ecureme logo
  ecureme home ecureme log In Sign Up!
eCureMe Life : Your Healthy Living. Click Here!
Welcome, eCureMe.com medical contents search February 9, 2010
       eCureMe Life
       Medical Supplies
       Calorie Count
       Self-Diagnosis
       Physician Search
       Message Board
      E-mail Doctor
      E-mail Veterinarian
      Self-Diagnosis
      Health-O-Matic Meter
      Calorie Count
      Natural Medicine
      Vitamins & Minerals
      Alternative Living
      My Health Chart
      Diseases & Treatments
      Atlas of Diseases
      Sexually Transmitted
      Diseases
      Drug Information
      Illegal Drugs
      Lab & Diagnostic Tests
      Internal Medicine
      Women’s Health
      Pediatrics
      Eye Disorders
      Skin Disorders
      Headache
      Mental Health
      Radiology
      Neurology
      Allergy
      Resource Links
      Physician Directory
      Dentist Directory
      Hospital Directory






Healthy Living February Issue
ONE NATION UNDER PRESSURE


Some Causes Of High Blood Pressure

Arteries are muscular organs that can both contract and expand. Excessive contraction or stiffening of the artery walls raises blood pressure. Hormones can also raise blood pressure. Some organs such as the kidneys and adrenal glands are especially important to the hormonal regulation of our pressure. However, the major cause of high blood pressure is a less than optimal lifestyle. Most people have some tendency to high blood pressure; whether they develop the problem and how soon they do, is largely a function of their everyday decisions.

Of course, there are those unusual people who seem to be genetically immune to hypertension. You may know of someone who does everything wrong-but still has a normal blood pressure reading. Even if that person is a close relative, do not assume that you can beat the odds. There appears to be many genetic factors that have either a direct or indirect bearing on blood pressure. It is unlikely that your genetic makeup is identical to any relative in all of those respects.



High Blood Pressure and Decreased Mental Ability

Numerous studies have documented that high blood pressure that is not controlled by lifestyle frequently causes gradual mental decline. One recently published study showed that for every 10 mm of mercury increase in systolic blood pressure at midlife, there was a 9 percent increased risk of poor intellectual ability 25 years later.16



Quality Of Life Reduced by High Blood Pressure

The toll that high blood pressure takes on the kidneys reminds us that high blood pressure does more than kill. It robs us of quality of life. "Morbidity level" is a measure of the illnesses that cause suffering and detract from life’s quality. A study relating morbidity level to blood pressure is shown in Figure 5: High Blood Pressure and Morbidity.17

This figure demonstrates how rapidly morbidity increases once a person’s blood pressure creeps over that 120 level. It may not be surprising to see that those with a systolic blood pressure greater than 160 have four times the risk of morbidity as those with a systolic blood pressure of less than 120. The risk doubles even when you move from less than 120 into the 120 to 139 range. When one exceeds 140 systolic, the risk of morbidity is even greater. Over the 160 level, the risk dramatically rises and stays about the same in the greater than 180 category. This figure confirms that a desirable systolic blood pressure is less than 120.

Since there are benefits to having systolic blood pressures of 120 or lower, why do physicians tend to avoid prescribing medications that help patients drop their blood pressures from, say, 138 systolic to 118 systolic? The reason is that all high blood pressure drugs have side effects. When pressures are only mildly elevated above the ideal, the risk of taking a drug is generally greater than the benefit of further lowering the blood pressure.

Also, when dealing with the lower end of the spectrum of clear cut high blood pressure, there is no consensus on the benefits of long term drug treatment. One recent study dealt with "mild hypertensives," those with systolic blood pressures in the 140 to 159 range and diastolics in the 90 to 99 range. The researchers observed: "concerns have been raised regarding the appropriateness of long term drug therapy for mild hypertensives and there is interest in the possibility of treating these patients with nonpharmacologic therapyˇ¦ ."18 Thus, there are growing misconceptions-even in the medical community-about the wisdom of using drug therapy to treat "mild" high blood pressure. More are looking to the non-drug or lifestyle approaches.

