Hypertension/High Blood Pressure Health Center

Key points

• The DASH diet focuses on foods that are high in calcium, potassium, and magnesium. These nutrients can lower blood pressure.
• Taking calcium, potassium, and magnesium supplements does not have the same effect as eating foods that are high in those nutrients.
• Don't make big changes in your diet all at once. Make small changes, and don't give up. As soon as those changes become habit, add a few more changes.
• You'll have more success if you make a plan that includes long-term and short-term goals as well as ideas for getting past barriers-things that might get in the way of changing your eating habits.
• Support from family and friends can go a long way toward helping you find success in changing your habits. Don't be afraid to let family and friends know what you're trying to do. And ask for their help.

More information about high blood pressure can be found in the topic:

• High Blood Pressure.

DASH is an eating plan that can help lower your blood pressure. DASH stands for Dietary Approaches to Stop Hypertension. Hypertension is high blood pressure.

The DASH eating plan focuses on foods that are high in calcium, potassium, and magnesium. These nutrients can lower blood pressure. The foods that are highest in these nutrients are fruits, vegetables, low-fat dairy products, nuts, seeds, and beans. Taking calcium, potassium, and magnesium supplements instead of eating these foods does not have the same effect.

The DASH eating plan

Food	Recommended servings	Examples
Low-fat and fat-free milk and milk products	2 to 3 servings a day	A serving is 8 ounces of milk, 1 cup of yogurt, or 1 1/2 ounces of cheese.
Fruits	4 to 5 servings a day	A serving is 1 medium-sized piece of fruit, 1/2 cup chopped or canned fruit, 1/4 cup dried fruit, or 4 ounces (1/2 cup) of fruit juice. Choose fruit more often than fruit juice.
Vegetables	4 to 5 servings a day	A serving is 1 cup of lettuce or raw leafy vegetables, 1/2 cup of chopped or cooked vegetables, or 4 ounces (1/2 cup) of vegetable juice. Choose vegetables more often than vegetable juice.
Grains	7 to 8 servings a day	A serving is 1 slice of bread, 1 ounce of dry cereal, or 1/2 cup of cooked rice, pasta, or cooked cereal. Try to choose whole-grain products as much as possible.
Meat, poultry, fish	No more than 2 servings a day	A serving is 3 ounces, about the size of a deck of cards
Legumes, nuts, seeds	4 to 5 servings a week	A serving is 1/3 cup of nuts, 2 tablespoons of seeds, or 1/2 cup cooked dried beans or peas.
Fats and oils	2 to 3 servings a day	A serving is 1 teaspoon of soft margarine or vegetable oil, 1 tablespoon of mayonnaise, or 2 tablespoons of salad dressing.
Sweets and added sugars	5 servings a week or less	A serving is 1 tablespoon of sugar or jam, 1/2 ounce of jelly beans (about 20), or 1 cup of lemonade.

The DASH eating plan is one of several lifestyle changes your doctor may recommend. Your doctor may also want you to decrease the amount of salt you eat. Lowering salt while following the DASH plan can lower blood pressure even further than just the DASH plan alone.

For more information on nutrition for high blood pressure, see:

Nutrition for High Blood Pressure.

Sample Menu for the DASH Diet.

Not eating enough potassium, calcium, and magnesium may help cause high blood pressure. These nutrients come from fruits, vegetables, and dairy products.

Researchers believe that it is the combination of 8 to 10 servings a day of fruits and vegetables and 3 servings of low-fat or nonfat dairy products that causes the DASH eating plan to lower blood pressure. Simply taking calcium, potassium, and magnesium supplements does not lower blood pressure.

Good sources of potassium, calcium, and magnesium

Nutrient	Good sources
Potassium	All fresh fruits and vegetables
Calcium	Low-fat and nonfat dairy products
Magnesium	Legumes (cooked dried beans and peas), seeds, nuts, halibut, milk, yogurt, brown rice, potatoes, tomatoes, bananas, watermelon, leafy green vegetables

Setting goals

You'll have more success in changing your eating habits if you make a plan. The plan should include long-term and short-term goals as well as ideas for getting past barriers-things that might get in the way of changing your eating habits.

What is your long-term goal? A long-term goal is something you want to reach in 6 to 12 months. When you have high blood pressure, the long-term goal is to lower your blood pressure to a specific level. Talk to your doctor about what your specific long-term goal should be.

What are the short-term goals that will help you reach your long-term goal? Short-term goals keep you going day to day. They are usually goals you hope to reach tomorrow or next week.

Look at the DASH eating plan. Come up with a short-term goal that looks pretty easy. For example, you might decide that your first short-term goal will be to eat 4 servings of vegetables every day. As soon as you've made those extra vegetables a habit, you can add another short-term goal.

