Strategies to Control Hypertension
At least 65 million Americans have high blood pressure. High blood pressure increases the workload of the heart and kidneys, increasing the risk of heart attack, heart failure, stroke and kidney disease. High blood pressure is the biggest risk factor for stroke.
It is up to you to take control! By making lifestyle changes, taking medications and working with your health care team, you can control your high blood pressure to help prevent future problems.
Important note: These are general recommendations and may not be appropriate if you have been diagnosed with another heart condition, such as heart failure. Always ask your health care provider for guidelines that are specific to your medical condition.
Take Control! Strategies to Control Blood Pressure
If you smoke - Quit!
Smoking and tobacco use are significant risk factors for a variety of chronic disorders including heart and blood vessel disease.
Quit smoking tips:
- Make a list of all the reasons you want to quit. Read over the list every day, before and after you quit.
- Make a list of activities you can do instead of smoking.
- Stop smoking in certain situations before actually quitting.
- Pick a date for quitting and stick to it.
- Get a "buddy" to help you quit and ask your family and friends for support.
- Join a smoking cessation support group or program - ask your doctor or nurse for a list of programs in your community.
- Ask your health care provider about using nicotine replacement aids to help you quit.
Achieve and maintain your ideal body weight
Being overweight is very closely connected to high blood pressure, especially if your body mass index (weight in kilograms divided by your height in meters squared) is 25 or greater. Excess upper body fat (for example a waist measurement of 35 inches or greater in women or 40 inches or greater in men) is also related to high blood pressure, diabetes, increased blood lipid levels, and coronary heart disease.
Weight loss tips:
- Keep a food journal to track exactly what and how much you eat.
- Choose foods low in saturated fat, cholesterol, trans fat (partially hydrogenated fats) and refined sugar.
- Eat at least 5 servings of fruits and vegetables each day. Try to avoid juice and canned fruit which are generally higher in sugar and may add more calories.
- Watch your portion sizes. One quarter of your plate should comprise a palm-size portion of lean protein, such as salmon or chicken breast; another quarter should comprise a fist-size portion of unrefined grain, such as brown rice; and one-half of your plate should be filled with a variety of colorful vegetables.
- Do not skip meals. Eating three meals a day plus snacks is essential in weight management.
- Make sure you are getting enough fiber - 25 to 30 grams of fiber are recommended each day. To help you boost your fiber intake, choose whole-grain, high-fiber breads and cereals; choose whole-wheat pasta and rice instead of white; and include more dried beans in your meals. Fiber helps fill you up faster, which can help you to eat less and curb hunger. Most importantly, soluble fiber can help lower you cholesterol.
- Exercise daily. Participate in physical activity daily as recommended by your physician or exercise physiologist.
- Eat the majority of your calories in the first half of your day. Enjoy portion-controlled snacks during the day to control hunger at night.
- Drink plenty of water. Include 6 to 8 glasses of fluid each day. Water helps keep you adequately hydrated and often helps prevent overeating.
- Set realistic goals. Weight loss should be gradual, no more than 1 to 2 pounds per week.
A registered dietitian can help you evaluate your current eating habits and plan strategies to help you lose weight.
By definition, one drink equals 12 ounces of beer or wine cooler, 5 ounces of wine or 1.5 ounces of 80-proof liquor.
Limit your alcohol intake
- Drinking too much alcohol can increase your blood pressure and make it more difficult to treat high blood pressure.
- If you have high blood pressure, do not drink more than two alcoholic drinks per day (see definition in the box ).
- Women and those of lighter weight should drink no more than a single serving per day (¾ ounce alcohol, OR 5 ounces wine, OR 12 ounces beer)
Regular aerobic activity helps to:
- Prevent and control high blood pressure
- Lose weight or maintain ideal weight
- Manage diabetes
- Manage stress
- Improve blood cholesterol levels
- Increase your energy to carry out daily activities
Your exercise should be:
- Regular: Moderate exercise 30 minutes per day, on most days of the week, is recommended.
- Aerobic: Activities such as walking, cycling, or water aerobics
- Safe: Before you begin an exercise program, ask your health care provider what type and amount of exercise is right for you. Exercise specialists and programs are available to help you begin a safe and regular exercise program.
Limit your intake of sodium (salt)
Many people are sensitive to sodium in their diet, especially those who are African American, older, or have hypertension or diabetes. Lessening the amount of sodium in the diet can lower blood pressure.
Sodium should be limited to no more than 2,400 milligrams of sodium per day, with a goal of further lowering it to 1,500 milligrams per day (or less according to your specific management guidelines). Sodium is found in table salt and many of the foods we eat, most commonly, preserved foods, canned foods, luncheon meats, cheeses and snacks.
Tips to limit sodium:
- Learn to read food labels to determine sodium content. Also read over-the-counter medication labels for sodium content.
- Use herbs and spices instead of salt to flavor foods.
- Avoid processed foods (canned and frozen foods, cheeses and luncheon meats)
A registered dietitian can help you evaluate your current food choices and help you select foods lower in sodium.
Include foods rich in potassium in your diet
- If your blood potassium is too low, blood pressure may increase. Including potassium-rich foods in your diet may help manage high blood pressure.
- High-potassium foods include salt substitutes, bananas, dried fruits, skim milk, coffee and potatoes.
