, FACC Systolic Blood Pressure Intervention Trial - SPRINT N Engl J Med2017;377:733-44.
- Puddey IB, Beilin LJ.Alcohol is bad for blood pressure. Clin Exp Pharmacol Physiol. 2006 Sep;33(9):847-52. Review
Submitted by Lisa Andrews, MEd, RD, LD