The DASH (Dietary Approach to Stop Hypertension) Eating Plan

What is the DASH eating plan?

The DASH (Dietary Approaches to Stop Hypertension) eating plan was originally designed to lower blood pressure, but it turns to be beneficial for other conditions like diabetes, stroke, and even several types of cancer.


Within two weeks of starting the DASH diet your blood pressure may drop from 8 to 14 points. Best response came from people with prehypertension and people whose blood pressure was only moderately high. Even though the DASH diet is not intended for weight-loss, you may lose unwanted pounds because it guides you toward a healthier eating habit.

The components of the DASH diet includes:

• Reduced sodium intake. The standard DASH diet recommends up to 2300 mg (1 teaspoon) of sodium per day, while the lower sodium DASH diet recommends up to 1500 mg (2/3 teaspoon) per day. The lower sodium version is especially helpful in lowering blood pressure for middle aged or older adults, for African-Americans and for those who already have high blood pressure.
  

  

  An apple a day keeps the doctor away? Try four or five.

• Fruits and vegetables. In a 2000 calories per day basis, DASH recommends 4-5 servings or fruit and another 4-5 servings of vegetables per day.One serving of vegetable includes 1 cup raw leafy or 1/2 cup of cooked vegetables. One serving of fruit includes 1 medium fruit or 1/2 cup fresh, frozen or canned fruit. Most fruits are low in fat except for coconut and avodacoes.
• Grains. In a 2000 calories per day basis, DASH recommends 6-8 servings or grain products such as bread, cereal, rice and pasta. One serving of grains includes 1 slice whole-wheat bread, 1 ounce of dry cereal, or 1/2 cup cooked cereal, rice or pasta. Whole grains are better choices because they have more fiber and nutrients than do refined grains
• Low or non fat diary products. In a 2000 calories per day basis, DASH recommends 2-3 servings or diary products such as milk, yogurt, and cheese. One serving includes 1 cup of skim or 1% milk, 1 cup of yogurt or 1.5 ounces of cheese.
• Lean meat, poultry, and fish.  In a 2000 calories per day basis, DASH recommends up to 6 servings. One serving includes 1 ounces of cooked skinless lean meat, poultry, or fish or 1 egg. Even lean varieties of meat my contain extra fat and cholesterol. So go easy on them.
• Seeds and nuts. DASH recommends 4-5 servings per week of seeds and nuts such as almonds, sunflower seeds, kidney beans, peas, and lentils. Serving sizes are small and are intended to be consumed weekly because these foods are high in calories. One serving includes 1/3 cup of nuts, 2 tablespoons seeds or 1/2 cup cooked beans or peas.
• Lower total fat with higher portion of unsaturated fat. In a 2000 calories per day basis, DASH recommends only 2-3 servings of fat. One serving includes 1 teaspoon of soft margarine, 1 tablespoon of low-fat mayonnaise or 2 tablespoons light salad dressing. Saturated fat and trans fat raises your blood cholesterol, especially the bad LDL cholesterol. Meat, butter, whole milk, cream, eggs, palm and coconut oils are high in saturated fat. Therefore, you would want to avoid them. 
• Reduce sweets and added sugars consumption. DASH recommends no more than 5 servings of sweets per week. One serving includes 1 tablespoon of sugar, jelly or jam or 1/2 cup of sorbet. 
• Limiting alcohol. DASH recommends that men limit alcohol to 2 or fewer drinks a day and women 1 or less.

To sum it all, the DASH eating plan emphasizes on a balanced diet, heavy on fruits and vegetables, with the right amount of protein, but lower in sodium and total fat. 

Metabolic Syndrome and Related Conditions

What is metabolic syndrome?

Metabolic syndrome (also known as metabolic syndrome X, syndrome X, cardiometabolic syndrome, and insulin resistance syndrome) is a combination of risk factors that raises the risk for cardiovascular disease and other health disorders like stroke and diabetes. Studies indicated that almost as high as 25% of the United States people suffers from metabolic syndrome and this number increases to around 35% as the population ages.

The term 'metabolic' is used to describe alterations in the normal biochemical processes in the body that occurs with these multiple condition. Metabolic syndrome occurs when a person has three or more of the following: 

• 

  abdominal obesity or apple shaped belly

  Abdominal obesity
• Triglyceride level ≥150 mg/dL
• HDL cholesterol <40 mg/dL in men or <50 mg/dL in women
• Systolic blood pressure ≥130 mm Hg
• Diastolic blood pressure ≥85 mm H
• Fasting glucose ≥100 mg/dL
• Insulin resistance or glucose intolerance

Having only one of these conditions doesn't mean you have metabolic syndrome, but having one increases your odds for getting another one.

"Standalone, each one of the conditions that made up metabolic syndrome is already a serious health problem. Combined, the risk of contracting a serious disease increases even more."