Further complicating the picture are the subtle side effects of high blood pressure drugs on quality of life. In one study, physicians and patients consistently felt that quality of life had improved or stayed the same while on high blood pressure drugs. However, the closest relatives of the medication-treated patients had a different perspective: 99 percent of them were aware of important changes in their loved ones. Specifically they reported such problems as memory loss (33 percent), irritability (45 percent), depression (46 percent), and decreased sexual interest (64 percent).19



Specific Lifestyle Changes for Lowering Blood Pressure

The National Institute of Health sponsored a study that demonstrated the power of lifestyle changes to lower blood pressure. Over 900 subjects (men and women, black and white) with mild hypertension were enrolled in a lifestyle change program. Specifically, program participants initially had diastolic blood pressures in the 85-99 range (average 90.5). Systolic blood pressures averaged 140.4.26 Some of the subjects were put on a lifestyle change regimen, while the remaining ones were treated with a single blood pressure medication. The reductions in blood pressure for the group treated with lifestyle change alone are shown in Figure 7: Lifestyle Changes can Reduce Blood Pressure. As impressive as this data is, lifestyle changes of a greater magnitude than those in this study can yield even more impressive reductions in pressure. We will explore that evidence later.

Another study determined the effect of just two lifestyle factors on blood pressure.27 It involved over 30,000 men, ages 40 to 75, who were categorized as to the amount of fiber they ate and their degree of obesity. The results shown in Figure 8: High Blood Pressure Risk Affected by Diet and Obesity illustrates that obesity was the largest single factor affecting blood pressure.

Obesity appears to be one of the most important high blood pressure factors in America. In the famous Framingham study, fully 70 percent of hypertension in men and 61 percent in women was directly attributed to increased body fat.28

A third study involved 73 men and women with high blood pressure who attended a three week live-in program at Weimar Institute in California. Their average age was 65. They adopted a series of lifestyle changes during this supervised program and reaped large reductions in blood pressure. The results are shown in Figure 9: Large Blood Pressure Reductions with Lifestyle Changes.29

These blood pressure reductions are greater than the reductions in the first study; the reason is that more lifestyle factors were changed. Over 90 percent of the participants were on at least one medication to control their blood pressure when they enrolled in the program. That figure dropped to 20 percent after three weeks; even those remaining on medicine were able to significantly reduce their dosage.

The average effect of lifestyle changes in this study is greater than indicated in Figure 9: Large Blood Pressure Reductions with Lifestyle Changes. Two sets of changes were made simultaneously: changes in lifestyle and reductions in blood pressure medicine. However, reducing the medicine would normally produce an average increase in blood pressure, but the exact opposite occurred. Why? Because the lifestyle changes had such a powerful effect that they more than offset the blood pressure increase that would be caused by the reduction in medicine.

Another interesting result is that over half of the drop in blood pressure occurred in the first week. Blood pressure levels respond quickly to lifestyle changes.

The above studies are in harmony with many others. Collectively they firmly demonstrate that lifestyle change is a potent defense against high blood pressure, bringing quick and positive results. Fatalists take note: the myth that your genes entirely dictate your blood pressure level has been completely discredited.

So far, we have seen the effects of several lifestyle factors in combination. Are there any studies that show the effect of a single lifestyle factor on blood pressure? The answer is yes. The remainder of the chapter looks at research on individual lifestyle factors. SDietary Factors That Reduce Blood Pressure

The first lifestyle factor we will focus on is diet. What I advocate is called dietary therapy, a self-imposed treatment. Dietary therapy obviously involves what you put into your body in the form of food. There are many foods in the average diet that affect blood pressure. Some are helpful and some are harmful. If you want to lower your blood pressure, you will need to know which foods to eat more of and which ones to avoid. Diet, however, is not really a single factor. We eat many different foods, each of which are made up of combinations of nutritional components. We will look at each of several components that affect blood pressure.



