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High blood pressure is a serious condition,which often has no symptoms. Once highblood pressure occurs, it usually lasts alifetime. But by taking action, you canprevent and control it.

This fact sheet will tell you what highblood pressure is, and how to preventor control it.

WHAT IS H IGH B LOODP RESSURE ?

Blood pressure is the force of blood againstthe walls of arteries. Blood pressure risesand falls throughout the day. But when thepressure stays elevated over time, then itscalled high blood pressure.

The medical term for high blood pressureis hypertension. High blood pressure isdangerous because it makes the heart work too hard and contributes to atherosclerosis(hardening of the arteries). It increases therisk of heart disease (see Box 1) and stroke,the first- and third-leading causes of deathamong Americans. High blood pressurealso can result in other conditions, suchas congestive heart failure, kidney disease,

and blindness.High blood pressure affects about 50millionor one in fourAmerican adults.Some people are more likely to develop itthan others. It is especially common amongAfrican Americans, who tend to develop itearlier and more often than whites. Also,many Americans tend to develop high

F A C T S A B O U T

N A T I O N A L I N S T I T U T E S O F H E A L T HN A T I O N A L H E A R T , L U N G , A N D B L O O D I N S T I T U T E

Lowering

Blood Pressureblood pressure as they get older, but hyper-tension is not a part of healthy aging.About 60 percent of all Americans age60 and older have high blood pressure.

B OX 1

R I S K F A C T O R SF O R H E A R T D I S E A S E

Risk factors are conditions or behaviorsthat increase your likelihood of develop-ing a disease. When you have morethan one for heart disease, your riskgreatly multiplies. So if you have highblood pressure, you need to takeaction. Fortunately, most of the heartdisease risk factors are largely within

your control.

Risk factors under your control are:

High blood pressure High blood cholesterol Cigarette smoking Diabetes Overweight Physical inactivity

Risk factors beyond your control are: Age (45 or older for men; 55 or older

for women)

Family history of early heart disease(having a mother or sister who hasbeen diagnosed with heart diseasebefore age 65, or a father or brotherdiagnosed before age 55)

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Others at high risk of developinghypertension are the overweight,those with a family history of highblood pressure, and those with ahigh-normal blood pressure (seeBox 2). High blood pressure alsois more common in the southeasternUnited States.

HOW IS B LOOD P RESSUREC HECKED ?

Blood pressure usually is measuredin millimeters of mercury (mm Hg)and recorded as two numberssystolic pressure (as the heart beats)over diastolic pressure (as the

heart relaxes between beats)forexample, 130/80 mm Hg. Bothnumbers are important, althoughfor some Americans systolic bloodpressure is especially important(see Box 3).

The test to measure blood pressureis simple, quick, and painless.Typically, a blood pressure cuff called a sphygmomanometer (pro-

nounced sfig-mo-ma-nom-e-ter)is used. The cuff is placed aroundthe upper arm and inflated with airuntil blood flow stops. Then, thecuff is slowly deflated, letting bloodflow start again.

As the cuff is deflated, a stethoscopeis used to listen to the blood flow in an artery at the inner elbow. The first

thumping sound heard gives the bloodpressure as the heart contractsthisis the systolic pressure. When thethumping sound is no longer heard,the blood pressure is between heart-beatsthis is the diastolic pressure.

Because blood pressure changesand is affected by many factors, thetest will be repeated on differentdays to confirm a reading of highblood pressure.

A systolic blood pressure of less than120 and a diastolic blood pressureof less than 80 mm Hg are optimal.Systolic blood pressures of 140 orhigher, or diastolic blood pressuresof 90 or higher mm Hg are high. If systolic and diastolic pressures fallinto different categories, go by thehigher category. Even levels slightlyabove optimal can increase the risk of heart disease and other problems.

BOX 2

a For adults 18 and older who are not on medicine forhigh blood pressure and do not have a short-termserious illness. Source: The Sixth Report of the Joint National Committee on Prevention, Detection,Evaluation, and Treatment of High Blood Pressure,National High Blood Pressure Education Program,November 1997.

b If systolic and diastolic pressures fall into differentcategories, overall status is the higher category.

c Millimeters of mercury

2

B L O O D P R E S S U R E L E V E L S F O R A D U L T S a

Category Systolic b Diastolic b Result

(in mm Hg) c (in mm Hg) c

Optimal less than 120 and less than 80 Good for you!

