Stephen J. Schueler, M.D.

Hypertension Home Care

Home care for hypertension includes:

  • Stop smoking:
  • Avoid exposure to secondary smoke.
  • Avoid alcohol, or drink alcohol in moderation:
    • For men: no more than 2 alcoholic beverages per day
    • For women: no more than 1 alcoholic beverage per day
  • Avoid caffeine.
  • Avoid alcohol, or drink alcohol in moderation:
    • For men: no more than 2 alcoholic beverages per day
    • For women: no more than 1 alcoholic beverage per day
  • Eat a healthy heart diet:
    • Limit your intake of fat to 30% of your total calories.
    • 10% to 15% of your total calories should be in the form of monounsaturated fats, such as olive oil, canola oil and peanut oil.
    • Low cholesterol diet.
    • Low salt diet.
    • Eat foods rich in omega-3 fats
  • If you have been prescribed medications to control high cholesterol, so not skip doses.
  • Take any prescribed heart medications as directed:
    • Don't skip doses of your heart medication.
    • Avoid running out of your prescribed heart medications.
    • Don't stop your medication when you feel better.
    • Talk to your doctor before stopping your heart medication if you feel worse.
    • Be aware of potential drug side effects.
  • Manage stress:
  • Get regular exercise:
  • Maintain a normal body weight:
    • You should weigh yourself every day and record the results.
    • Notify your doctor if you gain more than 6 pounds over 1 week.
    • You may experience symptoms when your blood pressure is higher than usual.
    • You may experience symptoms when your blood pressure is lower than usual.
    • Notify your doctor for repeated blood pressure readings over 140/90.
    • Notify your doctor for repeated blood pressure readings that are 20 points higher than usual.
  • Do not use nonprescription cold and allergy medications without your doctor's consent:
    • Decongestant medications can elevate your blood pressure.
    • Nonprescription asthma inhalers can elevate your blood pressure
  • Take prescription medications as directed:
    • Skipping doses of your blood pressure medicine will raise your blood pressure.
    • Watch out for drug side effects and potential drug interactions that could cause your blood pressure to go up or down.
    • Patients with kidney impairment should be advised to avoid nonsteroidal anti-inflammatory medications, aspirin, and other medications that are metabolized by the kidney. Acetaminophen can be used for pain and fever control because it is not metabolized by the kidneys.
  • Control chronic stress and anxiety
  • Let your doctor know if you are suffering from severe or prolonged depression.

Hypertension Diet

A healthy diet for hypertension includes:

  • Control calories:
    • Eat just enough calories to achieve and maintain a healthy weight.
  • Eat quality fats:
    • Use virgin olive oil and other unsaturated, low-cholesterol fats.
    • Eat foods rich in omega-3 fats
  • Eat the right amount of fats, carbohydrates and protein:
    • Limit your fat intake to 20 or 30 percent, but don't substitute simple carbohydrates for fat.
    • Less than 7% of the day's total calories from saturated fat.
    • Up to 10% of the day's total calories from polyunsaturated fat.
    • Up to 20% of the day's total calories from monounsaturated fat
  • Avoid fad diets:
    • Eat a well-rounded diet instead.
    • Eat small, frequent meals.
    • Avoid large and heavy meals.
  • Limit cholesterol in diet:
    • To less than 200 milligrams a day.
  • Limit iron intake:
  • Eat enough dietary fiber:
    • Whole grains are best.
  • Eat plenty of fresh fruit and vegetables
  • Check with your doctor about supplementing your diet with B vitamins:
  • Reduce salt in your diet:
    • No more than 1,500 milligrams per day is optimal.
    • Avoid cooking with salt.
    • Avoid fast food.
    • Avoid salty foods, such as pickles, cured meats, salty snacks, and canned soup.
    • Avoid seasonings that contain sodium, such as soy sauce, steak sauce, garlic and onion salt, and monosodium glutamate.
    • Do not add salt to your food after it is prepared.
    • Read food labels and buy foods that are low in salt.
    • When eating out, ask that your food be prepared without salt.

