Managing Hypertension: 4 Mistakes to Avoid, 4 Must-Dos

High blood pressure is one of the most common chronic conditions in the world. It is also one of the most neglected.

Not because people do not know they have it. But because most people who have it are not managing it as well as they should, out of complacency as well as the failure to realise the serious health consequences of that. In my years of coaching people with hypertension, I see the same mistakes being made repeatedly. Four of them stand out.

If you have hypertension, see how many of these you recognise in yourself.

Watch the short podcast episode below, or read on.

Mistake 1: Not Taking It Seriously Enough

High blood pressure earns its reputation as the silent killer for a reason. It causes no symptoms. People feel perfectly fine while it quietly damages their heart, kidneys, brain, and eyes over years and decades. By the time symptoms appear, serious damage has often already been done.

Nearly half of all people with hypertension globally do not even know they have it. Many who do know are not doing enough about it. They feel well, so the urgency is lacking. That complacency is exactly what makes hypertension so dangerous.

Taking it seriously does not mean being anxious about it. It means doing everything you are willing and able to do to control it better and prevent its complications. Now, not later.

Mistake 2: Depending Mainly on Pills Without Improving Lifestyle

Medication brings the blood pressure number down. That matters. But the blood pressure reading is not the whole story.

The goal of managing hypertension is not just a good reading at your next clinic visit. The goal is preventing the serious complications that poorly controlled hypertension leads to over time. And achieving a good reading through medication alone, without addressing the underlying lifestyle and dietary habits that are driving the problem, does not fully achieve that goal.

Lifestyle and diet improvement is a must-do for hypertension, regardless of whether you are already on medication, and regardless of whether your blood pressure is already at target. Pills and lifestyle are not doing the same job. One manages the number. The other addresses the underlying causes and reduces the broader cardiovascular risk that hypertension brings. You need both.

Mistake 3: Adding Foods to Lower Blood Pressure Instead of Changing the Diet

This is one of the most common diet mistakes I see. A person is told they have high blood pressure. They go online and search for foods that lower blood pressure. They find a list. They start adding those foods to their diet.

But they do not change the existing diet that is contributing to the high blood pressure in the first place.

Adding celery juice or hibiscus tea or potassium-rich foods to an otherwise unhealthy diet does very little if the diet itself remains full of the habits that are driving the problem. The question to ask is not what to add. The question is what in your current diet is actively contributing to your high blood pressure, and what needs to change.

Focus on changing and improving the diet. Not just adding to it.

Mistake 4: Following Generic Advice Without Looking at Your Own Specific Situation

Hypertension is not a one-size-fits-all condition. The lifestyle and dietary factors that are contributing to your high blood pressure are specific to you. What works for someone else may not work for you.

A good example is salt. Many people reduce their salt intake significantly and see little improvement in their blood pressure. This is not unusual. People respond to sodium differently. Some are salt-sensitive and will see a meaningful drop in blood pressure when sodium is reduced. Others are relatively salt-resistant and see much less change even with significant reduction. There is no easy way to tell which category you fall into without personalised assessment.

High blood pressure is also driven by multiple factors: weight, specific dietary habits, exercise levels, sleep quality, stress, alcohol, genetics, and other medical conditions. The contribution of each factor is different for each person. Generic lists and standard advice can only go so far. Managing hypertension well requires identifying which specific factors in your own lifestyle and diet are the key drivers, and targeting those directly.

If possible, seek support from a doctor or healthcare professional who focuses on lifestyle medicine and offers personalised lifestyle and diet coaching for hypertension.

Interested in 1-1 Lifestyle Coaching with Dr Chan for Hypertension?

If you are living with hypertension and would like personalised support in identifying and improving the specific lifestyle and eating habits that are contributing to your high blood pressure, find out more about 1-1 coaching with Dr Chan through the link below.

Find out more about 1-1 Personalised Lifestyle Coaching with Dr Chan Here

Related Posts

• Lifestyle Coaching for Chronic Diseases: What It Is and Why It Matters
• Lifestyle vs Pills for Diabetes: 3 Mistakes

About Dr Chan Tat Hon

Dr Chan graduated from the National University of Singapore medical school in 1992. For the last ten years, his work has focused on lifestyle medicine. He works with healthcare and corporate organisations to design and deliver lifestyle behaviour change programmes, train health coaches and build communities engaged in cultivating healthy behaviours to combat diseases.

