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Hypertension: Controlling the "silent killer"

An alarming one in three American adults has high blood pressure. Known medically as hypertension, many people don't even know they have it, because high blood pressure has no symptoms or warning signs. But when elevated blood pressure is accompanied by abnormal cholesterol and blood sugar levels, the damage to your arteries, kidneys, and heart accelerates exponentially. Fortunately, high blood pressure is easy to detect and treat. Sometimes people can keep blood pressure in a healthy range simply by making lifestyle changes, such as losing weight, increasing activity, and eating more healthfully. This report details those changes, including a Special Section that features numerous ways to cut excess salt from your diet — a policy strongly recommended by new federal guidelines. This report also includes tips on how to use a home blood pressure monitor, as well as advice on choosing a drug treatment strategy based your age and any other existing medical issues you may have.

Prepared by the editors of Harvard Health Publications in consultation with Randall M. Zusman, M.D., Associate Professor of Medicine, Harvard Medical School and Director, Division of Hypertension, Massachusetts General Hospital. 48 pages. (2011)

Blood pressure basics

  • Understanding the numbers
  • What does blood pressure measure?

Types of hypertension

  • Essential hypertension
  • Isolated systolic hypertension
  • Secondary hypertension
  • White-coat hypertension
  • Labile hypertension
  • Resistant hypertension
  • Malignant hypertension
  • Hypertension during pregnancy

Are you at risk for hypertension?

  • Risk factors you can’t change
  • Controllable risk factors
  • Sedentary lifestyle

How hypertension damages your health

  • Stroke
  • Coronary artery disease
  • Atrial fibrillation
  • Dementia
  • Kidney disease
  • Eye damage

Diagnosing hypertension

  • Testing for hypertension
  • Monitoring blood pressure at home

Lifestyle changes to lower your blood pressure

  • Quit smoking
  • Attain a healthy weight
  • Follow a healthful diet
  • Be active
  • Stress less

SPECIAL BONUS SECTION: Conquering your salt habit

  • Strategies for cutting back on salt

Medications for treating hypertension

  • Classes of hypertension drugs
  • The right drug for the right person

Resources

Glossary

Conquering your salt habit

Salt — sodium chloride — is essential for survival. Your body depends on sodium to transmit nerve impulses, contract muscle fibers, and, along with potassium, to balance fluid levels in all your cells. Because the human body is so good at conserving this vital mineral, you need only a tiny amount of sodium. Some tribes, like the South American Yanomamo Indians, consume a mere 200 mg, or about one-tenth of a teaspoon of salt—per day. Thousands of years ago, when humans roamed the earth gathering and hunting, sodium was scarce. But potassium — found naturally in many plant-based foods — was abundant. In fact, the so-called Paleolithic diet provided about 16 times more potassium than sodium.

Today, the average American diet contains about twice as much sodium as potassium, thanks to the preponderance of salt hidden in processed foods. This sodium-potassium imbalance, which is at odds with how humans evolved, is thought to be a major contributor to high blood pressure. Findings from the Trials of Hypertension Prevention study suggest that changing the balance between these two minerals can help the heart and arteries. Researchers measured the amounts of sodium and potassium excreted over the course of 24 hours by nearly 3,000 volunteers. (The amount excreted is a good stand-in for the amount consumed.) The higher the ratio of sodium to potassium, the greater the chance of having a heart attack or stroke, needing bypass surgery or angioplasty, or dying of cardiovascular disease over 10 to 15 years of follow-up, as described in Archives of Internal Medicine in 2009. To reverse the ratio, choose foods with a high proportion of potassium to sodium (see Table 6).

Table 6: The power of potassium

Most people eat too much sodium and not enough potassium. To counteract this trend, try eating more foods with a high potassium-to-sodium ratio.

Food

Potassium-to-sodium ratio

Banana

422 to 1

Black beans, cooked without salt

305 to 1

Orange

232 to 1

Grapefruit juice

126 to 1

Peanuts, dry roasted, no salt

93 to 1

Peanuts, dry roasted, with salt

0.8 to 1

Avocado

69 to 1

Raisins

68 to 1

Baked potato, plain, with skin

54 to 1

Fast-food French fries

2.5 to 1

Peanut butter, without salt

42 to 1

Peanut butter, with salt

1.4 to 1

Brussels sprouts, steamed

35 to 1

Applesauce (jar), no salt

31 to 1

Applesauce (jar), with salt

2.2 to 1

Oatmeal, regular

18 to 1

Quaker’s Instant Oatmeal

0.5 to 1

Cantaloupe

17 to 1

Halibut, baked

8 to 1

Spinach, boiled

7 to 1

Salmon, baked

6 to 1

Salmon, canned

0.8 to 1

V8, low-sodium

6 to 1

V8, regular

1 to 1

Carrots, raw

5 to 1

Milk, 1%

3 to 1

Cheerios

0.9 to 1

Marinara sauce, prepared

0.8 to 1

Pork and beans, canned

0.7 to 1

Fast-food cheeseburger

0.4 to 1

French bread

0.2 to 1

Cornflakes

0.1 to 1

The following reviews have been left for this report. Log in and leave a review of your own.

Looking at the table of contents, and the DASH diet reference, it seems to me much of the content would be found on the website of the National Institute of Health for free. Marsha Lomis
I may have missed it, but find no reference to potassium salt substitutes and wondered why there were no comments about this.
The script is an excellent review about this illness which I can 100 % back up. I was and I still am a healthy person of 73 years but suffered a set back by expiriencing last year an AION on my left eye loosing my left eye vision. The reason was given to me as a changing high blood pressure but measuring it for 3 month twice a day I never exceeded 130/ 80
I haven't purchased this either, but am guessing, based on the table of contents, that this is another "cut out the salt" tome. The 2011 meta-study, looking at seven of the best studies and led by Rod Taylor, a statistician at the University of Exeter, UK, found "no statistically significant difference in the subjects' rates of heart disease compared with rates in people who didn't reduce their salt intake. Furthermore, a low-salt diet was not linked to reduced death rates in people with normal blood pressure or high blood pressure. "In one trial in heart-failure patients, we rather worryingly found that reductions in salt increased risk of death". The "reasons" given, that after all these years, the effect of cutting out salt can't be shown to reduce mortality would be funny were the topic not so serious. What I suspect you won't find in this report is mention of the effect on carbohydrates on blood pressure. Carbs raise insulin and insulin tells the kidneys to retain sodium. High serum sodium, as opposed to just high sodium intake, does raise blood volume and that does raise blood pressure. So, the "special section" on cutting back on salt and the section on drugs seem to me headed in the wrong direction.