High Blood Pressure

High Blood Pressure

What is it?

Overview

What Is It?
Your diet—the way you eat—is ingrained in your lifestyle. To change your weight—whether you want to lose a few pounds, or more, and keep them off—or to ensure you don't succumb to the expanding-waistline syndrome, you must permanently adopt a healthy lifestyle.

Americans are obsessed with both food and dieting. As a nation, we love to eat. We eat out often, when meals are often higher in fat and calories than meals eaten at home; we eat larger portions; and we indulge in dozens of delicious "new" food products found on our grocery store shelves every year.

But we also spend billions of dollars a year on commercial weight-loss products and services hoping for a quick fix to our weight problem. And what a problem: with all that eating, the Centers for Disease Control and Prevention (CDC) reports that 68 percent of the nation is overweight or obese. What's more, dieting is failure-prone, and the statistics are even worse when it comes to those who can keep the weight off.

The answer to this weight loss/weight gain cycle lies in how you manage your weight on a day-in, day-out basis. Your diet—the way you eat—is ingrained in your lifestyle. To change your weight—whether you want to lose a few pounds, or more, and keep them off—or to ensure you don't succumb to the expanding-waistline syndrome, you must permanently adopt a healthy lifestyle.

Unfortunately, it's not just all that tempting food that stands in the way of your efforts to achieve or maintain a healthy weight. Technology has altered Americans' lifestyle. Most of us, most of the time can be found sitting—in front of a computer or TV, in a car, at a restaurant. About a quarter of adults—and an even greater percentage of women—report they are sedentary and engage in no physical activity during leisure time, and less than half exercise regularly. And as women age, their tendency to be sedentary steadily increases.

Being overweight increases your risk for many diseases. If you are overweight, you are more likely to develop heart disease and stroke, the leading causes of death for both men and women in the United States.

Overweight people are more likely to have high blood pressure, a major risk factor for heart disease and stroke, and high cholesterol, also a risk factor. They're twice as likely to develop type 2 diabetes—a major cause of death, heart disease, kidney disease, stroke, amputation and blindness—as those not overweight.

Additionally, several types of cancer are associated with being overweight. In women, these include cancer of the uterus, gallbladder, cervix, ovary, breast and colon. Being overweight can also cause problems such as gout (a joint disease caused by excess uric acid), gallbladder disease or gallstones, sleep apnea (interrupted breathing during sleep), and osteoarthritis, or wearing away of the joints. Anyone with risk factors for health problems must be concerned about extra weight.

It all seems so simple: eat less, exercise, lose weight. But few people succeed in losing more than a few pounds on diets and even fewer succeed in maintaining that weight loss. An estimated 90 percent of dieters regain the weight in five years. One reason is that many factors other than overeating can play a part in weight, including your genetic makeup, cultural influences and natural hormonal and neurologic regulators.

Extreme dieting programs can sometimes be harmful and are rarely successful over the long term. Thus, weight loss should not be your only or even your primary goal if you are concerned about your health. Instead, the success of your weight-management efforts should be evaluated not just by the number of pounds you lose, but by improvements in your chronic disease risk factors, such as reduced blood pressure, cholesterol and blood sugar levels, as well as by new, healthy lifestyle habits. In fact, some experts believe that weight is not the sole cause of the diseases associated with being overweight, but that the accompanying unhealthy foods and sedentary lifestyles also contribute to these diseases.

On the flip side, some women are underweight, despite having tried to achieve or maintain a "normal" weight. Having a metabolism that burns too many calories can be as dangerous as being overweight. Underweight women are susceptible to vitamin and mineral deficiencies, resulting in a loss of bone density and muscle tissue.

A Word About Teens

Teenage girls today feel a lot of pressure from the media, friends and sometimes their own parents to be very slim. This pressure can create a distorted body image, making them see themselves as fat when they are not fat, or they see themselves as fatter than they really are.

According to the National Eating Disorders Association (NEDA), 40 percent of newly identified cases of anorexia are in girls ages 15 to 19, and over half of teenage girls use unhealthy weight-control behaviors, such as skipping meals, fasting, smoking cigarettes, taking laxatives and vomiting.

Fad dieting can keep teenagers from getting the calories and nutrients they need to grow properly. Stringent dieting may cause girls to stop menstruating and prevent girls from developing adequate muscle tone. If the diet doesn't provide enough calcium or vitamin D, bones may not lay down enough calcium, which may increase the risk of osteoporosis later in life.

The flip side to teenagers feeling pressured to be thin is that some may have legitimate concerns about their weight that adults dismiss. Adolescent obesity can carry serious lifelong health consequences. The best advice to teenage girls: Instead of dieting because everyone is doing it or because you are not as thin as you want to be, first find out from a health care professional or dietitian whether you carry too much body fat for your age and height. If you need to lose weight, follow the sensible guidelines laid out here. Depending on your age, your health care professional may recommend you eat more low-fat dairy products than is recommended for adults because of your heightened need for calcium.

Diagnosis

Diagnosis

The weight management techniques discussed here are straightforward. But if you are over 40, have been inactive for some time, suffer from shortness of breath or weakness that interferes with daily activities or suffer from a chronic condition, consult a health care professional before beginning any effort to reduce your weight or increase your activity level.

If you are healthy, you may not need to consult a health care professional before launching a weight management program but you might want to talk to a professional who specializes in this area. These include:

  • Nutritionist. There is no accepted national definition for the title "nutritionist." Some states have a statutory definition of nutritionist saying that the RD credential is not required for certification as a nutritionist, but is required for licensing as a dietitian. In general, the license or certification as a dietitian can be obtained with a bachelor's degree, a related supervised practice experience component and an exam (or proof of RD status with the Commission on Dietetic Registration), while the nutritionist licensure or certification typically requires a master's degree or higher.

    Make sure any nutritionist you see is licensed by a state agency. Nutritionists and dietitians evaluate the diets and nutritional habits of clients and help structure more healthful eating patterns and weight management strategies based on their patients' health needs, food selection and calorie goals. Nutritionists do not usually advise patients with chronic illnesses, disorders and other disease conditions.

  • Registered dietitians (RD). An RD after someone's name indicates a dietitian who has completed academic and practice requirements established by the American Dietetic Association, including a bachelor's degree, an accredited pre-professional experience program, successful completion of a national credentialing exam and ongoing continuing professional development. A registered dietician may have a master's degree and advanced training in certain subspecialties, such as diabetes education.

  • Endocrinologist. Endocrinology is the field of medicine involving the body's chemical messengers, or hormones, and its biochemical control mechanisms, or metabolism. Endocrinologists are physicians who care for patients with complex hormonal disorders and metabolic conditions, including obesity as well as diabetes, thyroid disorders, metabolic bone disease, pituitary and adrenal conditions and growth and gonadal disorders.

  • Personal trainer. Trainers provide one-on-one exercise-related goal-setting help, motivation, professional expertise and personalized attention—all key components of reaching your personal health and fitness goals. A personal trainer should be certified by an accredited professional organization such as the American Council on Exercise, the American College of Sports Medicine or the American Aerobics and Fitness Association. Keep in mind that personal trainers vary greatly, not only in educational background and cost, but also in personal philosophy, training and consulting practices.

Lose, Maintain or Gain?

To determine if you are overweight, of normal weight or underweight, you or your health care professional can calculate your body mass index (BMI), which describes body weight relative to height and is strongly correlated with total body fat content in adults. Your BMI equals your weight in kilograms divided by your height in meters squared. Or you can divide your weight in pounds by your height in inches squared and then multiply by 703.

The following chart shows body mass indices for people of various heights and weights. To determine your BMI, find the row that most closely approximates your weight. Read across the row until it crosses the column closest to your height.

Weight 100 105 110 115 120 125 130 135 140 145
Height
5'0" 20 21 21 22 23 24 25 26 27 28
5'1" 19 20 21 22 23 24 25 26 26 27
5'2"18 19 20 21 22 23 24 25 26 27
5'3" 18 19 19 20 21 22 23 24 25 26
5'4" 17 18 19 20 21 21 22 23 24 25
5'5"1717 18 19 20 21 22 23 24 25
5'6" 1617 18 19 19 20 21 22 23 23
5'7" 1616 17 1819 20 20 21 22 23
5'8"15 16 1717 18 19 20 2121 22
5'9" 15 16 16 1718 18 19 20 2121
5'10"1415 16 1717 18 19 19 20 21
5'11"1415 15 16 1717 18 19 2020
6'0" 14 14 15 16 16 1718 18 19 20
6'1" 13 14 15 15 16 16 1718 18 19
6'2" 13 13 14 15 15 16 1717 18 19
6'3" 12 13 14 14 15 16 16 1717 18
6'4" 12 13 13 14 15 15 16 16 1718

Weight 150155 160 165 170 175 180 185 190 195 200
Height
5'0" 2930 31 32 33 34 35 36 37 38 39
5'1"28 29 30 31 32 33 34 35 36 37 38
5'2"27 28 29 30 31 32 33 34 35 36 37
5'3" 2727 28 29 30 31 32 33 34 35 35
5'4"26 27 27 28 29 30 31 32 33 33 34
5'5" 2627 27 28 29 30 31 32 32 33 34
5'6" 2425 26 27 27 28 29 30 31 31 32
5'7" 2324 25 26 27 27 28 29 30 31 31
5'8"2324 24 25 26 27 27 28 29 30 30
5'9" 2223 24 24 25 26 27 27 28 29 30
5'10"22 22 23 2424 25 26 27 27 28 29
5'11"2122 22 23 2424 25 26 26 27 28
6'0"20 2122 22 23 2424 25 26 26 27
6'1" 2020 2122 22 23 2424 25 26 26
6'2"1920 21 2122 22 23 2424 25 26
6'3" 1919 20 212122 22 23 2424 25
6'4" 1819 19 2021 2122 23 23 2424

Weight 205 210 215 220 225 230 235 240 245 250
Height
5'0" 40 41 42 43 44 45 46 47 48 49
5'1" 39 40 41 42 43 43 44 45 46 47
5'2" 37 38 39 40 41 42 43 44 45 46
5'3" 36 37 37 38 39 40 41 42 43 44
5'4" 35 35 36 37 38 39 40 41 42 43
5'5" 35 35 36 37 37 38 39 40 41 42
5'6" 33 34 35 36 36 37 38 39 40 40
5'7" 32 33 34 34 35 36 37 38 38 39
5'8" 31 32 33 33 34 35 36 36 37 38
5'9" 30 31 32 32 33 34 35 35 36 37
5'10" 29 30 31 32 32 33 34 34 35 36
5'11" 29 29 30 31 31 32 33 33 34 35
6'0" 28 28 29 30 31 31 32 33 33 34
6'1" 27 28 28 29 30 30 31 32 32 33
6'2" 26 27 28 28 29 30 30 31 31 32
6'3" 26 26 27 27 28 29 29 30 31 31
6'4" 25 26 26 27 27 28 29 29 30 30

A BMI between 18.5 and 24.9 is considered within the normal, healthy range; 25 to 29.9 is considered overweight; 30 or more is considered obese; and 40 or greater is considered extremely obesity. An exception is athletes, who have more muscle mass and less body fat than normal. They might have a BMI as high as 30 and yet not be obese. BMI is also adjusted for age and gender in people under age 18.

If your BMI falls under 18.5, you may be underweight; if so, you may want to ask your health care professional to assess your health.

For more information on calculating your BMI and how to achieve and maintain a healthy weight, visit the National Heart, Lung, and Blood Institute's Aim for a Healthy Weight program.

Your health care professional might also measure your body composition, which is the percentage of lean muscle and fat. The most common test is the use of a caliper-like device to measure skinfold thickness and subcutaneous fat, which lies just under the skin at targeted sites such as the back of your upper arm, waist or thigh. The accuracy of skinfold thickness measurements depend on the skill of the examiner and may vary widely.

Or, your health care professional may conduct a bioelectrical impedance analysis (BIA) test. There are two forms of BIA. Using one form, the patient stands on a special scale with footpads and a harmless amount of electrical current is sent through her body to calculate the percentage body fat. The second type of BIA involves the use of a portable instrument called an impedance analyzer to transmit a noninvasive, low-frequency electrical current through electrodes placed on the patient's hand and foot with a gel. The change in voltage between electrodes is measured, and the patient's body fat percentage is calculated.

In addition, because abdominal fat is an independent predictor of disease risk, you or your health care professional should measure your waist. Women with a waist circumference over 35 inches (and men over 40 inches) have the greatest risk of developing insulin resistance, diabetes, high blood pressure and cardiovascular disease (heart disease and strokes).

Your health care professional may also ask you about chest pain, faintness or dizziness, bone or joint pain and any medications you may be taking. He or she will probably check the health of your heart and joints, measure your blood pressure and determine if you have a hernia or diabetes. These issues may affect how vigorously you should exercise or what types of exercises you should avoid.

If you have heart disease or cardiovascular risk factors, you may be asked to take an exercise stress test. During this test, you walk on a treadmill while a health care professional monitors your heart's activity.

In some cases, your health care professional may suggest you start a weight management program. You may receive this recommendation if you have high blood pressure, blood sugar or cholesterol, and/or are overweight or have a high percentage of body fat.

Your health care professional can advise you about a weight-loss program suited to your weight and health goals. He or she also may refer you to a nutritionist or registered dietician and/or fitness professional or to a hospital-based weight-management or fitness class to provide guidance while you're getting started.