He also provides training and coaching to individuals with diabetes, hypertension, high cholesterol, cardiovascular diseases and other lifestyle-related chronic diseases through 1-1 personalised coaching, live webinars, and online courses.

• 1-1 Personalised Coaching with Dr Chan
• Online Courses and Programmes by Dr Chan
• Reversing Type 2 Diabetes: Essential Basics Online Programme
• LinkedIn Profile of Dr Chan Tat Hon

About This Podcast Episode

In this episode of The Habits Pharmacy Podcast, I share four important things I would strongly recommend to every person with hypertension who wants the best possible long-term health outcome despite having high blood pressure. The four things are: take it seriously, make lifestyle the cornerstone of your management, focus on changing your diet rather than simply adding foods to it, and personalise and individualise your approach. I also share the composite story of David, who spent months adding blood pressure-lowering foods to an otherwise unchanged diet without seeing improvement in his blood pressure.

Full Transcript

The following is the full transcript of the podcast episode above.

If you want to beat high blood pressure, there are four important things I would recommend you do. Hi, I'm Dr Chan. In this episode of the Habits Pharmacy Podcast, I'm going to share four important things that I would recommend to people with hypertension if they want to get the best possible lifelong health outcomes despite having high blood pressure.

If you have hypertension, these are the four things I would strongly recommend that you be mindful of. Number one, take it seriously. Number two, lifestyle as the cornerstone. Number three, change, not add. Number four, make it personal. Let's dive into each of them in greater detail.

Number one, take hypertension seriously. Take hypertension seriously because hypertension is a serious problem. It is one of the leading modifiable risk factors for death globally. About one in three adults globally has hypertension. More than a billion people aged thirty and above are living with hypertension worldwide, and nearly half of them do not even know they have high blood pressure. Poorly controlled high blood pressure is one of the leading causes of premature death and many serious health complications, including stroke, heart attack, heart failure, chronic kidney disease, vision loss, and even blindness and dementia.

Take hypertension seriously because it is a silent killer. It is very stealthy. It slowly, silently, but surely destroys one's health over years and decades, often without any symptoms at all. Many patients with poorly controlled high blood pressure feel perfectly well, and they only start to take it seriously when they are confronted with serious complications caused by years of neglect.

Take hypertension seriously because the reality is that the majority of people don't. One in three adults has hypertension, and one in two of them is undiagnosed. They are living with an unhealthy high blood pressure level that is slowly damaging their body without them knowing it, without them doing anything about it. In fact, many people first discover they have hypertension only after being diagnosed with a stroke, a heart attack, heart failure, chronic kidney failure, or even vision loss. They were unaware they had high blood pressure and not treating it for years until they found themselves at the A&E, at the emergency department, with hypertension-related complications. That is why doctors widely describe high blood pressure as the silent killer. So that is number one, take hypertension seriously because neglecting it or being complacent about it can lead to many very serious health consequences.

Number two, lifestyle as the cornerstone. You must make lifestyle the cornerstone of your efforts to beat hypertension fully and optimally, regardless of whether you are already taking medications for high blood pressure or not, regardless of whether your blood pressure is already well controlled or not. Because your main goal should not only be about achieving a good blood pressure reading, it should be about preventing and minimizing all the serious complications of hypertension. And to do that fully, just achieving a good blood pressure reading through medications is not good enough.

Lifestyle and diet improvement is still a must-do. Even if you had taken medications to bring your blood pressure down to target, lifestyle improvement remains essential because it addresses many of the underlying drivers of cardiovascular disease and complications of hypertension, not just the blood pressure reading itself. Of course, not all cases of hypertension are caused by unhealthy lifestyle and diet. Some are the result of certain medical conditions or medications. But even then, in such cases, lifestyle and eating habits improvement is still very important in minimizing the progression and preventing the complications of hypertension. So that is number two. If you have hypertension, lifestyle must be the cornerstone, the foundation of your endeavor to achieve the best possible long-term health outcome despite having high blood pressure.

Number three, change, not add. Number three is specifically about diet. If you have hypertension, focus on changing and improving your diet, not just adding to it. Let me explain this with the story of David. David is not a real patient. He is a composite case story based on my years of coaching people with hypertension to improve their lifestyle and diets to better control their high blood pressure.