Salt-A Major Culprit

Salt is the first component of the diet that we want to explore, because there is much evidence that it significantly raises blood pressure. The relationship between salt in the diet and blood pressure is listed in Figure 10: Salt Raises Blood Pressure.30 It is no exaggeration to say that salt is a major culprit in causing high blood pressure. For hypertensive patients, the greater the reduction in dietary salt, the greater the reduction in blood pressure. One basic cause of hypertension appears to be an inability of the kidney to eliminate an increased salt load. To excrete this excess salt, the body makes adjustments that boost the blood pressure, which then enables the kidney to eliminate the salt.31

Salt consists of two elements-sodium and chloride; it is 40 percent sodium. It is found in a majority of foods in the supermarket, and the amount per serving is listed (as sodium) on the container or package by law. Surprisingly, research suggests that it is actually the combination of sodium with chloride that does the damage.32 In animal studies on high blood pressure, neither excess sodium alone nor excess chloride alone causes high blood pressure.33 However, the labeling of sodium content usually provides the necessary information: sodium and chloride typically are found in roughly equal amounts in foods. Thus by limiting the sodium intake, we generally limit the chloride intake as well.

A study involved 20 high blood pressure patients who were taking no medication, but reduced their previously high sodium intake to less than 3000 mg a day.34 The resulting reduction in average blood pressure is outlined in Figure 11: Reduced Salt - Reduced Blood Pressure. This is a dramatic demonstration of the effect of changing just one item in the diet-salt. The average reduction was 19 mm systolic pressure and 14 mm diastolic after one year. We would expect further blood pressure reduction if the salt intake was further reduced.

I have treated many people in my practice that say, "I am already on a low salt diet," and they firmly believe it because they do not add salt at the meal table. Since the salt shaker sits unused on the table (or is removed completely), and they do not use a huge amount in cooking, they are confident that they are on a low salt diet.

At this point, I ask my high blood pressure patients to go through a little quiz that you might like to take regarding the salt content of some common foods. Do you know what foods are high in sodium content and what foods are low? The foods in Figure 12: Which Foods are Higher in Sodium? are shown in pairs for comparison.35

I ask the reader to make choices before reading further. Which has more sodium, a cup of corn chips or a cup of corn flakes? How about 1/4 cup of peanuts or a can of tomato soup? Or a bag of potato chips versus a cup of instant mashed potatoes? When you finish scanning the list, look at Figure 13: Sodium Content Comparison of Foods which lists the same foods along with the amounts of sodium. Notice that the foods with the highest sodium content are on the right. You may be surprised to see that a cup of tomato soup contains six times as much sodium as 1/4 cup of peanuts. Sauerkraut is not considered to be a low sodium food, but Egg McMuffin is twice as high. Cured ham is a high sodium food, but Chinese style rice has almost three times as much. Frozen peas have very low sodium, but canned peas are five times as high because salt is added in the processing.

The purpose of this little exercise is to encourage you to read labels when you shop for groceries. If you trust to guess work, you will likely often be wrong. We all need to be aware that there is a high amount of hidden sodium in certain foods.

What is the maximum safe intake of sodium? It depends on your circumstance, as shown in Figure 14: Sodium Intake Limits.36

Notice that the average American consumes 4000 mg per day, which is 16 times the minimum necessary level of 250 mg. It is commonly believed that only those who have hypertension, heart disease, or liver disease should limit their sodium intake, but that is not the case. A recent study showed that the higher the sodium intake the higher the risk of having a heart attack, whether or not the person had hypertension.37 The lowering of sodium to the recommended levels could reduce the mortality rate of stroke by 39 percent and heart attack by 30 percent according to a panel of blood pressure experts recently convened by the Columbia School of Public Health in New York.

In addition, a low sodium diet reduces the risk of some cancers, osteoporosis, and kidney stones as listed in Figure 15: Low Sodium Diet Reduces Risk.38

For example, eating more than 3 teaspoons (6.6 grams) of salt per day or eating pickled vegetables more than twice a month significantly increases the risk of stomach cancer.39,40 In addition, a recent large international study showed that if you have normal blood pressure you will reduce your risk of ever developing hypertension if you are already on a low sodium diet.41

If your diet is such that the daily intake of sodium totals up to less than the maximum safe amount, you may use some salt from the shaker. How much can you use? Actually very little. One teaspoon of salt contains roughly 2300 mg of sodium42 (compared to a limit of 2400 mg for a person with normal blood pressure). Therefore, even if the sodium content of your food is lower than the maximum for your condition, you could use very little additional salt from the shaker in cooking or at the table and still be safe.

