1 Y O U R G U I D E T O. Lowering Your Blood Pressure With DASH. DEPARTMENT OF HEALTH AND HUMAN SERVICES. National Institutes of Health National Heart, Lung, and Blood Institute YOUR Guide TO. Lowering Your Blood Pressure With DASH. DEPARTMENT OF HEALTH AND HUMAN SERVICES. National Institutes of Health National Heart, Lung, and Blood Institute NIH Publication No. 06-4082. Originally Printed 1998. Revised April 2006. Contents Introduction .. 1. What Is High Blood Pressure ?.. 3. What Is the DASH Eating Plan? .. 5. How Do I Make the DASH? .. 7. How Can I Get Started on the DASH Eating Plan?.. 23. A Week With the DASH Eating Plan.. 29. Recipes for Heart Health .. 45. To Learn More .. 55. Contents iv RICARDO ELEY. My doctor noticed my Blood Pressure was a little high. I try to be more aware of the foods I eat. I limit alcohol, and watch my portions. I also work out 5 7 days a week. My son is learning from me and is doing the same things I do.
2 1. Introduction What you choose to eat affects your chances of developing high Blood Pressure , or hypertension (the medical term). Recent studies show that Blood Pressure can be lowered by following the Dietary Approaches to Stop Hypertension (DASH) eating plan and by eating less salt, also called sodium. While each step alone lowers Blood Pressure , the combination of the eating plan and a reduced sodium intake gives the biggest benefit and may help prevent the development of high Blood Pressure . This booklet, based on the DASH research findings, tells how to follow the DASH eating plan and reduce the amount of sodium you consume. It offers tips on how to start and stay on the eating plan, as well as a week of menus and some recipes. The menus and recipes are given for two levels of daily sodium consumption . 2,300 and 1,500 milligrams per day. Twenty-three hundred milligrams is the highest level considered acceptable by the National High Blood Pressure Education Program.
3 It is also the highest amount recommended for healthy Americans by the 2005 Dietary Guidelines for Americans. The 1,500 milligram level can lower Blood Pressure further and more recently is the amount recommended by the Institute of Medicine as an adequate intake level and one that most people should try to achieve. The lower your salt intake is, the lower your Blood Pressure . Studies have found that the DASH menus containing 2,300 mil- ligrams of sodium can lower Blood Pressure and that an even lower level of sodium, 1,500 milligrams, can further reduce Blood Pressure . All the menus are lower in sodium than what adults in the United States currently eat about 4,200 milligrams per day in men and 3,300 milligrams per day in women. Introduction Those with high Blood Pressure and prehypertension may benefit especially from following the DASH eating plan and reducing their sodium intake. 2. L I L LY KRAMER.
4 My family's food choices have always been pretty good. We eat a lot of fruit, vegetables, and low-fat yogurt.. Your Guide to Lowering Your Blood Pressure With DASH. 3. What Is High Blood Pressure ? Blood Pressure is the force of Blood against artery walls. It is measured in millimeters of mercury (mmHg) and recorded as two numbers systolic Pressure (when the heart beats) over diastolic Pressure (when the heart relaxes between beats). Both numbers are important. (See box 1 on page 4.). Blood Pressure rises and falls during the day. But when it stays elevated over time, then it's called high Blood Pressure . High Blood Pressure is dangerous because it makes the heart work too hard, and the high force of the Blood flow can harm arteries and organs such as the heart, kidneys, brain, and eyes. High Blood Pressure often has no warning signs or symptoms. Once it occurs, it usually lasts a lifetime. If uncontrolled, it can lead to heart and kidney disease, stroke, and blindness.
5 High Blood Pressure affects more than 65 million or 1 in 3 . American adults. About 28 percent of American adults ages 18 and older, or about 59 million people, have prehypertension, a condition that also increases the chance of heart disease and stroke. High Blood Pressure is especially common among African Americans, who tend to develop it at an earlier age and more often than Whites. It is also common among older Americans individuals with normal Blood Pressure at age 55 have a 90 percent lifetime risk for develop- ing high Blood Pressure . High Blood Pressure can be controlled if you take these steps: Maintain a healthy weight. What Is High Blood Pressure ? . Be moderately physically active on most days of the week. Follow a healthy eating plan, which includes foods lower in sodium. If you drink alcoholic beverages, do so in moderation. If you have high Blood Pressure and are prescribed medication, take it as directed.
