High Blood Pressure / Hypertenstion at Advanced Queen's Medical Care Medical Director Michael Shirazi MD -- Internal Medicine Diplomate of American Board of Internal Medicine 83-06 Queens Blvd, Elmhurst NY 11373 (718) 672-4600
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						When choosing fats, select monounsaturated oils, such as olive or canola oils. (One study reported a reduced need for anti-hypertension medication in people with a high intake of virgin olive oil, but no sunflower oil, a polyunsaturated fat.) Choose whole grains over white flour or pasta products. Choose fresh fruits and vegetables every day. Important foods include most fruits (especially potassium-rich fruits including bananas, oranges, prunes, and cantaloupes) and vegetables (especially carrots, spinach, celery, alfalfa, mushrooms, lima beans, potatoes, avocados, broccoli). Note: Grapefruit boosts the effects of calcium channel blocking drugs, which are often used for hypertension. (Regular oranges do not appear to pose any hazard, but one study suggested that Seville oranges, also called bitter oranges, may be similar to grapefruit in their effect.) Include nuts, seeds, or legumes (dried beans or peas) daily. Choose modest amounts of protein (preferably fish, poultry, or soy products). Oily fish may be particularly beneficial. In one study, after eight weeks on the diet, subjects from a broad range of backgrounds experienced a significant reduction in blood pressure. A 2000 study reported that a combination of the DASH diet and salt restriction is very effective in reducing blood pressure. (Each approach has positive benefits, but the combination is best.) Some individuals should take particular measures to restrict salt.  Lose weight if overweight. A weight loss of as little as 4.5 kg (10 lb) can reduce blood elevations in a large proportion of individuals who are >10% above ideal body weight. Eliminate or limit alcohol intake to <1 oz/day of ethanol (24 oz of beer, 8 oz of wine, or 2 oz of 100-proof distilled spirits). The US Dietary Guidelines for Americans state that alcoholic beverage intakes for women should be less than half of that listed in this recommendation. Reduce sodium intake to less than 100 mmole/day (<2.4 g sodium or approximately 6 g sodium chloride [1 tsp salt]). A reduction to this level of salt intake in hypertensives, especially in those who are elderly or black, helps to attenuate the rise in systolic blood pressure (SBP) associated with age, lower systolic blood pressure and diastolic blood pressure (DBP) in many with established HTN, and decrease or eliminate the need for medication. Maintain adequate intakes of dietary potassium, calcium, and magnesium. For adults, the usual intake of potassium is 3500 mg (90 mEq)/day; the Recommended Dietary Allowance for calcium is 800 to 1200 mg/day, and for magnesium is 280 to 350 mg/day. Reduce dietary saturated fat and cholesterol for overall cardiovascular health. However, as consistent data becomes available regarding the interrelationship of genotype, diet, and plasma lipid response, nutrition recommendations for specific genotypes may emerge that are very different from the general dietary guidelines being prescribed currently. Reducing total fat intake also helps to reduce caloric intake which is important in weight control and the management of type 2 diabetes mellitus and other disease states that increase the risk of HTN. Consistent with the recommendations listed in the Second Report of the National Cholesterol Education Program (NCEP 2001), total fat intake should be <30% and saturated fat should be <10% of total daily calories, and cholesterol intake should be <300 mg/day. Stop smoking Increase aerobic physical activity to 30 to 45 minutes most days of the week.