It is obvious that these limits can be unwittingly exceeded. In our office we provide descriptions of diets containing one gram of sodium per day that can be easily followed. They are included for your use in Appendix V, entitled, "One Gram Sodium Diet". Sodium content of some additional foods is provided in Figure 16: Sodium Content of Selected Foods43 as additional help in controlling your sodium intake.

Notice that soy sauce is high in sodium, and dill pickles are even higher. Pickles in general are very high. Sauerkraut has the highest amount of sodium on the chart. You will find variations according to the brand, but all sauerkraut is high. On the other hand, salad dressings are usually low in sodium when used sparingly. Hot dogs and bologna are high, in the same range as dairy products. Canned soups and canned spaghetti sauce tend to be very high and should be used sparingly if at all. Some soups may be higher or lower than those stated. The point is that labels should be read before you buy. Approximately 80 percent of our salt intake comes from processed foods.44

What about restaurant food? There is much hidden sodium in food served by eating establishments. Restaurants compete with each other, and because Americans demand it, salt-flavored food appears to be essential to remaining competitive. Some restaurants, however, specialize in offering optional low salt meals to attract health minded customers. Prepared foods, whether they are found in the supermarket or the restaurant, are often dangerously high in sodium. The only protection we have is to read the labels (or get specific nutritional information, in the case of restaurants) so we can be aware of where hidden sodium exists.

Some people become discouraged at this point and wonder if there are any common foods that are very low in sodium. The answer is a resounding yes. Figure 17: Food Groups Low in Sodium, the final chart on sodium content, lists food groups that are extremely low in sodium.45

These foods have so little sodium that you can eat as much of them as you like without being concerned about exceeding the daily limit. Unsalted nuts are safe to eat; the added salt found in some processed nuts makes them high in sodium. Thus, we see that there are many foods that can be freely eaten without concern about their sodium content. Fruits provide a double benefit in that they are also high in potassium, which tends to reduce blood pressure even further. This is partially why a natural diet high in fruits, vegetables, and grains is the answer to the blood pressure problem.

Any food that is low in sodium can be made high, of course, by holding the salt shaker over it. Any person with high blood pressure should keep the salt shaker where it belongs-resting on the table, or better yet, hidden in the cupboard. Of course, if the prepared foods in your diet contain less sodium than the chart previously shown, you may add a little salt according to the formula previously given. In our house we keep the salt shaker in the cupboard, reserved for guests, even though no one in our family has a blood pressure problem.

A common reaction to the idea of reducing salt in the diet is, "I cannot eat food without the level of salt that I am accustomed to. There will be no taste to the food. I am hooked on salt." You may be surprised as to the changes that can occur in your taste buds with a little effort and patience.

My grandfather Nedley was told by his physician that he should reduce his salt intake because of high blood pressure. He was a heavy salt shaker user, and said that it was impossible for him to cut down. He argued that without his customary use of salt his food had no taste, and that he may as well eat salt and die, because life was not worth living if he could not enjoy his food. After he had a slight stroke, he immediately changed his stance-he took the salt out of his diet. My grandmother stopped cooking with salt, avoided prepared foods containing salt, and removed the salt shaker from the table. Grandpa complained bitterly that the taste of food had disappeared with the salt.

After a few weeks, however, his complaining faded away. One day Grandma mistakenly put a little salt in his mashed potatoes. He took one bite, pushed them away, and said, "I can’t eat it. All I can taste is salt." His salt addiction was gone. The food additive that he once was addicted to he now loathed. Most of my patients that have undergone a similar experience with a certain food (loathing what was once enjoyed) state that it may take up to four months after the decided dietary change is strictly adhered to before this advantageous change in taste occurs.

