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Does blood pressure increase during deliberate period of focus?

Does blood pressure increase during deliberate period of focus?



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Does blood pressure increase during a deliberate period of focus?

My reason for formulating this hypothesis is personal experience.

A simple example is when I work, sitting, at the PC. Let's say I work 25-45 minutes. When I am working my breathing becomes more shallow and it's always through my nose. Then, when I've completed the work I usually, automatically, take a deep breath… as I physically feel relieved it's over even if it's work I enjoy. Then I notice I am a tiny bit lightheaded and, as I feel relieved, and I don't particularly want to get up, I usually have a desire to surf the web.

So, I'm wondering if concentration causes blood pressure to increase, which then quickly reduces when I'm done with my task, which is causing this feeling I am describing as lightheadedness. Alternatively is the blood pressure change related to the reduced breathing as I focus?… is there such a thing?


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RESULTS

Participant characteristics

Eighteen of the 24 practices participating in the original trial 15 were approached. Six were excluded due to geographical distance from the research team. Eleven agreed to participate however, it was not necessary to extend recruitment beyond nine practices as, by this point, data saturation had been achieved. 23 Participants, as previously identified in the original trial, were all patients with hypertension, treated with at least one or two antihypertensives. 15 Participants from these practices formerly agreeing to take part in further research were identified and initially invited (n = 155). Of these, 42 declined, 64 did not reply, 18 participants replied ‘yes’ but were subsequently not contactable, resulting in a sample of 31 patients. Of 78 primary care HCPs employed within these practices and invited to participate, 11 declined and 50 did not reply, resulting in a sample of 17 (13 GPs, three practice nurses, one healthcare assistant). In secondary care, 17 patients were invited to take part, 10 of whom agreed to participate, and seven declined. All of the eight secondary care professionals (five specialist nurses, one consultant physician, one renal registrar, and one consultant nephrologist) who were verbally invited agreed to take part.

Focus groups

Thirteen focus groups were held in total, with between three and nine participants. The baseline characteristics of patients and HCPs are given in Table 1. Half of the participants (primary and secondary) were female and nearly two-thirds (28/41 68%) were self-monitoring or had some self-monitoring experience. Four interviews were held with HCPs (one primary care, three secondary care) resulting in a total of 66 participants (41 patients, 25 HCPs).

Analysis revealed a series of themes from patients and HCPs that emerged from the interviews and focus groups, some of which were shared, while others were unique to a particular group or setting (Table 2).

Series of themes revealed in clinician and patient focus groups and interviews

Positive views for using a schedule versus ad hoc monitoring

Patients in both primary and secondary care considered that self-monitoring schedules improved adherence to medication and allowed understanding of blood pressure variability: ‘I’ve become even more, almost regimented about it, so I can actually have a better pattern as to what is working and what isn’t working and which tablets I’m taking might be working and which aren’t working.’ (Focus group [FG] 2, patient, female [F], secondary care [SC])

Similarly, HCPs supported the use of a schedule on the basis of allowing patients to take greater ownership of their condition, increasing adherence to regular monitoring, and subsequently facilitating treatment decisions. Implementing a schedule therefore appeared well supported: It [monitoring with a schedule] gives them some ownership of the problem and they tend to actually find it interesting … what the medication is doing, and … helps them to appreciate the variability of BP that one minute it might be slightly high and then it might go down again when you repeat the testing, which is sometimes reinforcing what we are doing when we are rechecking the pressures in the surgery and seeing it come down for the second or third week.’ (FG12, healthcare professional [HCP], male [M], primary care [PC])

Determining a more accurate estimate of blood pressure through more readings was perceived as an advantage for both the patient and the health professional alike: ‘If you know … I think it would help, if you can get them to follow it and they are willing to do it then I think it could help patients because you know it’s got more readings.’ (Interview 17, specialist consultant, F, SC)

