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High Blood Pressure (Hypertension) The Medical Research Council warns that poorly managed hypertension (high blood pressure) is having a major impact on the burden of disease in South Africa. People with high blood pressure are at risk of damage to arteries and vital organs. If high blood pressure is not treated, the heart becomes too weak for the increased workload, which results in heart problems. Almost half of the cases of heart disease and strokes in middle-aged South Africans are caused by high blood pressure. Fortunately high blood pressure can be easily detected, and once you know you have it, it is possible to control it. What is high blood pressure? Blood is carried around the body in pathways called arteries and veins. If there is too much blood flowing through these pathways, blood pressure increases and hypertension develops. Common causes and symptoms Hypertension can be caused by various factors, such as kidney problems or hormonal imbalances.. Although its cause is not completely understood, genetic factors are known to play a role.. Most people with high blood pressure have no signs or symptoms, even if blood pressure readings reach dangerously high levels. Some may experience dull headaches, dizzy spells or a few more nosebleeds than normal, although these signs and symptoms typically don't occur until high blood pressure has reached an advanced, even life-threatening, stage. Answering the questions below can help to determine whether you are at risk for hypertension: - Are you overweight? Overweight people have a 2 to 6 folds greater risk of blood high pressure than normal-weight people. - Do you exercise for less than 30 minutes a day? Regular exercise can lower blood pressure substantially. - Are you a smoker? Smoking causes an increase in blood pressure and affects your heartbeat. - Do you add too much extra salt to your food? Excessive salt in your diet can lead to higher blood pressure. - Does anyone in your family suffer from high blood pressure? A family history of high blood pressure puts you at greater risk. If you answered ‗yes‘ to any of the above questions, you have a greater risk of blood high pressure and it is highly recommended that you have your blood pressure regularly checked.. The management of hypertension Lifestyle changes can help you to prevent and to control high blood pressure — even if you're taking blood pressure medication. Here's what you can do: o Maintain a healthy weight. If you're overweight, losing even 2 to 2.5kg can lower your blood pressure. Reaching your ideal body weight will provide an even greater blood pressure reduction. o Increase physical activity. Regular physical activity can help lower your blood pressure and keep your weight under control. Strive for at least 30 minutes of physical activity a day. o Limit alcohol. Even if you're healthy, alcohol can raise your blood pressure. If you choose to drink alcohol, do so in moderation — no more than one drink a day for women and two drinks a day for men. o Decrease the salt in your diet. Although 2,400 mg of sodium a day is the current limit for otherwise healthy adults, limiting sodium intake to 1,500 mg a day will have a more dramatic effect on your blood pressure. While you can reduce the amount of salt you eat by avoiding the saltshaker, you should also pay attention to the amount of sodium that's in the processed foods you eat, such as canned soups, cold meats and sausages, bread or frozen dinners. o Don't smoke. Tobacco injures blood vessel walls and speeds up the process of hardening of the arteries. o Manage stress. Reduce stress as much as possible. Practice healthy coping techniques, such as muscle relaxation and deep breathing. Getting plenty of sleep can help, too. o Eat healthy foods. Try the Dietary Approaches to Stop Hypertension (DASH) diet, which emphasises fruits, vegetables, whole grains and low-fat dairy foods. This diet can lower your blood pressure by a few points in just two weeks, and it offers other health benefits, too, such as protection against osteoporosis, cancer, heart disease, stroke and diabetes. The DASH diet: What to eat The DASH diet is low in saturated fat, cholesterol, total fat and sodium, while rich in protein, fibre and healthy nutrients, particularly magnesium, potassium and calcium. The key to the DASH diet is variety, including lots of whole grain foods, fruits, vegetables and low-fat dairy products. It also includes some fish, poultry and legumes. Red meat, sweets and fats can be included in small amounts. Here are the food groups in the DASH diet and tips on incorporating them into your meals: Food group Servings Serving sizes Whole grains 6 to 8 a day 1 slice wheat free rye, seed loaf or low GI bread 30g low GI bran cereal ½ cup cooked oats porridge, brown rice or pasta Vegetables 3 to 5 servings a day ½ cup of cooked or raw 1 cup leafy raw, shredded or chopped ½ cup cooked legumes, drained 200ml or ¾ cup 100% pure juices Whole, e.g. apple 1 medium, approx. 100g Grapefruit, ½ a fruit Fruit 2 to 4 servings a day Melon, watermelon, pawpaw, 1 wedge, approx. 