Although metabolic syndrome is a serious condition, with aggressive lifestyle changes, you can delay or even prevent the development of serious health problems. Weight reduction, physical activity, healthy diet, and regular monitoring of blood glucose, blood cholesterol, and blood pressure are beneficial to people with metabolic syndrome.
 
Risk factors of getting metabolic syndrome are increasing age, racial background (Hispanics and Asian are at a greater risk), obesity, family history of diabetes and other diseases like hypertension or polycystic ovary syndrome in women.

Understanding Hypertension (High Blood Pressure) Part 2: About Treament

Continuing from Part 1: How high is high? This entry is all about the treatment of hypertension.

What is the goal of hypertension treatment?

The goal of treatment is to reduce blood pressure to <140/90 mmHg in otherwise healthy subject and to <130/80 in patients with diabetes or chronic kidney disease. Even though lifestyle modification is an important part in the treatment plan, most people with high blood pressure will require medication to achieve this goal.

Lifestyle modification

Lifestyle modification, however, remains as the first and most critical step in managing hypertension. Examples of changes you can try to help reduce your blood pressure are as follows:

• Eat healthy diet, including the DASH (Dietary Approaches to Stop Hypertension) diet which consists eating more fruits and vegetables, reduce fatty foods and eating less red meat.
  

  

  reduce salt intake

  Reduce the amount of sodium in your diet to less than 1500 milligrams a day (less than two-third teaspoon of salt).
• Try to lose some weight if you are overweight or obese.
• Quit smoking.
• Exercise regularly, especially aerobic exercise such as brisk walking or jogging at least 30 minutes a day
• Limit alcohol consumption to two drinks a day for men and one drink a day for women. Drinking red wine in a small amount helps maintain cardiovascular health due to its antioxidant properties.

Medications

If lifestyle modification fails to control the blood pressure, then starting medication is the next step. Depending on the stage of your hypertension, usually your physician will start giving a single drug or a combination of two drugs. Diuretics (a type of drug that makes you urinate a lot) are almost always the first choice regardless what your initial condition is. Listed below are the common medications for hypertension:

take your medicine regularly

• Angiotensin-converting enzyme (ACE) inhibitors 
• Angiotensin receptor blockers (ARBs)
• Alpha blockers
• Beta blockers
• Calcium channel blockers
• Central alpha agonists
• Diuretics
• Renin inhibitors
• Vasodilators

The most important thing to be aware of when you're starting medication is to always remember to monitor your blood pressure regularly to avoid sudden drops in your blood pressure.

Choosing the Right Blood Pressure Monitor

There are many types of blood pressure monitor available to choose from. Here are a few things you need to know before choosing a home blood pressure monitor that suits your needs.

What are the types of blood pressure monitor?

manual blood pressure monitor

• Manual monitor is the oldest model and probably the one you seen the most used by your doctor. This model requires a stethoscope to use, the cuff requires manual pumping, and the gauge contains mercury. Using this model requires a bit of skill compared to the automatic ones because you will need to put the stethoscope over the artery on your elbow and pay attention to the sound of blood flowing through the artery as you inflate and deflate the cuff. 

automatic blood pressure monitor

• Automatic monitor is easier to use because all you need to do is to turn it on and the machine will do everything for you. You do not need to pump the cuff yourself, nor do you need to use a stethoscope. The measurement result will be displayed on a digital screen. Semi automatic monitors are basically the same with automatic ones, except that you will still need to pump the cuff manually.

 

• A newer variety of blood pressure monitor which is the wrist blood pressure monitor. It's compact in size, easy and convenient to use, but it is also one of the most expensive monitors available. The latest model of wrist blood pressure monitor appears like a watch. This type is useful to measure your blood pressure continuously or during exercise.

 

What brand should I get? 

Known reputable manufacturers such as Omron, Braun, and Microlife claim their brand to have more benefits than the other, but there's no evidence that one brand is better than the other. The accuracy of a blood pressure monitor depends more on how the operator uses the machine rather than the build of the product.

What are the parts of a blood pressure monitor?

The two most important parts of a blood pressure monitor are the cuff and the gauge or monitor. The cuff is an inflatable band that is wrapped around your upper arm when you measure your blood pressure. The gauge or monitor is the part that where you read the result of the measurement.

Things to consider in choosing a blood pressure monitor

• Choose the right size of cuff for you. If the cuff too big for your arm, the reading will appear to be reduced than it actually is. Similarly, if the cuff is too small, the reading may appear higher than it actually is. You may be falsely diagnosed yourself with high blood pressure this way.
• Make sure the gauge or monitor display is clearly visible and easy to read. Make sure the device is validated and calibrated for accuracy by the manufacturer. 
• Ease of use. Manual monitors are harder to use than automatic ones and you may require another person’s assistance to use it.
• The price. The more expensive devices usually come with advanced function such as memory or print out capability, but measurement capability is not that different than cheaper ones.