In contrast to secondary care clinicians, those in primary care considered the negative impacts of a schedule: ‘… these people do panic about one-off readings, if they had that in front of them and said OK, if you get a high reading, do another 6 days of readings before you contact us. That might actually stop their panic and reduce that workload potentially … therefore, I’ve got to do 7 days now …’ (FG10, HCP, M, PC) ‘Or they get 6 more days of panic.’ (FG10, HCP, F, PC)

A number of patient focus groups agreed with HCPs’ views that complying with specific instructions regarding home measurements could cause more anxiety, making it no different from the anxieties experienced within the clinic: ‘I think I’d prefer to [not monitor on a set day]. As I say, I just do it and, you know, I think if it’s not right, you’ve got to do it a certain day at a certain time. You can get more agitated.’ (FG1, Patient, M, PC) ‘I think half of it’s [preference for home monitoring] because they [the doctor] tell you to sit it up on your table, because you’re going to have your arm like this, certain height, your wrist, wrist certain height, level you’ve got to be sitting comfortable and this and that.’ (FG1, Patient, M, PC) ‘…all that’s more stressful.’ (FG1, Patient, M, PC)

Flexibility

Finding a balance that combines rigour with a degree of flexibility within a schedule was discussed in more than half of the 13 patient focus groups in both primary and secondary care. Patients mentioned a range of issues about fitting self-monitoring within their daily life. Those with more spare time felt that scheduling monitoring could undermine their ‘free time’ when they were at their most relaxed. Unpredictable situations were also considered, such as illness, when patients might want to increase the frequency of the measurements: ‘… you would have to look at your own circumstances really because with some people it would work for 3 days, some people work it every other day, some people you need to review it every day, especially if your medication has just been changed and you want to see if it’s working but then at the same time, depending on how you react to the results.’ (FG2, patient, F, SC) ‘It depends on your lifestyle. Sometimes it might be difficult, I have a 4-year-old grandson that I have occasionally, it wouldn’t really be practical when he’s around because it’s not always that easy really.’ (FG9, patient, F, PC)

Through further discussion, questions were raised concerning how or whether a rigid schedule should be followed during more relaxed time periods, such as holidays and weekends: ‘What if you’re on holiday and … stuff, are you still able to do that?’ (FG14, patient, F, SC) ‘In terms of the internet, you can still connect from anywhere.’ (FG14, patient, M, SC) ‘… you wouldn’t want to do it on holiday though.’ (FG14, patient, F, SC) ‘That’s correct, but you might be more relaxed.’ (FG14, patient, M, SC) ‘… if you were doing it for x amount of months and you were on holiday during that period, what would you do?’ (FG14, patient, F, SC)

Patients felt measuring blood pressure at home should allow for flexibility rather than complying with a strict imposition of rigid times, although some alluded to how such measurement variation could influence results. Work and family were perceived to influence ability to monitor with a degree of rigour: ‘You get up in the morning at a certain time … you can monitor then and lunchtime if you’ve got time, but obviously for those people who work may not be in a position to do that.’ (FG2, patient, F, SC) ‘It just depends on your circumstances, doesn’t it, whether you go to work or whether you’ve got a family, if it’s young children and dealing with children, you know, it depends.’ (FG11, patient, F, PC) ‘It depends if it’s taken the same time every day or in the evening … would it work if one night you took it at 7:00 [pm], because you know you’re going out and you’d have a late night … but the next night … you stay in and you do it at 10:00 at night.’ (FG11, patient, F, PC)

For HCPs, consideration of whether a schedule was feasible related to what was ‘doable’ for the patient and this varied between patients. Factors brought up included people’s personal routines, carer responsibilities, and job patterns, along with each individual’s attitude to their own health: ‘It completely depends on their social … whether they’ve got four, five kids, whether they’ve got a job they need to be at 6 o’clock in the morning, whether they work nights, it’s all very subjective to what … I think it [following a schedule] is doable.’ (FG7, HCP, F, SC) ‘It depends on the patient how you feel in their consultation how comfortable they are.’ (FG10, HCP, M, PC)