What about salt substitutes? The early versions had an unpleasant bitter, metallic taste that few could tolerate. Cardia Salt is one brand name that corrects the flavor problem. It contains potassium, magnesium, and only half the sodium of regular table salt. Preliminary studies of 40 men and women show that replacing regular table salt with Cardia Salt lowered blood pressure an average of 13 mm diastolic pressure and 8 mm systolic pressure in six months. Other studies have shown similar results.46

Salt substitutes have three drawbacks. The main one is that they only correct part of the sodium problem-the amount of sodium added with the salt shaker. Processed foods such as soups, dairy products, and others listed in the preceding charts will remain as high sources of sodium in the diet. The second drawback is that some people with renal failure or on certain blood pressure medicine (such as Capoten and other ACE inhibitors) will dangerously elevate their serum potassium by consuming salt substitutes and risk sudden cardiac death. The third drawback is that they increase the desire for the "real thing," and the victory that my grandfather obtained becomes elusive.



Monosodium Glutamate Not a Problem

What about another source of sodium, monosodium glutamate? This chemical has been labeled as a hidden substance that is undermining our health. It is commonly found in food served in Chinese restaurants, and is an additive present in some foods that we buy in the supermarket. It has been blamed for causing sweating and many other bizarre symptoms in some people.

Be aware of an important and basic fact regarding monosodium glutamate (MSG)-it is not a substance that is foreign to the body. It is a combination of two natural substances: sodium and glutamic acid. Glutamic acid is one of 20 amino acids naturally present in the body, and is necessary for normal body functions.

As a result of the many complaints against MSG, it has been the subject of many studies, with surprising results. The studies have all been consistent in proving that MSG is not a problem. The results of one of the studies are shown in Figure 18: MSG not a Problem in Restaurants.47 If there is a "Chinese Restaurant Syndrome," it does not appear to be related to monosodium glutamate. It may be related to something else that is in the food. Since sodium apart from chloride is not as harmful as sodium chloride with respect to blood pressure, MSG would not be expected to raise one’s pressure. In fact, studies show that blood pressure is actually lowered somewhat by consuming MSG.48

What about sea salt? Is it less damaging than "regular" salt? No, it has the same sodium and the same chloride. Sea salt will tend to raise your blood pressure just as much as regular salt. Granted, there may be some trace amounts of additional nutrients in sea salt that could be helpful to other body functions; nonetheless, it will do as much damage to your blood pressure as regular salt.



Losing Weight

For individuals who are overweight, initiating a weight loss program can significantly lower the blood pressure. The blood pressure will usually drop as much as a low salt diet will drop it.49 The hypertensive patient does not need to reach optimum weight for a drop in blood pressure to occur. Just initiating a weight loss program and shedding about 5 pounds will bring the blood pressure down substantially in most cases. In order for the effect to be maintained, however, the individual needs to stay on the weight loss program until ideal weight is achieved. A simple four-step plan is prescribed for most of my overweight patients to achieve their desired weight.
  1. No snacks. Drink only water between meals.
  2. Eat a good breakfast and a moderate lunch. Eliminate the evening meal. If something "must" be eaten in the evening, whole fruit is all that is allowable.
  3. Eliminate or at least greatly reduce refined sugar and free fats or fatty foods in the diet, while emphasizing foods high in fiber.
  4. Daily moderate exercise for approximately 45 minutes a day.
Virtually all of my patients that stick to this simple program achieve lasting weight loss.



Oatmeal Helps

A common breakfast food, oatmeal, has been found to reduce blood pressure. In one study, 850 people were categorized for the amount of oatmeal they consumed. One-bowl-per-day users had lower blood pressure and lower cholesterol.53 The effect was independent of age, weight, and intake of sodium, potassium, and alcohol.

The conclusion is that people who are trying to control their blood pressure naturally may get an unexpected benefit from eating a bowl of oatmeal each day. Thus oatmeal offers a double benefit for our hearts. Most of us have known for some time that oatmeal helps to lower blood cholesterol levels because it is rich in water-soluble fiber. The information on blood pressure provides an additional endorsement for this versatile grain.



