Integrative Approach to Hypertension

As a family medicine PA, a lot of my job is discussing and managing chronic disease. Hypertension is a big one!

When I first started working, I was pretty adamant about counseling surrounding salt intake (eye roll). Now that I have a few years of experience under my belt, I would say the majority of my counseling is brainstorming what gets in the way of making healthful choices – ie stress, work, grief, anxiety, depression, poor sleep, child care to name just a few.

From a nutrition counseling standpoint, I typically ask about access to nutrient dense foods, take a 24 hour nutrition recall, inquire about sources of refined/processed foods.

I’ll also aim to remove any guilt or shame from a diagnosis. There are SO many different factors that influence health and health behaviors beyond individual decisions. Policy making, genetics/family history and other predisposing factors, access to medical care, access to nutrient dense foods and/or transportation, environment, social circumstances are all incredibly important factors.

I will spend some time discussing the diagnosis of hypertension, ie the measure of pressure or force of blood against vessels walls. Overtime, untreated high blood pressure can lead to stroke, heart attack, sexual dysfunction, and even dementia to name a few.

I always like to emphasize that no food is ever off limits. Noting a food as inherently “bad” often leads to a pattern of restriction and binging. Instead, all foods are okay and healthy. We aren’t robots and food is much more than simply input and output. Instead, it’s sustenance, nourishment, emotion, culture, community, joy, and so much more! And speaking of shame, sometimes medications are necessary to act as a bridge, or necessary for much longer term. Each individual person is different and has different healthcare needs!
Including my general recommendations for hypertension care below.
General recommandations: 

NUTRITION:

  • Be mindful of refined salt intake, ie salt in processed foods. When looking at pre-made foods, read the labels first to look for amount of sodium. If these items are cheaper, simply rinse them before eating or adding them to a recipe.
  • Get friendly with other spices! Try adding thins like garlic, rosemary, oregano, turmeric, and paprika to add additional flavor to dishes.
  • Eat lots of food with potassium! Spinach, broccoli, squash, papaya, avocados, and bananas are excellent sources
  • Magnesium is important too! Whole grains, dark leafy vegetables, avocado, bananas, dark chocolate are all winners.
  • Eat LOTS of non-starchy vegetables (cauliflower, broccoli, onions, zucchini, tomatoes, kale, spinach, lettuce, for example)
  • Aim for including lots of healthy omega-3 fatty acids (salmon, avocado, nuts, seeds), and moderate amounts of protein at every meal.
  • Think about gut health! The microbiome is extremely important for managing chronic disease.
  • If possible, keep a period of 12 hours of not eating between your last meal (dinner) and next meal (breakfast). Time restricted feeding can be really helpful for cardio-metabolic health in some patients.
  • Be mindful of excessive alcohol and caffeine consumption. Both can greatly affect blood pressure.
  • Apply mindful eating at each meal, eating slowly and paying attention to hunger cues.

LIFESTYLE:

  • Focus on getting enough restful sleep, ~7-9 hours per night.
  • Do something every day that brings you joy! This will help manage stress, which alone has a profound impact on blood pressure.  There are also apps available like Calm and Headspace. Yoga, tai chi, therapy, journaling,
    meditation, and deep breathing are all excellent ways to manage stress sustainably.
  • Move your body in a way you find enjoyable and that gets your heart rate up 3-5 times per week.
  • Consider smoking cessation if you haven’t done so already.
  • Try to go for a walk a few times throughout the day. Walking can be a powerful form of movement for blood pressure regulation!
  • Ask friends, family, peers, colleagues or your healthcare team for support!

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