Lower Blood Pressure & Cholesterol According to the Latest AHA Guideline

Although none of us can change non-modifiable risk factors such as age, gender and family history, we can embrace the modifiable changes we can make.

Steve Wolf, a film and live event producer, met with his doctor last year to discuss lifestyle changes for diet and physical activity that could potentially improve his health and well-being and add years to his life. He met with Clay Cauthen, M.A., M.D., a cardiologist in Austin, Texas, with the aim of lowering his weight, blood pressure and cholesterol—all risk factors for heart disease.

Right around the time Wolf was visiting his doctor, the American Heart Association and American College of Cardiology released their Guideline on Lifestyle Management to Reduce Cardiovascular Risk, which provides recommendations to improve cardiovascular health based on the latest research. Although he didn’t know it at the time, Wolf is exactly the kind of person this new "lifestyle guideline" was designed to help. On his own, the go-getter chose to implement many of the recommendations of the guideline in his daily life.

"The [recommendations in the] guideline are relevant, proven, and they work," says Clyde W. Yancy, M.D., M.S.C, F.A.C.C., F.A.H.A., M.A.C.P., chief of the Division of Medicine-Cardiology at Northwestern University Feinberg School of Medicine in Chicago. He’s also associate director of the Bluhm Cardiovascular Institute at Northwestern Memorial Hospital in Chicago and a past president of the AHA.

"The guideline incorporates not just drug therapy but nondrug therapy if we are to succeed in reducing the burden of heart disease and stroke, currently the leading causes of death and disability in the United States," he says. "Our approach must be multifaceted, including modifying lifestyles, and it can make a real difference in the health of individuals and communities."

Although none of us can change non-modifiable risk factors such as age, gender and family history, Wolf embraced the modifiable changes he knew he could make to his diet and physical activity and reports the following impressive results:

  • He dropped 39 pounds—down from 189 pounds to his high school weight of 150 pounds.
  • His blood pressure fell from 141/92 mm Hg to 118/79 mm Hg.
  • He reduced his total cholesterol number by two-thirds.

Wolf didn’t smoke, so he adopted six of the AHA’s Life’s Simple 7® keys to prevention of heart disease: manage blood pressure, control cholesterol, reduce blood sugar, eat right, lose weight and get moving. He started by replacing his desk with a treadmill to which he attached his computer so he can walk while he works for two hours.


Among Life’s Simple 7, three components merit special attention, as Wolf knows all too well: blood pressure, cholesterol and physical activity.

Also known as the "silent killer," high blood pressure, or hypertension, may have no apparent symptoms. Even so, hypertension and prehypertension (having a blood pressure that’s higher than normal but has not yet reached hypertension levels) are risk factors for heart attack, angina, stroke, kidney failure and peripheral artery disease. It’s well known that people with prehypertension will likely develop high blood pressure if it’s just left undetected or untreated.

The word "diet" is being replaced with "dietary pattern," soon to become healthcare buzzwords. "We don’t mean that you can’t have a medium-rare steak once a month or a piece of birthday cake," Eckel says. "It’s not about eating something one time, but rather the daily overall pattern of your diet that ultimately matters."

Guideline authors also note that "foods are typically consumed in combinations rather than individually." They urge you to make meals matter, and to limit foods and beverages high in calories but low in nutrients.

"The guideline represents the process of science that slowly builds consensus," says Rachel Johnson, Ph.D., M.P.H., R.D., a registered dietitian at the University of Vermont Department of Nutrition and Food Sciences. "Nutrition is an evolving science and we’re learning so much more all the time. For example, we used to just talk about ‘fat’, and now we’re learning all about the quality and type of fat. Dietary patterns teach us how food ‘fits together.’"

These new prevention guidelines focus on selected critical questions for each topic and are based on the highest quality evidence available, the authors wrote. They sought to evaluate evidence that particular dietary patterns, nutrient intake and levels, and types of physical activity can play a major role in cardiovascular disease prevention and treatment through effects on modifiable cardiovascular disease risk factors, including blood pressure and cholesterol levels.


For adults who would benefit from lowering their LDL-cholesterol or those who would like to practice a heart-healthy lifestyle, the guidelines recommend a diet that emphasizes consumption of:

  • vegetables: root and green varieties
  • fruits: fresh if possible
  • whole grains: cereals, breads, rice and pasta
  • low-fat or no-fat dairy products
  • poultry
  • fish: especially fatty fish (salmon, mackerel, herring, lake trout, sardines, albacore tuna), which are rich in omega-3 fatty acids
  • legumes
  • non-tropical vegetable oils: olive and canola
  • nuts: walnuts, almonds or hazelnuts AND
  • limiting the intake of sweets, sugar-sweetened beverages and red meats

Although slightly different, several established dietary patterns meet these recommendations such as the Dietary Approaches to Stop Hypertension, or DASH, diet (dashdiet.org), the USDA Food Pattern (cnpp.usda.gov/USDAfoodpatterns.htm) or diet and lifestyle recommendations from the AHA (heart.org/recommendations).