Things to consider when performing blood pressure readings

Sometimes, your blood pressure will appear higher in a physician's office compared to when you measure it by yourself. This condition is called white coat hypertension and is the result of fear and anxiety when you visit your doctor to have your blood pressure measurement. It doesn't mean that blood pressure monitor is not accurate.

When taking measurement, the level of your arm and the manometer itself must be at the same level as your heart in order to provide accurate measurement.

Caffeine, alcohol, and tobacco may temporarily raise your blood pressure. Avoid taking any of them at least 30 minutes before measuring your blood pressure. Exercise, pain, and a full bladder may also falsely increase your blood pressure.

---

Other articles on hypertension:

• According to the American Heart Association, hypertension affects one in three adults in the United States. Approximately one in three people with high blood pressure don't realize they have it. Read more about hypertension
• The DASH (Dietary Approaches to Stop Hypertension) eating plan was originally designed to lower blood pressure, but it turns to be beneficial for other conditions like diabetes, stroke, and even several types of cancer. Read more about DASH eating plan
• The goal of treatment is to reduce blood pressure to <140/90 mmHg in otherwise healthy subject and to <130/80 in patients with diabetes or chronic kidney disease. Read more about hypertension treatment

Understanding Hypertension (High Blood Pressure) Part 1: How High Is High?

How high is your blood pressure? 

systolic ≥160 and diastolic ≥100 in stage 2 hypertension

Blood pressure readings are usually given as two numbers, for example 120 over 80 (written as 120/80 mmHg). The top number is called the systolic blood pressure, and the bottom number is called the diastolic blood pressure. Both numbers are equally important to consider in the diagnosis of hypertension.

The classification of hypertension or high blood pressure in the Seventh Report of the Joint National Committee on Prevention, Detection, and Treatment of High Blood Pressure (JNC7) is as follow:

Normal                           : systolic <120 mmHg and diastolic <80 mmHg
Prehypertension          : systolic 120-129 mmHg and diastolic 80-89 mmHg
Hypertension, stage 1 : systolic 140-159 mmHg and diastolic 90-99 mmHg

Hypertension, stage 2 : systolic ≥160 mmHg and diastolic ≥100 mmHg

If you are measuring your blood pressure by yourself, the best time to measure your blood pressure is in the morning after you wake up. Blood pressure tends to be higher after exercise. Anxiety, such as in the cases of white coat hypertension, pain, a full bladder, caffeinated drinks, and smoking can also cause the measurement to go higher than it should. Therefore, make sure you are in a resting condition when taking your measurement.

When you find your blood pressure to be higher than normal, don't start panicking. More importantly, do not engage in self-medication. A few years back, I met a person who took over five types of herbal medications to treat hypertension. She ended up getting a kidney failure either because of the disease itself or because of the numerous shady treatment options she undertook. Consult your doctor first if you think your blood pressure readings are abnormal. There's always a possibility for error in measurement.

Note that some electronic self measuring devices may yield slightly different numbers with the ones obtained by a healthcare professional. Some factors like the cuff size and your position when taking your measurement may also affect your result. When in doubt, repeat your measurement over a few days or ask trained individual to repeat it for you.

Hypertension is a silent disease.

According to the American Heart Association, hypertension affects one in three adults in the United States. Approximately one in three people with high blood pressure don't realize they have it. Under diagnosis is a major problem even with the campaign to routinely screen for hypertension in people as young as 18 years old.

What causes hypertension?

The majority (about 95%) cases of hypertension is called primary or essential hypertension, which is caused by a combination of many risk factors like age, genetics, lifestyle, obesity, and dietary habit (especially salt intake). A small number of cases (around 5%) is caused by a specific disease that affects one or more organs in our body and is called secondary hypertension. Kidney diseases or a tumor of the adrenal gland may cause secondary hypertension.

What are the symptoms and complications of hypertension?

Most of the time people feel no symptoms even when their blood pressure is high. Because of this, people can develop complications like cardiovascular diseases, kidney failure, eye problems, and brain damage without knowing they have high blood pressure. The range of symptoms varies from mild headache or dizziness in mild hypertension to heart attack or stroke in severe cases. If you experience severe headache, nausea or vomiting, confusion, changes in your vision, or nosebleeds you may have a dangerous form of high blood pressure that requires immediately medical attention.

---

Other articles on hypertension:

• The goal of treatment is to reduce blood pressure to <140/90 mmHg in otherwise healthy subject and to <130/80 in patients with diabetes or chronic kidney disease. Read more about hypertension treatment
• The DASH (Dietary Approaches to Stop Hypertension) eating plan was originally designed to lower blood pressure, but it turns to be beneficial for other conditions like diabetes, stroke, and even several types of cancer. Read more about DASH eating plan
• Here are a few things you need to know so you can choose the right blood pressure monitor that suits your needs. Read more about choosing blood pressure monitor