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Is Treating High Blood Pressure with Diet and Exercise alone possible?

High Blood Pressure: The Silent Killer

Is Treating High Blood Pressure with Diet and Exercise alone possible?


Dr Lee Joon Loong

MBBS (Australia), EIMS-certified Primary Care Physician

Medical Director, Paddington Medical


Has your doctor told you that you have high blood pressure, also known as hypertension? Or are you just in denial? Cannot accept the fact that you possibly have a “chronic disease”? Did you know that hypertension can be a “silent killer” because you may not get any symptoms till it's too late?


Don’t worry, you are not alone. High blood pressure is the most common chronic medical problem in our clinic. 23.5% of Singaporean adults aged 18 to 69 years old have hypertension.


What is high blood pressure or hypertension?


Blood pressure in an adult fluctuates every second, but an average healthy adult should have a blood pressure of around 120/80 mmHg. Hypertension is defined as having a systolic blood pressure of more than 140mmHg and/or diastolic blood pressure of more than 90mmHg.

This means that on your blood pressure machine, the top number should not be more than 140 and the bottom number should not be more than 90. If this number is persistently high, you should be seeing your GP / Family Doctor to get a medical review.


Does the diagnosis of high blood pressure mean I need medications now?


So, now you must be worried about starting medications. Your main worry would be that your doctor would put you on lifelong medications. You are also concerned about medication side effects. Lastly, you are also worried about the ever increasing costs of healthcare too.


What if it’s possible to control your blood pressure with just lifestyle modifications alone? What if someone told you that if you changed your diet and did just a little bit more exercise, you won’t need to take any pills? Does this sound too good to be true?



Let’s talk about the benefits of exercise first. Does exercising lower my blood pressure?


Aerobic cardiovascular exercise in healthy adults has been found to lower the systolic blood pressure (top number on your BP machine) by 2 to 5 mmHg, and improve the diastolic blood pressure (bottom number on your BP machine) by 1 to 4 mmHg, regardless of the initial BP levels.


For people who have hypertension, exercise is shown to have lowered the blood pressure more, with a reduction of the systolic BP by 7.4mmHg and diastolic BP by 5.8 mmHg. One study even showed a persistent BP lowering effect up to 22 hours following the exercise session.


So the facts are clear, exercise is good for you! But you must be thinking now:



What kind of exercise is good? How much exercise to do per day, per week? I don’t have time to exercise, how?


Well, before starting any exercise session, please kindly visit your friendly neighborhood GP / Family Doctor for a full medical check up, to make sure you do not have any other hidden risk factors that you are not aware of.


Most people with hypertension may begin moderate-intensity aerobic exercise, except those with severely high blood pressure levels. It is recommended that people with hypertension undergo an exercise test supervised by a medical professional before engaging in moderate-intensity exercise.


So here are some general exercise principles based on Exercise is Medicine Singapore (EIMS) Guidelines using the FITT principles.


Frequency

At least 3 to 4 training sessions per week, daily exercise if possible.

Intensity

Moderate to vigorous intensity, which means you should not be able to speak in full sentences while exercising, alternatively if you wear a heart rate monitor, exercise within 64 to 75% of maximal heart rate (calculated using 220-age).


Time

30 to 60 minutes per session, with an average of at least 40 minutes per session.


Type

Any type of aerobic activity but choose an activity that you can sustain for 30 to 60 minutes. Examples include brisk walking, jogging, swimming and cycling.



Above exercise regimen sound too overwhelming? Can I start slow first?


Of course you should start slow, and increase slowly. After medical clearance with your friendly neighbourhood doctor, preferably one who is a certified EIMS Primary Care Physician, you should probably start with a low intensity form of aerobic exercise.


The caveat is to keep the number of sessions per week at a minimum of 3 sessions, with at least 30 min per session. Find a time to squeeze this workout in, whether it be lunch break, waking up 30 minutes earlier in the morning or setting aside the children’s post bed-time for a quick 30 minute work-out.


Don’t stress yourself out too much initially. Slowly build up your aerobic fitness over time. In about 2 to 3 weeks, you will definitely notice some improvement in your aerobic fitness, and that’s the time to start increasing your exercise intensity. As a side effect, you will probably feel better in general.


Now, let’s go on to diet modifications.


Diet, let’s all face it, is the most difficult to change or modify. I personally love my char kway teow, biryani, chicken rice, laksa, nasi lemak, beer and wine. How can I possibly tell my patients to cut out all these delicious foods? If I personally can’t cut these out from my diet, how can I possibly tell my patients to abstain from all these?


Pick a sustainable diet routine.


I find that the most successful patients who modified their diet are not those who go on faddish, unsustainable diets. These diets are probably sustainable for around 2 to 4 weeks, but beyond 8 weeks? If we can’t sustain the diet, how can we possibly expect the effects of these “good diets” to continue?


So what do we do then? My advice is simple. Get a healthy diet 80% or 90% of the week, and for 10% to 20% of the rest of the week, let’s enjoy our delicious food. But the caveat is, during the 80 to 90% of the time, we should be disciplined with our diet.


What is it in the diet that we should particularly look out for?


For hypertension in particular, one should pay attention to the amount of sodium (AKA salt) in our diet. The recommended daily sodium intake should be around 2300mg per day, but in reality, most of us are taking in excess of 3000mg per day. Excess sodium will stress our kidneys and lead to hypertension, or worsening it.


What exactly is 2300mg of sodium or 3000mg of sodium?


Just so that it is easy to visualise, char kway teow contains 1500mg of sodium while laksa with gravy contains 8000mg of sodium! So you can see, some common foods we love to eat are not as harmless as they appear!


Now, I’m not saying cut out these foods. What’s most important is that we recognise the amount of sodium in these foods and we eat these foods, 10 to 20% of the time. Here’s a quick guide to the sodium levels for some of the most well-loved local delicacies.



This is all too much for me to understand. Can someone break it down for me?


Consider seeing a nutritionist or a dietitian for a detailed breakdown of what types of food contain high sodium levels. The first time is to be aware, then the next step is to implement.


In addition, consider seeing a doctor who is EIMS - (Exercise is Medicine Singapore) trained, to firstly review any additional undiagnosed risk factors before secondly giving an exercise prescription, which is specifically tailored to your health and body.

In conclusion, I’m confident that if you have a good diet 80 to 90% of the time, coupled with at least 150 minutes of moderate to vigorous exercise a week, your blood pressure will be lowered. But if by some chance you still have slightly higher blood pressure than normal, please do visit your friendly neighbourhood doctor!


By Dr Lee Joon Loong

MBBS (Australia), EIMS-certified Primary Care Physician

Medical Director, Paddington Medical




References: Exercise is Medicine Singapore, Exercise Prescription Guide, Dr B Tan, Dr Ng CS, Dr I Lim, CGH (2015)