Variation in practice

Capturing current home monitoring experiences revealed substantial variation among patients and HCPs. There were some expected individual differences in the number and times of day measurements were taken and in logging readings. There were also some unexpected accounts: ‘I usually disregard the highest reading I do it three times and disregard the highest reading than the other two.’ (FG3, patient, M, PC) ‘If I do mine, I take the best of three, a good average.’ (FG3, patient, M, PC) ‘I take measurements in just one arm.’ (FG4, patient, F, SC) ‘I do both [arms].’ (FG4, patient, F, SC) ‘Yeah. . one would be higher, one would be lower.’ (FG4, patient, F, SC) ‘And I’d always, look at the higher one because that’s normal for me.’ (FG4, patient, F, SC)

Across primary and secondary care sites, HCPs described variability in the advice they gave to patients. ‘Eyeballing averages’ appeared to be the most common technique described: ‘I will tend to try and work out a ballpark average by eyeballing the figures … I will look at them and see if there are several over 90 [mmHg, diastolic blood pressure] or if there are others that are sort of within the normal range then I will be more comfortable, but I would be looking at a pattern of generally lower BP than before and managing a patient on treatment … I will often say two or three times a week is a reasonable amount and then assessing in a month’s time, that gives you enough readings to make a judgement.’ (FG12, HCP, M, PC) ‘As long as you give them a general view about the volume of readings, you know, that you feel would be helpful to … you know, for, for them and us to manage their BP, then that’s usually fine.’ (Interview 15, consultant physician, M, SC)

These behaviour patterns were corroborated by patients’ accounts. Other guidance given to patients was around aspects of measurement, for example, discarding readings, length of time between measurements, whether to measure before or after blood pressure medication, and measurement technique, again with little consensus on a unified recommendation: ‘I think to do it properly they need to be sitting down with the cuff on for 5 minutes at rest, and then obviously take a measurement, a minute, take a measurement, a minute, and if you’re going to do a third, another minute. I tend to say before medication, before they’ve taken the tablets, sort of first thing.’ (FG7, HCP, F, SC)

Not surprisingly, clinicians appeared to draw on national guidelines as their primary source of guidance when interpreting SMBP data: ‘I tend to ignore the first couple of readings to be honest because they usually tend to be a bit higher, so I actually tend to ignore the first few and then take the average and the rest of the readings.’ (FG12, HCP, M, PC) ‘Yes and then when I get the results I exclude the first day and work out the readings from the remaining six.’ (FG12, HCP, F, PC)

Guidelines appeared to give clinicians a basic framework from which to provide advice: ‘I think since the NICE 2011 [guidelines] that sort of gave healthcare practitioners a bit more of a definitive sort of thing to tell patients. Because up until then it was very much ad hoc, and there was less sort of stringent guidelines. But I’ve found that’s a useful tool, you know, telling them exactly how to do it in NICE, as per the diagnostic criteria.’ (FG7, HCP, F, SC)

Length of protocol

Longer and shorter schedules were presented to participants, as seen in Appendices 1 and 2. Comparison of patients’ and HCPs’ discussions revealed a key difference of opinion on implementing each of the schedules. Clinicians in both primary and secondary care felt the need for clarity about whether SMBP was being used for diagnostic purposes or for ongoing management because these would involve using different schedules: ‘With the diagnosis there’s a root work that would have to be followed, and you discard the first day’s readings and then average up the rest basically and then do it over a week, twice daily, so there’s a different process to ongoing monitoring which can be very ad hoc and just you look at the lowest reading I think, because that probably correlates best with the average doesn’t it?’ (FG6, HCP, M, PC)

Some HCPs suggested that a longer monitoring schedule with more frequent measurements over a week would be needed for diagnostic purposes, and a 3-day home monitoring schedule would be sufficient for longer-term monitoring. Others felt that the evidence base for this was lacking, whereas most secondary care clinicians stated that this was a standard recommendation to patients: ‘What we’re probably saying is 7 days for diagnosis and 3 days for monitoring, aren’t we really?’ (Interview 13, GP, NC, PC) ‘Three days would be great for the patients but if you want to get a true, accurate reflection of the BP probably 7 days is more appropriate, if you’re treating them … this is the problem as a clinician, because the evidence base is not there to say well, actually, if you monitor for 3 days this month the reading … it equates to monitoring for 7 days over this amount of … you know, so you know, as a clinician it’s very hard to just rely on those 3 days of … of monitoring.’ (FG7, HCP, F, SC)

