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
"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
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."
Source: NHLBI - National Institutes of Health (NIH),
U.S. Department of Health and Human Services