The Body: The Complete HIV/AIDS Resource Follow Us Follow Us on Facebook Follow Us on Twitter Download Our App 
Professionals >> Visit The Body PROThe Body en Espanol

When Tension Rises

April/May 2002

A note from The field of medicine is constantly evolving. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!

Article: When Tension Rises

More than 50 million American adults have it -- about one in four people. It is more common in African-Americans, who experience it at an earlier age and develop more severe symptoms than those in the white population. Americans tend to develop it with age, and about 60 percent of all Americans 60 years and over have it. It usually occurs most often in people over age 35 but children can also have it. It leads to heart failure, stroke, heart attack, kidney damage, blindness and more.

High blood pressure is called a silent killer because people can be free of symptoms for years and then suddenly have a stroke or a fatal heart attack. If you smoke, are obese, have high blood cholesterol levels or diabetes and high blood pressure, the risk of heart attack or stroke increases several times.

Fat plays a factor, too. Researchers have shown that excess fat around your middle predicts high cholesterol and high blood pressure. You may be experiencing changes in body shape and also having higher cholesterol and blood pressure levels.


Hypertension: The Silent Killer

Danger Signs

Warning signs of severe high blood pressure can include nosebleeds, racing or irregular heartbeat, headaches and dizziness.

If you do not have these symptoms, that does not mean your blood pressure is OK. Know for sure -- get your blood pressure checked.

High blood pressure not only makes the heart work harder, it causes the arteries to lose their elasticity and become hard and narrow, making it more difficult or impossible for nutrients to travel to all parts of the body. Think of a garden hose that was once soft and pliable, but has become hard and brittle from being out in the sun and weather all year.

High blood pressure can cause:

  • Heart attacks

  • Congestive heart failure

  • Impaired vision

  • Kidney damage

  • Complications during pregnancy to mother and fetus

  • Low birth weight and early delivery

Damage to Mother's Organs

High blood pressure is a key risk factor for heart disease, which is the No. 1 killer disease in the United States. It's a key risk factor for stroke, the third-leading cause of death for Americans. Survival from a stroke is often associated with serious, long-term disability and loss of independence.

Cause of High Blood Pressure

In 90 to 95 percent of the cases of high blood pressure, the cause is unknown. This is called essential or primary hypertension. Secondary hypertension may be due to problems with the kidneys, narrowing of certain arteries, or a structural abnormality of the large blood vessel leaving the heart (aorta).

Factors such as hereditary, age and race are risk factors for high blood pressure that cannot be controlled, but the good news is the list of factors that can be controlled is much longer. Both diet and lifestyle changes can make a big difference.

Listed below are risk factors that you can change to reduce your risk for developing high blood pressure.

  • Obesity. Maintain healthy weight, lose weight if necessary.

  • Exercise. Exercise for 20 to 30 minutes per day.

  • Alcohol. Decrease over-consumption of alcohol. American Heart Association says no more than one to two drinks per day (this may need to be further modified with HIV and medications). Binge drinking can cause a surge in blood pressure.

  • Stress. Effects of stress vary, but long-term chronic stress appears to elevate blood pressure. Find a way to decrease stress (exercise can help).

  • Smoking. Smoking temporarily raises blood pressure. Even worse, smoking causes damage to the peripheral vessels (those that go to the arms and legs) which speeds up the process of hardening of the arteries. Enroll in a smoking cessation class.

A Nutritional Remedy

Nutrition is another way to reduce your risk for hypertension. What we eat can play a role in determining our risk for a disease condition and what we eat can also play a role in treating a disease condition.

In earlier studies, single nutrients such as calcium and magnesium, used mostly as dietary supplements, were tested as potential treatments for lowering blood pressure. These studies concluded that no benefit exists or the findings were inconclusive.

Eating food -- yes, real food -- is what seems to make the difference. Rather than buy supplements that do not work, save your money and eat, and eat well.

Choose Foods Wisely

We are a society that "super-sizes" everything but our servings of fruits, vegetables and consumption of water.

Following the DASH diet (Dietary Approaches to Stop Hypertension) is a chance to eat more of certain foods and decrease your blood pressure and most likely your cholesterol, too.

Cutting Back on Salt

The debate seems to be over. Many people can benefit by reducing the sodium in their diet.

If you eat at fast food chains, ask for the nutrition profile of the foods they serve. As much as 3,000 mg of salt can be added to food in processing.

To manage your sodium intake at levels below 3,000 mg, you may need to be more selective of the places you eat, prepare more foods at home, purchase items labeled no-salt or low salt or eat more fresh foods.

Protein foods (luncheon meat, hot dogs, corned beef, cured meats, sardines) usually have more sodium than vegetables and grains, with fruit having the least sodium. Salted snacks such as potato chips, corn chips or tortilla chips, popcorn, salted nuts, Chex party mix, oriental cracker mix and pickles are also high in salt. One teaspoon of table salt has 2,400 mg sodium.

Salt Substitutes

Mrs. Dash or Lowry's low salt seasonings are examples of popular salt substitutes on the market.

Some salt substitutes contain potassium. If you are following a diet that restricts potassium, read the ingredients carefully to check for potassium. Consult your physician before using the product.

