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Welcome to part two of our discussion about high blood pressure. For those who missed it, a previous column examined new blood pressure guidelines released by the American Heart Association and the American College of Cardiology, in which normal is now a range below 120/80. It's a conservative definition that puts people with blood pressure in the range of 120-129/80 into the "elevated" category. This is not a diagnosis of high blood pressure, or hypertension. Rather, it's a warning sign that, without certain lifestyle changes, hypertension may well be in your future.

Now we'd like to expand on the techniques that can be helpful in getting better numbers.

-- Lose weight: Weight gain increases body mass, which means the heart has to pump harder to deliver blood throughout the body. At the same time, that increase in body mass offers greater resistance and results in elevated blood pressure. Studies show that a weight gain of even 5 pounds can cause blood pressure to rise.

-- Stop smoking: Not only do smokers face double the risk for stroke and heart attack as nonsmokers, they are also at increased risk of a range of cancers. In addition, the nicotine and other substances in cigarettes and other tobacco products make blood pressure go up.

-- Exercise regularly: Exercise strengthens the heart and makes it more efficient. Regular physical activity like brisk walks, cycling, swimming, dancing, hiking or active sports can lower your top (systolic) blood pressure number by four points. That's on par with what blood pressure medications will do. Aim for 150 minutes per week of moderate aerobic activity, or 75 minutes of vigorous activity.

-- Watch your diet: When it comes to food, the DASH diet (Dietary Approaches to Stop Hypertension) is a good guide. Not only does it naturally limit salt intake, but it also incorporates a healthful range of foods into your life. These include fresh fruits and vegetables, whole grains, legumes, nuts, lean proteins, limited saturated fats and limited amounts of sugar. You can get full details at: https://www.nhlbi.nih.gov/health-topics/dash-eating-plan.

-- Cut back on salt: New research suggests the relationship between salt and blood pressure is more complex than previously understood. Still, hidden salt in processed food means many Americans are getting far too much sodium. Switching to fresh foods and the rest of the DASH diet recommendations can make a difference.

-- Limit alcohol: Although we still don't know exactly how or why, drinking alcohol raises blood pressure. If you're a regular drinker, quitting can lower your top blood pressure number by several points.

-- Cut back on caffeine: As with alcohol, the mechanism behind the brief blood pressure spike that accompanies caffeine intake isn't fully understood. If you're looking to lower your blood pressure, though, we recommend cutting back on or quitting caffeine.

-- Reduce stress: Easier said than done, we know. But regular exercise, meditation, breathing exercises, yoga, a daily nap or just a bit of quiet time to yourself can help relieve tension.

-- Keep track: Make note of your blood pressure readings to track which direction you're trending. The American Heart Association supports self-monitoring, which can be done with a home blood pressure monitor and in partnership with your primary care physician.

Eve Glazier, M.D., MBA, is an internist and assistant professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and primary care physician at UCLA Health.

Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.

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