Treatment

Treatment

The key to weight management is incorporating three strategies into lifelong practices—eating healthfully, exercising regularly and, for some women, changing your relationship with food. Unfortunately, of the millions of American women who are trying to lose weight, a minority use this method.

The most important key to success is to approach any changes in diet and exercise not as punishment, but as a plan to implement pleasurable healthy substitutes for unhealthy overeating and sedentary behavior.

Eating for Weight Management

Keeping in mind the biological reason we eat—to provide our bodies the energy and nutrients it needs to carry out the tasks we ask of it—is a good way to think about food.

Since an estimated 90 percent of dieters who lose weight regain all or part of it within five years indicates that "dieting" is not the answer to weight management. The best "diet" is a way of life that you can follow for the rest of your life. Therefore, it should consist of a balance of a variety of foods.

You can ask a nutritionist or registered dietitian for guidance on the number of calories you should eat to reach and maintain your goal weight. But as a rule of thumb, you should take in about 250 calories per day less than is needed to maintain your current weight and add an exercise regime that burns an additional 250 calories a day if you want to lose weight. This regimen should help you safely lose about a pound per week.

Your basal metabolic rate (BMR) is the number of calories your body needs to maintain its basic functions. Several factors go into the calculation of your BMR, including your height, weight and age. To get an idea of your BMR, go to www.bmi-calculator.net/bmr-calculator. You need additional calories to provide energy for daily activities; the more active you are, the more calories you need.

A more accurate method is to keep a detailed food diary over a few days to a week during which you maintain your weight. Determine exactly how many calories you eat on an average day—several books and websites provide calorie counts for thousands of foods—and use that figure as a starting place for weight maintenance or weight loss.

After you've determined how many calories per day you should eat, plan daily menus. A registered dietitian or nutritionist can help you plan menus that include the types and amounts of food you should eat which, in most cases, should be based on the sensible guidelines set forth by the federal government in its 2010 Dietary Guidelines for Americans. The guidelines, available at www.healthierus.gov/dietaryguidelines, aim to help Americans lose weight in an effort to reduce the risk of obesity-related chronic diseases. The guidelines recommend balancing calories with physical activity and encourage Americans to eat more healthful foods, such as vegetables, fruits, whole grains, fat-free and low-fat dairy products and seafood, and to consume less sodium, saturated fats, trans fats, added sugars and refined grains.

The easiest advice to follow is to divide your plate into sections. Half your plate at main meals should consist of colorful vegetables, one quarter of grain products such as whole-grain bread, pasta, whole-grain rice and cereals, and one quarter of lean meat, fish or poultry. Several times a week, you should substitute dishes made from dried beans or peas as your main course. You should also eat plenty of fruits and get three cups of low-fat milk products like yogurt or cheese daily.

These guidelines will help reduce your calories and fat and increase the fiber in your diet, all of which have been shown to decrease the risk for heart disease. While you should try to cut back on fats and sugars, allow for an occasional treat. As soon as you label a food as "off limits," chances are you will crave and perhaps even binge on it. A few simple ways to cut back on calories include:

  • Hold the sauce. Dishes that include high-fat sauces, mayonnaise and regular salad dressings should be consumed only occasionally and only in small portions.

  • Drink more water. And steer clear of calories hidden in drinks like juice drinks, alcoholic beverages, fancy coffee concoctions and smoothies. Avoid excessive fruit juice consumption.

  • Eat high-volume foods. High-volume, low-calorie foods, like most fruits and vegetables, are high in water and fiber, helping you feel fuller longer. Up your intake of vegetables and cut back on fats and sweets.

  • Focus on nutrient-dense foods. The 2010 Dietary Guidelines suggest replacing foods that contain sodium, solid fats, added sugars and refined grains with nutrient-dense foods and beverages. These foods include vegetables, fruits, whole grains, fat-free or low-fat milk and milk products, seafood, lean meats, poultry, eggs, beans and nuts and seeds.

Health care professionals recommend women have moderate fat consumption, between 20 to 35 percent or less of your total calorie intake. Most fats should come from polyunsaturated fats and monounsaturated fats, which are found in vegetable sources. The Dietary Guidelines for Americans 2010 recommend consuming less than 10 percent of calories from saturated fats and restricting trans fats (also known as trans fatty acids) as much as possible. The guidelines also recommend limiting cholesterol to less than 300 milligrams per day.

Strategies for reducing saturated fat and cholesterol include:

  • Get 10 percent of less of your fat from saturated fat sources such as red meats, processed meats, organ meats or high-fat dairy products.

  • Choose low saturated-fat protein sources, such as fish, turkey, chicken, legumes (dried peas and beans), nuts and seeds.

  • Use lean cuts of meat and trim excess fat.

  • Substitute skim and low-fat milk for high-fat dairy foods.

  • Broil, bake or boil foods instead of frying.

  • Increase your consumption of fruits, vegetables and whole grains.

You've probably heard of "good" fats and "bad" fats. These labels refer to the effects various types of fat have on your body and health. Saturated fats are commonly found in animal-based food products, as well as in palm and coconut oils. They are solid at room temperature. Excess amounts of saturated fat are considered unhealthy because they can contribute to fatty deposits in the arteries, clogging them and leading to heart disease. Unsaturated fats are liquid at room temperature and are known as oil. Two types of unsaturated fats are monounsaturated and polyunsaturated, both of which are thought to help lower cholesterol. Examples of these fats are olive and canola oils. Monounsaturated fats also are found in avocados, nuts and olives.

Trans fats are actually unsaturated fats that have been chemically modified. Manufacturers add hydrogen to vegetable oil in a process called hydrogenation. This increases the shelf life and the flavor stability of foods containing these fats. Trans fats can be found in vegetable shortenings, some margarines, crackers, cookies, snack foods and other foods made with or fried in partially hydrogenated oils. Like saturated fat and dietary cholesterol, they raise LDL cholesterol and increase your risk for cardiovascular disease.

Essential fatty acids are a category of fatty acids found in polyunsaturated fats your body needs but cannot manufacture itself. Good sources of polyunsaturated fatty acids include soybean, corn and cottonseed oils.

When an unsaturated fat is solidified—into margarine, for example—the process turns it into partially hydrogenated oils, which contains trans fatty acids.

The Skinny On Fad Diets

Despite the ads that claim miracle weight-loss for some products, there simply is no magic formula for losing weight. Fad diets, like those based on cabbage soup, grapefruit or protein, may help you lose some pounds in the short run, but they don't work in the long term because they're impossible and unhealthy to maintain. The truth is permanent weight loss takes time and requires a permanent change in eating and exercise habits.

Extreme diets of less than 1,000 calories per day carry health risks and could trigger excessive overeating following the period of extreme caloric restriction. Such diets usually provide insufficient vitamins and minerals as well. Severe dieting also has unpleasant side effects, including fatigue, intolerance to cold, hair loss, gallstone formation and menstrual irregularities. Most of the initial weight loss is in fluids; later, fat is lost, but so is muscle.

It is very dangerous to be on severe diets longer than 16 weeks or to fast for more than two or three days. There have been rare reports of death from heart arrhythmia when liquid formulas didn't have sufficient nutrients.

High-protein, low-carbohydrate diets are still used by some people for weight loss. Although a high-protein diet will lead to quick weight loss, its long-term health and safety benefits are uncertain. One byproduct of this type of diet is the release of substances called ketone bodies, which can lead to a condition called ketosis and cause nausea and lightheadedness because you are restricting your body's source of fuel. Such high-protein diets may also be high in saturated fat and low in fiber-rich and healthful whole grains, fresh fruits and vegetables.

Carbohydrates provide your body with its main source of fuel and energy, namely, a form of glucose called glycogen. This complex carbohydrate is stored in liver and skeletal muscle. Simple carbohydrates (sucrose) offer quick energy boosts, while complex carbohydrates provide the body with fuel for several hours.

Examples of simple carbohydrates include fruit sugars (fructose) found in fruits, milk sugars (lactose) found in milk products, and other forms of sugar (sucrose) found in sweeteners such as corn syrup, honey, dextrose, high-fructose corn syrup and fruit juice concentrates. Complex carbohydrates are found in whole grains, rice, peas and dried beans, such as lentils and black, kidney and pinto beans.

Carbohydrates stored in the body are packed with water. That's why introducing a low-carbohydrate diet leads to rapid weight loss as the body turns to stored carbohydrates for energy, eliminating large amounts of fluid from your body. After the stored carbohydrates are gone, your body turns to fat and lean body tissue for fuel, inducing further weight loss.

Many people on low-carbohydrate diets eat less but feel fuller due to the high-protein, high-fat foods they consume. However, this creates more work for your kidneys, which have to process the high amounts of protein. This is especially dangerous for people with diabetes. Additionally, excess protein excretion can cause valuable calcium to be excreted.

Many health care professionals believe that rather than adhere to a low-carbohydrate diet, it's healthier to consume healthy carbohydrates in reasonable amounts. This means focusing on complex carbohydrates like beans, whole grains and vegetables, as well as simple carbohydrates that pack plenty of fiber, such as fruits.

Choosing A Diet Plan

With all of the fad diets circulating these days, you need to do your homework before embarking on a new weight-loss plan. The following questions will help you determine if a diet is healthy and legitimate or just a scam:

  • Does the plan promise dramatic and rapid weight loss? If a program is promising results that sound too good to be true, they probably are. A 10-pound loss in two weeks is unrealistic and may harm your overall health. A weight-loss goal of one to two pounds per week is a safe and effective rate for long-lasting results.

  • Does the plan exclude entire groups of foods? If a weight-loss plan excludes an entire group of foods such as grains, fruits, vegetables, dairy or protein, you risk missing out on essential vitamins and minerals.

  • Does the plan require extremely low calorie levels? Most experts agree that we need to consume at least 1,200 calories each day to maintain a healthy body. This is a minimum; most people actually need more. If a weight-loss plan restricts calories below this level, it's not nutritionally adequate, and you'll be in danger of nutrient deficiencies.

  • Are you required to buy special foods or supplements to follow the program? Weight-loss programs that rely on special foods or supplements tend to be money-making schemes to benefit the seller. These types of programs will drain your wallet without teaching you about nutrition and healthy eating habits.

  • Does the plan address lifestyle changes, such as increased exercise and improved eating habits? Realistic weight-loss plans should focus on the causes of your weight gain and on long-term lifestyle changes, not just on short-term losses.

  • Can you continue this way of eating for the rest of your life? Weight loss is difficult, but maintaining that weight loss is even harder. Any plan that allows you to lose weight should also be a plan you can continue indefinitely to maintain that weight.

The following claims and promotions should alert you to the probability of a bogus weight-loss scheme:

  • The plan is touted as requiring no sacrifice—no exercise or no change in your eating habits.

  • No reliable evidence or scientific proof is offered to back up claims that the plan is safe and effective.

  • Testimonialsand case histories of people who have supposedly been successful on the plan are offered as "proof" of its effectiveness. A few successes don't prove the plan will work for everyone.

  • The plan is described in sensational articles, or worse, advertisements made to look like articles, in tabloids and weight-loss magazines.

  • The plan is promoted as "cleansing" the body of "toxins" to let the body's "natural" curative powers help in your weight loss efforts.

Today's most popular weight-loss programs vary greatly. No single diet is appropriate for everyone, so you'll want to weigh factors that vary by plan, such as types of food you can eat, reliance on supplements or drugs, calorie levels allotted and support offered.

Popular Weight-Loss Plans

  • Mediterranean-Style Diet

    The Mediterranean diet is really a way of eating, rather than a particular diet. Some large studies point to the Mediterranean style of eating as a good alternative to low-fat dietary approaches as a way to reduce weight and, consequently, reduce your risk of heart disease and diabetes. Like the low-fat diets, the Mediterranean eating pattern focuses on fruits, vegetables, whole grains, nuts and seeds, but it also includes olive oil as a significant source of monounsaturated fat and wine in low to moderate amounts. The major protein sources are dairy, fish and poultry, with minimal red meat.

    The Mediterranean eating style allows a higher percentage of calories from fat than the low-fat diets typically endorsed by health organizations, but several recent major studies have shown that the diet is an alternative to low-fat diets, especially for lowering risk of diabetes and heart attacks, often related to weight.

  • Weight Watchers

    This diet program, one of the most popular among health care professionals, has helped millions of people worldwide lose unwanted pounds since it was founded in 1963. In general, the plan is healthy—long on fruits and vegetables and short on fat, protein and sugar. Weight Watchers provides two options—weekly in-person meetings or Weight Watchers Online. Weight Watchers meetings offer member support. (Your weight is kept private.) Meeting leaders have achieved their own weight loss goals with Weight Watchers and have been able to maintain their goal weight. The discussions can be helpful because they focus on the common challenges you face when trying to lose weight—what to do about eating in restaurants or at a wedding, for example. They also let members exchange dietary advice on tasty alternatives or ideas for trimming calories. Weight Watchers Online offers members comprehensive guides to help them learn how to follow the Weight Watchers approach and food plan, including interactive tools and customized sites for men and women. Exercise is stressed as part of the program.