Normal less than 130 and less than 85 Keep an eye on it.

High-Normal 130-139 or 85-89 Your blood pr essure

could be a problem.Make needed changes in what you eat and drink, get physical activity, and lose extra

weight. If you also have diabetes, see the doctor.

Hypertension All stag esYou have Stage 1 140-159 or 90-99 high blood pressure.Stage 2 160-179 or 100-109 Ask your doctor or Stage 3 180 or higher or 110 or higher nurse how to control it.

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BOX 3

3

HOW C AN YOU P R EV ENTOR C ONTROL H IGH B LOODP RESSURE ?

Everyone can take steps to preventhigh blood pressure or, for those who

already have it, to keep it under control.The steps are:

Maintain a healthy weight.

Be physically active.

Follow a healthy eating plan,which includes foods lower in saltand sodium.

If you drink alcoholic beverages,do so in moderation.

If you have high blood pressureand are prescribed medication,take it as directed.

Each of these steps is discussedmore fully.

Maintain a Healthy Weight

Overweight increases your risk of

developing high blood pressure. Infact, blood pressure rises as bodyweight increases. Losing even 10pounds can lower blood pressureand it has the biggest effect in thosewho are overweight and already havehypertension.

Overweight also is a risk factor forheart disease. And it increases yourchance of developing high bloodcholesterol and diabetestwo morerisk factors for heart disease.

Two key measures are used todetermine if someone is overweight.These are the body mass index, orBMI, and waist circumference.

BMI relates weight toheight. It gives anapproximation of total

body fatand thats what increasesthe risk of obesity-related diseases.

To find your BMI, use the formulain Box 4, or check the chart in Box5 for an approximate value. Box 6

gives the BMI categories for menand women. Overweight is definedas a BMI of 25 to 29.9; obesity isdefined as a BMI equal to or morethan 30.

But BMI alone does not determinerisk. For example, in someone whois very muscular or who hasswelling from fluid retention (callededema), the BMI may overestimatebody fat. BMI also may not accu-rately estimate total body fat inolder persons or those losing muscle.

Thats why waist measurement isoften checked as well. Anotherreason is that too much body fatin the abdomen (or stomach area)also increases disease risk. A waistmeasurement of more than 35 inch-

es in women and morethan 40 inches in men isconsidered high.

WAT C H T H ATS Y S T O L I C

Both numbers in a bloodpressure test are importantbut, for some, the systolic isespecially meaningful. Thatsbecause, for those middle agedand older, the systolic pressuregives the most accurate diagno-sis of high blood pressure.

Systolic blood pressure is thetop number in a blood pressurereading (see page 2). It is highif it is 140 mm Hg or above.

For American adults, the sys-tolic pressure increases sharplywith age, while the diastolicincreases until about age 55and then declines. Thus, manyolder Americans have only ahigh systolic pressurea condi-tion known as isolated systolichypertension, or ISH.

A high systolic pressure causesblood vessels to stiffen andcan lead to cardiovasculardisease and damage kidneysand other organs.

Clinical studies have proventhat treating a high systolicpressure saves lives andgreatly reduces illness. Yet,most Americans do not havetheir high systolic pressureunder control.

Blood pressure must be con-trolled to under 140/90 mm Hg.The treatment is the same forISH as for other forms of highblood pressure. So talk withyour doctor. Ask about yourblood pressure leveland espe-cially your systolic blood pres-sure. If your blood pressure istoo high, ask about adjustingyour drug and making lifestylechanges to bring it to less than140/90 mm Hg.

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6

pressure and lower an alreadyelevated blood pressure.

A key ingredient of healthy eating ischoosing foods lower in salt (sodiumchloride) and other forms of sodium.A recent study showed just howimportant lowering sodium is in

keeping blood pressure at a healthylevel (see Box 19 on page 15).

Most Americans eat more salt andsodium than they need. Some people,such as African Americans and theelderly, are especially sensitive tosalt and sodium and may need tobe particularly careful about howmuch they consume.