Key Dietary Recommendations for Chronic Disease Prevention
Energy (calories)to maintain BMI < 25
Total fats< or = to 30% of total daily calories
Saturated fats< 7% of total daily calories
Polyunsaturated fats< 10% of total daily calories
Monounsaturated fats< 13% of total daily calories
Cholesterol< or = to 300 mg per day
Dietary fiber25-30 grams per day
Fiber type3:1 insoluble to soluble fiber
Sodium< or = to 1,500 mg per day
Calcium 9-24 yrs1,200-1,500 mg per day
Calcium 25-50 yrs1,000 mg per day
Calcium 51-65 yrs1,200 mg per day
Calcium >65 yrs1,500 mg per day
Vitamin D 9-50 yrs200 IU per day
Vitamin D 51-70 yrs400 IU per day
Vitamin D >70 yrs600 IU per day
Folic acid400 micrograms (ug) per day
Fruits & vegetables5-7 servings per day
Alcohol (men)< or = to 2 drinks per day
Alcohol (women)< or = to 1 drink per day

Hypertension Fiber

In addition to lowering cholesterol levels, some studies have shown that people with hypertension who increase fiber in the diet for at least 8 weeks can significantly lower their blood pressure. You must keep up with the high fiber diet or the positive effect on blood pressure will go away.

High Fiber Diet
Dietary fiber is a plant material that humans cannot digest. Fiber increases the amount of stool in your intestine. The most well known fiber is bran.

Fiber comes in two forms, based on whether it will dissolve in water: soluble and insoluble fiber. Most experts believe that about 3/4 of fiber intake should be insoluble.

Common fiber supplements include Citrucel and Metamucil. Regular use of these high-fiber products is safe. They are also more effective when used regularly. Drink plenty of water when taking extra fiber.

Water Soluble Fiber

ExamplesDietary Sources
Pectins, gums, & mucilagesfruits, vegetables, oats, bran, barley, legumes

Insoluble Fiber
ExamplesDietary Sources
Cellulose, hemicellulosevegetables, wheat bran, & whole grains

Fiber tends to bind water, which leads to softer stools and a more rapid passage of material through the intestines. This rapid transit may reduce the exposure of the bowel to toxic substances and improve overall bowel health. Fiber can also bind fats and cholesterol. As an added benefit, high fiber foods usually contain important vitamins and minerals.

Use of a High Fiber Diet
Most people in developed countries do not eat enough fiber. A healthy diet should include more than 25 grams of fiber each day, or 10-13 grams per 1,000 calories. Some experts believe that every extra gram of fiber eaten each day can lower the risk of heart disease by as much as five percent.

This diet is often recommended for preventing or treating the following:

General Guidelines
In general, fruits, vegetables and whole grains are high in fiber. Check food labels of prepared products to see if there are at least 3 grams of dietary fiber per serving. Look for the term 'whole grain' as a major part of the food.

Raw foods tend to have more fiber than cooked, canned or pureed items. Even chopping and peeling skins removes some fiber. Dried fruits are especially high in fiber. Beans, black-eyed peas, brans and oatmeal are very high in fiber.

Unprocessed wheat bran can be added to many home meals and most baked foods. Bran is the outer layer of the wheat grain, and is present in 'whole grain' foods. Adding 2-3 teaspoons of bran per serving is a great way to increase the fiber content of casseroles, meat loaf, and baked goods. Whole grain flour has 6 times the fiber of standard, bleached flour. Oat bran can be used in place of about 1/3 of regular flour when baking.

Try adding nuts or bran to dairy foods such as yogurt or cottage cheese, which normally have very little fiber. Avoid white bread and flour pasta.

Change your diet slowly and drink plenty of fluids to allow the fiber to do its work. Rapid changes in the diet can cause bloating, gas and diarrhea. A varied, high-fiber diet is much better than taking fiber supplements.

Example High-Fiber Diet
Breads and Grains
Eat at least 3, and as many as 10 servings each day of various whole grain foods. Any grain food should say 'whole grain' and contain at least 3 grams of fiber per serving.

Examples include:
  • Barley
  • Brown rice
  • Oatmeal or oat bran
  • Rye bread
  • Wheat germ
  • Whole grain bagels
  • Whole grain breads
  • Whole grain muffins
  • Whole grain or bran cereals
  • Whole grain pita bread
  • Whole wheat crackers
  • Whole wheat pasta

Eat at least 3-4 servings each day. All fruits are good, and dried fruits are especially high in fiber.