Eating with DASH

Here are some ideas for eating with the DASH plan:

• Drink fat-free milk. A glass of fat-free milk has only 80 calories and no fat. It's packed with nutrients that lower blood pressure. Have a "skinny" latte (made with fat-free milk) as a way to add milk to your diet. If you don't drink coffee, try a skinny steamed milk or chai drink.
• Make a baked potato bar. Serve baked potatoes with a variety of vegetables, such as broccoli. And use other toppings, such as low-fat shredded cheese, chili, salsa, and refried beans. If you use toppings from a can or jar, be sure to choose low-sodium varieties. Or even better, make them yourself from fresh ingredients. Be creative. You could end up with 4 or 5 servings of vegetables at one meal.
• Eat a variety of cut-up vegetables with a low-fat dip such as hummus. Try some new vegetables. Make a stir-fry with lots of different vegetables.
• Buy a vegetarian cookbook, and try one recipe each month or each week.
• Add garbanzo beans to a salad, use fat-free refried beans, and/or make split pea or black bean soup.
• Combine a ready-made pizza crust with low-fat mozzarella cheese and lots of vegetable toppings. Use tomatoes, zucchini, spinach, carrots, cauliflower, and onions.
• For breakfast, have whole-grain cereal, fruit, and low-fat or fat-free milk.
• Take fruit to work or school as a snack.
• Make a dip for fruit from low-fat or nonfat vanilla yogurt and cinnamon.

Get more tips in the topic Quick Tips: Adding Fruits and Vegetables to Your Diet.

Many people find that it helps to write down everything they eat every day. That way they can easily see how much of each food group they've eaten and where they need to add or cut back tomorrow.

A registered dietitian can work with you to change your eating habits and help you plan menus that follow the DASH eating style. Ask your doctor to recommend someone. See a sample DASH menu.

For more help on starting a new healthy eating plan, see:

Healthy Eating: Starting a Plan for Change.

Dealing with barriers and slip-ups

Take the time to think about what things could get in the way of your success. These are called barriers. And by thinking about them now, you can plan ahead for how to deal with them if they happen.

An example of a barrier might be eating in restaurants. If you do that a lot, you may want to plan ahead for how you will stay on your DASH plan when you eat out. Possible solutions could include:

• Eat out less often.
• Look at menus ahead of time to find dishes you can eat and still stay on your eating plan.
• Find new restaurants that offer vegetarian and low-fat dishes.

It’s perfectly normal to try something, stop it, and then get mad at yourself. Lots of people have to try and try again before they reach their goals.

• If you feel like giving up, don't waste energy feeling bad about yourself. Remember your reason for wanting to change, think about the progress you've made, and give yourself a pep talk and a pat on the back. Then you may feel like trying again.
• When you hit a barrier-and most people do-get support. Talk to your family members and friends to see if someone wants to eat healthy foods with you or cheer you on.
• Don't forget little rewards. Something to look forward to can keep you moving right along.

For more help on dealing with barriers, see:

Healthy Eating: Overcoming Barriers to Change.

Getting support

Having a lot of support can make it easier to change your eating habits. For example, if family members tell you that they love how you're getting healthier, you may be motivated to keep up the good work. Here are some other ways to get support:

• Work with a partner. It’s motivating to know that someone is sharing the same goals.
• Friends and family members can eat healthy meals with you. They can encourage you by saying how they admire you for making hard changes.
• Join a class or support group. People in these groups often have some of the same barriers you have.
• Don't forget to reward yourself. When you reach one of your goals, give yourself a present. Buy a new healthy cookbook. Go to the movies. Or just take some time for yourself. Do whatever it takes to remind yourself that you've been meeting your goals. You're successful!

For more information about getting support, see:

Healthy Eating: Getting Support When Changing Your Eating Habits.

Staying with it

It can be frustrating to start a new project like healthy eating and then have to stop because something gets in the way-illness, travel, or even just boredom. Your goal is to get back in the habit and make it a routine part of your life.

Remember that you can't create a habit overnight. Keep at it, even if you slip up along the way. It can take as long as 3 months of repetition to form a habit, so every day is a step in the right direction.

When you slip up, don't get mad at yourself or feel guilty. Think of it as a learning experience. Figure out what happened. Why did you stop? Think of ways to get yourself going again. Learn from your slip-ups so that you can keep on toward your goal of healthy eating.

For more information on staying with a healthy eating plan, see:

Healthy Eating: Staying With Your Plan.

Now that you have read these tips on following the DASH eating plan, you are ready to change your eating habits to lower your high blood pressure.

For more sample menus and recipes for the DASH eating plan, contact the National Heart, Lung, and Blood Institute.

• Go to www.nhlbi.nih.gov and search for DASH.
• Or go to www.nhlbi.nih.gov/health/public/heart/hbp/dash.
• Or write to the NHLBI Health Information Center, P.O. Box 30105, Bethesda, MD 20824-0105, and request information on the DASH diet.