Patient education: High blood pressure, diet, and weight (Beyond the Basics)

HIGH BLOOD PRESSURE OVERVIEW — 

High blood pressure, also known as hypertension, is a common condition that can lead to serious complications if untreated. These complications can include stroke, heart failure, heart attack, kidney damage, and dementia. Worldwide, hypertension contributes to cardiovascular death more than any other risk factor. Making dietary changes (reducing sodium intake and increasing potassium intake unless there is underlying kidney disease), exercising, and losing weight (for people who are overweight) are effective treatments for reducing blood pressure. All of these lifestyle changes are effective when used alone but often have the greatest benefit when used together. Since the effects of lifestyle changes are usually relatively modest, many people with hypertension will also require medications to achieve goal blood pressure.

An overview of hypertension and a discussion of treatments can be found elsewhere. (See "Patient education: High blood pressure in adults (Beyond the Basics)" and "Patient education: High blood pressure treatment in adults (Beyond the Basics)".)

HIGH BLOOD PRESSURE DEFINITION — 

Blood pressure is reported as the systolic pressure (“top number”) over the diastolic pressure (“bottom number”). Systolic pressure is the pressure inside your arteries when your heart is contracting. Diastolic pressure is the pressure inside your arteries when your heart is relaxed.

The American College of Cardiology/American Heart Association (ACC/AHA) defines hypertension, elevated, and normal blood pressure as:

Normal blood pressure — Less than 120 over less than 80.

Elevated blood pressure — 120 to 129 over less than 80.

Hypertension

●Stage 1: 130 to 139 over 80 to 89

●Stage 2: At least 140 over at least 90

Other expert groups may differ slightly in how they define hypertension and when they recommend treatment.

All people with elevated blood pressure and hypertension should be encouraged to modify their lifestyle to lower their blood pressure. Doctors also prescribe blood pressure lowering medications for people with:

●Stage 2 hypertension

●Stage 1 hypertension and known cardiovascular disease or increased cardiovascular risk

Your healthcare provider can help determine if blood pressure lowering medications are appropriate for you.

Prevalence of high blood pressure — 

Hypertension is a common health problem. In the United States, approximately 46 percent of adults have hypertension.

Hypertension is more common as people age. In the United States, for example, hypertension affects 76 percent of adults aged 65 to 74 years and 82 percent of adults aged 75 years or older.

Unfortunately, many people's blood pressure is not well controlled. According to a national survey, hypertension was under good control in only 47 percent of adults.

DIETARY CHANGES AND BLOOD PRESSURE — 

Making changes to what you eat can help control high blood pressure.

Reduce sodium (salt) — Reducing the amount of sodium you consume can lower blood pressure if you have hypertension or elevated blood pressure.

The main source of sodium in the diet does not come from the salt shaker; it comes from the salt in food from restaurants and in frozen, canned, and processed foods. Read food labels with special attention to the sodium content (figure 1).

The body requires a small amount of sodium in the diet, and most people consume more sodium than they need (over 3 grams per day). A low-sodium diet contains fewer than 2.4 grams (2400 milligrams) of sodium per day. Although the ideal target for daily sodium intake remains controversial, the optimal goal is less than 1500 mg per day.

A detailed discussion of low-sodium diets is available separately. (See "Patient education: Low-sodium diet (Beyond the Basics)".)

Reduce alcohol — Drinking a lot of alcohol increases your risk of developing high blood pressure. A "drink" is defined as 5 oz of wine, 12 oz of beer, or 1 oz of hard liquor. Drinking more than two drinks per day in men or one drink per day in women increases the risk of high blood pressure compared with not drinking, and it also makes hypertension more difficult to control. Binge drinking (consuming four to five drinks within two hours) is an even greater problem for overall health and hypertension.

Eat more fruits and vegetables — Adding more fruits and vegetables to your diet may reduce high blood pressure or protect against developing high blood pressure; it can also help improve your health in general.

Eat more fiber — Eating an increased amount of fiber may decrease blood pressure. The recommended amount of dietary fiber is 20 to 35 grams of fiber per day. Many breakfast cereals are excellent sources of dietary fiber. More information about increasing fiber is available separately. (See "Patient education: High-fiber diet (Beyond the Basics)".)

Eat more fish — Eating more fish may help lower blood pressure, especially when combined with weight loss.

Caffeine — Caffeine can temporarily increase blood pressure in people who don't consume it regularly. In regular caffeine users, a moderate amount of caffeine (equivalent to approximately two cups of coffee daily) usually does not affect blood pressure. However, excessive amounts of caffeine (such as in many supplements and large-size beverages) may raise blood pressure in susceptible people.

Dietary Approaches to Stop Hypertension (DASH) eating plan — The DASH eating plan (figure 2) combines many of the dietary interventions noted above. It is high in fruits, vegetables, whole grains, fiber, and low-fat dairy products, with reduced saturated fat, total fat, and meat intake. All people, including those with and without high blood pressure, who strictly follow the DASH eating plan can have fairly significant reductions in blood pressure, particularly when combined with a low-sodium diet.