Summary

In this chapter on hypertension, we have looked at a number of key facts. Some of the most important points are listed below:
  1. High blood pressure is dangerous to your health; it is the cause of many debilitating and fatal diseases.
  2. An optimal blood pressure will not exceed 120/80 at rest.
  3. The majority of those with high blood pressure can bring it under control by natural means, that is, by lifestyle changes.
  4. Making changes in lifestyle is the best and safest approach to reducing blood pressure, as opposed to taking drugs.
If you want to use lifestyle to lower your blood pressure, you will want to make the following changes:
  1. Eat plenty of fruits, vegetables, grains, and unsalted nuts in moderation, and other low sodium foods.
  2. Avoid foods such as dill pickles, cured ham, Chinese rice, bouillon, and other high sodium foods. Read the labels.
  3. Avoid low fiber foods such as meat and dairy products.
  4. Eliminate coffee, cola drinks, and alcohol from the diet.
  5. Stop smoking.
  6. Keep the salt shaker at rest.
  7. Bring your weight down to the recommended level for your height and build.
  8. Adopt an aerobic exercise routine, such as brisk walking.
  9. Learn to cope with stress.
With the above changes in lifestyle, you have a very good chance of reducing your blood pressure to a normal level and keeping it there without the need for medication.

Take the time now to make sure your blood pressure is in the ideal range. If it is not, do not put off those simple lifestyle changes. None of us like to change our lifestyle at first, but any one can develop new enjoyments for new ways of living. Beyond that, the lifestyle changes we have discussed are small compared to the lifestyle changes you may have to make as a stroke or heart attack victim. And the diet that a kidney failure patient is on is much more difficult to adjust to than a pure vegetarian diet. It also lacks the rich variety of the vegetarian diet and is much less satisfying.

Yes, you may be one of the lucky ones who, like my grandfather, received a "wake up call" before it was too late to change. But you may not be so fortunate. The nursing homes and cemeteries of our nation are filled with many people who just had "a little high blood pressure."