Most Americans should consume

no more than 2.4 grams (2,400milligrams) of sodium a day. Thatequals 6 grams (about 1 teaspoon)

of table salt a day. For someonewith high blood pressure, the doctormay advise less.

The 6 grams includes ALL salt andsodium consumed, including thatused in cooking and at the table.Boxes 8 and 9 offer tips on how to

choose and prepare foods lower insalt and sodium.

Sodium is found naturally in manyfoods. But processed foods account

for most of the salt and sodium Americans consume. Processedfoods with high amounts of saltinclude regular canned vegetablesand soups, frozen dinners, lunchmeats, instant and ready-to-eatcereals, and salty chips and othersnacks. You should use food labelsto choose products lower in sodium.Boxes 10, 11, and 12 can help you

on most, and preferably all, daysof the week. Examples of moderate-level activity are brisk walking,bicycling, raking leaves, and gar-dening. For more examples, see

Box 7.You can even divide the 30 minutesinto shorter periods of at least 10minutes each. For instance: Usestairs instead of an elevator; getoff a bus one or two stops early;or park your car at the far end of the lot at work. If you alreadyengage in 30 minutes a day, youcan get added benefits by doingmore. Do a moderate-level activity

for a longer period each day orengage in a more vigorous activity.

Most people dont need to see a doc-tor before they start a moderate-levelphysical activity. You should check first with a doctor if you have hearttrouble or have had a heart attack, if you are over age 50 and are not usedto doing a moderate-level activity,if you have a family history of heart

disease at an early age, or if you haveany other serious health problem.

To help get you started, a samplewalking program is given on page 16.

Follow A Healthy EatingPlan, Which Includes FoodsLower In Salt and Sodium

Research has shown that whatyou eat affects the developmentof high blood pressure. A healthyeating plan can both reduce therisk of developing high blood

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learn how to read and comparefood labels.

Sodium also is found in many foodsthat may surprise you, such as bakingsoda, soy sauce, monosodium glu-

tamate (MSG), seasoned salts, andsome antacidsthe range is wide.

Before trying salt substitutes, youshould check with your doctor,especially if you have high bloodpressure. These contain potassiumchloride and may be harmful forthose with certain medical conditions.

For an overall eating plan, considerthe DASH diet. DASH stands for

Dietary Approaches to StopHypertension. DASH was a clini-cal study that tested the effects onblood pressure of nutrients as theyoccur together in food. It found thatblood pressures were reduced byan eating plan low in saturated fat,total fat, and cholesterol, and rich infruits, vegetables, and lowfat dairyfoods. The DASH diet includeswhole grains, poultry, fish, and

nuts, and has reduced amounts of fats, red meats, sweets, and sugaredbeverages. It also is rich in potassi-um, calcium, and magnesium, aswell as protein and fiber.

A second study, called DASH-Sodium, found that even whenusing the DASH diet, loweringsalt and sodium is importantbloodpressure was lowest when bothlifestyles were followed. SeeBox 19 for more on the findingsfrom DASH-Sodium about theeffects of lowering salt.

Box 13 gives the servings andfood groups for the DASH diet. Thenumber of servings you requiremay vary, depending on yourcaloric need.

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BOX 7

You should be aware that theDASH diet has more daily servingsof fruits, vegetables, and grainsthan you may be used to eating.The servings make it high in fiber,

which may temporarily cause bloat-ing and diarrhea. To get used to theDASH diet, gradually increase yourservings of fruits, vegetables, andgrains. Box 18 offers some tipson how to adopt the DASH diet.

A good way to change to the DASHdiet is to keep a diary of your cur-rent eating habits. Write down whatyou eat, how much, when, and why.Note whether or not you snack onhigh fat foods while watching tele-vision, or if you skip breakfast andeat a big lunch. Do this for severaldays. You'll be able to see whereyou can start making changes.

If you are trying to lose weight, youshould choose an eating plan lowerin calories. You can still use theDASH diet, but follow it at a lower

calorie level (see Box 14). Again, afood diary can be helpful. It can tellyou if there are certain times youeat but arent really hungry, or whenyou can substitute lower-caloriefoods for higher-calorie items.