Try seasoning with herbs, spices, salsa, vinegar, lemon and garlic to create robust flavors to replace the salt in dishes. Be patient and give your taste buds a chance to adjust to foods that are lower in salt. This may take a couple of weeks.

Using the Nutrition Food Label

Food labels are an easy tool to keep track of the amount of sodium in foods you are eating.

The milligrams of sodium per serving size are listed right after the word "sodium." Choose a sodium level for yourself and keep track of your sodium intake for the day. The DASH study found benefits at 3,000 mg a day and the greatest benefits at 1,500 mg.

Compare the nutrition label of a regular food item and that food in a low-sodium or salt-free version. You might try eating the product that is lowest in salt and putting a pinch of table salt on it until your taste buds adjust.

How the DASH Diet Can Lower Blood Pressure

Start with three fruits daily and add two more after two weeks and so on. Add one fruit at lunch and another piece of fruit at snack time or bedtime.

Have a piece of fruit instead of dessert. Add one more vegetable at dinner -- that makes two.

Add spinach leaves, grated carrots, and sliced cucumber to sandwiches instead of iceberg lettuce. (Avoid sprouts.)

Add carrots, broccoli, squash, legumes, beans or other vegetables to pasta dishes. It adds nutrients plus color to the pasta.

Use non-fat or low-fat dairy products as the source of calcium. If milk is a problem, try low-fat yogurt with live cultures, lactose-free products or soy milk.

Have milk instead of water or other beverage.

Make protein shakes with plain yogurt and fruit or canned pumpkin and a little nutmeg or cinnamon.

Make oatmeal with milk and water.

Snack on nuts and dried fruit -- a great portable snack or add them to your breakfast cereal.

Limit saturated fat -- fatty meats, butter, cheese, cream.

Instead eat more fish, skinless chicken or turkey, tofu, legumes.

Be patient and give the DASH diet a chance to work. Stay focused on your goals.

The DASH diet is high in fruits and vegetables, which means foods rich in potassium and magnesium. If you have kidney disease, you may need to restrict potassium intake. Please consult with your doctor before starting the DASH diet.

The DASH diet is much higher in fiber than most American diets. Increase fiber slowly to your diet to avoid any gastrointestinal problems such as diarrhea or bloating. Remove the skins from fruits and vegetables if you start having looser stools.

If you are a diabetic, the DASH diet may include more fruit than your current meal plan. Frequent blood glucose monitoring may be necessary for a while to see how the diet affects your sugar levels. Vegetables have less carbohydrate than fruit, so replacing some of the fruit with vegetables would help control your blood sugar. Remember to exercise, too. Consult with your doctor before starting the DASH diet.

The amount of protein in the DASH diet is less than usually recommended for people living with HIV. Generally, more than 8 ounces are needed depending upon gender, body size, HIV status and other factors. You can still follow the DASH diet; just be sure to include more protein sources.

Sample Dash Diet (2,000 Calorie Meal Plan)
CategoryNumber of ServingsServing Size
Grains and grain products7-81 slice of bread,1 cup dry cereal,* 1/2 cup pasta, rice or cooked cereal
Vegetables4-51 cup raw leafy or 1/2 cup cooked vegetables, 6 oz vegetable juice
Fruits 4-5 6 oz fruit juice4-56 oz fruit juice, 1 medium fruit, 1/4 cup dried fruit, 1/2 c fresh, frozen or canned
Low-fat or fat-free dairy foods2-38 oz milk, 1 cup yogurt, 1-1/2 oz cheese
Meats, poultry and fish2 or less3 oz cooked meat, poultry or fish
Nuts, seeds and dry beans4-5 per week1/3 cup or 1-1/2 oz nuts, 2 Tbsp or 1/2 oz seeds, 1/2 cup cooked dry beans
Fat and oils2-31 tsp soft margarine or vegetable oil, 1 Tbsp low-fat mayonnaise, 2 Tbsp light salad dressing, 1/8 medium avocado
Sweets (should be low in fat)5 per week1 Tbsp sugar, 1 Tbsp jelly or jam, 1/2 oz jelly beans 8 oz lemonade
The DASH study was published in the December 18, 2001 issue of The Annals of Internal Medicine.

* Serving sizes vary between 1/2 to 1-1/4 cup. Check the products' nutrition labels.

** Fat content changes serving counts for fats and oils, i.e., 1 Tbsp regular salad dressing equals 1 serving; 1 Tbsp low-fat dressing equals 1/2 serving; 1 Tbsp of fat-free dressing equals zero servings.

*** People living with HIV/AIDS need at least 3 servings. Remember to wash thoroughly and follow food safety guidelines if eating foods raw.

Janelle L'Heureux, M.S., R.D. Janelle L'Heureux, M.S., R.D., is a nutritionist in AIDS Project Los Angeles' Treatment Education Program. She can reached by calling (213) 201-1556 or by e-mail at

Back to the April/May 2002 issue of Positive Living.

A note from The field of medicine is constantly evolving. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!

This article was provided by AIDS Project Los Angeles. It is a part of the publication Positive Living.
See Also
Guide to Conquering the Fear, Shame and Anxiety of HIV
Trauma: Frozen Moments, Frozen Lives
More on Coping With Stress and Anxiety