Preferred monitoring regimen

Although the focus for the HCPs was on matching schedules to the type of clinical decision being made, patients (in primary and secondary care) focused more on feasibility, whether a protocol was easy to implement in daily life. On this basis the 3-day schedule was preferred: ‘Those 3 days are more convenient than the 7 for obvious reasons. It’s time isn’t it?’ (FG3, patient, M, PC) ‘… 3 days two readings, I’d be happy to kind of wrap it up and get it sorted rather than stretch it out over 7 days a week.’ (FG14, patient, M, SC)

For many of the secondary care patients, the shorter schedule was already recommended by their HCP. All patients discussed benefits of the 7-day schedule, with patients in primary care expressing willingness to comply with monitoring over 1 week if a clear clinical reason for doing so was given. Among the study sample, if instructed to do so by an HCP, patients would generally comply with a 7-day schedule: ‘So, if somebody said, “Well, it’s best to do it every morning for 3 days”, … I would probably fit in with whatever I was told would be best.’ (FG11, patient, F, PC) ‘I’d probably say yes if it was 1 week a month because you could plan around that week.’ (FG8, patient, M, PC)

Initiation of monitoring

Starting to self-monitor in primary care tended to be an individual decision, with patients devising their own regimen for measuring blood pressure. Most were comfortable with monitoring blood pressure independently. A few primary care patients were reluctant to change their schedule once they had established a routine: ‘I take medication twice a day and I take it first thing in the morning and middle of the evening. So we’re used to that sort of routine, it’s just that I don’t want to do more [measurements] in terms of this sort of thing, where I’m satisfied with what I do at the moment.’ (FG9, patient, M, PC) ‘The trouble is now, I’m quite happy with routine, I take it [measuring BP] once a fortnight and it’s kept me going for 15 years.’ (FG9, patient, M, PC)

In secondary care, monitoring with some degree of schedule was commonly advised, therefore patients appeared more informed about the reasons for adopting a schedule: ‘This is … another reason why it’s important to home monitor because at least you can get an accurate picture of when you’re watching … you can identify the times when it is not OK, then you and the GP or Doctor X [hypertension consultant] can discuss that and then address how you can control that.’ (FG2, patient, F, SC)

Education needs

A number of other issues arose as a result of discussing the use of schedules. Patients felt that understanding the rationale behind the basic instructions for SMBP needed to be improved: ‘I mean, I never … I never quite understand why they do the best of three and record the best of three.’ (FG8, patient, F, PC)

Some appeared confused about their own blood pressure thresholds and identified that education was needed regarding interpreting SMBP results: ‘That’s the problem. I mean, the doctors say 200 and above is very, very high and I think it’s normal for me. So when it’s 180 at home, I’m worried that something is wrong.’ (FG4, patient, F, SC) ‘I think it could be very useful, indeed … you know, educating the patient. Making sure they’re aware of [schedules], you know, what they’re doing, how to do it, and what to do with the information.’ (FG4, patient, F, SC)

When discussing morning and evening blood pressure measurement, some indicated a preference regarding the time of day, most notably evenings: ‘I tend to take mine of an evening.’ (FG5, patient, F, PC) ‘Apparently it naturally changes throughout the day, doesn’t it, there’s like a peak and a trough, isn’t there?’ (FG5, patient, M, PC) ‘I’m not good in the mornings, I’m better at night time. I’m more of a night person, I’m more relaxed at night. I’m a natural night worker I used to be, you know, so I tend to do anything complicated then.’ (FG5, patient, F, PC)

