A 33 year old chap popped into my clinic on Friday, sweaty from running from the train, asking for a quick blood pressure check. His General Practitioner had told him his blood pressure was a bit high and he should get it checked a couple more times and then return for review – with the likely treatment being blood pressure medication.
The SPRINT trial reported in 2015 http://www.nejm.org/doi/full/10.1056/NEJMoa1511939#t=article informed the updating of the Heart Foundation management advice for hypertension. Measurement of blood pressure for this trial was 3 measurements, with the patient in a room by themselves for 5 minutes before the measurement x 3 was taken. This reduces the social anxiety that can come from monitoring blood pressure in company.
Lifestyle intervention for high blood pressure is unsurprising.
(Heart Foundation Guideline for the diagnosis and management of hypertension in adults. 2016.)
- Physical exercise moderate intense activity 150-300 minutes per week.
- Waist circumference less than 94cm males, less than 90cm for Asian males and less than 80cm females.
- Vegetable intake five serves a day and 2 serves of fruit, salt less than 6gm/day and total fat intake 20-35% energy intake.
- Smoking cessation
- Alcohol no more than 2 standard drinks/day.
This 33 year old did not smoke, attended the gym at least 3 times a week, alcohol was once a week – 2 standard drinks. So what was missing?
On review, his blood pressure was 148/86 – certainly higher than the preferred 120/80, however he had run to the clinic from the train, and was rather anxious about the outcome of the reading.
Rather than consider medication – what was missing from the lifestyle recommendation by the Heart Foundation? Nutrition.
His diet was high in refined carbohydrates and barely two cups of vegetables a day. His waist circumference was 98cm.
My top three recommendations:
- Purchase a blood pressure monitor, and measure your blood pressure at home twice a day – morning and evening for two weeks. Write these measurements down and then take them to show you General Practitioner. I would not be surprised if this chaps readings were lower at home than when in clinic. Purchasing your own blood pressure monitor gives you control and understanding about blood pressure variations during the day. Measuring blood pressure at home without the stress of being in a clinic environment could suggest his blood pressure is “white coat hypertension” – higher blood pressure when in clinic environment only.
- Reduce simple refined carbohydrates in the diet and replace with vegetables – multi-coloured, especially green such as spinach, kale, capsicum, broccoli and cauliflower. To increase your intake of vegetables to 7 per day, you have to start at breakfast. Rather than cereal from a packet, consider omelette or frittata with spinach, kale, grilled tomato, olives. Lunch can be roasted vegetables or salad – at least 2 – 3 cups with protein such as chicken/tuna/salmon. Dinner can be protein of your choice with most of the plate being multi-coloured vegetables.
- Magnesium supplement 1-2 tablets at night (at least 500mg) will not only help you sleep better, and reduce restless legs, it has been shown to modestly reduce blood pressure 2-3mg/Hg. With the increase in vegetable intake and self-monitoring in a home environment together will assist blood pressure reduction.
In an otherwise well 33 year old, with no family history of cardiovascular disease, preventing heart disease by increasing vegetable intake, monitoring his own blood pressure and taking supplemental magnesium can make a significant difference to his well-being and reduce high blood pressure.
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