6 All steps but the last also help to prevent high Blood Pressure . 4. B O X 1. Blood Pressure Levels for Adults*. Systolic Diastolic . Category (mmHg) (mmHg) Result Normal Less than 120 and Less than 80 Good for you! Prehypertension 120 139 or 80 89 Your Blood pres- sure could be a problem. Make changes in what you eat and drink, be physically active, and lose extra weight. If you also have diabetes, see your doctor. Hypertension 140 or higher or 90 or higher You have high Blood Pressure . Ask your doctor or nurse how to control it. * For adults ages 18 and older who are not on medicine for high Blood Pressure and do not have a short-term serious illness. Source: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Your Guide to Lowering Your Blood Pressure With DASH. Blood Pressure ; NIH Publication No. 03-5230, National High Blood Pressure Education Program, May 2003.
7 If systolic and diastolic pressures fall into different categories, overall status is the higher category. Millimeters of mercury. 5. What Is the DASH Eating Plan? Blood Pressure can be unhealthy even if it stays only slightly above the normal level of less than 120/80 mmHg. The more your Blood Pressure rises above normal, the greater the health risk. Scientists supported by the National Heart, Lung, and Blood Institute (NHLBI) conducted two key studies. Their findings showed that Blood pressures were reduced with an eating plan that is low in saturated fat, cholesterol, and total fat and that emphasizes fruits, vegetables, and fat-free or low-fat milk and milk products. This eating plan known as the DASH eating plan also includes whole grain products, fish, poultry, and nuts. It is reduced in lean red meat, sweets, added sugars, and sugar-containing beverages compared to the typical American diet. It is rich in potassium, magnesium, and calcium, as well as protein and fiber.
8 (See box 2. for the DASH studies' daily nutrient goals.). B O X 2. Daily Nutrient Goals Used in the DASH Studies (for a 2,100 Calorie Eating Plan). Total fat 27% of calories Sodium 2,300 mg*. Saturated fat 6% of calories Potassium 4,700 mg What Is the DASH Eating Plan? Protein 18% of calories Calcium 1,250 mg Carbohydrate 55% of calories Magnesium 500 mg Cholesterol 150 mg Fiber 30 g * 1,500 mg sodium was a lower goal tested and found to be even better for Lowering Blood Pressure . It was particularly effective for middle-aged and older individuals, African Americans, and those who already had high Blood Pressure . g = grams; mg = milligrams 6. The DASH eating plan follows heart healthy guidelines to limit saturated fat and cholesterol. It focuses on increasing intake of foods rich in nutrients that are expected to lower Blood Pressure , mainly minerals (like potassium, calcium, and magnesium), protein, and fiber.
9 It includes nutrient-rich foods so that it meets other nutrient requirements as recommended by the Institute of Medicine. The first DASH study involved 459 adults with systolic Blood pressures of less than 160 mmHg and diastolic pressures of 80 95. mmHg. About 27 percent of the participants had high Blood Pressure . About 50 percent were women and 60 percent were African Americans. It compared three eating plans: a plan that includes foods similar to what many Americans regularly eat; a plan that includes foods similar to what many Americans regularly eat plus more fruits and vegetables; and the DASH eating plan. All three plans included about 3,000 milligrams of sodium daily. None of the plans was vegetarian or used specialty foods. Results were dramatic. Participants who followed both the plan that included more fruits and vegetables and the DASH eating plan had reduced Blood Pressure . But the DASH eating plan had the Who Helped With DASH?
10 The DASH studies were sponsored by the NHLBI and conducted Your Guide to Lowering Your Blood Pressure With DASH. at four medical centers. There was also a central coordinating center at Kaiser Permanente Center for Health Research in Portland, OR. The four medical centers were: Brigham and Women's Hospital, Boston, MA; Duke Hypertension Center and the Sarah W. Stedman Nutrition and Metabolism Center, Durham, NC;. Johns Hopkins Medical Institutions, Baltimore, MD; and Pennington Biomedical Research Center, Baton Rouge, LA. 7. greatest effect, especially for those with high Blood Pressure . Furthermore, the Blood Pressure reductions came fast within 2 weeks of starting the plan. The second DASH study looked at the effect on Blood Pressure of a reduced dietary sodium intake as participants followed either the DASH eating plan or an eating plan typical of what many Americans consume. This second study involved 412 participants.