B E P H Y S I C A L L YA C T I V E

Engage in at least 30 minutesof moderate-level activity on

most, and preferably all, daysof the week. Examples ofmoderate-level activity are:

Walking briskly (3-4 miles

per hour)

Conditioning or general

calisthenics

Home care and general

cleaning

Home repair, such as

painting

Mowing the lawn (withpower mower)

Gardening

Dancing

Racket sports, such as

table tennis

Golf (walking the course)

Fishing (standing and

casting, walking, or

wading)

Swimming (with moderate

effort) Cycling (at a moderate

speed of 10 miles per hour

or less)

Canoeing or rowing (at a

speed of about 2-3.9 miles

per hour)

Source: Adapted from Pate, et al., J ournal of the American Medical Association ,1995, Vol. 273, page 404.

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sels open wider. Pressure goes down.There are different types of diuretics.They are often used with other high

blood pressure drugs.

Beta-blockers These reduce nerveimpulses to the heart and blood ves-sels. This makes the heart beat lessoften and with less force. Bloodpressure drops and the heart worksless hard.

Angiotensin converting enzyme(ACE) inhibitors These preventthe formation of a hormone called

angiotensin II, which normallycauses vessels to narrow. Theblood vessels relax and pressuregoes down.

Angiotensin antagonists These area new type of high blood pressuredrug. They shield blood vessels fromangiotensin II. As a result, the ves-sels are wider and pressure lowers.

8

If You Drin k Alcoh olicBeverages, Do So InModeration

Drinking too much alcohol can

raise blood pressure. It also canharm the liver, brain, and heart.Furthermore, alcoholic drinkscontain calories, which matterif you are trying to lose weight.

If you drink alcoholic beverages,have only a moderate amountone drink a day for women;two drinks a day for men.

What counts as a drink?

12 ounces of beer (regular orlight, 150 calories),

5 ounces of wine (100 calories), or

1 1/2 ounces of 80-proof whiskey(100 calories)

If You Have High BloodPressure And Are PrescribedMedication, Take It As Directed

If you have high blood pressure,the lifestyle habits noted above maynot lower your blood pressureenough. If they dont, you will needto take medication.

However, even if you do need med-ication, you still must follow thelifestyle changes. Doing so will help

your medication work better and mayreduce how much of it you need.

There are many drugs available tolower high blood pressure. Theywork in various ways. Often, two or

more drugs work better than one.

Heres a rundown on themain types of drugs andhow they work:

Diuretics These aresometimes called waterpills because they work inthe kidney and flush excesswater and sodium from thebody through urine. Thisreduces the amount of fluidin the blood. And, sincesodium is flushed out of blood vessel walls, the ves-

BOX 8

T I P S T O R E D U C E S A L T A N D S O D I U M

Buy fresh, plain frozen, or canned with no salt added vegetables.

Use fresh poultry, fish, and lean meat, rather than canned orprocessed types.

Use herbs, spices, and salt-free seasoning blends in cooking andat the tablesee Box 9 on ways to spice up food.

Cook rice, pasta, and hot cereals without salt. Cut back on instantor flavored rice, pasta, and cereal mixes, which usually haveadded salt.

Choose convenience foods that are lower in sodium. Cut back onfrozen dinners, mixed dishes such as pizza, packaged mixes,canned soups or broths, and salad dressingsthese often have alot of sodium.

Rinse canned foods, such as tuna, to remove some sodium. When available, buy low- or reduced-sodium, or no-salt-added ver-

sions of foodssee Boxes 10,11, and 12 on how to use food labelsfor guidance.

Choose ready-to-eat breakfast cereals that are lower in sodium.

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BOX 9

S P I C E I T U P

Make foods tasty without using salt. Try these flavorings, spices, and herbs:

For Meat, Poultry, and Fish

Beef . . . . . . . . . . . . . .Bay leaf, marjoram, nutmeg, onion, pepper, sage, thyme

Lamb . . . . . . . . . . . . .Curry powder, garlic, rosemary, mint

Pork . . . . . . . . . . . . . .Garlic, onion, sage, pepper, oregano

Veal . . . . . . . . . . . . . .Bay leaf, curry powder, ginger, marjoram, oregano

