Our lifestyle, how we eat, drink, exercise and handle stress influences our blood pressure, increasing the risk of hypertension and aggravating hypertension once it develops. When one improves the lifestyles factors, blood pressure may be lowered.
Diet and weight are perhaps the most important influences and have already been discussed. In this chapter, the way in which alcohol, stress and exercise are related to the blood pressure is discussed, and how blood pressure can be lowered by improvement in some aspects of our lifestyle.
Alcohol and High Blood Pressure
Numerous studies have shown that the more alcohol that is consumed the higher the blood pressure and the more likely tne development of hypertension.
Some reports suggest that the effect of alcohol begins with very small amounts. Thus people who do not drink alcohol have the lowest blood pressure. Other reports show, however, that there is a threshold at which alcohol consumption affects blood pressure. Thus one or two alcoholic drinks a day are associated with progressively higher blood pressures. Finally, there are few studies which report that individuals who drink one or two alcohol drinks a day have lower blood pressure than either those who abstain or those who drink more than the equivalent of three alcoholic drinks a day. In other words, taking three or four drinks per day is certainly harmful, but it is unclear whether consumption below this level affects blood pressure.
The best advice about alcohol is this: if you drink, do it in moderation.
Even for people with high blood pressure, small amounts of alcohol don’t seem to increase blood pressure. And some evidence suggests that moderate drinking may reduce the risk of heart attack and boost the production of good’ (High-Density Lipoprotein, or HDL) cholesterol. HDL cholesterol helps protect your arteries from becoming narrowed or blocked by accumulation of plaque.
Excessive alcohol is the problem. It can increase your blood pressure and interfere with your medication. Heavy drinking is responsible for about 8 percent of all cases of high blood pressure (in United States of America).
Alcoholic drinks contain various amounts of ethanol-the more ethanol, the stronger the drink. For most men, moderate drinking is no more than two drinks-l ounce (30 ml) of ethanol a day. Two drinks equate to two 12 ounce (360 ml) cans of beer, two 5 ounce (150 ml) glasses of wine or two 1 ounce (30 ml) shot glasses of 100 proof whisky.
For women and small-framed men moderate drinking is half that-one drink or no more than half an ounce (15 ml) of ethanol daily. The amount is less because women and smaller-sized men generally absorb more ethanol.
Effect of Alcohol on Blood Pressure?
Exactly how excessive alcohol more than a moderate amount increases blood pressure is unknown. One theory is that it triggers the release of the hormone epinephrine (adrenaline) which narrows your blood vessels.
However, it is clear that reducing your consumption of alcohol can reduce your blood pressure. Excessive drinkers who cut back to moderate levels of alcohol consumption can lower their systolic blood pressure by about 5 mmHg and their diastolic pressure about 3 mm Hg.
Combining a nutritious diet with reduced alcohol use can produce an even larger reduction-a drop of about 10 mm Hg in systolic pressure and 7 mm Hg in diastolic pressure. One reason for this effect is that people who consume too much alcohol generally don’t get adequate amounts of nutrients that help control blood pressure, such as potassium, calcium and magnesium.
People on blood pressure medication who limit alcohol also tend to be more diligent about taking their medication. When influenced by alcohol, they may forget to take their pills or take them improperly.
Alcohol and Blood Pressure Medications
Although it is all right to drink alcohol in moderation, if you take medication you may need to pay careful attention to when or how you consume alcohol. Alcohol can interfere with the effectiveness of some blood pressure medications and increase their side effects.
If you mixes alcohol with beta blocker, which relaxes your blood vessels and slows your heart rate, you may feel light- headed or faint especially if you are a bit overheated or if you stand suddenly. You can experience the same symptoms if you drink alcohol near the time you take an angiotensin-converting enzyme (ACE) inhibitor, which widens your blood vessels or certain calcium antagonists, which can slow your heart rate. If you feel dizzy or faint, you have to sit until the feeling passes. Drinking water will also help.
If you take a central acting agent that works through your central nervous system, you could become unusually depressed after drinking alcohol. Both the medications and alcohol are sedatives. Basically, one must listen to one’s body, and when and if one feels light-headed or depressed after a drink or two one must talk to one’s doctor about how much alcohol one can safely drink and when.