References

  1. Klag, MJ, Whelton, PK, et al. Blood Pressure and End-stage Renal Disease in Men. N Engl J Med 1996 Jan 4;334(1):13-18.
  2. The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC V). Arch Intern Med 1993 Jan 25;153(2):154-183.
  3. The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC V). Arch Intern Med 1993 Jan 25;153(2):154-183.
  4. MacMahon S, Peto R, et al. Blood pressure, stroke, and coronary heart disease. Part 1, Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 1990 Mar 31;335(8692):765-774.
  5. The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC V). Arch Intern Med 1993 Jan 25;153(2):154-183.
  6. The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC V). Arch Intern Med 1993 Jan 25;153(2):154-183.
  7. The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC V). Arch Intern Med 1993 Jan 25;153(2):154-183.
  8. Kaplan NM. Hypertension in the Population at Large. In: Clinical Hypertension-6th edition. Baltimore, MD: Williams and Wilkins, 1994 p. 1-22.
  9. Weinberger MH. Systemic hypertension. In: Kelley WN, DeVita VT Jr., editors, et al. Textbook of Internal Medicine-2nd edition. Philadelphia, PA: JP. Lippcott Company, 1992 p. 236-237.
  10. Launer LJ, Masaki K, et al. The association between midlife blood pressure levels and late-life cognitive function. The Honolulu-Asia Aging Study. JAMA 1995 Dec 20;274(23):1846-1851.
  11. Hancock WE. Coronary Artery Disease: Epidemiology And Prevention, 1991. In Scientific American Medicine (CD ROM), 1995.
  12. Isselbacher KJ, Braunwald E, editors, et al. Atherosclerosis and Other Forms of Arteriosclerosis. In: Harrison’s Principles of Internal Medicine-13th edition (CD-ROM). New York, NY: McGRAW-HILL, Inc. Health Professions Division, 1994 p. 1113-1119.
  13. National High Blood Pressure Education Program Working Group report on primary prevention of hypertension. Arch Intern Med 1993 Jan 25;153(2):186-208.
  14. Kaplan NM. Hypertension in the Population at Large. In: Clinical Hypertension-6th edition. Baltimore, MD: Williams and Wilkins, 1994 p. 1-22.
  15. Klag, MJ, Whelton, PK, et al. Blood Pressure and End-stage Renal Disease in Men. N Engl J Med 1996 Jan 4;334(1):13-18.
  16. Launer LJ, Masaki K, et al. The association between midlife blood pressure levels and late-life cognitive function. The Honolulu-Asia Aging Study. JAMA 1995 Dec 20;274(23):1846-1851.
  17. McGee D. The Framingham Study: An Epidemiological Investigation of Cardiovascular Disease, Section 28. U.S. Department Health Education and Welfare, DHEW Publication No. 79-618. 1973.
  18. Elmer PJ, Grimm R Jr, et al. Lifestyle intervention: results of the Treatment of Mild Hypertension Study (TOMHS). Prev Med 1995 Jul;24(4):378-388.
  19. Jachuck SJ , Brierley H , et al. The effect of hypotensive drugs on the quality of life. J R Coll Gen Pract 1982 Feb;32(235):103-105.
  20. 1995 Statement From the National High Blood Pressure Education Program Coordinating Committee. Bethesda, MD: National High Blood Pressure Education Program.
  21. Weinberger MH. Systemic Hypertension. In Kelley WN, DeVita VT, editors, et al. Textbook of Internal Medicine. Philadelphia, PA: J.P. Lippcott Co., 1992 p. 238.
  22. Jachuck SJ , Brierley H , et al. The effect of hypotensive drugs on the quality of life. J R Coll Gen Pract 1982 Feb;32(235):103-105.
  23. van Swieten JC, Geyskes GG, et al. Hypertension in the elderly is associated with white matter lesions and cognitive decline. Ann Neurol 1991 Dec;30(6):825-830.
  24. The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC V). Arch Intern Med 1993 Jan 25;153(2):154-183.
  25. Kaplan NM. Hypertension in the Population at Large. In: Clinical Hypertension-6th edition. Baltimore, MD: Williams and Wilkins, 1994 p. 1-22.
  26. Elmer PJ, Grimm R Jr, et al. Lifestyle intervention: results of the Treatment of Mild Hypertension Study (TOMHS). Prev Med 1995 Jul;24(4):378-388.
  27. Ascherio A, Rimm EB, et al. A prospective study of nutritional factors and hypertension among US men. Circulation 1992 Nov;86(5):1475-1484.
  28. Kannel WB, Garrison RJ, Dannenberg AL. Secular blood pressure trends in normotensive persons: the Framingham Study. Am Heart J 1993 Apr;125(4):1154-1158.
  29. Crane MG, Diehl H, et al. Effect of Lifestyle Modification on Hypertension. Submitted for publication 1996.
  30. Freis ED. The role of salt in hypertension. Blood Press 1992 Dec;1(4):196-200.
  31. Freis ED. The role of salt in hypertension. Blood Press 1992 Dec;1(4):196-200.
  32. Kaplan NM. Primary Hypertension: Pathogenesis. In: Clinical Hypertension-6th edition. Baltimore, MD: Williams and Wilkins, 1994 p. 55.
  33. Kaplan NM. Primary Hypertension: Pathogenesis. In: Clinical Hypertension-6th edition. Baltimore, MD: Williams and Wilkins, 1994 p. 55.