    In the past, Weight Watchers used a system that assigned point values to each food. Dieters were allowed to consume a specific number of points per day based on their weight, and members weren't given much direction about how to divide those points between the various food groups. As a result, a dieter on this program could eat too much of a single, and perhaps unhealthy, type of food. However, with the Points Plus program launched in 2010, dieters get more direction on how to make healthy food choices. The program still focuses on calorie restriction, but it encourages members to choose healthful foods that are high in nutrients and low in sugar and fat.

  • NutriSystem

    This diet is based mostly on NutriSystem's prepackaged foods and involves reducing participants' calorie intake to an average minimum of 1,200 calories per day for women and 1,500 for men. The NutriSystem program is now completely at-home—participants have the option to go online to chat with one of their weight loss counselors about diet and exercise. While the program was developed by registered dietitians and health educators with input from physicians, there have been some complaints in the media that the counselors are not highly trained. If you are concerned about this, you may want to ask about credentials at your center, and always discuss any diet plan with your health care professional.

    Because clients eat prepackaged meals, they have few food decisions to make. Thus they're not learning how to make choices in the real world or change their lifestyles. The program also sells vitamin and mineral supplements.

  • Jenny Craig

    This program also relies on its own brand of prepackaged foods, plus some additional supermarket foods, and provides calorie recommendations depending on your gender and current weight. Clients can attend weekly lifestyle classes and receive one-on-one counseling or choose an at-home program that allows for consultations via phone. As their comfort level grows, clients are given the option to transition to regular foods.

    Jenny Craig emphasizes increased physical activity, changing ingrained eating habits and learning how to balance meals and food choices. The program was developed by registered dietitians and psychologists with input from physicians.

    Relying on prepackaged foods makes dining out and socializing difficult and de-emphasizes behavior modification and lifestyle change that are very important to long-term weight loss. Also, Jenny Craig makes "weight-loss supplements" an integral part of the system. While vitamin and mineral supplements may be helpful to overall health, no herbal or enzymatic supplements should be relied upon for weight loss.

  • Liquid Fasting Programs (Optifast, HMR and New Directions)

    These programs consist of a highly structured dieting approach that combines medical, behavioral and nutritional knowledge and skills to support weight loss. The medical team (physician, registered nurse, dietitian or psychologist) provides medical supervision for the dieter in an out-patient medical setting. The diets use vitamin-fortified liquid-meal replacements or prepackaged foods to achieve a reduced calorie intake. Part of the structure includes mandatory weekly group sessions that support the weight-loss efforts and promote positive eating behaviors. In some settings, one-on-one counseling is available.

    The programs emphasize changes in lifestyle behaviors to support weight loss including daily physical activity and menu planning. Once the diet is completed, the patient transitions back to a recommended, healthy eating plan. In many locations, exercise physiologists are available to help design personal exercise plans.

    During the weight-loss phase of the programs, dieters use only the meal replacement products. Because of this, some dieters find it difficult to transition from liquid to regular food. The support of the trained program staff is essential to this transition. Most programs emphasize that the maintenance phase of these programs is the key to success with long-term weight maintenance.

    Due to the close contact with medical professionals, these programs are beneficial for individuals with significant weight to lose or for those with serious health problems associated with their weight. Participation involves the approval of your health care professional. Some locations may also offer the opportunity to utilize prescription weight-loss medications.

  • Low-Carb Diets

    These trendy diets, including the Atkins, Sugar Busters and Protein Power plans, claim that carbohydrates—and not fat or an overindulgence in calories—are what make people gain weight. They go against the recommendations of the U.S. Department of Agriculture (USDA), the American Heart Association, the American Dietetic Association and the American Diabetes Association.

    Fat and protein intake are unlimited in some of these plans, more limited in others. The higher fat and protein level of the Atkins Diet can provide more fullness with meals and snacks. Foods containing simple carbohydrates are restricted, so blood sugar surges after a high-carbohydrate meal doesn't occur, helping control appetite. This also prevents blood sugar levels from rapidly plummeting, which contributes to hunger.

    These diets rebel against the past decade's message for healthy eating—moderate fat; increased whole grains, fruits and vegetables; and moderate amounts of protein. These recommendations are based on scientific evidence that eating a well-balanced diet will decrease risks of chronic disease and increase health. While high-fiber diets rich in fruits and vegetables are shown consistently to decrease chronic diseases, diets high in animal protein continue to raise concern of possible increased risks for certain cancers.

    Several recent studies found that high-protein diets have no proven effectiveness in long-term weight reduction and may damage health of those who stay on them for a long time.

    Note: Because prolonged ketosis (a side effect of high-protein diets) can lead to kidney damage, people with a family history of renal disease or who have renal problems should avoid high-protein diets.

  • The Zone

    This diet relates excess weight to both overeating and/or to unbalanced consumption of calories from the carbohydrate, fat and protein groups. In the Zone, your diet is exactly one-third lean protein, two-thirds fruits and vegetables and a dash of monounsaturated fat. The diet claims that this is "the metabolic state in which the body works at peak efficiency." The diet consists of one gram of fat for every two grams of protein and three grams of carbohydrates.

    Compared to many other low-carb regimens, this diet promotes a higher percentage of low-fat protein foods. This diet is most likely successful because it restricts caloric intake enough to lose weight. The average person eating in the Zone consumes no more than 800 to 1,200 calories a day. Some critics consider this a strict, controlled eating regimen, requiring significant effort to adhere to a complex set of rules, charts and tables.

  • South Beach Diet

    The South Beach Diet is sometimes lumped in with low-carb diets like Atkins, but it differs in some significant ways. It focuses on replacing "bad carbs" with "good carbs" and "bad fats" with "good fats." It restricts simple carbohydrates, such as refined sugar and enriched grains, but permits complex, fiber-rich carbohydrates such as whole-grain bread and brown rice. It also allows more vegetables and focuses on the "glycemic index," which relates to how quickly the body digests foods. Simple carbs digest quickly and cause spikes in blood sugar. It recognizes that while foods rich in "bad fats" may help control the hunger cycle, they also contribute to high cholesterol and heart disease. So the South Beach Diet replaces them with foods rich in unsaturated fats and omega-3 fatty acids, such as lean meats, nuts and fish. The three-phase diet ends with a maintenance phase to help you learn how to maintain a healthy weight.

  • Flat Belly Diet

    The Flat Belly Diet follows many of the same principles as the Mediterranean diet but also emphasizes how much and how often you should eat. It starts with a four-day "jump start" and then has a four-week plan that focuses on: eating an unsaturated fat at every meal; limiting meals to 400 calories per meal; and eating every four hours during the day. It teaches you how to eat a balanced diet with proper portions of vegetables, fruits, whole grains, nuts and seeds, low-fat dairy products and low-fat proteins, such as fish, poultry and beans. It also includes an exercise plan to help you manage your weight.

  • Single-Food Diets

    Diets that push grapefruit or eggs, cabbage soup or oranges have surfaced over the years. These diets are dangerous because they're unbalanced nutritionally and rely on too few calories.

  • Liquid Meal Replacement Diets

    These liquid meal replacements, such as Slim-Fast, are milk-based products that have added vitamins and minerals. If "balanced" is defined as containing adequate amounts of the nutrients the government has established as the Reference Daily Intakes (RDIs), then Slim-Fast meets the requirements. Slim-Fast users get a daily menu of three snacks, two shakes or meal bars and one balanced meal, customized to their tastes.

    Recent research shows that meal-replacement diet plans such as Slim-Fast work. A landmark 10-year study demonstrated that the Slim-Fast Meal Replacement Plan helped individuals lose weight and maintain body weight long-term. Participants weighed an average of 33 pounds less after 10 years than a matched group.

    After analyzing studies comparing several types of restricted-calorie diets, the American Dietetic Association issued a practice guideline concluding that structured meal-replacement plans could be at least as effective for losing weight as reduced-calorie diets and sometimes more effective. The guidelines also suggest that for overweight and obese adults who struggle with food selection and portion control, one or two daily meal replacements fortified with vitamins and minerals and supplemented with self-selected meals and snacks may be a successful weight loss and maintenance strategy.

Using Medication to Lose Weight

Women with increased medical risk from their obesity may benefit from adding a weight-loss medication to their nutritional and exercise regimen.

Most research-based and professional associations recommend lifestyle therapy for at least six months before embarking on a weight-loss plan using physician-prescribed drug therapy. Even then, it must be used only as part of a comprehensive weight-loss program that includes dietary therapy and physical activity. Currently available prescription medications include:

  • phentermine (Adipex-P, Fastin, Ionamin, Obenix, Oby-Cap, Teramine, Zantryl)

  • diethylpropion (Tenuate, Tepanil)

  • phendimetrazine (Adipost, Bontril, Melfiat, Obezine, Phendiet, Plegine, Prelu-2)

  • orlistat (Xenical)

Most prescription weight-loss drugs are FDA-approved for short-term use only, usually less than 12 weeks. Orlistat (Xenical) is the only drug approved for long-term use. Orlistat also is now available over the counter under the brand name Alli in 60 mg pills, half the strength of the prescription dosage in Xenical, making it the first FDA-approved over-the-counter weight loss drug. Like Xenical, Alli blocks digestion of about 25 percent of the fat eaten at a meal. Orlistat has been found to be safe and effective in combination with a low-fat (less than 30 percent fat), low-calorie diet and can help people lose 50 percent more weight than dieting alone.

Safety is an issue with some weight-loss medications. The drug sibutramine (Meridia) was removed from the market in 2010 because studies showed an increased risk for heart problems, including non-fatal heart attack and stroke. The FDA is also reviewing reports of serious liver injury in people taking orlistat. No definite association has been established, but people taking orlistat should watch out for any symptoms of liver injury, such as weakness, fatigue, fever, jaundice or brown urine and report these signs to their doctors.

Most of these drugs decrease appetite by affecting levels of certain brain neurotransmitters that affect appetite. Orlistat does not act directly on the central nervous system but instead blocks an enzyme essential to fat digestion so your body doesn't absorb fat. In general, combining weight loss medications with an increase in activity level and a decrease in calories can help you lose 10 pounds more than what you might lose with nondrug obesity treatments.

If you are, may be or could become pregnant or are nursing, be sure to tell your health care professional. The effects of most of these drugs have not been tested on unborn babies; however, medications similar to some of the short-term appetite suppressants have been shown to cause birth defects when taken in high doses. Also, diethylpropion and benzphetamine pass into breast milk.

Before you take any product for weight loss, be sure to discuss it with your health care professional first. There are numerous potentially dangerous over-the-counter drugs and herbs that claim to help you lose weight. These over-the-counter drugs, except for Alli, and herbs have not been approved by the FDA and may cause significant health complications and even death.

Surgery

For clinically severe obesity, your health care provider may recommend surgery for weight loss. Many people, including some health care professionals, wrongly believe that obese people merely need to stop eating so much to lose weight. In reality, extreme obesity is a potentially deadly disease that sometimes requires a treatment as dramatic as surgery. Surgery is an option for carefully selected patients under the care of a health care professional. The surgery, called bariatric surgery, reduces the size of your stomach, limiting the amount of food it can hold. Most physicians consider people for the surgery who:

  • have tried other methods of weight loss (changes in eating behavior, increased physical activity and/or drug therapy) and are still severely obese

  • have a BMI of at least 40 (or 35 in addition to other medical conditions such as diabetes, hypertension and heart failure)

  • understand the procedure, risks of surgery and effects after surgery

  • are motivated to make a lifelong behavioral commitment that includes well-balanced eating and physical activity needed to achieve—and maintain—desired results

There are several types of bariatric surgery:

  • Roux-en-Y gastric bypass (RYGB). In this procedure, sometimes referred to as "stomach stapling," the stomach is reduced to the size of a golf ball. The stomach is divided into a large portion and a small portion. The small portion is sewn or stapled together to make a small pouch, which holds only about a cup of food. The small pouch is then disconnected from the upper portion of the digestive tract and reconnected to a lower portion of the intestine. Not only do you eat fewer calories, but your body absorbs fewer calories because part of the intestine, the duodenum, has been bypassed.

  • Adjustable gastric band. This procedure is performed laparoscopically, through a small incision in the abdomen. The surgeon wraps a saline-filled silicone band around the top of the stomach to create a small pouch about the size of a thumb. The size of the pouch can be altered by increasing or decreasing the amount of saline (salt water) in the pouch. You eat less because you feel full sooner.

Other less common procedures include:

  • Biliopancreatic bypass with duodenal switch (BPDS). In this procedure, much of the stomach is removed, leaving only a "gastric sleeve" that is attached to the small intestine, completely bypassing the duodenum and upper small intestine.

  • Biliopancreatic diversion with duodenal switch is a similar procedure, but a smaller portion of the stomach is removed, and the remaining stomach (gastric sleeve) remains attached to the duodenum. The duodenum is connected to the lower part of the small intestine. As with the gastric bypass procedure, you absorb fewer calories with both of these procedures. You also eat less because your stomach is smaller. Removing part of the stomach is also thought to reduce production of an appetite-related hormone called grehlin. This procedure is generally used for people who have a body mass index of 50 or more.

All procedures can lead to complete remission of diabetes, sleep apnea, hypertension, kidney failure and other weight-related medical conditions.

While bariatric surgery is extremely safe, the greatest risks come after the surgery. Some occur soon after the operation, such as hemorrhage, obstruction, infection, hernias, pulmonary embolisms (blood clots in the lung) and leaks between the areas where tissue was sewn together.