Examples include:
  • Apple
  • Banana
  • Berries
  • Grapefruit
  • Nectarine
  • Orange
  • Peach
  • Pear

Eat at least 3-5 servings per day, preferably raw and unpeeled

Examples include:
  • Asparagus
  • Broccoli
  • Cabbage
  • Carrots
  • Green beans
  • Green pepper
  • Onions
  • Peas
  • Potatoes with skin
  • Snow peas
  • Spinach
  • Squash
  • Sweet potatoes
  • Tomatoes
  • Zucchini

Meat substitutes:
Meat has no fiber and contains various amounts of cholesterol and saturated fats. There are many high-fiber foods that can partially or completely replace meat in the diet. Using several servings of meat substitutes each day will greatly increase total fiber intake.

Examples include:
  • Almonds
  • Brazil nuts
  • Cashews
  • Garbanzo beans
  • Kidney beans
  • Lentils
  • Lima beans
  • Peanut butter
  • Peanuts
  • Pinto beans
  • Sesame seeds
  • Soybeans, but not tofu
  • Split peas
  • Sunflower seeds
  • Veggie burgers
  • Walnuts

  • Bean dip
  • Cookies made with oatmeal, whole wheat flour, fruit and nuts
  • Popcorn
  • Tortilla corn chips (baked)
  • Trail mix
  • Whole wheat pretzels

Hypertension Lifestyle

Lifestyle changes for those with hypertension include:

Hypertension Self Monitoring

If you have hypertension, it is important to become familiar with self-monitoring.

Self Monitoring

  • You should take your blood pressure at least once per week and record the results:
    • You may experience symptoms when your blood pressure is higher than usual.
    • You may experience symptoms when your blood pressure is lower than usual.
    • Notify your doctor for repeated blood pressure readings over 140/90.
    • Notify your doctor for repeated blood pressure readings that are 20 points higher than usual.
  • You should weigh yourself every day and record the results:
    • Notify your doctor if you gain more than 6 pounds over 1 week.
    • If you are overweight, your doctor can suggest a diet that can help you lose weight.

Taking your Blood Pressure
A number of devices are available for home blood pressure measurement. Digital blood pressure devices are easy to use: they automatically calculate the pulse and display the systolic and diastolic pressures. However, a simple blood pressure cuff with a stethoscope is the most accurate way to measure blood pressure.

Tips for Measuring an Accurate Blood Pressure
  • Remain seated or supine with the arm supported at heart level.
  • Do not smoking or ingest caffeine for 30 minutes prior to measurement.
  • Rest for 5 minutes before taking your blood pressure.
  • The blood pressure air bladder should nearly encircle the arm: persons with large arms may require an extra large adult cuff. Cuffs are usually marked to indicate the acceptable size range.
  • Apply cuff 1/2 inch above elbow crease.
  • Locate brachial pulse and place the stethoscope bell at this location.
  • With the valve closed, pump up cuff bulb to approximately 210 mm Hg, or a point where no sounds are heard through the stethoscope.
  • Open the valve slowly (2-3 mm Hg per second) and listen for the point where the tapping sounds are first heard. The corresponding reading on the dial is the systolic pressure. And then, listen for the point where the tapping sounds stop. The corresponding reading on the dial is the diastolic pressure.
  • Perform two more readings per session, separated by 5 minutes.
  • The blood pressure must be elevated during at least 3 separate sessions to diagnose hypertension.

Systolic Pressure Guideline for Adults
Systolic Blood PressureAssessment
Over 140-159Hypertension Stage 1
160 or higherHypertension Stage 2

Diastolic Pressure Guideline for Adults
Diastolic Blood PressureAssessment
Below 80Normal
90-99Hypertension Stage 1
100 or higherHypertension Stage 2

Hypertension Stress

Tips to manage stress in someone with hypertension:

  • Accept what you cannot change.
  • Allow yourself to cry.
  • Allow yourself to experience simple pleasures that give you joy.
  • Ask for help if you need it.
  • Associate with people you enjoy and who treat you well.
  • Avoid drugs and alcohol.
  • Do not be dominated by one thing, such as work or relationships.
  • Do not feel guilty when you have to say "no" to extra duties or tasks.
  • Donate some of your time in order to help others.
  • Energize your body with regular exercise.
  • Engage in hobbies.
  • Fuel your body with healthy foods
  • Have the courage to be imperfect.
  • Make a list of all the stresses that cause you distress: dispose of the ones you can and reduce your exposure to the others as much as possible.
  • Practice relaxation and meditation.
  • Reevaluate and rearrange your priorities.
  • Schedule time for fun. Laughter dissolves tension.
  • Seek professional help when you are overwhelmed.
  • Stay on a regular sleep schedule.
  • Take a few minutes of quiet time each day.
  • Take responsibility for how you feel.
  • Talk with someone you trust.
  • Avoid stimulants, such as:

Hypertension Taking Control

The successful treatment of hypertension requires your participation. Here are answers to some important questions.

Do you have control over your health and wellness?
Many people believe they have no control over their health and wellness. Many ignore personal health decisions or simply leave them to their doctors, relatives, or friends. In reality, you have the greatest potential to determine your relative health.

How is this possible? Do people really have control of their own health? The biggest killers are heart disease and cancer. Although many of these diseases seem to strike at random, our lifestyle choices greatly influence personal risk.

How can you participate in your health care?
To participate you must:

  • Learn to take responsibility for your own health.
  • Learn to partner with your doctor.
  • Learn how to make active decisions about your health.

How can you learn what you need to know?
  • Educate yourself.
  • Be skeptical: Learn to separate fact from fiction.
  • Billions of dollars are spent each year marketing dietary supplements, vitamins, and new medical treatments. Much of this is unnecessary and wasteful.
  • Be careful about where you get your health information.
    • Some of the best sources for health information on the web are professional societies and non-profit organizations.
    • Ask your doctor what he or she recommends.
  • Examine the credentials of the authors.
    • If you are reading about symptoms and disease, your best source is a licensed physician.
    • Pay attention to when the content was last updated.
    • Make sure the person is not just trying to sell you something.

Important questions you need to answer:
  • What things in your control can increase your risk for disease?
  • What can you do to decrease this risk?
  • What are vaccines and how can they help you?
  • How do your lifestyle choices increase your risk for disease?
  • How can you reduce stress?
  • What minor health problems can you treat at home?
  • When is a medical problem "serious"?
  • When should you call the doctor?

How can you find the right doctor?
Key points:
  • Everyone should have a primary care physician or family doctor. A primary physician is usually a family practitioner, internist, or pediatrician.
  • Establish a relationship in advance with your doctor.
  • Make sure you are comfortable with your primary care physician.
  • The internet contains many resources where you can do research to locate the doctor that is best for you.
  • You may wish to schedule a brief visit with the doctor to see if he or she is right for you.
    • Be open-minded, and allow your doctor to know you well. This will improve communication.

Important information you need to make your decision:
  • Physician credentials:
    • Internship and residency training is usually best from respected institutions, universities, and major hospitals.
    • Look for board certification in the specialty.
    • Ask about membership in medical societies.
  • Community and professional reputation are also important.
    • Are other patients happy with the doctor?
    • Has the doctor been disciplined by hospitals or agencies?
    • How long has the doctor been in practice?
    • In general, more than a few malpractice suits over a 5-10 year period should trigger caution.
  • Does the doctor communicate well? Are your questions answered during busy times?
  • Does the doctor welcome you to help make decisions about your care?
  • Is the doctor available when you need care?
  • What is the doctor's after-hours coverage?
  • Is he or she a member of a large group?
    • Do the doctors' cross-cover one another?
  • Where do they admit patients?

What is shared decision making?
You and your doctor must work together to jointly decide the best course of action to manage your health. This process is called "shared decision making". Your doctor becomes a guide and teacher and helps steer you toward the best treatment. Most doctors welcome this partnership. You must learn about your illnesses for shared decision-making to work.

For any recommended test, medication, or surgery, remember to ask:
  • How will this help me?
  • How much will it cost?
  • Is it covered by your insurance?
  • What are the potential side effects and risks?
  • What are my alternatives?

For tests, remember to ask:
  • Is it done in the office or at another facility?
  • Is it painful?
  • How will the results of this test influence my care?