- If you take a diuretic (“water pill”) to control your blood pressure, it is important to have your doctor check your blood potassium level during your regular check-ups. You may need to take a potassium supplement to keep your blood potassium within the normal range.
- Talk with your doctor about including potassium-rich foods in your diet. Some medical conditions (such as kidney disease), may require you to LIMIT the amount of potassium in your diet.
- A registered dietitian can give you more information about foods rich in potassium.
- The DASH (Dietary Approaches to Stop Hypertension) study looked at the impact of foods on high blood pressure. The study results indicate that people who: increased calcium intake to more than 1200 mg/day, lowered fats to less than 26% of calories, and increased fiber, potassium and magnesium in their diets each day decreased systolic blood pressure (the top blood pressure number) by 5.5 mm Hg and diastolic blood pressure (the bottom number) by 3.0 mm Hg.
- In people with high blood pressure, the systolic blood pressure decreased by 11.4 mm Hg and the diastolic blood pressure decreased by 5.5 mm Hg. Learn more about the DASH eating plan.
Control stress and anger
During periods of stress or anger, blood pressure rises. If the stress and anger persists, over time, high blood pressure can occur. Stress and anger are also related to heart disease.
Tips to control stress and anger:
- Manage your time
- Set realistic goals of what you can accomplish each day
- Take time each day to relax
- Learn relaxation techniques
Stress management professionals are available to help you learn new strategies to control stress and anger
Take medications to control high blood pressure, as prescribed
Depending on your blood pressure readings, other risk factors and the presence of other medical conditions, your doctor may prescribe medications to help you reach your blood pressure goal.
There are many different types of blood pressure medications. You will need to work with your doctor to find the best drug to achieve your blood pressure goal with the least side effects.
Tips when taking high blood pressure medications:
- Follow your doctor’s orders about taking your medications
- Do not stop taking your medications without first talking to your doctor
There are many different types of blood pressure medications. You will need to find the best drug to achieve your blood pressure goal with the least amount of side effects.
Follow-up with your health care team
To control high blood pressure, you must work with your health care team of doctors, nurses, and other health care providers. Once your high blood pressure is diagnosed, your doctor may want to see you often until it is under control (every one to four weeks). He or she may want you to monitor your blood pressure at home and keep a record of your blood pressure at different times of the day. Once your blood pressure is in control, regular follow up visits are still required to ensure control and minimize side effects. Your doctor will tell you how often to schedule visits.
When you come to the doctor, bring:
- A list of your current medications
- Your blood pressure record
- A list of any questions you may have
It’s up to you
By making lifestyle changes, taking medications and working with your health care team, you can control your high blood pressure to help prevent future problems
- Joint National Committee on Detection, Evaluation, and Treatment of Blood Pressure. The Seventh Report of the Joint National Committee on Detection, Evaluation, and Treatment of Blood Pressure. NIH Publication No. 03-5233, May, 2003.
- Appel LA, Moore TJ, Obarzanek E, et al. A Clinical Trial of the Effects of Dietary Patterns on Blood Pressure. New England Journal of Medicine, 1997; 336:1117-24.
- Smokeless In Cleveland - A smoking cessation program provided by registered respiratory therapists, behavioral medicine staff and supported by physicians to help any smoker quit; located at various Cleveland Clinic Health System (CCHS) locations. Call 440.312.6741.
- The CCF Smoking Cessation Program offers a variety of methods to help people who want to become nonsmokers. The program features four three-hour classes in a five-week period. For more information about the program, please call 216.986.4000 in Independence or 440.943.6340 in Willoughby.
- To search for information on the web, go to:
Nutrition & Weight Management
- To make an appointment with a registered dietitian, call the Cleveland Clinic Preventive Cardiology and Rehabilitation Program - 216.444.9353 or 800.223.2273 ext. 49353 - Or have an eClevelandclinic Nutrition Consultation.
- For information on our "Cooking For Your Heart" Culinary Program, 216.445.4308.
- Weight Management: A Team Approach - 10-week program for individuals who are under a doctor’s care for weight management, conducted by clinicians from the Department of Psychiatry and Psychology with licensed registered dietitians. Call 216.444.6115 or 800 223.2273, ext. 46115 for more information.
- A Healthier Weigh - An 8 week nutrition and fitness group designed to teach you a step-by-step approach to developing healthy eating habits. Presented by registered, licensed dietitians from the Department of Nutrition Therapy who provide one-on-one feedback, tailored to your lifestyle. Call 216.444.3046 or 800.223.2273, ext. 43046 for more information.
- To search for nutrition information on the web, go to:
- Leo Pozuelo, MD, Cardiovascular Behavioral Health Clinic, contact Cleveland Clinic Preventive Cardiology and Rehabilitation at 216.444.9353 or 800.223.2273 ext. 49353.
- Department of Psychiatry and Psychology, Section of Health Psychology for an individual consultation: 216.444.9040 or 800.223.2273 ext. 9040
- To search for information on the web, go to:
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Call a Heart & Vascular Nurse locally 216.445.9288 or toll-free 866.289.6911.
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This information is provided by Cleveland Clinic and is not intended to replace
the medical advice of your doctor or health care provider.
Please consult your health care provider for advice about a specific medical condition.
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