Now we switch from what you need less of to what you need more of. “You can think of potassium as the opposite of sodium;’ says Dr. Simon. Just as a high sodium intake can raise blood pressure, so too can a low potassium intake, since potassium works as a blood-vessel dilator. But this doesn’t mean huge amounts of potassium are needed.
The DV for potassium is 3,500 milligrams, “but it’s safe to consume substantially more than that;’ says Dr. Simon. The trick is getting enough potassium in your daily menu, without going on the chimpanzee diet. Actually, bananas are not the highest source of potassium, which can be found in a wide assortment of fruits and vegetables. And there are some surprisingly rich sources. (See “Postssium and Magnesium Sources” on page 34.)
One caution: If you’re taking a potassium-sparing diuretic, which causes the kidneys to hoard the mineral, you should not increase your potassium intake without discussing with your doctor any changes you’d like to make.

Calcium and Magnesium Connection

Along with potassium, you can add calcium and magnesium to the list of minerals that may help lower your blood pressure through some unknown ways. People with hypertension tend to have lower consumption of all three. African Americans seem to be especially vulnerable to low calcium intake. As with potassium, you don’t necessarily need these minerals by the shovelful. Instead, you simply need to be certain you’re getting enough calcium and magnesium.

There are two ways to make certain blood-pressure drugs (ACE inhibitors) are more effective. One is to take more drugs. Another may be to add flavors like pepper, rosemary or basil to your cooking instead of salt, according to a recent study that comes to us from the United Kingdom. When 11 high-pressure people on ACE inhibitors needed to lower their pressures more, they got the same results from a low-salt diet as they did from taking extra drugs called thiazide diuretics.

What’s more, the low-salt diet was still flavorful. People were asked simply to leave out the salt in cooking or at the table and avoid salt-laden foods such as pickles, olives and anchovies Still not convinced that doing it yourself may be better than drugs? Let’s look at side effects. When thiazide diuretics are used to bolster ACE inhibitors, uninvited sidekicks can include loss of that heart-rhythm-sustaining nutrient potassium; loss of libido and maybe even an increased risk of heart attack. Side effects of favorite flavorings like rosemary or basil: We don’t know of any.
It’s not a particular surprise that a low-salt diet has the same power as a diuretic, says John H. Laragh, M.D., director of the hypertension center at Cornell Medical Center, New York City. “Diuretics are what I call a ‘poor-willpower-man’s low-salt diet;” he says. A diuretic thwarts a blood-pressure rise by preventing the kidneys from holding salt. A low-salt diet prevents you from holding salt by avoiding it in the first place.
There are two things that sustain high blood pressure. One is rennin, a hormone secreted into the bloodstream by the kidneys.Its action is blocked by ACE inhibitors.) The other is the body’s sodium content, also regulated by the kidneys, says Dr. Laragh. Taking away dietary sodium under a doctor’s supervision might be O.K., but Dr. Laragh warns against being overzealous about it. (You need at least 2,000 milligrams a day.) If you take in too littie sodium, your body may become too dehydrated and illequipped to withstand the daily stress of exercise or infection since the blood flow to the tissues is reduced. In this regard, a new study links low amounts of sodium in the diet with an increased risk of heart attack. Too little sodium in the blood and” … the blood volume and flow to the capillaries won’t be as luxurious as it could be. Blood flow to the brain and kidneys will be reduced, exercise tolerance will be reduced and resistance to infection will be reduced;’ says Dr. Laragh. “This leads me to believe that it makes good sense to have a moderate salt intake whenever possible. The optimal amount of salt in the diet is not the same for everyone;’ he says. Work with your physician to find the level that’s right for you.

Odium free: Less than 5 per serving, No need to restrict yourself, since 400 servings a day would still keep you at 2,000 milligrams of sodium!

Very low sodium: Thirty-five milligrams or less per serving. You’re still in the safe zone.

Low sodium: One hundred forty milligrams or less per serving. Don’t get reckless. A few servings can add up in a hurry.

Reduced sodium: Three-quarters less sodium than is typical for that food. Fact is, many foods are typically high in sodium, so reducing that amount may not be as helpful as you think. Also, the container may not say simply “salt,” but if it says any
of these, you can bet it is salt. Don’t be fooled by:

• sea salt
• garlic salt
• onion salt
• seasoned salt
• brine

NOTE: If a serving size is very small, for example two table-
spoons of salad dressing, then 35 to 140 milligrams can still be quite a high concentration of sodium for such a small portion.