For surgery or other procedures, remember to ask:
  • How long will it take to heal?
  • How many cases has the doctor done?
  • What would your doctor do if he or she were the patient?
  • Where is it done?
  • Who will perform it?
  • What are the doctor's qualifications?

What should you expect?
Shared decision making becomes impossible if you do not know what to expect from your doctor.

The American Hospital Association has published a "Patient's Bill of Rights" that is a good guide. It states that you have the right:
  • To be spoken to in words that you understand
  • To be told what's wrong with you
  • To know the benefits of any treatment and any alternatives
  • To know what a treatment or test will cost
  • To share in treatment decisions
  • To read your medical record
  • To refuse any medical procedure

What should you do before an office visit?
  • Bring all important medical information with you to the visit.
  • Make sure you can answer questions about the following:
    • Allergies and side effects to medicines
    • Current medicines you are taking. This includes herbs and vitamins. Make a list if necessary.
    • Insurance information
    • Marital and sexual history
    • Past injuries and hospital stays
    • Past medical problems
    • Past surgeries and operations
    • Pre-visit questionnaires
    • Use of tobacco, alcohol and drugs
    • Work history

What should you expect from the visit?
  • You should plan to wait if you go without an appointment. Emergencies or sick patients in the hospital may interrupt your doctor.
  • Bring along a book or toys for the kids. You may also have to wait during busy times.
  • Tell your doctor about your problem in a clear manner. Start from the beginning and go through each symptom as it appeared.
  • Before the visit, think about what makes your problem better or worse. Your doctor will probably ask you questions about this.
  • Most doctors ask many questions about unrelated symptoms. These questions help assure that there are no other problems that need attention.
  • Be sure to answer all questions truthfully. This includes sensitive questions about smoking, drug use, sexual activity, and work. Your history is the most important part of deciding what is wrong with you.
  • If you have any difficulty communicating your concerns, bring a family member or friend to assist in this task.
  • Talk to your doctor and do not leave the office without asking necessary questions. Your doctor can make you more comfortable if he or she understands your concerns.

What should you know about your medications?
Every year many people become ill because of problems with medications.

Remember to ask:
  • What side effects to expect.
  • What drug interactions are possible.
    • Find out if a new medicine reacts with those that you are taking now.
    • Many over-the-counter drugs and dietary supplements can also cause serious side effects and drug interactions.
    • Some drugs interact with certain foods, vitamins, nicotine, and alcohol.
  • Make sure you can drive or operate machines safely while taking a medicine.
  • Ask your doctor how much a prescription costs.
    • Is there a less expensive option or a generic version?

What is a treatment plan?
A treatment plan is what you and your doctor decide to do for an illness. A treatment plan cannot be effective without your participation.

Three simple questions can help you get the most from your treatment plan:
  • What is my main problem?
  • What do I need to do?
  • Why is it important for me to do these things?

Other important points:
  • Be sure you understand your treatment plan.
  • Stick with the treatment plan and allow time for improvement.
  • Don't stop medicines when you feel better; check with your doctor first.
  • Call your doctor if your condition is becoming worse.
  • Your doctor should tell you what to expect and when to follow-up or call the office.

Hypertension Warning Signs

Notify your doctor if you have hypertension and any of the following:

Continue to Hypertension Prevention

Last Updated: Mar 4, 2011 References
Authors: Stephen J. Schueler, MD; John H. Beckett, MD; D. Scott Gettings, MD
Copyright DSHI Systems, Inc. Powered by: FreeMD - Your Virtual Doctor

PubMed Hypertension References
  1. Aronow WS. Treatment of hypertension in the elderly. Geriatrics. 2008 Oct;63(10):21-5. Review. [18828653]
  2. Kearney PM, Whelton M, Reynolds K, Whelton PK, He J. Worldwide prevalence of hypertension: a systematic review. J Hypertens. 2004 Jan;22(1):11-9. [15106785]
  3. Then KL, Rankin JA. Hypertension: a review for clinicians. Nurs Clin North Am. 2004 Dec;39(4):793-814. [15561162]
  4. Toto RD. Hypertension and kidney literature review 2000. Clin Nephrol. 2002 Oct;58(4):253-9. [12400839]
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