Reflected in both primary and secondary care was the consensus that a clearer understanding of the basic elements of blood pressure measurement and how to accurately interpret and act on blood pressure results was necessary before any additional guidance could be absorbed. Patients viewed provision of such education as the HCP’s responsibility: ‘Yes. I mean to me I wouldn’t know, because I’m new to it, when to do it, what number is particularly high, what number I should be at, you know.’ (FG5, patient, F, PC) ‘Something would have to be defined per person, I think, to do it.’ (FG14, patient, M, SC) ‘Give some guidance as to what’s your norm.’ (FG14, patient, F, SC)

Patient and HCP focus groups revealed synergy between the lack of education patients described and gaps in HCPs’ knowledge regarding SMBP. Clinicians felt that, although there was national guidance available on how patients should self-monitor for diagnostic purposes, there was a lack of guidance regarding longer-term management. A central problem was that every patient was different and therefore there was no universal rule of thumb when it came to SMBP: ‘It’s patient education and if we don’t educate them then it’s down to them knowing what to do and how to do it, I guess … it is difficult to know where to start.’ (FG7, HCP, F, SC) ‘The people who’ll search the web for these sites are the ones that are going to be more proactive and engaged in their care, it’s the ones that haven’t got access to internet and haven’t got access to this and that equipment are the ones that you need to focus on more, really.’ (FG7, HCP, F, SC)

Consequently, clinicians felt there should be more informative guidelines provided on all aspects of home monitoring, but more so if a schedule was implemented. Descriptions of the reference sources for guidance on SMBP appeared to vary from clinician to clinician and within primary care even within the same practice: ‘The trust here, it’s very sort of ad hoc … There’s no sort of indication … is it a validated monitor, or when are you doing it? … So I think there is a huge sort of disparity around with what actually sort of advice is given and there’s no sort of real check.’ (FG7, HCP, F, SC) ‘I think there’s something online and even on Facebook about self-monitoring and you can print out a chart for patients but no substantial guidance for us.’ (FG6, HCP, M, PC) ‘I mean I think these days the world runs on guidelines really and actually the more explicit and the more clear and evidence-based our guidance is the better … so yes, more structured guidance is really important here.’ (Interview 15, HCP, M, SC)


Does blood pressure increase during deliberate period of focus? - Psychology

Mental confusion, also called delirium, is a change in a person’s awareness. Confusion affects how a person thinks, sees the world around them, and remembers things.

The main signs of mental confusion or delirium are sudden changes in awareness. A person with confusion or delirium might suddenly get very sleepy and unaware of their surroundings or act very upset and nervous. The person will not recognize this change in themselves and is most often noted by family members or medical providers.

Who gets mental confusion or delirium?

Confusion is the most common sign that cancer or treatment is affecting the brain. It is a common problem for people with any advanced illness including advanced cancer or those at the end of life. A person with mental confusion will think and act very differently from normal. The condition can be difficult and stressful for the person affected as well as their loved ones. It may also make it harder for the health care team to care for other symptoms.

How does someone with mental confusion act?

There are 3 types of confusion.

Hypoactive, or low activity. Acting sleepy or withdrawn and "out of it."

Hyperactive, or high activity. Acting upset, nervous, and agitated.

Mixed. A combination of hypoactive and hyperactive confusion.

Mixed mental confusion is the most common. More than 2 in every 3 people who have mental confusion go back and forth between types.

What are the symptoms of mental confusion?

The main symptom is a change in general awareness and consciousness. This may include:

Trouble remembering things, writing, or finding words

Speech and thoughts that do not make sense

Not knowing where they are, what day it is, or other facts

Mixing up day and night and difficulty sleeping

Personality changes, restlessness, anxiety, depression, or irritability

Seeing things that others do not (hallucinating) or believing things that are not really happening (delusions)

What causes mental confusion?

Mental confusion may have more than 1 cause. This is especially true if a person is weak or very sick. Finding the cause is important so their doctor can choose the best treatment. Here are some possible causes.

Medications. Medications that can cause mental confusion include:

Anti-nausea or allergy medications

New medications for other conditions

A person may develop confusion or delirium if they suddenly stop taking certain medications, especially if they have previously been taking these medications for a prolonged period.

Organ problems. Mental confusion or delirium can happen if certain organs are not working correctly. These can include the liver, kidneys, heart, or lungs. Seizures or cancer that has spread to the brain can cause delirium.