When David was told by his doctor that he had high blood pressure, he became obsessed with finding the best superfoods, the best medicinal foods that might help lower his blood pressure. He went to YouTube, Facebook, Instagram, and TikTok, subscribed to many channels, followed many content creators, and watched many videos, especially those with titles such as Top 10 Best Foods for High Blood Pressure, Five Foods to Naturally Lower Your Blood Pressure. From his research, he ended up with a long list of foods, herbs, and ingredients touted to be good for lowering blood pressure. Faced with such a long list, he simply randomly picked a few that he was more familiar with and comfortable with trying, and tried adding them to his diet in a piecemeal random manner whenever he could. But after many months of doing that, his blood pressure did not improve much.

What do you think David did wrong? After all, he did add foods known to lower blood pressure to his diet, but his blood pressure didn't improve. Why? Let me ask you this. If there are many specific aspects of David's existing diet that are clearly unhealthy and clearly contributing significantly to his high blood pressure, do you think it would be good enough to simply add blood pressure-lowering foods to that unhealthy diet in a random manner without changing or improving his existing unhealthy diet? I hope the answer is already obvious and abundantly self-evident. But the sad reality is that in my years of coaching patients with hypertension, this is a very common problem. Many would come to me and ask, "Doctor, what should I eat to lower my blood pressure?" expecting me to give them a list of foods to simply add to their diet. Instead, I would say to them, "To fully and optimally tackle your high blood pressure, you cannot simply add to your diet without improving and changing it. Focus first on what you are already eating regularly, and then from there, identify all the specific aspects of your diet that are clearly contributing to your high blood pressure problem. Then work to change and improve each of them and eventually all of them. Focus first and mainly on changing your diet, not just adding to it." So that is number three. When it comes to diet and hypertension, focus on improving and changing, not simply adding.

Number four, make it personal. Your management of hypertension must be individualized and personalized because you are unique. The underlying lifestyle causes and contributors to your high blood pressure are unique to you. What works for other people may not work for you. For example, many people have said to me during coaching sessions, "Doctor, I have already cut down significantly on my salt intake, but my blood pressure has hardly improved." This is more common than most people think. People respond to salt intake differently. About half of them with hypertension are what we call salt sensitive. They will see a meaningful drop in blood pressure when they reduce their sodium intake. While the other half are relatively salt resistant. Their blood pressure is much less affected by salt intake, and they may only see a small change even if they reduce their salt intake very significantly. Unfortunately, there's no easy way to tell who is salt sensitive and who is not, and many people fall somewhere in between.

Hypertension is also multifactorial. High blood pressure can be driven by excess weight, many different specific aspects of diet, lack of exercise, poor sleep, alcohol, stress, genetics, or other factors. And the contribution of each of these factors is different for different people with hypertension. And most people with high blood pressure also have one or more other chronic conditions such as diabetes or high cholesterol, and may also be on different medication regimes as well. That is why individualizing and personalizing the management plan, especially the lifestyle and diet modification plan, is not just necessary but very critical. Any generic one-size-fits-all food list or diet plan is simply not going to be good enough if one truly hopes to manage hypertension optimally.

So let me reiterate these four important things that I would strongly urge every person with hypertension to do. Number one, take it seriously. I'm not saying you need to be anxious or constantly worried, but do not be complacent. Take hypertension seriously. Do everything you are willing and able to do to control your blood pressure better and prevent its many serious complications. Number two, make improving your lifestyle and diet the cornerstone, the foundation of your endeavor to beat hypertension, regardless of whether you are already on medications or not, regardless of whether your blood pressure is already well controlled or not. Make improving your lifestyle and diet the cornerstone of your efforts. Number three, specifically with regards to your diet, focus on improving and changing it, not just simply adding to it. Number four, make it personal. Your hypertension management plan, including which aspects of your lifestyle or diet to pay more attention to, to make more effort in, should be personalized and individualized. If possible, seek support from your doctor or other healthcare professionals who focus on lifestyle medicine and offer lifestyle and diet coaching.

If you have hypertension, I hope you have found this episode of the Habits Pharmacy podcast useful. If you want to find out more about what I do, whether it's about one-to-one lifestyle and diet coaching, online learning programs, or how to contact me, you can go to my websites, thehabitsdoctor.com or thehabitspharmacy.com. I'm Dr Chan. Let your habits be your medicine to combat lifestyle-related chronic diseases such as hypertension. See you at the next episode, and until then, live well, eat well, and be well.

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