Long-term complications include nutritional deficiencies, including malabsorption of vitamin B12, iron and calcium; and hypoglycemia, or low blood sugar, which can lead to various medical conditions, including neuropathy.

Most people undergoing bariatric surgery have rapid and extreme weight loss. It often helps patients lose as much as 50 percent of their excess body weight. Just over half of people who undergo weight loss surgery have kept the weight off five years after the procedure.

After surgery, you have to learn to eat smaller amounts of food at one time, to chew food well and to eat slowly. If you don't adjust your eating habits, you won't lose as much weight. Additionally, especially in the first three months after surgery, you must be sure to eat the proper amounts of protein, calories, minerals and vitamins as recommended by your health care professional and you will likely need nutritional supplements for the rest of your life.

Trying To Gain Weight?

For the underweight woman who needs to gain weight, either for health reasons or appearance's sake, the journey can be difficult. Weight gain can be more difficult than weight loss. The underweight woman may have a higher metabolism, fewer fat cells or a genetic tendency to be leaner. She may also be taller, or just not care about food.

Winning at weight gain comes down to pairing a balanced eating pattern with regular physical activity—like any healthy lifestyle. The trick is to make sure you eat more calories than you burn. But you shouldn't give up exercise because it has many health benefits! Consider adding a weight training program because building muscle will increase your weight. Here are some more tips that can help:

  • Plan ahead for extra meals and snacks. Instead of the traditional three square meals a day, add two or three substantial snacks between three moderate-size meals. By spreading out your food choices during the day, you'll be more likely to enjoy your meals and snacks without feeling stuffed.

  • Concentrate on calories. Tip the scales toward weight gain by choosing foods that are calorie-dense, or high in calories. While rich desserts and fried foods quickly come to mind, the emphasis should be on foods that pack other nutrients, such as protein, vitamins and minerals, in addition to calories. These include dairy foods, nuts, peanut butter or avocados. Aim for the higher end of the recommended number of servings from each group in the Food Pyramid. And watch your use of added sugars and saturated and trans fats.

  • Let snacks work in your favor. Smart snacking plays an important role in gaining weight. Choose snacks that add calories, vitamins and minerals, such as powdered milk added to a yogurt or ice cream-based shake with fruit and fruit juice, nuts and seeds. Dip crackers, chips and fresh vegetable relishes into high-calorie dips made with low-fat cheese, low-fat sour cream, mashed beans or salad dressings made with mono- or unsaturated oils. Space out snacks during the day so you don't spoil your appetite for later meals.

Physical Activity is Key to Weight Management

Daily physical activity is essential to weight management. Exercise not only burns calories, it also tempers your appetite, boosts metabolism, improves sleep and provides psychological benefits, such as an increased feeling of control and self-esteem, as well as reducing stress.

If you are over 40, have been inactive for some time, suffer from shortness of breath or weakness that interferes with daily activities, or have a chronic health condition, consult a health care professional before increasing your physical activity. Notify your health care professional about any chest pain, faintness or dizziness, or bone or joint pain you're experiencing and any medications you're taking.

Physical activity is defined as any bodily movement produced by skeletal muscles resulting in energy expenditure. The best kinds of exercises for burning calories are moderate- to vigorous-intensity physical activities. The calories burned per hour are listed for a 140-pound healthy woman.

Moderate-intensity activities include:

  • hiking (386 calories)

  • light gardening/yard work (302 calories)

  • dancing (319 calories)

  • golf, walking and carrying the clubs (244 calories)

  • bicycling, less than 10 mph (370 calories)

  • tennis, singles (386 calories)

  • walking, 3.5 mph (370 calories)

  • yoga (336 calories)

Vigorous-intensity physical activities include:

  • aerobics, high-impact (445 calories)

  • calisthenics (512 calories)

  • running/jogging, 5 mph (580 calories)

  • swimming (580 calories)

  • bicycling, 12-14 mph (554 calories)

  • racquetball, casual (445 calories)

  • skiing, downhill (554 calories)

  • weight lifting, vigorous (400 calories)

While you and your health care professional should set up a detailed exercise plan based on your individual health status, the 2010 Dietary Guidelines recommend that for substantial health benefits, healthy women engage in at least150 minutes of moderate-intensity aerobic exercise or at least 75 minutes of vigorous aerobic exercise per week while not exceeding caloric intake requirements. For additional and more extensive health benefits, the guidelines recommend at least 300 minutes of moderate-intensity aerobic exercise or at least150 minutes of vigorous-intensity aerobic exercise per week. The guidelines also recommend muscle-strengthening activities that involve all major muscle groups on two or more days per week.

If you have been inactive, you need to work up slowly to this amount so you don't get injured or overly fatigued and then become discouraged. Start with five or 10 minutes (or whatever you're comfortable with) every other day, adding one minute every other session. Low- to moderate-intensity physical activity, like housework, gardening and walking the dog provide a great deal of general health benefits, but for weight loss, you need to up the ante and exercise at a higher intensity with more vigorous activities like brisk walking or jogging, singles tennis or other racquet sports, aerobics classes, ice or roller skating, swimming or cycling.

Because the goal of moderate to vigorous physical activity is to work your heart muscle, your exercise needs to increase your heart rate. One way to determine if you are exercising intensely enough is to measure your heart rate. After warming up and sustaining an aerobic activity for about five minutes, take your pulse by placing two fingers on the carotid artery on the side of your neck, just under your jaw line and about one to two inches in front of your ear. Count the beats for 10 seconds.

Your heart rate should be about 50 to 85 percent of its maximum, which is your age subtracted from 220.

If you're out of shape or older than 60, aim for an intensity at the lower end of the 50 to 85 percent range of your maximum heart rate. To determine what your heart rate should be during exercise, subtract your age from 220; divide that number by six for a 10-second heart rate count, then multiply that number by 0.5 for the lower end of the range and 0.85 for the higher end. For example, if you're 70:

  • 220 - 70 = 150 (this would be your maximum heart rate for one minute)

  • 150 / 6 = 25 (this would be your maximum heart rate for 10 seconds)

  • 25 x 0.50 = 12.5 (this would be 50 percent of your maximum, or the lower end of where your 10-second heart rate should be when you're exercising)

  • 25 x 0.85 = 21.25 (this would be 85 percent of your maximum, or the higher end of where your 10-second heart rate should be when you're exercising).

The following chart illustrates recommended heart rate counts based on your age. (These are rates per minute; use the instructions above to convert your 10-second count to heart beats per minute.)

Target HR Zone
50-85%
Average Maximum
Heart Rate
100%
20 years 100-170 beats per minute 200 beats per minute
25 years 98-166 beats per minute 195 beats per minute
30 years 95-162 beats per minute 190 beats per minute
35 years 93-157 beats per minute 185 beats per minute
40 years 90-153 beats per minute 180 beats per minute
45 years 88-149 beats per minute 175 beats per minute
50 years 85-145 beats per minute 170 beats per minute
55 years 83-140 beats per minute 165 beats per minute
60 years 80-136 beats per minute 160 beats per minute
65 years 78-132 beats per minute 155 beats per minute
70 years 75-126 beats per minute 150 beats per minute

An easier way to judge intensity is the "talk test." You shouldn't be exercising so hard that you can't talk with a friend or recite a poem. If you can't talk without gasping for breath, slow down. On the other hand, if your exercise is easy enough that you can sing a song out loud, you probably need to increase your intensity.

Another type of exercise has received much attention over the past several years for its contribution to weight loss efforts. Strength training, which includes weight lifting and isometrics, or using your own body weight as resistance, not only improves muscular strength and endurance but raises metabolism, enabling you to burn more calories.

Make sure you take a few minutes to warm up before doing any kind of exercise and stretch when you finish.

It's best to incorporate a combination of both types of exercise into your lifestyle— moderate to vigorous physical activities to burn fat and strength training to build muscle. Neither is as effective alone.

At the same time, you need to reduce the amount of television you watch, since TV watching is independently associated with weight gain.

Some Techniques May Not Live Up to Expectations

Spot exercising, or training particular areas of your body, won't reduce body fat in specific locations because exercise draws on fat stores throughout your body. Gimmicky devices such as bust developers, vacuum pants and exercise belts do absolutely nothing to reduce fat in specific locations or, in the case of the bust developer, to add bulk. Electrical pads wrapped around the waist, arms or thighs have been reported to cause burns and fires. Similarly, cellulite-removal creams have been shown in several studies to be ineffective. Their apparent effect on fat may simply be from constricting blood vessels and forcing water from the skin, which could potentially be dangerous for people with circulation problems.

Liposuction is an increasingly popular technique to reduce fat in specific areas on the body. Liposuction, also called lipoplasty or suction lipectomy, is a surgical procedure that vacuums out fat from beneath the skin's surface to reduce fullness in areas such as the abdomen, hips, thighs, knees, buttocks, upper arms, chin, cheeks and neck. But depending on how much fat is removed, liposuction may not lead to weight loss, and it definitely won't change any behaviors associated with weight gain. It is also not an appropriate strategy for everyone, as age and skin tone can play a role in how successful the technique will be.

Get Your Mind In Gear

Another key to successful weight loss is incorporating behavioral strategies into your new eating and exercise activities. These include learning about nutrition, planning what to eat and making sure you eat regularly to end impulsive and thoughtless eating.

Some specific and helpful behavioral strategies include:

  • Set the right goals. Your goals should focus on specific dietary and exercise changes, such as, "I will eat five servings of fruits and vegetables every day this week," or, "I will work up to being able to walk briskly for 30 minutes at a time," rather than just on weight loss. Select two or three goals at a time to incorporate into your lifestyle rather than trying to change everything at once. Effective goals are specific, attainable and forgiving, which means that you don't have to be absolutely perfect. Remember, too, in setting your goals, that losing more than one to two pounds per week can be unhealthy and greatly increases the chances of regaining the weight.

  • Reward success. To encourage yourself to attain your goals, reward yourself for successes. An effective reward is something that is desirable and timely such as attending the cinema or taking an hour for yourself. Don't use food as a reward!

  • Keep a food and exercise diary. Many behavioral psychologists believe it's necessary to track your daily food consumption to achieve long-term weight loss. From a simple pad of paper to a computerized program that provides reports and analyses of your progress, the best tool is the one you use every day. Incorporate your goals, such as eating five servings of fruits or vegetables each day, into your self-monitoring efforts.

  • Monitor your weight sensibly. Keep track of your weight, but don't weigh too often. One day's diet and exercise patterns won't have a measurable effect on the scale the next day, and your body's water weight can change from day to day, which may frustrate you and derail your efforts.

  • Join a support group. Weekly meetings with a nearby support group or even over the Internet can help in a variety of ways. They provide accountability, helpful ideas, emotional support, an outlet for sharing frustrations and a variety of other psychological benefits.

  • Use positive self-talk. Take responsibility and see yourself as in control, able to talk yourself into exercising every day rather than being angry, hopeless or in denial.

  • Find ways other than food to respond to stress and other situations in your life. Certain cues, from stress to watching television, may stimulate unhealthy eating. In some cases, you can avoid those cues; don't go to that Mexican restaurant where you always eat too many chips, for example. For situations that can't be avoided, however, such as the business lunch or an argument with your spouse, relearn new ways to respond. If you track the situations surrounding your overeating in your food diary, you can more easily determine the cues you need to be aware of.

  • Change the way you go about eating. There are a variety of tricks—from using a smaller plate to eating more slowly—that can help you eat less. Setting an eating schedule, starting meals with a broth-based soup, only buying foods on a pre-planned menu and other similar efforts can all help.

  • When eating out, don't feel compelled to finish your entire meal if portion sizes are too large. The steady growth of food portion sizes served both in restaurants and at home has encouraged the overeating that is fueling the obesity epidemic in the United States, according to survey by the American Institute for Cancer Research.

  • Appropriate portion size is very important. When dining out, for instance, try to take home at least half of your dish. You can ask the waiter to box up half of it before you start eating. When eating at home, serve your plate and leave the remaining food in the kitchen; do not place it on the table. Half your plate should be filled with vegetables, one quarter with a protein and one quarter with grain products such as whole-grain bread, pasta, whole-grain rice and cereals. Never, ever, supersize any kind of fast food or takeout meal.

Prevention

Prevention

It's best to use weight management techniques before you become overweight, to prevent weight gain in the first place. The federal government issues helpful dietary guidelines, spelling out how much and which food you should eat and how much you should exercise to stay healthy. The guidelines, which are revised every five years (most recently updated in 2010), are widely used by health care professionals, food makers and educators, and also form the basis of the well-known U.S. Department of Agriculture (USDA) Food Pyramid used to teach healthy eating habits based on food groups such as grains, vegetables and fats.

The 2010 Dietary Guidelines recommend:

  1. Addressing the obesity epidemic in the United States by reducing calorie intake and increasing physical exercise

  2. Be physically active most days of the week

  3. Letting the Food Pyramid guide your food choices

  4. Eating a variety of grains daily, especially whole grains

  5. Eating a variety of fruits and vegetables daily

  6. Keeping food safe from foodborne illness

  7. Choosing beverages and foods that limit intake of sugars

  8. Choosing and preparing foods with less salt

  9. Drinking alcoholic beverages in moderation

  10. Choosing a diet low in saturated fat, trans fatty acids and cholesterol, and moderate in total fat

Specifically, the 2010 Dietary Guidelines recommend the following for adult women; to find the amounts that are right for you (exact amounts vary based on your age), visit the Food Pyramid Web site at www.MyPyramid.gov:

Meats and beans (Protein)

  • Eat five ounces of protein every day (five and a half ounces if you are between the ages of 19 and 30) .Vary your choices of meats, poultry, fish, beans, peas, nuts and seeds).