EXERCISE — 

Both aerobic and resistance exercise can lower your blood pressure and improve cholesterol levels even if you don't lose weight. Recommendations from the American Heart Association suggest that to achieve substantial health benefits requires one of the following:

●150 to 300 minutes per week of moderate-intensity aerobic activity (such as brisk walking)

●75 to 150 minutes per week of vigorous-intensity aerobic activity (such as jogging) plus muscle-strengthening exercises (resistance training) involving all major muscle groups at least twice per week

However, to maintain this benefit, you must continue to exercise regularly. Although this level of exercise is recommended to achieve substantial reductions in blood pressure (4 to 5 mmHg systolic), any amount of physical activity is better than none. Even gentle forms of exercise, like walking, have health benefits. (See "Patient education: Exercise (Beyond the Basics)".)

WEIGHT LOSS AND BLOOD PRESSURE — 

Being overweight or having obesity increases your risk of having high blood pressure, diabetes, and cardiovascular disease. The definition of overweight and obese are based on your body mass index (BMI) (table 1). You can find your BMI using an online calculator (calculator 1 and calculator 2). People who are overweight or have obesity can see significant reductions in blood pressure with even modest weight loss.

To lose weight:

●You must eat fewer calories and get more physical activity. (See "Patient education: Losing weight (Beyond the Basics)".)

●Your healthcare provider may recommend weight loss treatments, such as weight loss medications or surgery. (See "Patient education: Weight loss treatments (The Basics)" and "Patient education: Weight loss surgery (The Basics)".)

AVOID TAKING MEDICATIONS AND SUPPLEMENTS THAT INCREASE BLOOD PRESSURE — 

In susceptible individuals, nonsteroidal anti-inflammatory drugs or "NSAIDs" (such as ibuprofen and naproxen) can increase blood pressure. Oral contraceptive (birth control) pills may increase blood pressure in some people. Additionally, any stimulant, including those found in some decongestants, weight loss products, and illegal drugs, can increase blood pressure. If you are regularly consuming any of these substances, you should talk to your health care provider.

SLEEP — 

It might help to get plenty of sleep every night. Some studies have shown that people who do not get enough sleep are more likely to develop high blood pressure over time. Even if it does not reduce your blood pressure, quality sleep is good for your overall health. Try to get between seven and nine hours of sleep each night.

WHAT IF I STILL HAVE HIGH BLOOD PRESSURE? — 

If you continue to have high blood pressure despite making lifestyle modifications including changes in your diet, exercising more, and losing weight, you may need a medication to reduce your blood pressure. Medications for high blood pressure are discussed separately. (See "Patient education: High blood pressure treatment in adults (Beyond the Basics)".)

WHERE TO GET MORE INFORMATION — 

Your healthcare provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our website (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for health care professionals, are also available. Some of the most relevant are listed below.

Patient level information — UpToDate offers two types of patient education materials.

The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.

Patient education: Understanding your risk of high blood pressure (The Basics)
Patient education: High blood pressure in adults (The Basics)
Patient education: Controlling your blood pressure through lifestyle (The Basics)
Patient education: DASH diet (The Basics)
Patient education: Low-sodium diet (The Basics)
Patient education: Mediterranean diet (The Basics)
Patient education: Vegetarian or vegan diet (The Basics)
Patient education: Medicines for high blood pressure (The Basics)
Patient education: Lowering your risk of heart disease (The Basics)
Patient education: High blood pressure emergencies (The Basics)
Patient education: Good sleep hygiene (The Basics)

Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.

Patient education: High blood pressure in adults (Beyond the Basics)
Patient education: High blood pressure treatment in adults (Beyond the Basics)
Patient education: Low-sodium diet (Beyond the Basics)
Patient education: Risks and benefits of alcohol (Beyond the Basics)
Patient education: High-fiber diet (Beyond the Basics)
Patient education: Exercise (Beyond the Basics)
Patient education: Losing weight (Beyond the Basics)

Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research upon which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.

Ambulatory blood pressure monitoring: Indications and procedure
Tapering and discontinuing antihypertensive medications
Cardiovascular risks of hypertension
Hypertension in adults: Initial drug therapy
Definition, risk factors, and evaluation of resistant hypertension
Diet in the treatment and prevention of hypertension
Overview of hypertension in adults
Medication adherence in patients with hypertension
Renin-angiotensin system inhibition in the treatment of hypertension
Salt intake and hypertension
Hypertension in adults: Blood pressure measurement and diagnosis
Antihypertensive therapy for secondary stroke prevention
Treatment of hypertension in patients with diabetes mellitus
Treatment of hypertension in patients with heart failure
Treatment of hypertension in older adults, particularly isolated systolic hypertension
Treatment of resistant hypertension
Goal blood pressure in adults with hypertension
Evaluation of secondary hypertension

The following organizations also provide reliable health information:

●National Library of Medicine

(medlineplus.gov/healthtopics.html)

●National Heart, Lung, & Blood Institute (NHLBI)

(www.nhlbi.nih.gov)

●American Heart Association

(www.heart.org)

ACKNOWLEDGMENTS

The UpToDate editorial staff acknowledges Norman Kaplan, MD, who contributed to earlier versions of this topic review.

We are saddened by the death of George Bakris, MD, who passed away in June 2024. UpToDate acknowledges Dr. Bakris's past work as a section editor for this topic.