Cut back on the saltshaker first. “That’s what we go after;’ says Dr. Kaplan. “Salt poured on food is the thing people have the most immediate control over.”

Then go after the foods Dr. Kaplan calls “salt mines,” for example, anchovies, sauerkraut, pickles and salami. “All we’re talking about here is taking a few of life’s pleasures away;’ says Dr. Kaplan. “It won’t be easy for those few people who are addicted to salami. But it’s usually not a major sacrifice.” The greatest salt mine may be potato chips. “You’d need to eat 10 whole potatoes to get the amount of sodium in just 10 potato chips;’ says Dr. Simon.

The next sodium source on your list should be processed foods because salt and other sodium compounds act as preservatives and flavor enhancers and are often used liberally in them. Not surprisingly, processed foods (which include some of the worst salt mines already mentioned) are the biggest source of sodium in the American diet, perhaps accounting for more than 70 percent of our intake. Canned foods are the worst offenders. But you can find a high sodium content in some frozen foods, baked goods and many staples at fast-food restaurants. Reading food labels is critical to finding your way past the salt mines in the supermarket. (See “Label Shakeout” at left.)

How much of a difference does all this sodium-searching really make? Well, for many people, for each teaspoon of salt they eliminate, they can expect a five-point drop in systolic (top number) pressure and half that in diastolic (bottom number) pressure. For millions of Americans, this would be enough of a drop to eliminate the need for medications.

Being “sodium sensitive” means that your blood pressure rises in reaction to increased sodium intake. ”All people are, more or less, sodium sensitive. And there is no sharp break between those who are more sensitive and those who are less;’ says Dr. Kaplan. “It’s like height or any other biological phenomenon. It varies a great deal among individuals. Some people are exquisitely sensitive. If they touch salt, their blood pressure goes way up. For a few others, their intake hardly seems to matter.” About half of people with high blood pressure fit into the category of highly sodium sensitive. For many of these people, sodium restriction is definitely a good idea. Among those people who are not salt-sensitive, restricting salt too much-to less than half a teaspoon a day-also may raise their blood pressure. So if you happen to be hypertensive, what should you do?

Reducing Sodium

The best approach is to start by making sure that you get no more sodium than your body needs. The average American consumes about 4,000 milligrams of sodium each day. That’s quite a few shakes beyond the 2,400 milligrams that the National Academy of Sciences suggests as a maximum intake for just about everyone. A level teaspoon of salt contains about 2,400 milligrams of sodium, so if your current intake is 3,500 milligrams or less, you can get yourself to the adequate-intake zone by getting rid of about half a teaspoon of salt each day.

If you have high blood pressure (defined as a reading of 140/90 and above), you do want powerful medicine to control it. This doesn’t have to mean drugs. As study after study has shown-diet is powerful medicine. It can’t always replace pills and other medical means when blood pressure is elevated, but it often does. And it can frequently either boost the effect of medication or allow for a lower dose. More good news: Those who are most helped by good eating are the ones who most need help. The higher your blood pressure, the more it is likely to fall if you use your head when you fill your belly.
Diet therapy to reduce high blood pressure calls for the following:

•     An eating plan geared to weight control. For those people who are overweight, a low-fat (made up of less than 20 percent of calories diet, high in unrefined complex carbohydrates is ideal.
• Limiting sodium intake to 2,400 milligrams a day (the amount in a level teaspoon of table salt). Discuss with your physician whether it would be wise to limit your sodium intake even more.
• Including in your diet a variety of fruits and vegetables that together provide at least 3,500 milligrams of potassium a day.
• Getting your Daily Value (DV) for magnesium and calcium.

If you already have high blood pressure, doctors may need to prescribe medication to bring it under control. There are four main classes of drugs. Diuretics, which help the body excrete extra fluids to lower blood pressure, are usually tried first. Betablockers are designed to slow the heart rate and reduce the amount of blood the heart pumps. AC’E inhibitors help reduce the chemicals that cause your blood vessels to constrict. And calcium channel blockers also help to relax and widen blood vessels.
However, although they are often prescribed by doctors, drugs should be your last option. They all have side effects, ranging from fatigue to headaches to depression. Besides, there’s a lot you can do to help lower blood pressure on your own. And keep in mind that every little bit helps. For each point you drop in the diastolic measure, for example, Dr. Goldberg says you cut your risk of heart attack by 2 to 3 percent. And a massive study of approximately 350,000 Americans found that life expectancy in the United States would jump by 1.5 years if the average systolic blood pressure reading fell just 10 points, from 130 to 120.