Fruits, vegetables and milk

  • Eat at least one and a half cups a day of fruit (two cups if you are between the ages of 19 and 30) and two-and-a-half cups a day of vegetables (two cups if you are age 51 or older).

  • Eat a variety of fruits and vegetables every day and choose from all of the five vegetable subgroups (dark green, orange, legumes, starchy vegetables and other vegetables) several times per week. You may consume fresh, frozen, canned or dried; go light on fruit juices.

  • Drink three cups per day of either fat-free or low-fat milk or equivalent milk products such as yogurt and cheese.

Carbohydrates

  • Eat six servings (five servings if you are 51 or older) of grains (cereal, breads, crackers, rice or pasta) a day. At least three ounces should be whole grain, and the other three enriched or whole grain. One ounce equals about one slice of bread, one cup of cereal or one-half cup of cooked rice, cereal or pasta.

  • Eat fruits and vegetables that are high in fiber and choose whole grains

  • Try to avoid adding sugar or sweeteners to foods and beverages

Sodium and Potassium

  • Do not consume more than 2,300 mg (approximately 1 teaspoon) of sodium per day. Reduce sodium intake to 1,500 mg per day if you are 51 or older, are African American, or have hypertension, diabetes or chronic kidney disease.

  • Use little or no salt when preparing foods

  • Eat fruits and vegetables high in potassium such as potatoes, sweet potatoes, soybeans, bananas and spinach.

Facts to Know

Facts to Know

  1. About 68 percent of the nation is overweight or obese.

  2. According to the CDC, there has been a dramatic increase in obesity in the United States over the past 20 years. In 2009, only the District of Columbia and Colorado had a prevalence of obesity less than 20 percent.

  3. According to the National Eating Disorders Association (NEDA), 40 percent of newly identified cases of anorexia are in girls ages 15 to 19, and over half of teenage girls use unhealthy weight control behaviors, such as skipping meals, fasting, smoking cigarettes, taking laxatives and vomiting.

  4. Obesity rates for children are 12.4 percent in those ages 2 to 5, 17 percent in those ages 6 to 11 and 17.6 percent in those ages 12 to 19.

  5. Children and teens who are overweight often have a lifelong struggle with their weight and are at high risk for developing diabetes, high blood pressure, diseased arteries, damaged hearts and liver damage.

  6. If a woman's waist circumference divided by her hip measurement is greater than 0.8, she is considered to have a high amount of visceral fat, which is the type of fat that surrounds the internal organs. This is especially true if her waist measurement is more than 35 inches. This type of fat is associated with higher risk of certain diseases and conditions like diabetes and heart disease.

  7. If you eat 250 calories per day fewer than needed to maintain your weight and exercise enough to burn an additional 250 calories a day, you will lose about a pound per week.

  8. Your basal metabolic rate (BMR) is the number of calories your body needs just to maintain its basic functions. You need additional calories to provide energy for daily activities; the more active you are, the more calories you need. Several factors go into the calculation of your BMR, including your age, height, weight and gender. To get an idea of your BMR, go to http://www.bmi-calculator.net/bmr-calculator.

  9. The CDC reports that compared with whites, African Americans have a 51 percent higher prevalence of obesity, and Hispanics have a 21 percent higher prevalence.

  10. Despite the ads that claim miracle weight-loss for some products, there simply is no magic formula for losing weight. The truth is, permanent weight loss takes time and requires a permanent change in eating and exercise habits.

Questions to Ask

Questions to Ask

Review the following Questions to Ask about weight management so you're prepared to discuss this important health issue with your health care professional.

  1. Do I need to lose or gain weight? How much? What should be my weight goal?

  2. What is the average weight for a person of my height, body composition and fitness level?

  3. Do I have any medical conditions that could affect my weight?

  4. Could the medications I am taking affect my weight?

  5. What types of health problems are associated with being overweight?

  6. Based on my current weight and weight management goals, how many calories a day should I eat?

  7. Should I follow a special diet plan or take a diet supplement?

  8. What are the success rate, risks and benefits for this diet plan or diet supplement?

  9. What are the best types of exercises for me?

  10. What warning signals should I watch out for while I'm exercising?

  11. Should I take a weight-loss drug? How effective is the drug you're recommending? What are its risks and potential side effects?

  12. Can you recommend a hospital-based weight-management program or a registered dietitian who can help me put together a healthy eating plan?

Key Q&A

Key Q&A

  1. How do I know if I'm overweight, underweight, or if my weight is normal?

    One measure of overweight and obesity is your body mass index (BMI), which can be determined by dividing your weight in pounds by your height in inches squared and then multiplying by 703. For example, a woman who is 5 feet 6 inches and weighs 140 would have a BMI of 22.6, as follows:

    • 5 feet 6 inches = 66 inches

    • 66 squared = 4,356

    • 140 divided by 4,356 = 0.0321

    • 0.0321 x 703 = 22.6

    If a woman's BMI is under 18.5, she is considered underweight; between 18.5 and 24.9, she is considered of normal weight; between 25 and 29.9, overweight; 30 or greater, obese. However, if she has more muscle mass than normal, these numbers won't apply, and her health care professional should measure her body composition to determine her degree of overweight. BMI is also adjusted for age, as well as gender, for people under age 18.

  2. My health care professional says I need to lose 10 pounds. Why should I bother with such a small amount?

    Being overweight, even by 10 pounds, can be bad for your health. If you are overweight, you are more likely to develop health problems including heart disease and stroke, type 2 diabetes, some forms of cancer, gout, gallbladder disease, sleep apnea and osteoarthritis.

  3. As hard as I try, I just can't lose that 10 pounds. Shouldn't I just give up?

    No, because your weight management efforts may be paying dividends, even if you aren't losing pounds. Eating more healthfully and adding physical activity to your day have health benefits of their own, including improvements in your chronic disease risk factors such as blood pressure, blood sugar levels and cholesterol.

  4. I need to lose 10 pounds. Are weight-loss drugs appropriate for me?

    Weight-loss medications may be appropriate for carefully selected patients who are at significant medical risk because of their obesity. They are not recommended for use by people who are only mildly overweight unless they have health problems that are made worse by their weight. These prescription drugs should be used only with the careful supervision of a health care professional. When they are used, these medications must also be combined with physical activity and improved diet.

  5. My health care professional says my weight is normal, but I need to exercise more. Why should I exercise if I don't need to lose weight?

    Exercise not only improves your cardiovascular health and conditioning, but it can help ward off illnesses like cancer, diabetes and osteoporosis. Plus, it has psychological benefits and helps reduce stress.

  6. My health care professional says I'm underweight. What's so bad about that?

    Underweight women are susceptible to vitamin and mineral deficiencies, resulting in a loss of bone density and muscle tissue.

  7. What sort of health care professional can help me set and achieve weight management goals?

    A physician may be the best place to start for a full health assessment and referral. An endocrinologist is a physician who specializes in metabolic conditions including obesity. A registered dietitian can evaluate your diet and suggest ways of fighting various health problems or simply becoming healthier by modifying your diet. A personal trainer provides one-on-one goal setting and professional expertise, most often in the area of fitness and exercise.

  8. Is liposuction an effective way to lose fat?

    Liposuction does, indeed, remove fat from specific regions of your body. But if you haven't learned to eat healthfully and incorporate physical activity into your lifestyle, you will regain any lost weight (although your new fat deposits may develop in different sites on your body). In addition, liposuction surgery has side effects and can have serious complications. You should talk to an unbiased health care professional, such as your primary care physician, before making any decisions about liposuction.

  9. What is a healthy diet?

    Half your plate at main meals should consist of colorful vegetables, one quarter should consist of grain products such as whole-grain bread, pasta, whole-grain rice and cereals and one quarter should consist of meat, fish or poultry. Several times a week, substitute dishes made from dried beans or peas as your main course. Eat plenty of fruits. Eat three cups of low-fat milk products like yogurt each day. These proportions will help lower your saturated fat intake and increase the amount of fiber in your diet, both of which have been shown to decrease risk for heart disease. While you should try to cut back on fats and sugars, allow for an occasional treat. Also, most of your fat consumption should come from monounsaturated or polyunsaturated fats with saturated fats accounting for less than 10 percent of your fat intake.

  10. How much should I exercise?

    The "Dietary Guidelines for Americans 2010" recommend that for substantial health benefits, healthy women engage in at least150 minutes of moderate-intensity aerobic exercise or at least 75 minutes of vigorous aerobic exercise per week while not exceeding caloric intake requirements. For additional and more extensive health benefits, the guidelines recommend at least 300 minutes of moderate-intensity aerobic exercise or at least150 minutes of vigorous-intensity aerobic exercise per week. The guidelines also recommend muscle-strengthening activities that involve all major muscle groups on two or more days per week.

Lifestyle Tips

Lifestyle Tips

  1. Know the difference between weight loss myths and facts

    Can you lose 20 pounds in a week? Not likely; a much more realistic goal is to lose one-half to two pounds per week. It's slower, but it's more likely to come off and stay off. Eat smaller, balanced meals instead of skipping meals to lose weight; it's more effective. Don't expect to "eat all you want" and still lose weight. You can eat a variety of foods, but the total amount of calories has to be less than you use every day. There is no such thing as "fat-burning" foods. Exercise is what you need instead.

  2. How to control emotional overeating

    If you know you're likely to reach for food when you're anxious or upset, avoid strict diets. These tend to give you a sense of deprivation. Use a moderate diet with healthy snacks to keep you going. Make a point of noticing emotional triggers that make you want to eat—try writing them down. When they occur, grab a cool drink of water to give you a chance to think, then begin an activity you've decided to substitute for eating, such as a 15-minute walk, calling a friend, reading a chapter of a book you enjoy or using the computer.

  3. Serve up your daily fruit and vegetable servings

    Fresh fruit and vegetables are good choices, but sometimes they spoil before a busy person can eat them. You can get canned fruits instead—look for those packed in water or juice, not heavy syrup. Frozen vegetables are OK too, but skip those packaged with cheese, butter or cream sauces. Try to eat one and a half to two cups of fruit and two to two and a half cups of vegetables daily. One cup of fruit or 100 percent fruit juice or half a cup of dried fruit can be considered one cup from the fruit group. One cup of raw vegetables, cooked vegetables or vegetable juice or two cups of leafy greens can be considered one cup from the vegetable group.

  4. The lowdown on food labels

    According to the U.S. Food and Drug Administration (FDA), a fat-free food must have less than 0.5 grams (g) of fat per serving. Low-fat foods have 3 g or less per serving. Make sure you read the label to see how many servings there are! Reduced-fat or less-fat foods must have at least 25 percent less fat than the full-fat version. Light or "lite" foods may have at least one-third fewer calories and no more than half the fat of the full-fat version or no more than half the sodium content. However, you should always read labels to see what you're paying for!

  5. Helping your overweight child

    Be supportive, not critical. Your child should understand that you love and value him or her at any weight. Don't let your well-intentioned influence turn into another source of stress that drives your child to eat for comfort. Your child knows better than anyone about his or her weight and needs your encouragement. Don't single your child out for lifestyle changes; put the whole family on a healthy diet with more physical activity. If your child is self-conscious about some activities, choose others. Don't put your child on any restrictive diet, except as specifically recommended by your health care professional.

Organizations and Support

Organizations and Support

For information and support on Weight Management, please see the recommended organizations listed below.

