Rapid dose titration is said to lower blood pressure better than using the traditional method of adjusting dosage over several months. The dosage adjustment is made at a hypertension clinic where the patient is seen for 3–4 days. Home BP measurement is an important part of the treatment plan.

If those three words describe your personality, you may have more of a problem than just the lack of friends. Researchers at Arizona State University in Tempe have proven that people with hostile dispositions also have greater increases in diastolic blood pressure (the second number in a blood pressure reading).

A higher diastolic pressure means that the vessels in the body are under increased pressure even when the heart is between beats, a situation than can contribute to heart disease and stroke.

At the beginning of the study, the researchers designated 80 males and females as either high or low in hostility after taking a test measuring their suspiciousness, cynicism, mistrust, and resentment. Then each volunteer participated in a one-on-one discussion of capital punishment with a person who was trained to remain calm while presenting a point-of-view that disagreed with the volunteer’s.

The blood pressure of those who had been categorized as high-hostile began rising even before the conversation started, and they continued to have higher blood pressure readings than those categorized as low-hostile. This could mean, according to researchers, that people with hostile attitudes have high levels of mistrust and anticipate trouble in interpersonal relationships—even before they have proof that there is reason for suspicion.

Another factor that raised blood pressure of the people in the high-hostile group, according to researchers, was the need to control the situation between the person conducting the conversation and themselves.

Men and women whose scores placed them in the high-hostile group had similar increases in blood pressure.

Researchers examined the attitudes of nearly 1,100 men. The investigators from Brown University School of Medicine in Providence, Rhode Island, found that those with hostile attitudes were more likely to be overweight, especially in the upper part of the body which is a greater risk factor for heart disease than extra weight carried in the hips and legs. The subjects also were more likely to exhibit insulin resistance, often a precursor of diabetes.

A hostile attitude in this second study also appeared to be linked to lower income and educational status.

“We’ve been focusing on diastolic through the years, but we now know that systolic blood pressure is a better predictor of future cardiovascular events such as heart attacks, strokes, and heart failure, and that treating it reduces those risks,” says Dr. Edward Roccella, NHBPEP coordinator.

“As people age, there’s a tendency for systolic blood pressure to rise, while diastolic pressure declines [after age 55]“, he explains. This is related to arteriosclerosis, a stiffening of the arteries that accompanies ageing, and may lead to increased blood pressure. “We used to think [increasing blood pressure] was a natural part of ageing. That gave rise to the erroneous belief that a systolic BP of 100 plus your age was acceptable.” Regardless of age, the Sixth Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommended blood pressure (BP) goal is 140 over 90 mm Hg; achieving it may be a long-term challenge for older people.

Because diastolic BP tends to fall in older people, its predictive and diagnostic capabilities in that population are greatly reduced compared with systolic BP. For instance, the proportion of participants in the NHLBI’s Framingham Heart Study correctly identified as candidates for antihypertensive therapy was 91% using systolic BP alone, compared with 22% using only diastolic pressure. The diagnostic power was further increased in people over 60.

Isolated systolic hypertension (ISH) (systolic 140 mm Hg or above, diastolic less than 90 mm Hg) is the most common form of high blood pressure, note advisory authors. About two-thirds of hypertensive people over age 60 have isolated systolic hypertension, yet less than a quarter of hypertensive Americans over 70 years of age have managed to meet recommended BP goals. While systolic hypertension is notably more difficult to manage than diastolic pressure, it’s well worth the effort.

Dr. Roccella cites the Systolic Hypertension in the Elderly Program (SHEP) study, in which 4,736 individuals over 60 years of age with isolated systolic hypertension were randomized to receive thiazide diuretic-based treatment, with or without beta-blockers, or placebo. After five years, those receiving treatment had an overall systolic BP reduction from 171 to 142 mmHg. Heart attacks were reduced by 27%, strokes by 37%, and heart failure by 55%; as well, trends toward improvement in depression and dementia scores were noted. “Even more astounding, if you’ve had a previous heart attack, lowering your blood pressure can reduce the chance of developing heart failure by 90%,” he said.
Lifestyle changes alone may make the difference, he says. Lose some weight, walk daily, eat a high-fiber, low-salt diet, and if you drink alcohol, do so moderately. “If that fails to bring BP down to goal, stick with it, because it could improve the effectiveness of medications.”

Salt vs. sodium

Table salt is the common name for sodium chloride, a mixture that is 40% sodium and 60% chloride. The American Heart Association recommends limiting sodium intake to no more than 2400 mg per day, about the amount of sodium present in 1 ¼ teaspoons of table salt.

Sodium’s connection to high blood pressure

High blood pressure affects one in four adults and is a major risk factor for stroke, heart disease, and kidney failure. About 30% of the American population is believed to be sodium-sensitive; meaning too much sodium in their diet contributes to high blood pressure by upsetting the body’s fluid balance. Since there’s no way of knowing if you’re one of the sodium-sensitive people, standard medical advice often begins with lowering dietary intake of sodium. Other minerals may be just as important in regulating blood pressure. Adequate intake of potassium from fruits and vegetables, calcium from dairy products and some vegetables, and magnesium from whole grains is crucial in determining blood pressure levels.

