All you need to know about high blood pressure

This week is World Salt Awareness Week, so we asked our friendly dietician at Pick n Pay to give us some advice about high blood pressure, and how to limit salt intake.

Understanding the problem

The stats are scary: 1 in 3 adults live with high blood pressure (hypertension) and hypertension is responsible for 1 in every 2 strokes and 2 in every 5 heart attacks.

South Africa has the highest prevalence of hypertension in Southern Africa, as well as the largest number of people whose blood pressure is uncontrolled, even while on treatment. Hypertension is known as the ‘silent killer’ because you can have no symptoms and still be suffering from it.

High blood pressure happens when the blood moves through your arteries at a higher pressure than normal. It is dangerous because it makes the heart work harder than usual and if left uncontrolled, high blood pressure is a risk factor for heart and kidney disease, stroke and blindness.

High blood pressure often has no warning signs and once it occurs it can last a lifetime.  This diagram illustrates some of the long-term effects of high blood pressure on the body.

Are you at risk of hypertension?

If you answer yes to any of these questions, you are at a higher risk of developing high blood pressure:

Are you overweight?

Do you exercise for less than 30 minutes a day?

Are you a smoker?

Do you add too much salt to your food?

Does anyone in your family suffer from high blood pressure?

How to prevent and manage high blood pressure

Although the exact causes of high blood pressure are unknown, certain factors may play a role in its development. These factors include older age, being overweight, a lack of exercise, drinking too much alcohol, smoking, and eating too much salt. Here are a few helpful tips to prevent and manage high blood pressure:

1. Aim for a healthy weight with a Body Mass Index (BMI) between 18-25, and a waist circumference of less than 88 cm for women and less than 102 cm for men.    
2. Keep active for 30-60 minutes on four or more days per week.  
3. Limit sodium intake to 1500 mg or less per day. That’s about 2/3 of a teaspoon of salt – across all your meals. Check the labels of pre-packaged food to see the hidden sodium!
4. Limit your alcohol intake to two drinks or less per day if you drink.  
5. Quit smoking.  
6. Find ways to manage and lower your stress levels.  
7. Take your blood pressure medicine as directed.  
8. Follow the Dietary Approaches to Stop Hypertension (DASH) eating plan.      

The DASH eating plan

The DASH eating plan follows heart healthy guidelines to limit saturated fat. 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 fibre.

It is simply a healthy way of eating, and it offers health benefits other than the lowering of blood pressure, including assisting with the prevention of osteoporosis, cancer, heart disease, stroke and diabetes. The guidelines include:

Focus on whole grains

• Plan for a small serving of whole grain foods with most of your meals – they have more fibre and nutrients than do the more refined grains.
• Have a wholegrain cereal or oats porridge for breakfast with (optional) sliced fruit and some protein like nuts.
• Seed loaf and rye breads are a better option than refined breads.
• Brown rice, whole wheat pasta, quinoa, barley and other grains can significantly boost your fibre intake.

Eat more fruits and vegetables

• Cauliflower rice makes a nutrient dense alternative for rice and other grains.
• Try vegetable ‘pastas’ made from baby marrow or pumpkin.
• Add spinach to soups, stir-fries, stews and casseroles.
• Add tomato purée and/or tinned chopped tomatoes in casseroles, mince and stews.
• A delicious salsa prepared with finely chopped mango or pawpaw, onion, coriander and avocado makes a great topping for cooked meat, fish or chicken.
• Add sliced fruit, such as nectarine, pawpaw and lychees to salads.
• Get creative with fruit and vegetable smoothies.

Choose low-fat dairy products

• Calcium, from dairy products, is not only essential for healthy bones, but also for blood pressure regulation.
• Because weight and heart health are often factors in developing hypertension, choosing low-fat or fat-free dairy is important.
• Plan 2 to 3 servings of dairy products daily.  This can be achieved easily with 1 cup of milk or yoghurt with breakfast, a small tub of yoghurt as a snack and 30g of cheese with a light meal.

Take care with fats and oils

• Lower your total fat intake, with the focus on using the healthier monounsaturated fats.
• Saturated fat is found in most animal products, so choose leaner varieties of meat and cut back on your serving size to allow more room for vegetables.
• Avoid having take-away meals and high fat pastries, pies and donuts.  
• Eat more heart-healthy fish, such as salmon, pilchards, sardines, herring and tuna.

Eat more nuts

• Add flaked almonds to cereal, stir-fries and salads.
• Enjoy a handful of unsalted nuts as a healthy snack.
• Nut butters, including peanut butter, can be great on seed toast or crackers.
• Add pine nuts to salads and stir-fries – dry-fry them for more flavour and crunch.

Love your legumes

• Aim to have two meat-free days, eating legumes instead, every week.
• Beans go well in salads with couscous, quinoa, pasta or rice.
• Prepare a delicious three-bean salad, but take care to drain and rinse the beans.
• Add legumes to mince, casseroles and stews to help the meal go further.

Limit your salt intake

• If you’re at risk of high blood pressure, you should limit the sodium in your diet to 1500 mg per day, which is approximately 3g of salt (2/3 of a teaspoon).
• Table salt is sodium chloride and it is 40% sodium. Here are the approximate amounts of sodium, in milligrams, in a given amount of table salt:
  • 1/2 tsp (2.5g) = 1,000 mg sodium
  • 1 tsp (5g) salt = 2,000 mg sodium
• Over half of the salt we eat is from salt added to processed foods such as bread, breakfast cereals, cheese, cold meats and sauces.

How to halve your salt intake

1. Cook at home. You can better control how much salt you use.
2. Eat more fresh, whole foods. 
3. Limit use of sodium-laden condiments, such as soy sauce and salad dressings.    
4. Use ‘light’ or ‘health’ salts wisely.  
5. Explore other seasonings, such as freshly squeezed lemon juice or add some heat with chillis or peppadews.
6. Swap out salty foods.  

Instead of these salty foods:	Use these alternatives:
Chips, pretzels, biltong, salted nuts	Vegetable crudités with hummus or tzatziki, unsalted nuts.
Instant cereals	Oats porridge made with milk or Swiss muesli.
Sandwiches made with cold meat, tuna in brine or cheese	Sandwiches made with left-over roasted meat, chicken, tuna in water or oil.
Instant pasta sauce	Home-made pasta sauce with canned or fresh tomatoes and herbs.

With these helpful tips, you should be able to eat a healthy, delicious diet with much less salt!

Pick n Pay Health Hotline

Did you know that Pick n Pay employs a registered dietitian to provide free food and nutrition-related advice to the public? Contact Leanne via the Health Hotline on 0800 11 22 88 or email her directly on healthhotline@pnp.co.za to start your nutrition conversation.

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Jez Timms and Farhad Ibrahimzade on Unsplash