Chicken . . . . . . . . . . .Ginger, marjoram, oregano, paprika, poultry seasoning, rosemary, sage,

tarragon, thyme

Fish . . . . . . . . . . . . . .Curry powder, dill, dry mustard, lemon juice, marjoram, paprika, pepper

For Vegetables

Carrots . . . . . . . . . . . .Cinnamon, cloves, marjoram, nutmeg, rosemar y, sage

Corn . . . . . . . . . . . . . .Cumin, curry powder, onion, paprika, parsley

Green beans . . . . . . . .Dill, curry powder, lemon juice, marjoram, oregano, tarragon, thyme

Greens . . . . . . . . . . . .Onion, pepper

Peas . . . . . . . . . . . . . .Ginger, marjoram, onion, parsley, sage

Potatoes . . . . . . . . . . .Dill, garlic, onion, paprika, parsley, sage

Summer squash . . . . .Cloves, curry powder, marjoram, nutmeg, rosemary, sage

Winter squash . . . . . . .Cinnamon, ginger, nutmeg, onion

Tomatoes . . . . . . . . . .Basil, bay leaf, dill, marjoram, onion, oregano, parsley, pepper

Calcium channel blockers(CCBs) These keep calcium fromentering the muscle cells of the heart

and blood vessels. Blood vesselsrelax and pressure goes down.

One short-acting type of CCB hasbeen found to increase the chance of having another heart attack. Short-acting CCBs are taken several timesa day. If you are on such a drug, youshould talk with your doctor aboutother medication choices.

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Vasodilators These directly openblood vessels by relaxing the musclein the vessel walls.

When you start on a medication,work with your doctor to get the

right drug and dose level for you.If you have side effects, tell yourdoctor so the medication can beadjusted. If youre worried aboutcost, tell your doctor or pharma-cistthere may be a less expensivedrug or a generic form that can beused instead.

Its important that you take themedication as prescribed, includingin the right amount. That can preventa heart attack, stroke, and conges-tive heart failure, a serious condi-tion in which the heart cannot pumpenough blood for the bodys needs.

The finding does not apply to thelonger-acting types of CCB, whichare taken once a day.

Alpha blockers These reducenerve impulses to blood vessels,

10

L A B E L L A N G U A G E

Food labels can help youchoose items lower in sodium.Look for labels on cans, boxes,bottles, bags, and other prod-ucts that say:

Sodium free

Very low sodium Low sodium

Light in sodium

Reduced or less sodium

Unsalted or no salt added

BOX 10

BOX 11

Food labels can help you choose foods lower in sodium, aswell as calories, saturated fat, total fat, and cholesterol. Thelabel tells you:

Amount per Serving: Nutrient amounts are given for oneserving. If you eat more or less than a serving, add or subtractamounts. For example, if you eat 1 cup of peas, you need todouble the nutrient amounts on the label.

Nutrients: Youll find the milligrams of sodium in one serving.

Number of Servings: The serving size is 1/2 cup.The package contains about 3 servings.

Percent Daily Value: Percent Daily Value helps you compareproducts and tells you if the food is high or low in sodium.Choose products with the lowest Percent Daily Value forsodium.

U S E T H E F O O D L A B E L

Nutrition FactsServing Size 1/2 cupServings Per Container about 3

Amount Per Serving

Calories 60 Calor ies f rom Fat 0

% Daily Value*

Total Fa t 0g 0 %Saturated Fat 0g 0 %

Cholesterol 0mg 0 %Sodium 125mg 5 %Total Carbohydrate 11g 4 %

Dietary Fiber 6g 22 %Sugars 5g

Protein 5g

Vitamin A 15% Vitamin C 30%Calcium 0% Iron 6%

* Percent Daily Values are based on a2,000 calorie diet.

Frozen Peas:

which allows blood to passmore easily.

Results from a clinical study indicatethat an alpha blocker may not be thebest choice for an initial treatment

for high blood pressure. If you nowtake an alpha blocker drug for highblood pressure, consult with yourdoctor about whether or not yourtreatment should be modified.

Alpha-beta blockers These work the same way as alpha blockers butalso slow the heartbeat, as beta-blockers do. As a result, less blood

is pumped throughthe vessels.

Nervous systeminhibitors Theserelax blood vessels

by controllingnerve impulses.

