Managing High Blood Pressure Through Diet and Exercise

Case study ( 7162 views as of May 20, 2024 )

Greg is 65 years old and was recently diagnosed with hypertension (high blood pressure). He is shocked by this diagnosis. Greg has always been at a healthy body weight and feels he eats an overall healthy diet. He does not smoke and has no other health conditions. His mother died at the age of 50 from a heart attack, but otherwise he has no family history of high blood pressure or any other heart conditions.

Today Greg is in to see the registered dietitian to learn more about healthy eating to manage his blood pressure. His doctor wanted to start him on antihypertensive medication but Greg was resistant and wanted time to see if he could manage his blood pressure through lifestyle changes. Greg tells the dietitian that he eats healthy and exercises weekly. After some further probing about his diet, Greg admits he is a “meat and potatoes” guy and doesn’t love eating vegetables but that his food is always homemade. He is a truck driver but packs his own lunch to avoid buying fast food while on the road. His weekly exercise consists of 45 minutes of swimming on Saturday mornings.

Greg is ready to make lifestyle changes to improve his blood pressure. The dietitian educates Greg on the DASH diet – Dietary Approaches to Stop Hypertension. The DASH diet encourages whole grains, lots of vegetables and fruit, nuts/seeds and legumes, lean meats and fish. Increasing his level of physical activity will also help lower his blood pressure, and Greg could consult with a personal trainer for help on building up his activity level.