Recommendations for Alcohol Consumption
Based on the evidence relating alcohol consumption to blood pressure, the Canadian hypertension society has recommended that one should drink no more than two standard alcoholic drinks per day. A standard drink is 120 ml (4 oz) of wine, 30 ML (1 oz) of liquor and 360 ML (12 oz) of beer. The society also recommends that if the blood pressure is still not controlled, abstinence may be helpful. Also, if you find it difficult to stick to the limit of two standard drinks per day, abstinence may be necessary, at least in the short run, to get you started in changing your drinking patterns.
If you drink alcohol, alcohol restriction can be tried as a first step in treating mildly elevated blood pressure, that is, a diastolic blood pressure between 90 mm and 100 mm Hg. It is also important to note that other types of anti-hypertensive treatments are likely to be made less effective if you continue to consume excess alcohol. For example, stress management has been shown to be less effective in patients who consume alcohol heavily. The same is likely to apply to anti-hypertensive medications, diet and exercise.
To begin to change your drinking pattern, it may be helpful to keep a record of:
- The number of abstinent day, moderate drinking days (consumed 1-4 standard drinks) and heavy drinking days (consumed 5 or more drinks) in a month.
- Number of days since last drink.
- Duration of this drinking pattern.
Second, alcohol consumption usually fits a pattern that serves a function for a person. Some of these functions can involve drinking to
- Reduce negative feelings of tension or sadness
- Have pleasure
- Aid some kind of performance (for example, socialising)
- Reduce social pressure or be part of the crowd. Sometimes drinking can serve no purpose, that is, it is just a habit. Alcohol consumption can have one or more functions in the same individual. Understanding the functions alcohol serves for a person can help you find alternatives for each function.
Third, you must set your own goal. The alternate goal is to drink no more than two standard drinks per day. At first you may want to set a slightly higher goal of, say, three drinks if you are used to drinking quite heavily. However, until you reach a goal of no more than two drinks per day, you may not experience much of a blood pressure response. In setting a drinking goal you should specify:
- The maximum number of drinking day per week
- The maximum number of drinks on drinking days
- When it is okay to drink;
- When it is not okay to drink (based on an analysis of your drinking pattern
- How long you are going to try and change your drinking pattern (that is at what point you may want to seek help from an experienced therapist).
Fourth, you may want to try various strategies to help you reach your goal. One strategy is pacing of drinking. Pacing includes measuring each drink, mixing drinks rather than having them straight, sipping drinks rather than gulping them, spacing drinks by alternating alcoholic and non alcoholic drinks or by letting at least one hour pass before taking the next drink, and avoiding drinking on an empty stomach.
Another strategy is self-monitoring of drinking. Selfmonitoring includes keeping a record of time of alcohol consumption, quantity consumed, function of drinking, urges or temptations to drink, and pressure from others to drink. Selfmonitoring will help remind you of the goal, clarify the reasons for your drinking and identify the problem areas.
Fifth, you must prepare in advance what you will do when alcohol is freely available (remember the pacing tips) or when pressures from other are likely to occur. Set ahead of time the maximum number of drinks you will consume. You should be prepared to counteract your excuses to go over your goal.
Sixth, you should take up activities that are incompatible with heavy drinking. For example, taking up an educational or physical fitness programme, developing or reactivating a hobby, and changing your social network to support your drinking goal.
Seventh, problems at home or work may make you feel like drinking. You must set a rule that alcohol should not be used to cope with problems. You must find other solutions. You may want to seek help from an experienced therapist for these problems but often it can help to ask a close friend for advice. If you find, that you cannot achieve your drinking goal, then you may find it helpful to ask your doctor to help plan and supervise the programme. He or she can also refer the person to an experienced therapist.
Cigarette Smoking and High Blood Pressure
Cigarette smoking is not a cause of hypertension. It does however cause a temporary increase in blood pressure by about 10 mm Hg systolic pressure and 8 mm Hg diastolic pressure while smoking and shortly thereafter. Of even more importance to the hypertensive patient, cigarette smoking appears to cancel the beneficial effects of some anti-hypertensive medications. For example, one large hypertension treatment trial found that beta blocker therapy decreased the risk of heart disease and stroke only among those who did not smoke. Furthermore, cigarette smoking is one of the most important risk factors for coronary heart disease, stroke and cancer. Risk factors potentiate one another. If you both smoke and have hypertension you are at a much greater risk of heart disease and stroke than if you had only one of these risk factors.
Tobacco and High Blood Pressure
Approximately one out of three people with high blood pressure smokes. Simply having high blood pressure puts you at increased risk for a heart attack or a stroke. But if you have high blood pressure and also smoke, you are three to five times more likely to die of heart attack, or heart failure than someone who doesn’t smoke. In addition, you are more than twice as likely to die of a stroke.