100g Juices, ¾ cup / 200ml Berries or small fruit, ½ cup Diced, cooked, drained or canned, ½ cup Dried, ¼ cup or 30g Avocado, 1 heaped Tbsp pulp or ¼ medium Olive, 3 olives or 30-50g Fat-free or low-fat dairy 2 to 3 a day 1 cup milk or yoghurt 30-40g Clover low fat, ricotta or mozzarella cheese ½ cup cottage cheese Lean meats, poultry and fish 6 or fewer a day 30g cooked lean meats, skinless poultry or fish (90g of meat is about the size of a deck of cards) Nuts, seeds and beans 4 to 5 a week 1/3 cup nuts 2 Tbsp peanut butter 2 Tbsp sunflower or pumpkin seeds Fats and oils 2 to 3 a day 1 1 1 2 Sweets 5 or fewer a week 1 Tbsp sugar or jam 1 cup sweetened drinks Sodium 1,500 to 2,400 milligrams (mg) a day (the lower the amount of sodium, the greater the blood pressure lowering effect) 1,500 mg of sodium equals about 4 grams, or 2/3 tsp of table salt tsp soft margarine tsp canola / olive oil Tbsp mayonnaise / salad dressing Tbsp low oil mayonnaise / salad dressing Meat should not be the focus of the meal. Reduce meat portions and increase the amount of vegetables you eat instead. Enhance the heart-health benefits of the DASH diet by eating fish, such as sardines, salmon, pilchards and herring. These types of fish are high in omega-3 fatty acids, which can help lower your total cholesterol. Saturated fat and trans fat are one of the main dietary culprits in raising your blood cholesterol. Keep your daily saturated fat to a minimum by limiting fatty meat, butter, brick margarines, cheese, full cream milk and cream in your diet. You should also avoid trans fats — a type of fat found mainly in hard margarines and processed foods, such as biscuits, baked goods and fried items — as much as possible. Although it can be high in energy, dark chocolate is another good choice if you're craving something sweet. Dark chocolate contains a substance that can help lower blood pressure and can enhance your results from the DASH diet. Just be sure to keep your portion size small, 1 block (6g) of at least 60% cocoa dark chocolate. If cutting back on sodium and table salt is difficult, do it gradually as this will give your taste time to adjust. It can takes six weeks or more for your taste buds to get used to less salty foods, but the drop in your blood pressure will be worth the adjustment. Here are some ways to reduce the sodium and salt in your diet: Add spices or flavourings to your food instead of salt. For example, season broccoli with lemon juice or oregano and popcorn with curry or garlic powder. Don't add salt when cooking rice, pasta or hot cereal. Rinse canned foods, such as tuna, to remove some of the sodium. High salt/sodium foods: Soup or stock powders/cubes/instant gravy powders Table salt and seasoned/herbal salts Cooked and tinned ham Bovril/Marmite/fish paste Canned fish in brine (salt water) and crumbed fish Canned vegetables and pickles Hard cheeses and processed cheese, e.g. cheese spreads or wedges Potato crisps, salted nuts and salted popcorn Salted savoury biscuits Butter and margarine – use the ―extra-light‖, soft margarines Processed meats, e.g. polony, salami, sausages, bacon and biltong Other important minerals By following the DASH diet, you'll be getting more nutrients that can help lower your blood pressure. The mix of potassium, calcium and magnesium in the DASH diet acts as a diuretic, helping the body excrete salt. Mineral What it does Where it's found Potassium Balances the amount of sodium in your cells Many fruits and vegetables, whole grains, legumes, dairy products Calcium Not proved to prevent high blood pressure, but eating too little is linked with high blood pressure Dairy products, green leafy vegetables, fish with edible bones, calcium-fortified foods Magnesium Deficiency linked with higher Legumes, green leafy vegetables, blood pressure nuts and seeds, whole grains, lean meats Meal-planning Ideas Breakfast A small cup of oats porridge cooked in low fat milk with half a pawpaw and lemon juice A cup of bran flakes with low fat milk or yoghurt and one small sliced banana A slice of brown toast with one poached or boiled egg with a grilled tomato and an apple Smoothie – blend a cup fat free yoghurt or milk with two fruits and one tablespoon smooth peanut butter and oat bran Snacks A piece of fresh fruit and a small tub of low fat or fat free fruit yoghurt Milo or Nesquik with low fat or fat free milk Dried fruit with a handful of unsalted nuts Carrot and cucumber sticks with mashed avocado dip Light meal One to two thin slices of seed loaf or rye bread with tuna in oil / skinless chicken / lean beef and salad vegetables with half a small avocado or five olives Two mini pitas filled with egg mayonnaise (two boiled eggs with one tablespoon ‗lite‖ mayo) A salad made up of mixed greens, raw vegetables, avocado, skinless chicken, mozzarella cheese, pawpaw and low oil dressing with a small baked potato One small can of pilchards in tomato or chilli sauce on two to four rye crackers with a mixed green salad and half a small avocado Main meal A small baked potato or sweet potato or a small cup of cooked brown rice or pasta and 1 palm sized portion of skinless chicken / lean beef / pork fillet / fish and vegetables or salad with half a small avocado or five olives Stir fry vegetables with one palm-sized portion of beef, pork or chicken strips with one tablespoon of sesame oil and soya sauce served with a small cup brown rice mixed with split peas or spaghetti Two pilchard fish cakes with sweet chilli sauce and two to three boiled baby potatoes and steamed vegetables Mushroom and tomato omelet (two eggs) served with roasted vegetables Optional dessert A small piece of fruit with some low fat or fat-free yoghurt Note – portion sizes are estimated and are only a guide. Contact a private dietitian for an individualised meal plan and portion guide.