American Dietetic Association
Website: http://www.eatright.org
Address: 120 South Riverside Plaza, Suite 2000
Chicago, IL 60606
Hotline: 1-800-877-1600
Email: adaf@eatright.org

Council on Size and Weight Discrimination
Website: http://www.cswd.org
Address: P.O. Box 305
Mt. Marion, NY 12456
Phone: 845-679-1209
Email: info@cswd.org

National Association to Advance Fat Acceptance (NAAFA)
Website: http://www.naafa.org
Address: P.O. Box 22510
Oakland, CA 94609
Phone: 916-558-6880

Overeaters Anonymous
Website: http://www.oa.org
Address: P.O. Box 44020
Rio Rancho, NM 87174
Phone: 505-891-2664

Shape Up America!
Website: http://www.shapeup.org
Address: 15009 Native Dancer Road
North Potomac, MD 20878

Body Blues: Weight & Depression
by Laura Weeldreyer

Breaking Free from Emotional Eating
by Geneen Roth

The China Study: The Most Comprehensive Study of Nutrition Ever Conducted and the Startling Implications for Diet, Weight Loss and Long-term Health
by T. Colin Campbell, Thomas M. Campbell II, Howard Lyman, and John Robbins

Eat, Drink, and Be Gorgeous
by Esther Blum and James Dignan

Fight Fat After Forty: The Revolutionary Three-Pronged Approach That Will Break Your Stress-Fat Cycle and Make You Healthy, Fit, and Trim for Life
by Pamela Peeke

Good Calories, Bad Calories: Fats, Carbs, and the Controversial Science of Diet and Health
by Gary Taubes

It's Not About Food: Change Your Mind; Change Your Life; End Your Obsession with Food and Weight
by Carol Emery Normandi and Laurelee Roark

Skinny Bitch
by Rory Freedman and Kim Barnouin

Strong Women Eat Well: Nutritional Strategies for a Healthy Body and Mind
by Miriam Nelson and Judy Knipe

Strong Women Stay Slim
by Miriam Nelson, Sarah Wernick, and Steven Raichlen

You Are More Than What You Weigh: Improve Your Self-Esteem No Matter What Your Weight
by Sharon Sward

You: The Owner's Manual
by Mehmet C. Oz and Michael F. Roizen

American Heart Association: Healthy Lifestyle
Website: http://esamericanheart.convertlanguage.com/presenter.jhtml?identifier=3055573
Address: American Heart Association
7272 Greenville Avenue
Dallas, TX 75231
Hotline: 1-800-AHA-USA1
Email: Review.personal.info@heart.org

Salud-Latina
Website: http://www.salud-latina.com

The Hormone Foundation
Website: http://www.hormone.org/Spanish/
Address: The Hormone Foundation
8401 Connecticut Avenue, Suite 900
Chevy Chase, MD 20815
Hotline: 1-800-HORMONE
Email: hormone@endo-society.org

Medline Plus: Weight Control
Website: http://www.nlm.nih.gov/medlineplus/spanish/weightcontrol.html
Address: US National Library of Medicine
8600 Rockville Pike
Bethesda, MD 20894
Email: custserv@nlm.nih.gov

Weight-Control Information Network: National Institute of Diabetes and Digestive and Kidney Diseases
Website: http://win.niddk.nih.gov/publications/la_futura_mama.htm
Address: Weight-control Information Network
1 WIN Way
Bethesda, MD 20892
Hotline: 1-877-946-4627
Email: win@info.niddk.nih.gov

Last date updated: 
Fri, 2011-05-13

What is it?

Overview

What Is It?
Blood pressure is the amount of force your blood exerts against the walls of your arteries. High blood pressure, or hypertension, occurs when your blood pressure is elevated over time. Left untreated, it can damage your small blood vessels and organs and lead to heart attacks, stroke, kidney failure and circulatory problems.

Blood pressure is the amount of force your blood exerts against the walls of your arteries. Normal blood pressure effectively and harmlessly pushes the blood from your heart to your body's organs and muscles so they can receive the oxygen and nutrients they need.

Blood pressure is variable—it rises and falls during the day. When blood pressure stays elevated over time, however, it is called high blood pressure or hypertension.

According to the American Heart Association, 76.4 million Americans have high blood pressure. High blood pressure was a primary contributing cause of death for 326,000 Americans in 2006.

Hypertension can occur in both children and adults, but it is more common in adults, particularly African Americans and the elderly. People with other conditions such as diabetes and kidney disease are likely to become hypertensive. In addition, being overweight, drinking alcohol excessively (defined as more than two drinks a day for men and one drink a day for women) and taking oral contraceptives may increase blood pressure.

About half of Americans with high blood pressure are women. More men than women have hypertension, until women reach menopause, when their risk becomes greater than men's. About 30 percent of women have high blood pressure.

Blood pressure is typically expressed as two numbers, one over the other, and is measured in millimeters of mercury (noted as mm Hg). The first number is the systolic blood pressure, the pressure used when the heart beats. The second number, diastolic blood pressure, is the pressure that exists in the arteries between heartbeats.

Depending on your activities, your blood pressure may increase or decrease throughout the day. If you are not acutely ill, are over 18 years of age and are not taking antihypertensive drugs, a blood pressure reading of 119 mm Hg or below systolic and/or 79 mm Hg or below diastolic (119/79) is considered normal.

If your systolic blood pressure is 120 to 139 mm Hg systolic and/or your diastolic pressure is 80 to 89 mm Hg, you have prehypertension. This means that you don't have high blood pressure now but are more likely to develop it in the future, and you have increased risk factors for cardiovascular disease and other conditions related to hypertension.

A blood pressure level of 140/90 mm Hg or higher is considered high.

You have stage 1 hypertension if your systolic pressure is 140 to 159 and/or diastolic is between 90 and 99. If your systolic pressure is 160 or above and/or your diastolic is 100 or more, you have stage 2 hypertension. Only one of the numbers needs to be above normal for a diagnosis of high blood pressure; that is, you can have isolated systolic or diastolic hypertension. Isolated systolic hypertension (ISH) is the most common form of high blood pressure in older Americans. The National Heart, Lung, and Blood Institute (NHLBI) estimates that 65 percent of people with hypertension over age 60 have ISH.

The cause of approximately 90 percent to 95 percent of all hypertension isn't known. This type of hypertension is called primary or essential high blood pressure. Secondary hypertension is somewhat different because it represents all of the specific diseases that cause elevated blood pressure. It is important to diagnose this type of hypertension because the treatment differs from primary hypertension. While there is no cure for primary hypertension, it is easily detected and is usually controllable.

Still, nearly one-third of those who suffer from high blood pressure don't know they have it, and people can have high blood pressure for years without knowing they have it. That's why high blood pressure has been called "the silent killer."

Of those with hypertension, only about 30 percent have the problem under control, defined as a level below 140/90 mm Hg. Left untreated, hypertension can result in permanent damage to the small blood vessels of the body, which can damage organs such as the heart, brain and kidneys, leading to heart attacks, stroke and kidney failure. It can also cause acute or chronic circulatory problems.

Elevated blood pressure levels significantly increase your risk for coronary heart disease, including heart attack and stroke. Consistent high blood pressure also increases your risk for congestive heart failure and can lead to other problems such as:

  • Atherosclerosis: Plaque collects on the walls of hypertension-damaged blood vessels, which can eventually lead to blockages that may result in a stroke or heart attack. Although this plaque builds up for many reasons as you age, high blood pressure hastens the process.
  • Eye damage: High pressure in blood vessels can cause tiny hemorrhages in the retina, the light-sensitive membrane in the back of your eye on which images are formed. If this happens, you may lose some of your vision.
  • Heart enlargement or failure: There are two types of heart failure. In the first, the walls of the heart are weak and thin as a result of being stretched by increasing amounts of pooling blood in the heart. In the second, commonly seen in people with hypertension, the heart muscle enlarges in response to the higher pressure and increased workload. It becomes so big it begins to close off the ventricular chamber, decreasing the amount of blood that can fill the heart. This is called diastolic dysfunction, because the heart muscle can't relax normally and allow blood to fill the chamber.
  • Kidney damage and failure: Hypertension causes arteries going to your kidneys to become constricted, making them less efficient at filtering waste from your body. Each year, high blood pressure causes more than 25,000 new cases of kidney failure in the United States. African Americans are particularly at risk. Early treatment of hypertension can help prevent kidney damage.

You should have your blood pressure checked whenever you see a health care professional. Because blood pressure can be variable, it should be checked on several days before a high blood pressure diagnosis is made. One elevated blood pressure reading doesn't necessarily mean you have high blood pressure, but it does warrant repeated measurements and means you have to watch your blood pressure carefully.

Dietary and lifestyle changes may help you control high blood pressure. If you have mild hypertension, you may be able to lower your blood pressure by reducing the amount of sodium (salt) in your diet, reducing fat intake, eating a diet high in fruits, vegetables and low-fat dairy (such as the DASH diet) and reducing alcohol consumption. If you are overweight, losing weight may reduce your blood pressure. Increasing your physical activity, even if you don't lose weight, can also reduce blood pressure.

For some people, lifestyle changes aren't enough to lower blood pressure. Luckily, high blood pressure can be successfully treated with long-term medication.

Commonly prescribed drugs include diuretics, beta blockers, angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin II receptor blockers (ARBs), direct renin inhibitors (DRIs), calcium channel blockers (CCBs), vasodilators, alpha-beta blockers, central-acting agents and alpha blockers. Because there is no cure for most hypertension cases, treatment generally must be carried out for life to prevent blood pressure from rising again.

Many of these drugs are also available to treat isolated systolic hypertension (ISH) to reduce your risk of coronary heart disease and stroke.

Causes of Hypertension

The 90 percent to 95 percent of hypertension cases in which the cause can't be determined are called essential or primary hypertension cases. Hypertension may also be a symptom of an identified problem (see below) that generally corrects itself when the cause is corrected. This type of high blood pressure is called secondary hypertension.

  • Renal artery stenosis (narrowing of the arteries leading to your kidneys)
  • Adrenal gland disease (Cushing's disease) or adrenal tumors
  • Kidney disease
  • Preeclampsia (hypertension and increased urine protein levels sometimes caused by pregnancy)
  • Thyroid disease

Other factors affecting blood pressure include:

  • Use of birth control pills
  • Psychologic stress
  • Severe pain
  • Drug or alcohol withdrawal
  • Use of amphetamines, cocaine or other stimulants
  • Use of steroids
  • Overuse of nicotine nasal sprays, gum, patches and lozenges designed to help smokers kick the habit
  • Sleep apnea

Your health care professional should monitor your blood pressure if you are taking oral contraceptives. Your blood pressure should also be carefully monitored if you're pregnant, because some women develop preeclampsia-related hypertension during pregnancy. One of the leading causes of maternal death, preeclampsia is hypertension combined with protein in the urine and/or swollen hands and feet. It typically occurs after the 20th week of pregnancy. It can lead to premature and low-birth–weight babies.

Diagnosis

Diagnosis

Your health care professional should check your blood pressure at least once every two years, and more often if it's high. A high blood pressure diagnosis is usually based on at least the average of two or more readings per visit, taken at two different visits after an initial screening.

The only way to properly check your blood pressure is to measure it with a device called a sphygmomanometer, commonly called a blood pressure cuff. This is a quick and painless test in which a rubber cuff is wrapped around your upper arm and inflated. As the cuff inflates, it compresses a large artery, stopping the blood's flow through that artery. When your health care professional releases the air in the cuff, he or she can listen with a stethoscope for the blood to start flowing through your artery again. Your health care professional can watch the sphygmomanometer gauge to determine systolic pressure—the pressure when the first sound of pulsing blood is heard—and the diastolic pressure, the pressure when the last sound of pulsing blood is heard.

In May 2003, the NHLBI released updated clinical practice guidelines for the prevention, detection and treatment of high blood pressure. These guidelines now cover new blood pressure categories, including a "prehypertension" level, which covers about 25 percent of Americans.

This prehypertension category alerts you to your real risk of high blood pressure. People with prehypertension are likely to develop hypertension over the next few years if they don''t get the condition under control. You don't need medication therapy, unless you have another condition like diabetes or chronic kidney disease. However, you should make any necessary lifestyle changes, such as losing excess weight, becoming physically active, limiting alcohol consumption and following a heart-healthy eating plan, including cutting back on salt and other forms of sodium, to reduce your blood pressure levels.

Blood pressure above 140 mm Hg systolic and/or 90 mm Hg diastolic is considered hypertensive. There are 2 stages of hypertension. Stage 1 hypertension is systolic blood pressure between 140 to 159 mm Hg and/or diastolic blood pressure 90 to 99 mm Hg. Stage 2 hypertension is blood pressure greater than 160 mm Hg systolic and/or 100 mm Hg diastolic. When systolic and diastolic pressures fall into different categories, your health care professional should select the higher category to classify your blood pressure. For example, 160/80 mm Hg would be considered stage 2 hypertension.

If you are hypertensive and have begun receiving initial medication therapy, you will probably need to return for follow-up and adjustment of medications once a month until your blood pressure goal is reached. More frequent visits may be necessary for those with stage 2 hypertension.

A small number of people experience "white coat hypertension," which is very elevated blood pressure when visiting their health care professional while blood pressure at home is normal. At home, you can check your blood pressure in a setting that's more comfortable for you to get a more accurate reading.

Home blood pressure monitoring also gives you the opportunity to measure your own blood pressure when your health care professional's office is not open. Inexpensive devices for home blood pressure monitoring are available at most pharmacies. Be sure to have your health care professional check your home blood pressure device when you start using it to make sure it's providing accurate readings.

Also, don't make any changes in your medication based on home blood pressure readings without first consulting your health care professional. Home blood pressure monitoring is an excellent adjunct to monitoring by your health care professional, but should it not be done in lieu of professional monitoring.

For many older Americans, only the systolic blood pressure is high, a condition known as "isolated systolic hypertension," or ISH (systolic at or above 140 mm Hg and diastolic under 90 mm Hg). Research finds that diastolic blood pressure rises until about age 55 and then declines, while systolic blood pressure increases steadily with age.

The systolic blood pressure is considered a more important number than the diastolic pressure when it comes to the diagnosis and treatment of hypertension, as well as in determining risk for heart disease and stroke.

In addition to taking blood pressure readings from both arms, your health care professional may conduct the following during a hypertension exam:

  • A complete medical history. Make sure you tell your doctor about any alternative medicines you're taking such as herbs, over-the-counter drugs and supplements. The American Heart Association notes that some may be life-threatening when combined with medicines to treat high blood pressure.

  • A physical examination. This includes checking your retinas and abdomen, listening to your lungs and heart, taking your pulse in several areas, including your feet, and looking for swelling in your ankles.

  • A urinalysis. The urine is tested for elevated protein, sugar, white blood cells or other abnormalities.

