Hypertension (high blood pressure) is an exceedingly common underlying cause of heart attacks, strokes, heart failure, and kidney disease in the United States. And studies have shown that the likelihood of all of these complications of hypertension can be decreased or eliminated by lowering blood pressure.
There is no doubt that blood pressure can be lowered significantly by lifestyle measures. These include maintaining ideal body weight, exercising regularly, eating a healthy diet, restricting sodium intake, and limiting alcohol to no more than two drinks a day in men and one drink a day in women.
Unfortunately, these measures do not lower blood pressure enough to prevent complications in many people, and - worse news - many others with high blood pressure simply fail to follow these lifestyle recommendations.
One example of this problem is illustrated by the failure of hypertensive patients to follow the DASH (Dietary Approaches to Stop Hypertension) diet, which was incorporated into national guidelines in 1998.
The DASH diet emphasizes fruits, vegetables, and low-fat dairy products, as well as more whole grains, poultry, fish, and nuts. The diet lowers the intake of sweets and sugar-containing beverages and calls for only small amounts of red meat, so as to decrease the intake of saturated fats and cholesterol.
Short-term studies showed that, among hypertensive subjects, the DASH diet lowered systolic pressure - in a blood pressure reading, the top number - by 11.4 mm Hg and diastolic pressure (the bottom number) by 5.5 mm Hg. Such reductions in blood pressure equal or exceed the fall in blood pressures achieved with most anti-hypertensive drugs.
A recent national survey, however, found that fewer adults were following the elements of the Dash diet in 2004 than in 1994. In the latest survey, only 36 percent of American adults had reduced their fat intake to less than 27 percent of calories (as recommended by DASH), compared with 43 percent who had in 1994.
The percentage of Americans reaching the DASH intake goal of 31 grams of fiber daily also fell, from 20 percent in 1994 to only 12 percent in 2004.
It is discouraging to recognize that the steady stream of dietary recommendations that can effectively lower blood pressure (as well as reduce the risk of coronary artery disease) has largely fallen on deaf ears. The only good news from the latest survey is that older Americans are much more likely to comply with such a diet.
Following proper lifestyle measures is likely to diminish the need for medications in many hypertensive patients, and to slow the progression of pre-hypertension to hypertension in many others.
Nonetheless, even if they follow an appropriate lifestyle, a large number of Americans will still need one or more anti-hypertensive medications to control their blood pressure adequately.