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What is the advantage of eating a mostly plant-based diet in managing hypertension?

It is not entirely clear why animal protein, particularly red meat, raises blood pressure. But we know that it does.

Dr. Frank Sacks, one of the originators of the DASH diet, did a study where he gave people muffins and measured their blood pressure. The muffins all tasted the same, but he put animal protein in one set of muffins. Sure enough, blood pressure went higher in the group that ate the animal protein, even though they didn't know they were eating it.

Does exercise have an impact in preventing or controlling hypertension?

Of course. What kind of exercise? The kind you enjoy. What is sustainable is pleasure and joy and freedom. If you enjoy exercise, you are going to do it.

And people will often do things for their kids that they would not do for themselves. I am not one of those people who particularly loves to exercise, but I do it on a regular basis because I love my wife, I love my children, and I want to be around to enjoy them fully.

The hardest thing is getting started. A lot of people think, "Man, I've gotta run a marathon or at least five miles three times a week -- or I might as well just roll over in bed." That isn't the case.

It turns out that just walking 20 or 30 minutes a day has almost the same benefits as doing more intensive exercise. You don't have to walk all that far or all that fast or all at once. A single exercise session can lower your blood pressure by 5 to 7 millimeters of mercury, and that may persist for as long as the rest of the day.

But it works both ways. When you stop exercising, after one or two weeks your blood pressure starts going up again. What we are learning, particularly with blood pressure, is how quickly it can get better and how quickly it can get worse.

How does stress affect blood pressure?

Lifestyle is more than just exercise and diet. Emotional stress also affects your blood pressure. Emotional stress makes your arteries constrict and your blood pressure rise -- just as tightening the nozzle on a hose makes the water pressure go up.

Chronic anger and hostility -- and particularly depression and hopelessness -- also have a strong effect on blood pressure. There is nothing wrong with an increase in blood pressure in times of stress. But when these mechanisms that evolved to protect us are chronically stimulated by the stresses of modern times, they can harm us or even kill us.

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