  • An electrocardiogram. Your health care professional will position a number of small contacts on your arms, legs and chest to connect them to an ECG machine. The results will be analyzed for any abnormalities indicating an enlarged heart or other abnormality.

  • A kidney profile. The blood is tested for abnormalities such as elevated creatinine.

  • A thyroid profile. The blood is tested for abnormalities such as an elevated level of thyroid hormone, and the thyroid gland is physically felt for enlargement.

Risk Factors for Hypertension

Although there are several risk factors for hypertension, family history is the primary one. High blood pressure tends to run in families.

African Americans and Hispanic Americans are more likely to develop high blood pressure than Caucasians. Studies find that having "Type A" qualities—being very driven, being a perfectionist who doesn't cope well with stress or know how to relax and having a quick temper—increases the risk of hypertension in men and may increase the risk for women.

Other risk factors for hypertension include:

  • Increasing age

  • Salt sensitivity

  • Obesity

  • Heavy alcohol consumption, defined as more than two drinks a day for men and more than one drink a day for women.

  • Use of oral contraceptives

  • An inactive lifestyle

  • Regular smoking or use of smokeless-tobacco, like snuff or chewing tobacco

  • High uric acid levels (anything over 7 mg/ml of blood)

Unfortunately, there is no proven method of preventing preeclampsia or pregnancy-induced hypertension and no tests to diagnose or predict these conditions. The only way to ensure a safe pregnancy is with regular visits to your health care professional for checks of the level of protein in your urine and your blood pressure.

You also should do everything you can on your own to prevent pregnancy-induced high blood pressure, including regular physical activity and limiting salt intake.

Treatment

Treatment

There are several drug classes to choose from when selecting a high blood pressure medication, including hundreds of single medications and combinations. Generally, all can lower your blood pressure, but often people respond differently to each drug.

You will probably have to try a few of them before finding the one that works the best for you with the fewest side effects.

The drug classes are:

  • Diuretics. Diuretics, which rid the body of excess fluids and salt, are the most frequently used drugs to treat high blood pressure. However, in large doses, some diuretics may deplete the body of potassium, which can lead to irregular heartbeat and reduce your glucose tolerance, which can cause diabetes. There are, however, potassium-sparing diuretics that don't cause this problem.

    Overall, diuretics are inexpensive and, in small doses, boost the effectiveness of many other antihypertensive drugs. National guidelines recommend that diuretics alone should be the first agent of choice provided you don't have any other conditions that prohibit their use. Some commonly prescribed drugs in this class include amiloride (Midamar), bumetanide (Bumex), chlorthalidone (Hygroton), chlorothiazide (Diuril), furosemide (Lasix), hydrochlorothiazide (Microzide, Esidrix, Hydrodiuril) and indapamide (Lozol).

  • Beta-blockers. These drugs reduce your heart rate and blood pressure and therefore your heart's output of blood. You should not be on one of these drugs if you already have a low heart rate, an airway disease such as asthma or peripheral vascular disease.

    Beta blockers can also mask hypoglycemia, or low blood sugar, so you should use with caution if you have diabetes and take insulin or sulfonylurea drugs.

    Common side effects include fatigue, breathlessness, depression and cold hands and feet. Other, milder side effects can include sleep problems and numbness or tingling of the toes, fingers or scalp. On the plus side, beta blockers can reduce your risk for second heart attack, irregular heartbeat, angina and migraines. Some commonly prescribed drugs in this class include atenolol (Tenormin), betaxolol (Kerlone), bisoprolol (Zebeta), carteolol (Cartrol), acebutolol (Sectral), metoprolol (Lopressor, Toprol-XL), nadolol (Corgard), propranolol (Inderal), sotolol (Betapace) and timolol (Blocadren).

  • Angiotensin-converting enzyme inhibitors (ACE inhibitors). These drugs interfere with the body's production of angiotensin II, a hormone that causes the arteries to constrict. The drugs enable muscles in your arteries to relax so they can open wider.

    The most common side effect is a dry, persistent cough. An added benefit of ACE inhibitors is that they slow the rate at which your kidneys deteriorate if you have diabetes-related kidney disease. For people with high blood pressure and diabetes or kidney disease, national guidelines recommend that initial drug treatments include ACE inhibitors. However, you should not be on ACE inhibitors if you are pregnant because they can cause life-threatening complications in the baby. Some commonly prescribe drugs in this class include captopril (Capoten), enalapril (Vasotec), lisinopril (Prinivel, Zestril), benazepril (Lotensin), fosinopril (Monopril), moexipril (Univasc), perindopril (Aceon), ramipril (Altace) and trandolapril (Mavik).

  • Angiotensin II receptor blockers. Angiotensin II receptor blockers work similarly to ACE inhibitors to block the hormone angiotensin II, which normally causes blood vessels to narrow. As a result, the blood vessels relax and become wider, causing blood pressure to go down. They're more effective if you also take a diuretic. These drugs do not cause any cough like ACE inhibitors. Some commonly prescribed drugs in this class are candesartan (Atacand), eprosartan (Teveten), irbesarten (Avapro), losartan (Cozaar), telmisartan (Micardis) and valsartan (Diovan).

  • Calcium channel blockers (calcium antagonists). Calcium channel blockers relax artery muscles and dilate coronary arteries and other arteries by blocking the transport of calcium into these structures, thus lowering blood pressure. There are two classes of calcium blockers: the dihydropyridines and the non-dihydropyridines:

    • Non-dihydropyridines. These drugs help reduce chest pain (angina) and heart-rhythm irregularities such as atrial fibrillation. Some commonly prescribed drugs in this class include verapamil (Isoptin, Verelan, Calan) and diltiazem (Cardizem).

    • Dihydropyridines. These drugs are also effective in treating patients with angina. They are sometimes used in treating systolic hypertension in elderly patients. Dihydropyridines generally have a weaker effect on the heart and some, such as amlodipine, take longer to work. But once they start working, they work well throughout the day, making them a good "once-a-day" drug. Some commonly prescribed drugs in this class include nifedipine (Adalat, Procardia and others), nicardipine (Cardene), isradipine (DynaCirc), amlodipine (Norvasc) and felodipine (Plendil).

      One dihydropyridine, fast-acting nifedipine, may increase your risk of heart attack when used for acute hypertension; therefore, nifedipine should only be used in the treatment of chronic high blood pressure. It is unclear whether other calcium channel blockers share this risk, so discuss this and other potential risks with your health care professional if you receive a prescription for a calcium channel blocker.

      Dihydropyridines also may cause ankle swelling, rapid heartbeat and headaches and may make you flush.

  • Alpha-blockers. These drugs work by relaxing certain muscles to help small vessels remain open. Alpha blockers work by stopping the hormone norepinephrine from constricting small arteries and veins, which improves blood flow and lowers blood pressure. Alpha blockers may increase your heart rate and can cause you to retain fluid, so they may be combined with diuretics or beta blockers. Other side effects include a drastic drop in blood pressure when you stand up—often seen after only one dose—and headache. However, some studies suggest alpha blockers have added benefits if you have high blood cholesterol levels or glucose intolerance. Some commonly prescribed drugs in this class include doxazosin (Cardura), prazosin (Minipress) and terazosin (Hytrin).

  • Alpha-beta blockers. Alpha-beta blockers reduce nerve impulses to blood vessels, thus decreasing vessel constriction, and they slow the heartbeat to reduce the amount of blood that must be pumped through the vessels. Some commonly prescribed alpha-beta blockers include caredilol (Coreg) and labetolol hydrochloride (Normodyne). Potential side effects of alpha-beta blockers include fatigue, decreased sex drive, anxiety and insomnia. More serious side effects include difficulty breathing, depression, feeling faint and swelling of the lips, tongue, throat or face.

  • Vasodilators. Vasodilators work to relax the muscles in the walls of the blood vessels, which helps the vessels widen. Some commonly prescribed vasodilators include hydralazine hydrochloride (Apresoline) and minoxidil (Loniten). More serious potential side effects of vasodilators include difficulty breathing; swelling in your face, throat, lips, tongue, feet or hands; and joint pain. Less serious side effects include nausea, vomiting, diarrhea, headache and anxiety.

  • Central-acting agents (or central agonists). These medications work by preventing your brain from telling your nervous system to increase your heart rate and narrow blood vessels. Some commonly prescribed drugs in this class include alpha methyldopa (Aldomet), clonidine hydrochloride (Catapres), guanabenz acetate (Wytensin) and guanfacine hydrochloride (Tenex). Potential side effects of central agonists include dizziness, dry mouth, nausea, vomiting and sleep problems. More serious side effects include allergic reaction, fast, pounding heart rate and confusion.

  • Direct renin inhibitors. Aliskiren (Tekturna) is the first drug in the class of renin inhibitors to be approved by the U.S. Food and Drug Administration (FDA) for the treatment of high blood pressure. Tekturna works by inhibiting renin, a kidney enzyme that helps regulate blood pressure. While other available blood pressure medications act at later stages of the blood pressure regulation process, Tekturna acts at the beginning. Side effects of Tekturna, which are usually mild, include diarrhea and in rare cases, allergic reactions. Tekturna should not be used in women who are pregnant.

Prevention

Prevention

Because we don't know the cause of most cases of high blood pressure, it's hard to say how to prevent it. However, diet and lifestyle changes can be key. You should consider these tips:

  • Increase the amount of exercise you get. Regular aerobic physical activity can enhance weight loss and reduce the risk for cardiovascular disease. You can reduce your blood pressure with moderately intense physical activity, such as a 30- to 60-minute brisk walk most days. If you have cardiac or other serious health issues, you should have a thorough medical evaluation, and perhaps have a cardiac stress test, before beginning any exercise program.

  • Lose weight. Losing just 10 pounds can help lower your blood pressure. Some obese people also have sleep apnea, in which they stop breathing dozens or hundreds of time a night, snore loudly and suffer from daytime sleepiness. Sleep apnea is linked with high blood pressure.

  • Reduce alcohol consumption. Most men with high blood pressure shouldn't drink more than two drinks per day, and women shouldn't have more than one alcoholic drink per day. A drink is equal to 12 ounces of beer, five ounces of wine or one and a half ounces of 80-proof liquor.

  • Reduce stress. When you relax, your heart rate slows, which reduces the amount of oxygen your body needs, reducing your pressure.

  • Quit smoking. Even more than lowering your blood pressure per se, it will reduce your overall cardiovascular disease risk more than any other single move.

  • Reduce your sodium intake. Salt can cause fluid retention so don't add salt to foods. Limit sodium intake to no more than 2,300 mg per day—the amount contained in one teaspoon of salt. Steer clear of processed foods (sauces, mixes and "instant" products such as flavored rice, cereals and pasta). A lower sodium level of 1,500 milligrams per day is recommended for people age 51 and older and anyone who is African American or who has high blood pressure, diabetes or chronic kidney disease. Get in the habit of checking labels for sodium content. If one portion has more than 300 mg, choose a lower-salt brand. Eat more vegetables that are fresh, frozen without sauce or canned with no salt. Salt substitutes may work for you, but check with your health care professional because they can be harmful if you have certain medical problems.

  • Increase dietary potassium. An analysis of several studies indicates that potassium can reduce blood pressure. Bananas are naturally high in potassium, and the mineral can also be purchased in supplement form. For people with blood pressure values above optimal levels, NHBPEP recommends increasing your dietary potassium intake to more than 3,500 mg per day—especially important if you have a high sodium intake. Increasing potassium intake is not recommend for patients with kidney disease. Ask you health care professional before increasing your potassium intake.

  • Eat a healthy diet. Aim for a diet rich in fruits, vegetables and low-fat dairy products, and low in saturated and total fat.

You can make all of your lifestyle changes at the same time. Studies find the best results come from adopting the DASH diet, which is rich in fruits, vegetables and low-fat dairy products.

Fish oil (omega-3 polyunsaturated fatty acids) and calcium supplements lower blood pressure only slightly in those with hypertension. Additionally, herbal and botanical supplements, which get very little scrutiny from the FDA, have not been proven to safely lower blood pressure and may, in fact, dangerously interact with some medications.

Finally, if you have high blood pressure, be sure to inform your health care professional about all medicines you are taking, including over-the-counter drugs. It is particularly important that you mention drugs such as steroids; nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen; nasal decongestants and other cold remedies; appetite suppressants; cyclosporine; erythropoietin; antidepressants; and monoamine oxidase (MAO) inhibitors.

You should take care when choosing over-the-counter drugs for colds. Many cold remedies contain decongestants that may raise your blood pressure. These medicines can also interfere with your blood pressure drug's effectiveness. Check with your health care professional before taking any over-the-counter drug if you have high blood pressure.

Facts to Know

Facts to Know

  1. About 76.4 million Americans have high blood pressure. It is a contributing factor in an estimated 326,000 deaths per year.

  2. More men than women have hypertension until women reach menopause, when a woman's risk becomes greater than a man's.

  3. About half of the 76.4 million Americans with high blood pressure are women, with the incidence becoming greater in women as they get older. About 30 percent of women have high blood pressure, and the risk is higher in older women and African American women.

  4. Your blood pressure consists of two numbers—the systolic pressure and the diastolic pressure. The higher number, the systolic pressure, represents the pressure while the heart is beating. The lower number, the diastolic pressure, represents the pressure when the heart is resting between beats.

