High Blood Pressure, Hypertension

Evidence-based diet plus exercise programs for hypertension and coronary artery disease:

Preventive Health Advisor views both dietary changes and an exercise program of vital importance as part of comprehensive treatment for hypertension. We believe that striving for an ideal diet alone will have a greater health benefit than exercise alone, but if both aspects are combined, then health benefits will be greatly potentiated.

Therapeutic Lifestyle Changes Diet (TLC):

The Therapeutic Lifestyle Changes Diet (9,25), plus 30 minutes of daily exercise at 50-75% of age-predicted maximum heart rate resulted in the following benefits (33):

1. 89% of participants reached an LDL cholesterol goal of under 130 mg/dL without lowering HDL levels or needing to add or increase lipid lowering therapy.
2. Mean total cholesterol, LDL cholesterol and triglycerides decreased by 9.2% (p=0.08), 9.3% (p<0.018), and 18.8% (p<0.05), on average respectively.
3. HDL cholesterol increased 2.6% on average (p=0.41).
4. Women: 12.3% reduction in LDL cholesterol and an 11.4% increase in HDL cholesterol.
5. Men: 7.9% reduction in LDL cholesterol and no change in HDL.
6. Systolic and diastolic blood pressure (BP) decreased 9% (p<0.001) and 13%, respectively (p <0.0001).
7. BP reductions were two-fold greater than in a DASH diet (Dietary Approaches to Stop Hypertension) diet.

The Pritikin Program

The Pritikin Program evidence-based benefits after 12-15 days improves most risk factors for coronary artery disease including hypertension (26,27,28):

1. Body mass index, 3% reduction
2. Blood pressure, glucose and LDL, all with 10%-15% reduction
3. Triglycerides, 36% reduction
4. Slowed or reversed progression of coronary heart disease and reduce the need for coronary artery bypass grafts (CABG), rates of angioplasty procedures and percutaneous interventions.
5. Usually program is done for 3-4 weeks allowing additional benefit as the patient continues the program.

Pritikin Program includes (27,28):

1. Very low fat, less than 10% of calories.
2. Low sodium and avoid salty foods.
3. High fiber with at least five ½-cup servings of whole grains daily (wheat, oats, and brown rice or starch vegetables such as potatoes, and dried beans and peas.
4. Refined grain products (white flour, regular pasta, white rice) are limited to two servings daily.
5. At least four 1-cup servings of raw vegetables daily or ½-cup servings of cooked vegetables. Dark green, leafy, and orange or yellow vegetables are preferred
6. At least three servings of fruit, one of which can be fruit juice.
7. Two servings daily of calcium-rich foods such as nonfat milk, nonfat yogurt or fortified and enriched soymilk.
8. No more than one caffeinated drinks daily. Instead drink water, low-sodium vegetable juices, grain-based coffee substitutes or caffeine-free teas.
9. No more than four alcoholic drinks per week for women and no more than seven for men, with red wine preferred over beer or distilled spirits.
10. No more than seven egg whites per week.
11. No more than 2 ounces (about 1/4 cup of nuts) daily.
12. Moderate amounts of fish, nonfat dairy, and lean meat with no more than one 3.5 cooked serving of animal protein per day with fish and shellfish are preferred. Lean poultry should optimally be limited to once a week and lean beef to once a month.
13. Adapted to vegetarians by replacing animal protein with protein from soy products, beans, or lentils.
14. Avoid fried foods, dressing with fat, and fatty sauces, animal fats, processed meat, dairy products not made with non-rat milk, egg yolks, salty snacks, cakes, cookies, and similar high-calorie choices.
15. Eat frequently with three meals a day plus two snacks.
16. Artificial sweeteners such as Splenda are okay.
17. 45 minutes of moderate exercise daily such as walking.
18. Medicare may approve coverage for qualifying individuals with a history or risk of cardiovascular events. The program has been approved for coverage under Part B of Medicare. Medicare will reimburse eligible beneficiaries for up to 72 one-hour ICR sessions, up to 6 sessions per day, at the Pritikin Longevity Center & Spa.

The Dean Ornish Program (29-31):

The Dean Ornish Program for Reversing Heart Disease improves most risk factors for coronary artery disease including hypertension. The program includes the following benefits:

1. Weight loss of 13.3 pounds in the first 12 weeks and 15.9 pounds after 1 year.
2. Significant reductions in systolic blood pressure (BP), diastolic BP, total cholesterol, triglycerides, and LDL-cholesterol after 12 weeks were still significant after 1 year.
3. Exercise capacity increased by 18% after 12 weeks and 24% after one year.
4. Reductions in depression were still significant after 1 year.
5. Hemoglobin A1C in diabetics continued to decrease after one year.
6. Improvement in severity of angina after 1 year.

Ornish Program includes (29-31):

Patients are instructed to eat a plant-based, meatless diet, as well as practice meditation and perform regular exercise. Adherence to the program has been quoted between 85 to 90% after one year in hospitals and clinics that have offered it.