So where’s the sodium?

Seventy five percent of the sodium in the American diet comes from processed foods, not from the salt shaker sitting on your dining room table. A preference for salty foods is acquired through frequent exposure and not an inborn taste preference. Just taste any brand of commercial baby food and you’ll immediately notice the lack of salt. Infants haven’t yet developed a liking for salt, and too much can damage their still fragile kidneys so it is intentionally left out of commercial baby food products.

Sodium helps preserve food by slowing the work of harmful bacteria, yeast and molds to prevent food spoilage and illness. Think back to the days of salt-cured meats and pickled vegetables. Salt was used in preserving these foods for later use, with flavor being only a secondary issue.

Other uses of sodium in food processing include:

- Slowing the fermentation process in cheese, bread dough and sauerkraut

- Holding processed meats such as sausage together

- Improving the texture of breads and crackers

- Enhancing flavors

Label reading for sodium content

The Food and Drug Administration (FDA) closely regulates statements about sodium content on food labels. The following terms found on food labels meet these guidelines:

· Sodium-free – less than 5 milligrams of sodium per serving

· Very low-sodium – 35 milligrams or less per serving

· Low-sodium – 140 milligrams or less per serving

· Unsalted, no salt added or without added salt – made without the salt that is normally used, but still contains the sodium that is a natural part of the food itself.

Sodium content of foods

Processed foods, including canned foods, cured meats, frozen dinners and commercially baked goods such as cookies and pastries contain the most sodium. Take a trip through the grocery store with us to identify foods low and high in sodium:

- Produce section:

· Fruit and vegetables are naturally low in sodium. Some people believe celery is high in sodium, yet one stalk contains only 35 mg of sodium. Fruits and vegetables are also high in potassium, which helps lower blood pressure levels.

- Baked goods:

· Breads, bagels and English muffins typically contain 140-345 mg of sodium per serving (1 slice bread, 1 bagel or English muffin).

· Cookies and crackers may appear low in sodium, but that’s because the serving sizes are small – typically two cookies or crackers. Sodium content per serving ranges from 25-270 mg.

· Muffins contain 150-350 mg sodium per serving. Remember that larger muffins contain more sodium.

· Pancakes and waffles contain 150-300 mg sodium each.

· A slice of pie or cake or a piece of pastry will give you 150-300 mg of sodium.

- Chips and Snack Foods

· One cup of pork skins has 850 mg sodium; one cup of cheese-flavored snacks 700 mg, one cup chips 165 mg, and one cup popcorn has 90 mg sodium. One cup is approximately the amount you can hold in both hands cupped together.

· Pretzels are typically high in salt: one soft pretzel has 770 mg sodium, while 10 small pretzel sticks contains 85 mg.

- Dairy Products

· One ounce of cheese typically contains 160-200 mg sodium. Feta, gorgonzola, and processed cheese contain even more sodium, up to 500 mg per ounce.

· One cup milk contains 120 mg sodium, but remember the calcium in milk helps lower blood pressure.

· One-half cup of most ice cream, frozen yogurt or yogurt contains 50-75 mg of sodium.

- Breakfast cereals

· Read breakfast cereal labels carefully for sodium content. Some types such as puffed rice contain almost no sodium while others pack a whopping 475 mg per cup.

- Cured meats

· Smoked meats such as lox contain 220 mg sodium per ounce. Canned tuna ranges from 75 mg sodium per can when unsalted to 500 mg per can when salted. Two pieces of cured bacon contain 500 to 800 mg sodium (about one-third of your daily total), while cured ham contains 345 mg sodium per ounce.

· Sausage and lunchmeat are high in sodium unless you search for unsalted varieties. One slice of lunchmeat contains 250 mg sodium, while one typical sausage can contain 700 mg of sodium.

- Frozen dinners

· The size of frozen dinners varies considerably, yet the sodium content remains consistently high. 550-1300 mg sodium per serving are not uncommon.

- Canned foods

· Canned soups contain 800-1100 mg sodium per cup. Remember that most cans of soups are meant to serve two people; if you eat the entire can yourself you’ll double the sodium content.

· Canned vegetables are processed with salt unless you seek out unsalted varieties. One-half cup of most canned vegetables contains 150-300 mg sodium.

Our recommendations

General recommendations for healthy people without high blood pressure are 2400 mg sodium per day. That’s the amount used on food labels to calculate the percent Daily Value. The American Heart Association recommends no more than 3000 mg sodium per day for healthy individuals. If you have high blood pressure, limiting sodium to the 2400-3000 mg range is a good start, since the typical American diet contains 4000-6000 mg of sodium per day! Physicians may recommend lower amounts of sodium, but it is difficult to follow a plan that contains less than 2000 mg of sodium without purchasing special low-sodium foods. To keep within the 2400-3000 mg sodium range, following the suggestions here:

- choose fresh fruits and vegetables as often as possible
- look for sodium-free frozen and canned vegetables
- use salt-free seasonings such as herbs, spices and vinegar in cooking and at the table
- avoid adding salt when cooking pasta, rice, or vegetables
- choose fewer salty snacks such as salted nuts, popcorn, chips, pretzels and crackers
- read food labels for sodium content.