  34. MacGregor GA, Markandu ND, et al. Double-blind study of three sodium intakes and long-term effects of sodium restriction in essential hypertension. Lancet 1989 Nov 25;2(8674):1244-1247.
  35. The Food Processor for Windows: Nutrition Analysis & Fitness Software [computer program]. ESHA Research. Salem, Oregon.
  36. Adapted from: Statement From the National High Blood Pressure Education Program Coordinating Committee. Bethesda, MD: National High Blood Pressure Education Program, 1995.
  37. Alderman MH, Madhavan S, et al. Low urinary sodium is associated with greater risk of myocardial infarction among treated hypertensive men. Hypertension 1995 Jun;25(6):1144-1152.
  38. Antonios TF, MacGregor GA. Salt intake: potential deleterious effects excluding blood pressure. J Hum Hypertens 1995 Jun;9(6):511-515.
  39. Chang-Claude J, Raedsch R, et al. Prevalence of Helicobacter pylori infection and gastritis among young adults in China. Eur J Cancer Prev 1995 Feb;4(1):73-79.
  40. Nazario CM, Szklo M, et al. Salt and gastric cancer: a case-control study in Puerto Rico. Int J Epidemiol 1993 Oct;22(5):790-797.
  41. Elliot P, Stamler J, et al. Intersalt revisited: further analyses of 24 hour sodium excretion and blood pressure within and across populations. Intersalt Cooperative Research Group. BMJ 1996 May 18;312(7041):1249-1253.
  42. The Food Processor for Windows: Nutrition Analysis & Fitness Software [computer program]. ESHA Research. Salem, Oregon.
  43. The Food Processor for Windows: Nutrition Analysis & Fitness Software [computer program]. ESHA Research. Salem, Oregon.
  44. Statement From the National High Blood Pressure Education Program Coordinating Committee. Bethesda, MD: National High Blood Pressure Education Program, 1995.
  45. The Food Processor for Windows: Nutrition Analysis & Fitness Software [computer program]. ESHA Research. Salem, Oregon.
  46. Neutel J. Replacing regular salt with a reduced sodium salt containing potassium and magnesium may offer a non-pharmacal approach to lowering blood pressure. Circulation 1996;94(8 supp):341.
  47. Tarasoff L, Kelly MF. Monosodium L-glutamate: a double-blind study and review. Food Chem Toxicol 1993 Dec;31(12):1019-1035.
  48. Corr"ea FM, Saavedra JM. Chemical lesion of the circumventricular organs with monosodium glutamate reduces the blood pressure of spontaneously hypertensive but not of one kidney-one clip hypertensive rats. Braz J Med Biol Res 1992;25(5):515-519.
  49. Effects of weight loss and sodium reduction intervention on blood pressure and hypertension incidence in overweight people with high-normal blood pressure. The Trials of Hypertension Prevention, phase II. The Trials of Hypertension Prevention Collaborative Research Group. Arch Intern Med 1997 Mar 24;157(6):657-667.
  50. Sung BH, Whitsett TL, et al. Prolonged increase in blood pressure by a single oral dose of caffeine in mildly hypertensive men. Am J Hypertens 1994 Aug;7(8):755-758.
  51. Sung BH , Lovallo WR , et al. Caffeine elevates blood pressure response to exercise in mild hypertensive men. Am J Hypertens 1995 Dec;8(12 Pt 1):1184-1188.
  52. Wakabayashi K, Nakamura K, et al. Alcohol consumption and blood pressure: an extended study of self-defence officials in Japan. Int J Epidemiol 1994 Apr;23(2):307-311.
  53. He J, Klag MJ, et al. Oats and buckwheat intakes and cardiovascular disease risk factors in an ethnic minority of China. Am J Clin Nutr 1995 Feb;61(2):366-372.
  54. Sleight P. Smoking and hypertension. Clin Exp Hypertens 1993 Nov;15(6):1181-1192.
  55. Kaplan NM. Measurement of Blood Pressure. In: Clinical Hypertension-6th edition. Baltimore, MD: Williams and Wilkins, 1994 p. 23-45.
  56. Kaplan NM. Measurement of Blood Pressure. In: Clinical Hypertension-6th edition. Baltimore, MD: Williams and Wilkins, 1994 p. 30.
  57. Boone JL. Stress and hypertension. Prim Care 1991 Sep;18(3):623-649.
  58. Yoshiuchi K, Nomura S, et al. Hemodynamic and endocrine responsiveness to mental arithmetic task and mirror drawing test in patients with essential hypertension. Am J Hypertens 1997 Mar;10(3):243-249.
  59. Kokkinos PF, Narayan P, et al. Effects of regular exercise on blood pressure and left ventricular hypertrophy in African-American men with severe hypertension. N Engl J Med 1995 Nov 30;333(22):1462-1467.
  60. Bou-Holaigah I, Rowe PC, et al. The relationship between neurally mediated hypotension and the chronic fatigue syndrome. JAMA 1995 Sep 27;274(12):961-967.



Go to Alternative Living Index Page






 
medical contents search

Home   |   About Us   |   Contact Us   |   Employment Ad   |   Help

Terms and Conditions under which this service is provided to you. Read our Privacy Policy.
Copyright © 2002 - 2003 eCureMe, Inc All right reserved.