Conversation based on: Managing High Blood Pressure Through Diet and Exercise

Managing High Blood Pressure Through Diet and Exercise

  • Hypertension, or high blood pressure, is a leading cause of death globally, affecting both developed and developing countries. There is overwhelming evidence that treating high blood pressure can significantly reduce the risk of cardiovascular events. Over a five-year period, lowering blood pressure can reduce the risk of stroke by about 40% and the risk of heart attack by about 15%. Various strategies can be employed to reduce blood pressure. Lifestyle changes such as adopting a healthy diet, engaging in regular exercise, and limiting sodium intake are important. However, in some cases, drug therapy is also necessary. It's crucial to understand that blood pressure is not a static measurement and tends to increase with age. Systolic blood pressure (the upper number) tends to rise steadily and peaks around the age of 80, while diastolic pressure (the bottom number) peaks around the age of 60. Therefore, even if a person has a normal blood pressure in their 40s or 50s, it may not remain normal in the future as it tends to increase in most individuals. Blood pressure is highly modifiable, and lifestyle factors play a significant role in its management. Regular exercise, a balanced diet, and sodium reduction can have a profound impact on preventing the development of high blood pressure. For the average individual, the normal blood pressure is considered to be 140/90, regardless of age. However, certain conditions such as kidney disease and diabetes increase the risk of cardiovascular events. Current guidelines recommend that individuals with diabetes or kidney problems aim for an upper limit of 130/80, rather than the general population's limit of 140/90. It's important to note that high blood pressure typically does not cause noticeable symptoms, underscoring the importance of having regular blood pressure checks to identify and manage hypertension. Unfortunately, the control of high blood pressure in Canada is suboptimal, with less than 20% of Canadians with hypertension having their blood pressure within recommended guidelines. Individuals should prioritize regular follow-ups with their family physician to have their blood pressure monitored. This ensures an understanding of their risk and allows for appropriate interventions if needed.
  • One of the things I struggled with when I was diagnosed with high blood pressure was the full scope of dietary changes needed. It takes a while to learn that it's not just eating more vegetables and lean meats - it's things like salad dressing and cheese
  • Greg has a mostly sedentary job as a truck driver and swims once a week for 45 minutes. In order to help manage his blood pressure with lifestyle modifications, introducing more exercise to his weekly routine is going to be very important to help him avoid medications. Exercise has been shown to have similar effects on lowering blood pressure as some medications. My advice to Greg would be to add at least 100 minutes of exercise to his routine - and to include a mix of aerobic exercise and weight-lifting activities. He can always look for an exercise specialist in his area to help guide his exercises and he can also have a baseline fitness assessment done in order to help measure his progress. He sounds very motivated, so a great opportunity for him to get going on the exercise aspect as well.
    • Greg could also consider talking to a life coach or wellness coach to help him break down his efforts into small steps that he can gradually build up to meet his goals. Making those lifestyle changes is really difficult unless a person is truly ready to change, and Greg is motivated so capitalizing on his intentions would set him up for success. A wellness coach can be really helpful when it comes to making healthy changes to improve things such as high blood pressure.
    • A personal trainer would be able to help Greg develop a fitness plan that would best suit his lifestyle and help manage his blood pressure
  • It's good that Greg is planning on making lifestyle changes to help manage his high blood pressure but it's important to remember that this should still be monitored by a doctor and that sometimes medication is the correct treatment
  • It's great that Greg avoids eating fast food while on the road, eating out regularly would certainly have a negative impact on his cardiovascular health. Since he already packs homemade meals, Greg could try packing some fruits and vegetables that are easy to munch on while on the road. Eating vegetables "mindlessly" might help with the transition to more fruits and vegetables in his usual diet. Taking a walk at rest stops would also be a good idea to increase his physical activity - a little exercise is better than none! This may also relieve some of the stress associated with his job, which may help lower his blood pressure further.
    • A lot of grocery stores have started offering pre packaged vegetables in snack size portions. That might make it easier to begin to eat healthier
  • If Greg's mother died at the age of 50 of a heart attack, it would have been the 1950's. It's entirely possible that she did in fact have high blood pressure and it was never diagnosed. Keeping family history in mind is a good thing, but it's never a good idea to go simply on family history
  • Primary hyperaldosteronism is a condition where the adrenal glands produce excessive amounts of a hormone known as aldosterone. Aldosterone is responsible for maintaining blood pressure in the body as well as normal potassium and sodium levels.
    • That's interesting. Would primary hyperaldosteronism then be a blood pressure issue or merely an adrenal issue ? Which would be treated as the primary condition ?
  • Greg definitely needs more exercise. He could still eat his 'meat and potatoes', but he should cut down on the serving size, filling half of his plate with veggies.
    • Here is a 1-day sample menu following the DASH Diet approach to healthy eating: Breakfast: 2/3 cup steel cut oatmeal with ¼ cup ground almonds and ¼ tsp cinnamon 1 cup mixed berries and 2 tbsp Greek yogurt Lunch: Quinoa and bean salad – 1 cup cooked quinoa, ½ cup mixed beans, cucumber, green beans, red onion, shredded carrots, celery, balsamic vinaigrette. 1 cup cantaloupe Snack: 1 cup seedless grapes and 1oz cheese Dinner: Kale salad in lemon Caesar dressing 4oz grilled salmon Roasted cauliflower, sweet potato and white potato Baked apple in cinnamon
    • One thing Greg could look at is ways to put vegetables in to his diet that doesn't detract from his "meat and potatoes". Adding puree'd cauliflower to mashed potatoes or using meaty portobello mushrooms to make steak sandwiches are baby steps on the road to healthier eating
    • There are lots of reliable resources to give meal plan options that are in line with the DASH diet. Check back here soon for a sample meal plan to help get you started.
    • Are there meal plans available for those beginning to follow the DASH diet ? It can often be confusing to try and change your eating habits without the help of a dietitian
    • I agree that Greg could continue to eat his meat and potatoes but he would benefit from reducing the frequency and portions of meat and try other protein options like beans, legumes and fish will help. These options are more in line with the DASH diet which has been shown to improve blood pressure. Also, filling up on high fibre veggies can help him reduce his portion sizes overall.
  • Maintaining good eating / exercise habits helps with health maintenance in general. What types of fruits, vegetables, nuts/seeds and legumes are best to consume to manage high blood pressure ? Would it be specific "coloured fruits / vegtables" ?
    • Generally speaking the darker the colour the more nutritious when talking about fruits and vegetables. You should aim to have at least 2 different coloured vegetables at each meal. All nuts and seeds are high in fibre and have heart healthy fats but the goal should be to have unsalted nuts and seeds for best blood pressure.
    • We have started to use the food processor to make kale salad with broccoli and brussel sprouts. We also add pumpkin seeds and cranberry. It is very good and helps us to eat more greens. Looking up recipes using peppers and green beans has also made for some interesting side dishes.
    • I think when most people here "add more vegetables" they immediately think "I'll have a salad" - especially "meat and potatoes" type people. Salads are a great place to start but don't just think iceberg lettuce. Think kale, spinach, chopped broccoli / carrots / mushrooms / peppers. Don't limit yourself to salads - there are some amazing recipes out there for vegetables.
  • Truck driving is actually a really stressful profession. Greg would benefit from increased exercise for a number of reasons. Managing his stress better would also help with his blood pressure
    • Yes, truck driving is very stressful. Other stress management techniques like yoga and meditation can also help along with increased exercise for overall health.
    • In addition to Greg's weekly swimming, he could benefit from an exercise program that can be done anywhere, without equipment, for when he is on the road. For example, stair climbing, jogging, learning weight resistance exercises using your own body weight.
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