Around half a million Israelis suffer from hypertension - a dangerous disease that can cause serious health problems, including heart attack and stroke. The good news is that it is possible to treat hypertension, and even prevent it, by means of proper nutrition and physical activity. Below is the complete menu for a diet that will protect you.

Dr. Sarah Kaplan, chief dietician, Meuhedet

It is estimated that a quarter of the population of the western world suffers from high blood pressure. The situation in Israel is not very different: surveys show that 15% - 20% of the country's residents over the age of 20 years - that is, some half a million people - suffer from hypertension.
The good news is that there are many tools for preventing and treating high blood pressure, foremost among them a change in lifestyle. Sometimes drug treatment should also be used, naturally accompanied by medical follow-up, but nutritional treatment should not be stopped.

What is blood pressure?

To maintain the body, all of its cells must receive the nutrition and oxygen necessary for their existence, and waste matter must be removed from them. This work is carried out by the blood, which flows through a broad network of blood vessels reaching every part of the body.
The blood vessels can be divided into 3 types: arteries, through which the heart pumps blood to all body parts; veins, which bring the blood back from the body to the heart; and capillaries - very fine tubes connecting the arteries to the veins and allowing the blood to reach every cell in the body.
The flow of blood through the blood vessels creates pressure on their walls. The pressure exerted on the walls of the arteries when the heart contracts and pumps blood through them is greater than that exerted on the veins, through which the blood flows when the heart relaxes between contractions.
Checking blood pressure produces two values, a high value and a lower value - for example, 120/80. The higher value is written on the left side and is called systolic pressure. This is the pressure created when the heart contracts and pumps blood to the arteries. The lower value is written on the right side and is called diastolic pressure. This is the pressure created when the heart relaxes between contractions.

What is hypertension?

People are defined as suffering from hypertension when repeated measurements indicate that their blood pressure is 140/90 or above. Hypertension is called "the silent killer", because there are usually no symptoms and thus patients can be unaware of the illness for many years, and therefore not receive treatment. In the long term, this can lead to serious complications such as heart attack, stroke, or renal insufficiency.
However, hypertension sometimes does cause symptoms, such as headache, fatigue, nausea, dizziness, blurred vision and palpitations.

What are the causes of hypertension?

For 85% - 95% of people suffering from hypertension, the reason for its development is unknown. This condition is called “primary hypertension”. The assumption is that these cases involve hereditary, environmental, mental and behavioral factors, such as engaging in particular professions, overweight, diabetes, smoking, hyperlipidemia (excess fats in the blood), lack of physical activity, and family history.
Another risk factor is sleep apnea, which is frequently connected to gaining weight and sensitivity to insulin.
For some 15% of patients, the reason for the development of hypertension is known. This condition is called “secondary hypertension". The causes in these cases are constriction of the aorta, obstruction of the renal artery, tumor of the adrenal gland, high level of calcium in the blood (hypercalcemia), and the use of birth control pills.
In addition, as people grow older, systolic blood pressure tends to increase, especially among women - who usually begin to suffer from various symptoms during menopause. When systolic blood pressure increases, the difference between the upper and lower pressures also increases, and this in itself is a risk factor.

Treating hypertension
The objective in treating patients with hypertension is to bring blood pressure back to normal values, which will prevent complications in the long term. Treatment of blood pressure can be divided into two types: with and without medications. Not everyone suffering from hypertension needs drug treatment.
For some people diagnosed with hypertension it is possible to reduce the blood pressure by changes in lifestyle:

When it is not possible to bring blood pressure back to normal values by changing lifestyle alone, the patient is referred to a physician for adding drug treatment. It is important to emphasize that nutritional treatment must be continued together with drug treatment.

Diastolic pressuree	Systolic pressure	Level of blood pressure
Less than 80	Less than 120	Normal
80-89	120-130	Pre-hypertension
90-99	140-159	Grade 1 hypertension
100 ot more	169 or more	Grade 2 hypertension

*According to the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC)

Preventing and treating hypertension through nutrition

In 2006, the American Heart Association (AHA) published dietary recommendations for treating hypertension. The AHA recommended a diet called DASH - Dietary Approach to Stop Hypertension, which has been proved to lower blood pressure significantly. Below we will detail the components of this diet, but it is important to emphasize that in any event, it needs to be personally tailored to meet each individual's needs with the help of a qualified dietician. This is of particular importance for people taking medications, due to the interaction between the medications and food. Here is A healthy lifestyle - for preventing and treating hypertension:

Nutrition	Recommendations
Weight	Achieving normal weight – BMI of up to 25.
DASH diet	A diet rich in fruit and vegetables and low in saturated fat and cholesterol, including low-fat dairy products, and with restricted use of sodium and processed foods.
Salt (sodium) consumption	3.8 grams of salt per day (1,500 mg sodium).
Potassium consumption	4.7 grams per day (4,700 mg).
Alcohol consumption	Up to one portion per day for women and two portions per day for men (portion: 330 ml beer, 140 ml wine, 40 ml spirits).