Effect of Smoking on Blood Pressure
The Nicotine in tobacco is what causes the blood pressure to increase shortly after you take that first puff. Nicotine like many other chemicals in tobacco smoke is picked up by tiny blood vessels in the lungs and distributed into the bloodstream. It takes only about 10 seconds for nicotine to reach the brain. The brain reacts to nicotine by signalling the adrenal glands to release Epinephrin (adrenaline). This powerful hormone narrows the blood vessels, forcing the heart to pump harder under higher pressure.
After smoking just two cigarettes, systolic and diastolic pressures increase an average of about 10 mm Hg. The blood pressure remains at this increased level for about 30 minutes after you finish smoking. As the effects of the nicotine wear off, the blood pressure gradually decreases. However, if you smoke heavily, the blood pressure is at a higher level throughout the day.
In a addition to promoting the release of adrenaline, smoking has other damaging effects. The chemicals in tobacco can scar the inner walls of the arteries, leaving them more susceptible to accumulation of cholesterol containing fatty deposits (plaque) that narrow the arteries. Tobacco also triggers the release of hormones that cause the body to retain fluid. Both of these factors, narrowed arteries and increased fluid, can lead to high blood pressure.
Why Quitting is Crucial
Stopping smoking may reduce the blood pressure by only a few points. But doing so is important for two reasons.
First, quitting smoking may increase the effectiveness of your medication. Smoking interferes with some blood pressure medications, keeping them from working as well as they can, or working at all.
Second, and more importantly, stopping smoking greatly reduces your risks for a heart attack, heart failure or stroke. Having high blood pressure puts you at increased risk for these conditions because of the damage it can cause to your arteries. Blood supply to the heart and brain may be reduced. Plus, the risk for formation of a blood clot increases.
Smoking also damages the arteries and produces cardiovascular risks. Therefore, when you combine high blood pressure with smoking, the odds for a heart attack, heart failure or stroke are much greater.
Breaking Tobacco’s Grip
There is no one perfect plan for quitting smoking. Some people can simply stop and never smoke again. For others, quitting takes several tries and various approaches.
Some steps can be followed which increases the chances of being successful.
Step I: Do Homework: That way you will know what to expect. You may experience physical withdrawal symptoms for at least 10 days. Common symptoms include irritability, anxiety and loss of concentration. Afterward, you may still have an urge to light up in familiar smoking situations, such as after a meal or while driving. These urges are generally very brief, but they can be very strong.
By knowing what to expect and having alternative activities planned you will be better prepared to handle the urges. These activities might include chewing gum after a meal or snacking on some carrot sticks while driving to keep your hands busy.
Most relapses take place within a week after quitting smoking. Often, the relapses occurs not only because of the power of nicotine addiction but also because the smoker didn’t have a well conceived quitting plan.
Step II: Set a Stop Date: Quitting cold turkey seems to work better than cutting down gradually. So carefully select a date to quit smoking. Do not try to quit when you know that the stress levels may be high.
Many smokers choose to quit during a relaxing vacation. One reason is that your routine changes on vacation, so it is easier to break free of smoking rituals than when you are at work or home.
Step III: Tell Others about Your Decision: Having the support of family friends and co-workers can help you reach your goal more quickly. However, many smokers keep the plans to quit a secret. That is mainly because they don’t want to look like a failure if they fail and cannot quit and go back to smoking.
It takes many people three or more tries before they are successful. So, there is no reason to feel like a failure just because your effort may not work out the first time. Asking and enlisting the help of one or more persons can really increase or enhance your chances of success.
Step IV: Changing Your Routine: Before the stop date, you must cut down on the number of places you smoke, for instance, you can stop smoking in the car, or smoke in only one room of the house or smoke only outside. This approach will help reduce the smoking urges so that you can be more comfortable in those places without smoking.
Step V: Having a Talk with the Doctor about Medications: Nicotine is a highly addictive substance. Withdrawal from nicotine can produce irritability, anxiety and difficulty in concentration. Medications are available that can lessen withdrawal symptoms and increase the chances of being successful. A frank talk with the family doctor can give a person an insight into what sort of medication may suit the person, his lifestyle and personnel habits.
Step VI: Taking a Day at a Time: On the particular stop day quit completely. Each day attention must be focused on remaining tobacco free.