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But you can be taking medicationand still not have your blood pres-sure under control. Everyoneandolder Americans in particularmustbe careful to control their bloodpressure to below 140/90 mm Hg.If your blood pressure is higherthan that, talk with your doctorabout adjusting your medicationor making any needed lifestylechanges to bring your bloodpressure down.

W HAT E LSE AFFECTSB LOOD P RESSURE ?

Other factors have been reportedto affect blood pressure. Heres areview of the latest findings:

Potassium. Potassium helps toprevent and control blood pressure.

Calcium and Magnesium. Thesenutrients may help prevent highblood pressure, and are importantnutrients for other reasons too.

A note: The DASH eating plan isrich in potassium as well as calciumand magnesium. In fact, it has abouttwo to three times the amounts thatmost Americans normally get intheir dietssee Box 16.

You should try to get these nutrientsfrom foods. So far, research onnutritional supplements has giveninconclusive results. Box 17 givessources for each nutrient.

C O M P A R E L A B E L S

Which of these two items is lower in sodium? To tell, check the Percent Daily Value.The answer is given below.

BOX 12


Amount Per Serving


% Daily Value*

Total Fat 0g 0 %Saturated Fat 0g 0 %



Protein 5g



Frozen Peas:


Amount Per Serving


% Daily Value*

Total Fa t 0g 0 %Saturated Fat 0g 0 %



Protein 4g



Canned Peas:

ANSWER: The frozen peas. The canned peas have three times more sodium than the frozen peas.

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BOX 14

D A S H D I E T S E R V I N G S F O R O T H E R C A L O R I E L E V E L S

BOX 13

T H E D A S H E AT I N G P L A N

The DASH plan shown below is based on 2,000 calories a day . The number of daily servings in a foodgroup may vary from those listed depending on your caloric needs. (See Box 14 for more.)

FO O D G R O U P D A I LY S E R V I N G S S E R V I N G S I Z E S(except as noted)

Grains & grain products 7-8 1 slice bread1 cup ready-to-eat cereal*1/2 cup cooked rice, pasta, or cereal

Vegetables 4-5 1 cup raw leafy vegetable1/2 cup cooked vegetable6 ounces vegetable juice

Fruits 4-5 1 medium fruit1/4 cup dried fruit1/2 cup fresh, frozen, or canned fruit6 ounces fruit juice

Lowfat or fat free dairy foods 2-3 8 ounces milk1 cup yogurt1 1/2 ounces cheese

Lean meats, poultry, and fish 2 or less 3 ounces cooked lean meats, skinlesspoultry, or fish

Nuts, seeds, and dry beans 4-5 per week 1/3 cup or 1 1/2 ounces nuts1 tablespoon or 1/2 ounce seeds1/2 cup cooked dry beans

Fats & oils** 2-3 1 teaspoon soft margarine1 tablespoon lowfat mayonnaise2 tablespoons light salad dressing1 teaspoon vegetable oil

Sweets 5 per week 1 tablespoon sugar

1 tablespoon jelly or jam1/2 ounce jelly beans8 ounces lemonade

*Serving sizes vary between 1/2-1 1/4 cups. Check the products nutrition label.**Fat content changes serving counts for fats and oils: For example, 1 tablespoon of regular salad dressing equals

1 serving; 1 tablespoon of a lowfat dressing equals 1/2 serving; 1 tablespoon of a fat free dressing equals 0 servings.

FOOD GROUPGrains &

grain productsVegetablesFruitsLowfat or fat free

dairy foodsMeats, poultry,

and fishNuts, seeds, and

dry beansFat & oilsSweets

Servings/Day at 1,600 calories/day

63-4

4

2-3

1-2

3/week20

Servings/Day at 3,100 calories/day

12-1366

3-4

2-3

142

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H O W T O L O W E R C A L O R I E S O NT H E D A S H E AT I N G P L A N

The DASH eating plan was not designed to promote weight loss.But it is rich in lower calorie foods, such as fr uits and vegetables. Youcan make it lower in calories by replacing higher-calorie foods withmore fruits and vegetablesand that also will make it easierfor you to reach your DASH diet goals. Here are some examples:

To increase fruits

Eat a medium apple instead of four shortbread cookies. Youll save80 calories.