Problems with fluid and electrolyte balance. The balance of fluids and minerals called electrolytes keeps your brain and body working correctly. Having much more or much less than normal can cause mental confusion. Things that can upset the balance include:

Too much of the mineral calcium in the blood.

Dehydration. This might happen if you are nauseated, vomiting, or having trouble swallowing. Diarrhea and urinating a lot can also cause dehydration.

Too much fluid in the body. Heart, kidney, or liver failure can cause this.

Too much or too little sugar in the blood.

Infection. Bladder, lung (pneumonia), brain, and blood infections (sepsis) can cause mental confusion and delirium. Sepsis is a life-threatening condition that happens when an infection spreads to your bloodstream.

Not enough oxygen in the blood. Health problems that cause low levels of oxygen in the blood can cause mental confusion. These include lung or heart problems, blood clots, and sleep problems.

How do doctors diagnose mental confusion?

Doctors will take a comprehensive history and physical exam, including a neurological exam to diagnose mental confusion. Based on this medical history and exam, additional tests and scans may be recommended as well.

How can mental confusion be treated?

Finding the underlying cause of mental confusion and treating it is the most effective solution. The doctor may recommend that the person with confusion or delirium stops taking certain medications or takes new medications to treat the underlying cause or to ease symptoms. Other treatments may be also be required. It is important to work closely with the health care team to find a solution.

There are things that can be done to help the person feel more comfortable and less confused. Here are some ideas:

Find a reassuring environment. This might be a quiet room with good light and familiar people and objects. It may also help to place a clock and wall calendar nearby.

If the person is hallucinating, ask the health care team to create a plan to help manage the hallucinations. They can help you learn what to expect and how to manage these symptoms.

Medications called antipsychotics may be useful to help alleviate certain symptoms. There can be side effects, but most of these can be managed well.

Relieving side effects is an important part of cancer care and treatment. This is called palliative care or supportive care. Talk with your health care team about any symptoms of mental confusion, or delirium. This includes any new symptoms or a change in symptoms.

Mental confusion at the end of life

Mental confusion or delirium is common at the end of a person's life. Some people believe that hallucinations at the end of life are part of the dying process. Treatment may not be needed if the hallucinations are not upsetting. For example, people may see family members or friends who have already died. This can be comforting. But if it is unpleasant or scary, treatment can help.

There are several medications available that can make a person with confusion or delirium more comfortable. The doctor may recommend sedation if a person with delirium is very agitated and they do not improve with other treatments. Sedation is medication that puts a person into a deep sleep. The goal of sedation is to make the person feel comfortable, not to speed up death. It may be hard for family and friends when their loved one does not interact as much.

Deciding how to treat mental confusion or delirium depends on the person with cancer and their preferences. If possible, people should talk with their health care team ahead of time about their treatment options and consider putting their health care wishes in writing.


12 Ways to Trigger Rest and Digest

You may be able to get acute stress under control pretty easily (especially if you make a point of managing it), and everyday stress often just passes with time (the rush hour traffic will end, you’ll turn in the project, the “big day” on the calendar comes and goes). But if you’re battling chronic stress over an extended period of time, your sympathetic and parasympathetic nervous systems are probably out of balance. Try some of the following activities and techniques to start triggering rest and digest on a regular basis:


Reducing Salt Intake Isn't The Only Way To Reduce Blood Pressure

Most people know that too much sodium from foods can increase blood pressure. A new study suggests that people trying to lower their blood pressure should also boost their intake of potassium, which has the opposite effect to sodium.

Researchers found that the ratio of sodium-to-potassium in subjects' urine was a much stronger predictor of cardiovascular disease than sodium or potassium alone.

"There isn't as much focus on potassium, but potassium seems to be effective in lowering blood pressure and the combination of a higher intake of potassium and lower consumption of sodium seems to be more effective than either on its own in reducing the risk of cardiovascular disease," said Dr. Paul Whelton, senior author of the study in the January 2009 issue of the Archives of Internal Medicine. Whelton is an epidemiologist and president and CEO of Loyola University Health System.