So what should we eat, and how?
Sodium (salt) consumption

The recommendation: Consumption of some 1,500 mg of sodium (3.8 grams of salt) a day. The consumption of salt should be limited, but this does not mean that food has to be boring or tasteless. Even as part of this diet, it is possible to vary the meals and make them tasty, nutritious and enjoyable. To enhance the flavor of the food, different cooking methods can be used, such as grilling, steaming, boiling in water and baking. In addition, spices can be used instead of salt (please see table).
When buying food products, it is important to read the package label to find out how much salt they contain. The terms sodium glutamate, monosodium glutamate, sodium nitrate and sodium indicate that the product contains salt. Various salt substitutes are sold, but these should only be used after receiving an approval of the physician.

Potassium consumption

The recommendation: Consumption of some 4,700 mg of potassium a day, mainly from fruit and vegetables. Research shows a direct connection between high potassium consumption and a reduction in blood pressure. However, be careful: it is important to remember that high consumption of potassium, mainly from food supplements, may create an excess of potassium in the body (hyperkalemia) - a condition which may affect the heart rate. Elderly people taking medications that raise the potassium level [such as the ACEI (angiotensin-converting enzyme inhibitors) or ARB (angiotensin receptor blockers) group, or diuretics] and people suffering from renal insufficiency are at particularly high risk of hyperkalemia. It is therefore necessary to consult a physician and dietician before taking supplements.
Potassium-rich food: Vegetables - artichokes, sweet potatoes, carrots, cabbage, cauliflower, coriander, wheat germ, beetroot, fava bean, parsley, mushrooms, kohlrabi, mint, dill, garlic, potato, spinach; Fruit - avocado, custard apple, banana, guava, melon, mango, grapes, kiwi, loquat, date, fig, dried fruit, fruit juice.

Calcium consumption

The recommendation: Consumption of some 1,500 mg of calcium a day. Research has found a direct connection between lack of calcium and hypertension.
Calcium-rich food: Milk, cheese, fish with bones, sesame, tehina, halva, cabbage, dried fruit, soya, almonds, walnuts, seeds.

Alcohol consumption

The recommendation: Consumption of one portion per day for women and two portions per day for men (portion: 330 ml beer, 140 ml wine or 40 ml spirits). Research has found a direct connection between alcohol consumption and hypertension.

Losing weight

The recommendation: BMI of 25 or less. Research indicates a direct connection between overweight and hypertension. Losing weight frequently produces a reduction in blood pressure even before the ideal weight has been achieved. A paper examining the results of 25 research studies found that a reduction of some 5% in body weight led to a significant reduction in systolic and diastolic blood pressure

What should be eaten to maintain a healthy blood pressure and what should be avoided?

Recommended food	Food that is not recommended
Meat Chicken, turkey, beef, veal, soya meat substitutes without salt.	Preserved meat, smoked meat, salami, sausages, smoked tongue, prepared soya dishes.
Seasonings Mustard powder, onion powder, garlic powder, cumin, nutmeg, oregano, vanilla, rum, ginger, vinegar, home-made horseradish, lemon, mint, curry, bay leaves, dill, parsley, red paprika, sesame, clove, turmeric.	Salt and any spice mixes containing salt, such as celery salt or sea salt. Ready-made sauces such as soy sauce, chili sauce, mustard or ketchup. Mixed spices such as grilled meat or grilled chicken seasoning.
Soups All home-made soups – vegetable, fruit or meat.	Prepared soups and all soup concentrates and powders.
Fish Fresh fish without salt.	Canned fish, salted or smoked fish, sardines, anchovy, bonito, frozen fish coated in breadcrumbs.
Cheeses and dairy products Milk, Eshel, Leben, salt-free white cheese.	Yellow cheeses, salted or melted cheese, molded cheeses, smoked cheeses
Vegetables All kinds, fresh and frozen.	Canned vegetables, vegetables prickled in brine such as cucumbers, olives or cabbage.
Fruit All kinds of fresh fruit, dried fruit without preservatives.	Fruit preserves dried fruit with preservatives or with added salt.
Fat Fats, unsalted margarine, avocado, unsalted snacks (walnuts, almonds, seeds), home-made tehina, home-made mayonnaise.	Salty butter, regular margarine, olives, olive spread, salted snacks, ready-made tehina, peanut butter.
Bread, baked goods and their substitutes All kinds of bread made of all types of flour, rice, potatoes, noodles, corn flour, semolina etc.	Soup nuts, salty snacks, salty crackers.

Physical activity to lower blood pressure

The change in diet should be accompanied by physical activity, under supervision of qualified professionals. Physical activity can lead to a reduction in blood pressure and prevent the development of hypertension in the future. Although physical exertion raises blood pressure, a moderate to high degree of physical activity, supported by professionals, may reduce the risk of developing hypertension in everyday life.
Physical activity is also an integral part of treatment for those suffering from high blood pressure. Health organizations recommend the general population to carry out 30 minutes of physical exercise every day. It may be divided to 3 brief 10-minute sessions.
The recommended activities are aerobic, such as running, walking, bicycling or rowing. These activities involve moving the body and the muscles at a fast rate. It is also recommended by health organizations to include also working out with weights to strengthen the muscles.
Patients suffering from hypertension must take special precautions in regard to physical exercise. Before starting the activity they should consult a physician and a professional trainer who will adjust the nature of exercise to personal capacity. They must also take care to take the appropriate medications at the right time.