  5. Blood pressure can fluctuate with eating, sleeping and changes in posture, but a normal blood pressure reading should be equal to or less than 119 mm Hg systolic and/or 79 mm Hg diastolic. Blood pressure between 120–139/80–89 is considered prehypertension and anything above this level (140/90) is considered hypertension or high blood pressure.

  6. If you have prehypertension, you are more likely to develop hypertension in the future and have increased risk factors for cardiovascular disease and other conditions related to hypertension. In fact, your risk of stroke triples if you have prehypertension.

  7. You may also have hypertension if either your systolic or your diastolic pressure is greater than or equal to 140 or 90 mm Hg, respectively. That is, you can have isolated systolic or diastolic hypertension. Isolated systolic hypertension is the most common form of high blood pressure in older Americans. The National Heart, Lung, and Blood Institute (NHLBI) estimates that 65 percent of people with hypertension over age 60 have ISH.

  8. Dietary and lifestyle changes may help you control high blood pressure. If you have mild hypertension, you may be able to lower your blood pressure by reducing the amount of sodium in your diet and cutting back on alcohol consumption. If you are overweight, losing weight will help, as will physical activity.

  9. Many people think high blood pressure is the result of lifestyle factors, such as stress, lack of exercise, drinking or smoking, but the cause of approximately 90 percent to 95 percent of all hypertension cases can't be determined.

  10. There is no cure for hypertension, but it is easily detected and usually controllable.

  11. Many people who suffer from high blood pressure don't know they have it because it usually produces no symptoms. And of those who have hypertension, less than half have the problem under control, defined as a level below 140/90 mm Hg.

  12. If left uncontrolled, high blood pressure can have very serious consequences. The condition can lead to stroke, heart attack, hardening of the arteries, congestive heart failure and/or kidney disease. In severe cases, it can lead to blindness.

  13. There are several drug classes—and hundreds of individual and combination medications—to choose from when treating high blood pressure. Generally, all can lower your blood pressure, but people often respond very differently to each drug, so you will probably have to try a few of them before finding the one that works best for you.

  14. Taking birth control pills has been linked with high blood pressure in women. The combination of birth control pills and smoking may be particularly dangerous. Ask your health care professional to take your blood pressure before you start taking the pill and have it checked every six months or so after you start taking it.

  15. If you already have high blood pressure and you get pregnant, your pregnancy could make the condition more severe, especially in the last three months. If it goes untreated, high blood pressure in pregnancy can be dangerous to both mother and baby. Therefore, health care professionals usually closely monitor blood pressure during pregnancy.

Questions to Ask

Questions to Ask

Review the following Questions to Ask about high blood pressure so you're prepared to discuss this important health issue with your health care professional.

  1. What does my blood pressure reading mean? Why are there two numbers and what do they measure?

  2. Do I have hypertension (high blood pressure)? Am I at risk for developing it? Why?

  3. Am I taking any medicines that could increase my blood pressure? Should I stop taking them?

  4. What are the possible consequences of hypertension? How can I limit my risk for hypertension and its complications?

  5. What medications are available to help me if I have hypertension? What are their benefits and side effects? Will these drugs interact with any other medications I am taking?

  6. What if I don't like or can't tolerate the side effects of my medication? Is it possible for me to switch to another one?

  7. My blood pressure is high, but I don't feel uncomfortable at all. Why not? Does this mean that my hypertension is not really harmful to me?

  8. I would never know I had hypertension except for the blood pressure readings. Should I keep taking my medication? Why?

  9. My blood pressure is only slightly above normal. Do I really have to do anything about it?

  10. Is there a cure for hypertension?

  11. How often should I have my blood pressure checked?

  12. Is it possible for me to lower my blood pressure by losing weight and living a healthy lifestyle? Is it possible for me eventually to lower it enough to stop taking medication?

Key Q&A

Key Q&A

  1. What exactly is hypertension?

    Hypertension is also called high blood pressure. Blood pressure is the pressure inside your arteries that harmlessly pushes the blood to your body's organs and muscles so they can receive the oxygen and nutrients they need. Blood pressure is variable-it rises and falls during the day. When blood pressure stays elevated over time, it is called high blood pressure or hypertension. A blood pressure reading at or above 140 systolic or 90 diastolic (presented 140/90 mm Hg) is considered hypertensive.

  2. What causes hypertension?

    No one knows for sure, although a number of factors are thought to contribute to it, such as family history. If you have two immediate family members who developed high blood pressure before age 60, you have two times the risk, and your risk goes up even further with each additional immediate family member with high blood pressure you have. Other risk factors include increasing age, salt sensitivity, obesity, heavy alcohol consumption, use of oral contraceptives, an inactive lifestyle, regular smoking or use of smokeless-tobacco (like snuff or chewing tobacco) and high uric acid levels.

  3. Are there different types of hypertension?

    Yes, there are two types of hypertension: Primary hypertension and secondary hypertension. Primary hypertension, the most common type, is also called essential hypertension. There is no known cause. About 5 percent to 10 percent of people with high blood pressure have it as a result of another condition or problem, such as such as kidney disease, or the use of certain medications, such as birth control pills. This is secondary hypertension.

  4. Can hypertension lead to other serious medical problems?

    Yes! All stages of hypertension are associated with risk of cardiovascular disease. Even slightly elevated blood pressure levels can double your risk for coronary heart disease. Consistent high blood pressure also increases your risk for congestive heart failure and can lead to other problems such as atherosclerosis, eye damage, heart enlargement or failure and kidney damage and failure.

  5. Who develops high blood pressure?

    African Americans and Hispanic Americans are more likely to develop high blood pressure than Caucasians. More men than women have hypertension until women reach menopause, when a woman's risk surpasses a man's.

  6. How often should I have my blood pressure checked?

    You should have your blood pressure checked whenever you see a health care professional-but every two years at the least.

  7. What can I do to prevent hypertension?

    Diet and lifestyle changes are key. You should increase your exercise, maintain a healthy weight and reduce alcohol consumption. Most men shouldn't drink more than two drinks per day and women shouldn't drink more than one drink per day. (One drink is defined as 12 ounces of beer, five ounces of wine or an ounce and a half of 80-proof liquor). You should also reduce your stress levels and lower your sodium intake, as well as follow a diet rich in fruits, vegetables and low-fat dairy products, and low in saturated and total fat.

  8. How is hypertension treated?

    Your health care professional has several drug classes from which to choose when selecting a hypertension drug for you. Generally, all can lower your blood pressure, but often people respond very differently to each drug. You will probably have to try out a few of them before finding the one that works the best for you, with the least amount of side effects.

Organizations and Support

Organizations and Support

For information and support on coping with Heart Disease, please see the recommended organizations, books and Spanish-language resources listed below.

American College of Cardiology (ACC)
Website: http://www.cardiosource.org
Address: Heart House
2400 N Street, NW
Washington, DC 20037
Hotline: 1-800-253-4636
Phone: 202-375-6000
Email: resource@acc.org

American Heart Association (AHA)
Website: http://www.americanheart.org
Address: 7272 Greenville Avenue
Dallas, TX 75231
Hotline: 1-800-AHA-USA-1 (1-800-242-8721)
Email: Review.personal.info@heart.org

American Society of Hypertension
Website: http://www.ash-us.org
Address: 148 Madison Avenue, Fifth Floor
New York, NY 10016
Phone: 212-696-9099
Email: ash@ash-us.org

International Society on Hypertension in Blacks
Website: http://www.ishib.org
Address: 157 Summit View Drive
McDonough, GA 30253
Phone: 404-880-0343
Email: inforequest@ishib.org

Medivizor
Website: https://medivizor.com

National Heart, Lung, and Blood Institute (NHLBI) - NHLBI Health Information Center
Website: http://www.nhlbi.nih.gov
Address: Attention: Website
P.O. Box 30105
Bethesda, MD 20824
Phone: 301-592-8573
Email: nhlbiinfo@nhlbi.nih.gov

National High Blood Pressure Education Program
Website: http://www.nhlbi.nih.gov/about/nhbpep
Address: NHLBI Health Information Center; Attn: Website
P.O. Box 30105
Bethesda, MD 20824
Phone: 301-592-8573
Email: nhlbiinfo@nhlbi.nih.gov

Pulmonary Hypertension Association
Website: http://www.phassociation.org
Address: 801 Roeder Road, Suite 400
Silver Spring, MD 20910
Hotline: 1-800-748-7274
Phone: 301-565-3004
Email: adrienne@phassociation.org

Sister to Sister: The Women's Heart Health Foundation
Website: http://www.sistertosister.org
Address: 4701 Willard Avenue, Suite 223
Chevy Chase, MD 20815
Hotline: 1-888-718-8033
Phone: 301-718-8033
Email: webmaster@sistertosister.org

WomenHeart: National Coalition for Women with Heart Disease
Website: http://www.womenheart.org
Address: 818 18th Street, NW, Suite 930
Washington, DC 20006
Hotline: 1-877-771-0030
Phone: 202-728-7199
Email: mail@womenheart.org

Women's Health Initiative (WHI)
Website: http://www.nhlbi.nih.gov/whi
Address: 2 Rockledge Centre
Suite 10018, MS 7936 6701 Rockledge Drive
Bethesda, MD 20892
Phone: 301-402-2900
Email: nihinfo@od31tm1.od.nih.gov

Women's Heart Foundation
Website: http://www.womensheart.org
Address: P.O. Box 7827
West Trenton, NJ 08628
Phone: 609-771-9600

Good News About High Blood Pressure: Everything You Need to Take Control of Hypertension...and Your Life
by Thomas Pickering

Healing Hypertension: Uncovering the Secret Power of Your Hidden Emotions
by Alan Rees

Heart of the Matter: The African American's Guide to Heart Disease, Heart Treatment, and Heart Wellness
by Hilton M. Hudson, Herbert Stern PhD

High Blood Pressure: Practical, Medical, & Spiritual Guidelines for Daily Living With Hypertension
by Mark Jenkins

High Blood Pressure: The Black Man and Woman's Guide to Living with Hypertension
by Hilton M. Hudson II MD FACS, James R. Reed

Mayo Clinic on High Blood Pressure
by Sheldon Sheps M.D.

American Heart Association
Website: http://esamericanheart.convertlanguage.com/presenter.jhtml?identifier=2114
Address: National Center Mailing Addresses
7272 Greenville Avenue
Dallas, TX 75231
Hotline: 1-800-AHA-USA1
Email: Review.personal.info@heart.org

MedlinePlus: Hypertension
Website: http://www.nlm.nih.gov/medlineplus/spanish/ency/article/000468.htm
Address: Customer Service
8600 Rockville Pike
Bethesda, MD 20894
Email: custserv@nlm.nih.gov

Last date updated: 
Mon, 2012-09-24

Shake the Salt Habit

foodToo much sodium can raise your blood pressure and contribute to developing or worsening hypertension (high blood pressure), the leading risk factor for cardiovascular disease. According to a June 2006 report from the American Medical Association (AMA), the higher your blood pressure, the greater your chances of suffering coronary heart disease, stroke, heart failure or kidney disease.

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Tuesday, Aug 25th 2009

Another Reason Not to Ignore High Blood Pressure

authored by Sheryl Kraft

Back in May, I wrote about my blood pressure, which started to climb (just like my mother's did) when I hit my 50s, despite a healthy diet and plenty of exercise.

Sometimes, heredity speaks louder than actions. Sigh.

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Friday, Jul 31st 2009

Five Big Health Stories You May Have Missed

authored by Sheryl Kraft

A lot is always developing and changing in the field of health -and in our everyday rushed lives, it's impossible to keep up with all the news. So, in my attempt to catch at least some of the most interesting events, here's a quickie of some of the latest.

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Monday, Jun 08th 2009

Pet a Dog. Lower Your Blood Pressure (and more).

authored by Sheryl Kraft

What did you do this past weekend? One of the highlights of my weekend was attending a dog show. After a week full of rain the sun finally came out here in Connecticut - and the weekend weather turned out to be absolutely perfect. But it wasn't only the sunshine that put me in such a good, relaxed mood. It was the dogs.

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Tuesday, May 12th 2009

Pass (On) The Salt!

authored by Sheryl Kraft

I used to think I was particularly sensitive to salt, since almost every time I ate out I had to send the food back because it was too salty (now when I order I say these three little words: "Hold the salt.")

Now I know it wasn't just me.

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Monday, May 11th 2009

A Diet That Does Double Duty

authored by Sheryl Kraft

When my formerly very low blood pressure started to climb a bit too high (just as my mother's did when she was in her 50s), my doctor recommended The DASH Diet. Now, this healthy diet has been found to also ward off another health risk.

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Tuesday, Dec 16th 2008

Low in Fat, High in Salt and Sugar?

authored by Kristen Mucci-Mosier


Are foods labeled "low-fat" really that good for you? When they come in the form of fruits and veggies, I say Mangia! But, it might be wise to take a closer look at the prepackaged items in your shopping cart. A recent report from Consumer Reports found that lower-fat foods can have pretty steep levels of sodium, including unlikely items such as Kellogg's Raisin Bran (350 mg a cup), Friendship 1% low-fat cottage cheese (360 mg), Twizzlers Black Licorice Twists (four have 200 mg), Aunt Jemima Original Pancake and Waffle Mix (200 mg a pancake), Heart Healthy V8 vegetable juice (480 mg) and even the Caesar salad from McDonald's has 890 mg of sodium.

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