Hypertension, now identified as a public health emergency, affects more than half of all adults in the United States. Our lifestyle choices or what we do (e.g., consume too many calories, too much saturated fat, sodium, and alcohol, and smoke) and do not do (e.g., exercise and consume enough potassium-rich foods), have a potent effect on whether our blood pressure remains in the healthy range or not.
Understanding Blood Pressure
Blood pressure is simply the force of blood pressing against the walls of the blood vessels. If this pressure exceeds a medically defined level, a patient is diagnosed with hypertension. A diagnosis of high blood pressure starts at a systolic (upper number) reading greater than 130 mm Hg or a diastolic (lower number) reading greater than 80 mm Hg. Like many other medical indices, blood pressure is a continuum which means that blood pressures slightly below the medical cutoffs are still a risk.
The chart below is from American Heart Association and shows the category ranges for blood pressure.
There are many ways that the average person can reduce their blood pressure through lifestyle changes. Each 2 mm Hg reduction in diastolic blood pressure reduces the prevalence of high blood pressure by 17%. The table below shows the individual contribution of different lifestyle factors to the reduction of blood pressure in people with hypertension.
The Salt in our Diets
At present, 90% of Americans consume more sodium than recommended. The current average intake of sodium is 3300 mg per day. Dietary Guidelines recommend no more than 2300 mg of sodium per day and 1500 mg for people over 50 or with various chronic conditions.
Most of the sodium we eat comes from packaged foods and dining out. According to the CDC, processed foods account for 65 percent of our sodium intake with a small number of specific packaged foods containing most of the salt, including bread and rolls, soups, sandwiches, cold cuts, macaroni and cheese, pizza, poultry, and snack foods. Dining out (including take-out) accounts for about 25 percent.
There is a wealth of clinical evidence that reducing sodium intake can have a significant impact on reducing blood pressure.
Helping Patients Reduce Sodium Intake
A good place to start reducing sodium is by encouraging your patients to reduce their reliance on processed foods and to begin reading labels for sodium content. Cooking more at home, limiting adding salt to food, and cutting the use of salt in recipes is also helpful.
Going from a high-sodium diet to a lower one can make food seem excessively bland. While nothing will completely replace the taste of salt, adding various spices can perk up the flavor of foods. In addition, the mallard reaction that happens when roasting protein foods and the caramelization that occurs when roasting vegetables with “high” sugar content such as sweet potatoes and squash, can impart a wonderful, slightly sweet flavor that does not require salt.
Encouraging patients to gradually reduce sodium intake can also help. Remind them that after a few months of following a low-sodium diet, their taste buds will have adapted, and they will no longer feel deprived.
The DASH Diet
The DASH (Dietary Approaches to Stop Hypertension) diet has been found to be particularly effective in treating hypertension. It focuses on bountiful amounts of fruits and vegetables, low-fat dairy, and fish, and provides more than adequate amounts of potassium and calcium while being low in sodium and saturated fat.
DASH does not eliminate any food groups, does not restrict meat protein significantly, and does not automatically reduce calories, although it can be made to. The food suggestions are similar to what many Americans eat; the diet simply rearranges the quantities and the style a bit. DASH encourages patients to work towards having 4 to 5 servings of vegetables (½ cup cooked or 1 cup raw is a serving), 4-5 servings of fruit (1 medium piece or ½ cup canned is a serving), and 2-3 servings of low-fat dairy. These minor changes can move the needle and following this paradigm, unhealthy foods are simply squeezed down into an acceptable space, without forcing patients to forego them completely.
Taking the Next Step
We know that changing eating habits can be challenging. We also know that the current practices of telling patients with hypertension to eat better, exercise more, and take their medications have not been sufficient to move the needle on individual or population health. Silver Fern’s Hypertension Program provides valuable insight that can help unlock the reasons why patients are not following through on treatment plans with modules focused on medication management, home blood pressure monitoring, lifestyle management, and psychosocial issues that impact patients’ ability to effectively control their blood pressure.
Silver Fern programs provide practitioners with insights into where the patient is now, where they would like to be, and the various and often interlocking reasons they are stuck. Once the “why” is determined, Silver Fern provides evidence-based suggested actions to help you get the patient on the right pathway to achieving their health goals.