Humans universally agree that “diets” are no fun. If you are like me, you have tried a great number of diets and weigh loss programs with varying degrees of success. Behavior change, which is a critical success factor in all diets is difficult, but having a heart attack or a stroke are worse and significantly less fun. Being overweight or obese is the single largest risk factor of hypertension. The combination of hypertension and obesity increases your risk for heart attacks and strokes dramatically. The added risk of tobacco use results in the triple threat for modifiable risk factors.

Blood pressure can be lowered with medication, but medication is costly and has side effects. Losing weight is one of the most important things you can do to improve your health when you have hypertension and obesity.

When your blood pressure is elevated, it essentially means that your heart has to work harder than normal to pump the blood around your body.

To lower your blood pressure you need to do one or both of the following:

1. Make the arterial space the blood is pumping through larger (decreasing the pressure against which the heart is pumping) and / or
2. Decrease the demand on the heart or do not make it work as hard.

To decrease the pressure the heart is pumping against, the recommended strategies are:

1. Consistently take medications prescribed by your doctor. Do not stop taking medications just because you feel good. Make sure to discuss it with your physician before changing or stopping your medicines.
2. Manage your cholesterol. If you have hyperlipidemia, or high cholesterol, you will have plaque build up inside your arteries making them narrower and harder to pump blood through. You can manage your cholesterol by eating a diet low in saturated fat and high in good quality nutrition.
3. Manage the stress in your life. Excess stress causes your blood vessels to constrict.
4. Do not smoke. Tobacco use causes vessels to constrict.

The key strategies to decrease the demand on the heart are:

1. Again, consistently take your medications prescribed by your doctor. They may include medications to make your heart work more efficiently.
2. Lose weight to lighten the work effort the of heart.
3. Gradually increase exercise to avoid overtaxing it through sudden bursts of high levels of strenuous exercise. The classic bad example is that of having a heart attack shoveling snow after an otherwise sedentary lifestyle.
4. Your doctor may recommend a reduced salt diet. If so, this is because salt causes fluid retention. More fluid causes the volume of blood needing to be pumped about to be greater.

Weight Loss remains one of the most modifiable factors of managing hypertensive and obesity, and your risk of heart attack and stroke.