Eat 1/4 cup of dried apricots instead of a 2-ounce bag of pork rinds.Youll save 230 calories.

To increase vegetables

Have a hamburger thats 3 ounces instead of 6 ounces. Add a 1/2cup serving of carrots and a 1/2 cup ser ving of spinach. Youll savemore than 200 calories.

Instead of 5 ounces of chicken, have a stir fry with 2 ounces ofchicken and 1 1/2 cups of raw vegetables. Use a small amount ofvegetable oil. Youll save 50 calories.

To increase lowfat or fat free dairy products

Have a 1/2 cup serving of lowfat frozen yogurt instead of a 1 1/2-ounce milk chocolate bar. Youll save about 110 calories.

And dont forget these calorie-saving tips:

Use lowfat or fat free condiments, such as fat free salad dressings. Eat smaller portionscut back gradually. Choose lowfat or fat free dairy products to reduce total fat intake. Use food labels to compare fat content in packaged foods. Items

marked lowfat or fat free are not always lower in calories than theirregular versions. See Boxes 11 and 12 on how to read and com-pare food labels.

Limit foods with lots of added sugar, such as pies, flavored yogurts,candy bars, ice cream, sherbet, regular soft drinks, and fruit drinks.

Eat fruits canned in their own juice. Add fruit to plain yogurt. Snack on fruit, vegetable sticks, unbuttered and unsalted popcorn,

or bread sticks. Drink water or club soda.

BOX 15

G E T T H O S EN U T R I E N T S

The DASH eating plan is richin various nutrients believed tobenefit blood pressure and inother factors involved in goodhealth. The amounts of thenutrients vary by how muchyou eat. If you eat about 2,000calories a day on the plan, thenutrients you will get include:

BOX 16

4,700

500

1,240

90

30

milligrams of potassium

milligrams of magnesium

milligrams of calcium

grams of protein

grams of fiber

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BOX 17 BOX 18

T I P S O N M A K I N GT H E S W I T C H T OT H E D A S HE AT I N G P L A N

Change gradually. Add avegetable or fruit servingat lunch and dinner.

Use only half the butter ormargarine you do now.

If you have trouble digestingdairy products, trylactase enzyme pills ordropstheyre available atdrugstores and groceries.Or buy lactose-free milk or

milk with lactase enzymeadded to it.

Get added nutrients such asthe B vitamins by choosingwhole grain foods, includingwhole wheat bread or wholegrain cereals.

Spread out the servings.Have two servings of fruitsand/or vegetables at eachmeal, or add fruits as snacks.

Treat meat as one part ofthe meal, instead of thefocus. Try casseroles,pasta, and stir-fry dishes.Have two or more meatlessmeals a week.

Use fruits or lowfat foodsas desserts and snacks.

G O O D S O U R C E S F O R G O O D N U T R I E N T S

Wheres the potassium, calcium, and magnesium? Read on. (In thedairy products mentioned below, remember to choose lowfat or fatfree types.)

Potassium Calcium catfish cheeselean pork milklean veal yogurtcod tofu (made with calcium sulfate)flounder broccolitrout spinachmilk turnip greensyogurt mackereldry peas and beans perchgreen beans salmonapricotspeachesbananasprunes and prune juiceorange juicelima beansstewed tomatoesspinachplantainsweet potatoespumpkinpotatoeswinter squash

Fats. Saturated fats and choles-terol in foods raise blood choles-terol, which increases the risk forheart disease. Foods high in fatsalso are high in calories, whichmust be reduced if you need tolose weight.

Caffeine. This may cause bloodpressure to rise but only temporarily.Unless you are sensitive to caffeine,you do not have to limit how muchyou consume in order to prevent orcontrol blood pressure.

Garlic or Onions. These havenot been found to affect bloodpressure. But, they are tasty substi-tutes for salty seasonings and canbe used often.

Stress Management. Stress toocan make blood pressure go up fora while, and it has been thought tocontribute to high blood pressure.

But the long-term effects of stressare as yet unclear. Furthermore,stress management techniques donot seem to prevent high bloodpressure. However, stress manage-ment techniques may help youcontrol over-eating.