Step VII: Avoiding Smoking Situations: Changing the situations in which you used to smoke, you must leave the table immediately after meals if this is a time you used to light up. You can take a walk instead. If you smoke while using a telephone, you can avoid long phone conversions or change the place where you talk. If you have a favourite smoking chair, you should definitely avoid it.
You may soon be able to anticipate when the urge to smoke will hit you. Before it hits, you can start doing something that makes smoking inconvenient such as washing your car or moving the lawn. Your smoking behaviour is deeply ingrained and automatic, so you need to anticipate your reflex behaviour and plan alternatives.
Step VIII: Time Each Urge: You can check the watch when a smoking urge hits. Most are short. Once you realise this, it is easier to resist. You can remind yourself that you can resist the urge for a few minutes and surely the urge will pass.
Medications to help you quit
The medications listed below can reduce the difficult side effects of nicotine withdrawal and make quitting smoking easier. They can be used under doctor’s instructions, gradually tapering their use over a period of week to months.
Nicotine Patches: Available as over-the-counter products and by prescription, the nicotine patch is placed on the skin, where it gradually releases nicotine into a person’s body. This helps reduce nicotine craving when he cuts back or stops smoking. These patches can sometimes irritate your skin, but the irritation can be minimised by rotating the side of the patch and applying an overthe-counter cortisone cream.
Nicotine Gum: This nicotine gum can be purchased over the counter. This should be bitten into a few times, then ‘parked’ between your cheek and gum. The lining of the mouth absorbs the nicotine that the gum releases. Nicotine gum satisfies the nicotine urge the same as the patch.
Nicotine Nasal Spray: This also helps to quit smoking in the same way as the patch or gum, but instead the nicotine can be sprayed into the nose. There it is quickly absorbed into the bloodstream through the lining of the nose, providing a quicker response to nicotine craving than the other products. It is intended mainly for when one needs a quick ‘hit’ of nicotine. This product is available only by prescription.
Nicotine Inhaler: This relatively new medication is available only by prescription. The device looks like a plastic cigarette. One end of the inhaler has a plastic tip like that used on cigars when the tip is put in the mouth and inhaled, like puffing on a cigarette. The inhaler releases a nicotine vapour into the mouth, reducing one’s craving for nicotine. It also helps smokers who miss smoking’s hand-to-mouth ritual.
Non-nicotine Medication: Bupropion (Wellbutrinzyban) is the first non-nicotine medication approved by the Food and Drug Administration as a stop-smoking aid. It is not clear exactly how the drug works, but it stimulates the same chemicals involved in nicotine addiction. Bupropion is also available only by prescription.
Eating and Blood Pressure
Healthy eating can to a large extent help to control high blood pressure and reduce cardiovascular risk. In a survey conducted it was found that over half the people with high blood pressure were either overweight or had an elevated cholesterol level. The combination of high blood pressure and these risk factors greatly increases the risk of developing cardiovascular disease.
Obesity and High Blood Pressure
Being overweight is a risk factor in the development of heart disease. Weightless has also been found to reduce blood pressure in people who have high blood pressure. This effect is more dramatic in those who are obese, and a reduction of blood pressure can occur with a weight less of as little as 10 pounds (4.5 kgs). There is evidence that some overweight people are at greater risk than others.
Recent research has shown that people who have their fat concentrated in the waist and abdomen (the ‘apple’ shape) are more likely to develop high blood pressure than if the excess fat is located on the thigh or buttocks (the “pear” shape).
Salt and High Blood Pressure
Salt plays an important role in the development of high blood pressure. Primitive societies have a low sodium intake and low incidence of high blood pressure. Western societies, however, have a high intake of sodium and have higher rates of hypertension.
Most of the studies done show that to a large extent blood pressure goes up as salt intake increases. However, the overall effect is quite small, particularly on the diastolic pressure. Reducing salt intake could reduce the amount of medication required to control blood pressure.
Sodium restriction can reduce blood pressure in some people with high blood pressure, and has also been found to enhance the effect of most drugs used in the treatment of high blood pressure.
Our taste preference for salt is an acquired habit and will greatly diminish after a few months of restricted intake. Processed food contains the maximum amount of sodium (salt). Most of the salt we eat is hidden. Fifteen percent of our daily sodium intake comes from salt added to food while cooking or eating and about 10 percent is naturally present in the food we eat. The remaining 75 percent comes primarily from processed foods and “fast foods”.