Researchers determined average sodium and potassium intake during two phases of a study known as the Trials of Hypertension Prevention. They collected 24-hour urine samples intermittently during an 18-month period in one trial and during a 36-month period in a second trial. The 2,974 study participants initially aged 30-to-54 and with blood pressure readings just under levels considered high, were followed for 10-15 years to see if they would develop cardiovascular disease. Whelton was national chair of the Trials of Hypertension Prevention.

Those with the highest sodium levels in their urine were 20 percent more likely to suffer strokes, heart attacks or other forms of cardiovascular disease compared with their counterparts with the lowest sodium levels. However this link was not strong enough to be considered statistically significant.

By contrast, participants with the highest sodium-to-potassium ratio in urine were 50 percent more likely to experience cardiovascular disease than those with the lowest sodium-to-potassium ratios. This link was statistically significant.

Most previous studies of the relationship between sodium or potassium and cardiovascular disease have had to rely on people's recall or record of what foods they eat to estimate their level of sodium consumption. This is a less precise measure of sodium intake than urine samples. In addition, many have been cross-sectional rather than follow-up studies.

The new study "is a quantum leap in the quality of the data compared to what we have had before," Whelton said.

Whelton was a member of a recent Institute of Medicine panel that set dietary recommendations for salt and potassium. The panel said healthy 19-to-50 year-old adults should consume no more than 2,300 milligrams of sodium per day -- equivalent to one teaspoon of table salt. More than 95 percent of American men and 75 percent of American women in this age range exceed this amount.

To lower blood pressure and blunt the effects of salt, adults should consume 4.7 grams of potassium per day unless they have a clinical condition or medication need that is a contraindication to increased potassium intake. Most American adults aged 31-to-50 consume only about half as much as recommended in the Institute of Medicine report. Changes in diet and physical activity should be under the supervision of a health care professional.

Good potassium sources include fruits, vegetables, dairy foods and fish. Foods that are especially rich in potassium include potatoes and sweet potatoes, fat-free milk and yogurt, tuna, lima beans, bananas, tomato sauce and orange juice. Potassium also is available in supplements.

Whelton is among the nation's top experts on high blood pressure. He has published more than 400 papers on the subject, and has been the principal investigator on more than $100 million of studies funded by the National Institutes of Health.

Co-authors of the Archives study include Nancy Cook (first author), Julie Buring and Dr. Kathryn Rexrode of Brigham and Women's Hospital Eva Obarzanek and Dr. Jeffrey Cutler of the National Heart, Lung and Blood Institute Dr. Lawrence Appel of Johns Hopkins University and Shiriki Kumanyika of the University of Pennsylvania.


Risk Factors

Personality

The time-urgent, competitive, easily angered type A personality enjoyed a long vogue as a potential marker of cardiovascular risk, especially while white collar occupational groups continued to experience a high rate of coronary events. That epidemiological picture has since undergone a radical change, with people of lower socioeconomic position now being at greater risk of CVD in many developed countries. The focus on personality as a cardiovascular risk factor has also faded because of the difficulties in classifying individuals' personalities reliably. There is also only limited evidence that personalities can be changed, although new ways of responding to the stresses of everyday life can be learned, and the evidence that attempting to do so results in a meaningful reduction in cardiovascular events is scant indeed.


The Bottom Line

It is clear that there is a range of supplements that can help to reduce high blood pressure, which can have benefits for those who are taking prescription high blood pressure medication and those without.

However, if you are taking prescription medication for high blood pressure, you will want to check with your doctor before using any dietary supplements as there could be interactions.

Supplementation should be used alongside making diet and lifestyle changes.

These modifications include increasing your intake of foods high in potassium, calcium, and magnesium, such as nuts and leafy green vegetables.

Being more physically active can also help to lower blood pressure, particularly increasing cardiovascular exercises, such as walking, swimming, and jogging.

ⓘ Any specific supplement products & brands featured on this website are not necessarily endorsed by Emma.