Magnesium whole wheat breadwhole grain ready-to-eat and

cooked cerealsbroccolichardspinachokraplantainoystersscallopscroakermackerelsea bassbeanssoy milk

tofunuts and seeds

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15

HERE S A R ECAP

By preventing or controlling highblood pressure, you will reduceyour risk for heart disease andstroke, as well as other conditions.The steps needed will help you feelhealthier. Those steps are to:

Maintain a healthy weight.

Be physically active. It only takes30 minutes of moderate-levelphysical activity on most, and

preferably all, days of the week. Follow a healthy eating plan,

which includes foods lower in salt and sodium. Have no more than2,400 milligrams of sodium(6 grams of salt) a day. Also, trythe DASH eating plan, which islow in saturated fat, total fat, andcholesterol, and rich in fruits, veg-etables, and lowfat dairy foods.

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L O W E R S A LT T O L O W E R B L O O D P R E S S U R E

The DASH study occurred in two parts. DASH, the initial study, found that the eating plan given onpage 12 reduced blood pressure. DASH-Sodium then examined the relationships between bloodpressure, eating patterns, and various sodium intakes.

DASH-Sodium looked at the effect on blood pressure of three sodium levels: a higher intake of3,200 milligrams per day (mg/day), which is similar to how much most Americans now consume, anintermediate intake of 2,400 mg/day, which is similar to the upper limit of current recommendations;and a lower intake of 1,400 mg/day.

The effect of each sodium level was tested for two diet plans: A control diet, typical of what manyAmericans eat, and the DASH diet.

Here are some key results: The less sodium consumed, the lower the blood pressure. Blood pressure was lower in the DASH diet than in the control diet at all three sodium levels.

The lowest blood pressures occurred with the DASH diet at the lower sodium level. Sodium level had a bigger effect in the control diet than in the DASH diet. The effects of sodium reduction were seen in all study participantsthose with and without high

blood pressure, men and women, and African Americans and others.

DASH-Sodium shows the importance of lowering sodium intakewhatever your eating plan.But for a true winning combination, follow the DASH diet and lower your intake of salt.

The DASH eating plan offers plentyof potassium, as well as calcium,magnesium, fiber, and protein.

If you drink alcoholic beverages,do so in moderation.

If you have high blood pressureand are prescribed medication,take it as directed.

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U.S DEPARTMENT OF HEALTHAND HUMAN SERVICES

Public Health ServiceNational Institutes of HealthNational Heart, Lung, and Blood Institute

NIH Publication No. 00-3281Originally Printed 1994Reprinted October 1996Revised May 2000

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A S A M P L E WA L K I N G P R O G R A M

Warm Up Activity Cool Down Total Time

WEEK 1Session A Walk slowly Then walk Then walk

briskly slowly5 min. 5 min. 5 min. 15 min.

Session B Repeat above pat te rnSession C Repeat above pa ttern

Continue with at least three walking sessions during each weekof the program.

WEEK 2 Walk slowly Walk br iskly Walk slowly5 min. 7 min. 5 min. 17 min.

WEEK 3Walk slowly Walk br iskly Walk slowly5 min. 9 min. 5 min. 19 min.






WEEK 9 Walk slowly Walk br iskly Walk slowly

5 min. 23 min. 5 min. 33 min.WEEK 10 Walk slowly Walk br iskly Walk slowly

5 min. 26 min. 5 min. 36 min.WEEK 11 Walk slowly Walk br iskly Walk slowly

5 min. 28 min. 5 min. 38 min.WEEK 12 Walk slowly Walk br iskly Walk slowlyAND 5 min. 30 min. 5 min. 40 min.BEYOND

WANT TOKNOW MORE?

The National Heart, Lung, andBlood Institute (NHLBI) has moreinformation about high blood pres-sure, heart disease, the DASH eat-ing plan, and related topics. Some ofit is in English and Spanish; muchof it is free. Contact the following:

NHLBI Health Information NetworkP.O. Box 30105Bethesda, MD 20824-0105Phone: 301-592-8573Fax: 301-592-8563Email: [email protected]

Also check out the NHLBI Web site.

Youll find special sites on high bloodpressure, achieving a healthyweight, and high blood cholesterol.The Web site is www.nhlbi.nih.gov.

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