You’re reminded to aim for only 5 to 6 percent of calories from saturated fat and to reduce intake of trans fats that are found in partially hydrogenated oil. Trans fat is created during the process of hydrogenation, when liquid oils convert into solid fats.

It is hard to instinctively know about factors such as calorie count and sugar content, so when you surf the grocery store shelves check Nutrition Facts labels. Of course, deciphering the lingo isn’t always easy, so this year the FDA proposed to update packaged foods labels to make them easier to understand and to reflect the latest scientific information, including the link between diet and chronic diseases such as obesity and heart disease. The proposed new labels also would replace out-of-date serving sizes.


To help keep your blood pressure at a "normal" level (see Know your numbers! below) follow the recommended dietary patterns above, and then also reduce your salt intake. "That simple step lowers blood pressure in most people," says Eckel.

The average American’s average sodium intake is 3,400 milligrams per day, much more than the guideline’s recommended maximum level of 2,400 milligrams per day. The AHA strongly recommends keeping sodium intake to no more than 1,500 milligrams per day. "Getting down to 1,500 milligrams is associated with further reduction of blood pressure Eckel says, "but try to reduce sodium by at least 1,000 milligrams a day."


The evidence is too strong to ignore—higher levels of physical activity result in lower rates of many chronic diseases including heart disease, along with longer life.

Per the guideline’s report, both aerobic activity and resistance training deliver "a modest cholesterol-lowering effect," says Eckel. Aerobic activity can also help decrease blood pressure on average by 2 to 5 mm Hg and 1 to 4 mm Hg, respectively. The authors found no evidence for the role of resistance training on blood pressure, however.

To sum up, adults with high blood pressure or high cholesterol should participate in aerobic physical activity three to four times a week, for an average of 40 minutes each, at moderate-to-vigorous intensity, Eckel says.

Remember that a healthy weight is an ideal partner for heart healthy nutrition, he says. "During active weight reduction, both [cholesterol] and blood pressure will fall. It’s important that lifestyle changes be continued after weight is lost, which means not returning to your former diet, including increased salt intake."


Now you may understand the guideline, but you’re probably wondering, "What do I do with it?" Start by exerting control over your own dietary pattern, says registered dietitian Sharon Palmer, R.D.N., author of the book The Plant-Powered Diet (The Experiment, 2012). Try her sensible tips for heart-healthy eating:

Down the hatch: In addition to incorporating plenty of water into your diet, mix up plant-based, unsweetened beverages. Brew your own iced tea by the pitcher—use herbal teas if caffeine is off limits for you. Chill and then add more flavor by mixing in sliced cucumbers or herbs such as basil or rosemary. For sweetness, add slices of fruit or berries.

Also try the new subtly flavored unsweetened waters, or make your own fizzy beverages, including sparkling water, with a home carbonation system.

Love legumes: Get to know these dietary darlings and snap up peas, kidney, pinto, black, white, Lima and navy beans, lentils, soybeans and peanuts. "It’s hard to find a more nutrient-rich food for such a low price point," says Palmer. "Legumes have protein, fiber, and plenty of vitamins and minerals. A package of beans with vegetables added makes a delicious and economical lunch for a week."

Mean lean: If you eat meat, choose skinless poultry or fish and use healthier cooking techniques such as grilling, steaming, baking or poaching to prepare it. Cut off visible fat and prepare it using healthier oils such as canola and olive oil. Limit red meat intake and only select lean cuts of meat such as beef round or loin (look for 90 to 95 percent lean on the package label), pork or lamb loin without visible fat. Use the same healthier cooking techniques above.

Fancy what’s fresh: For optimum nutrition, always choose fresh seasonal fruits and vegetables. During "off" months, use frozen fruit (which is often picked during its peak), fruit canned in its own juices, or dried fruits. "Buy juicy oranges in winter, crunchy apples in the fall," says Palmer.

Cook at home, sweet home: "Study after study shows that when you eat out, you consume more saturated fat, calories and sodium," Palmer says. "At home, you save money and can prepare food the healthy way you should and be more selective about portion sizes."

Those kinds of simple changes can go a long way toward longlasting health. Experts say it’s important for you to know that the power is within you to change your mind and your health. That starts with the belief that you can do it. Envision and then write down your goals. Build your support system because you really shouldn’t go this alone. Go through your pantry and fridge and replace unhealthy foods with healthy ones. Then put one foot in front of the other to start moving.

To help motivate himself, Wolf tries to put what he wants most ahead of what he wants now. "I may want a steak and a milkshake now, but I want to be around for my children," he says. "So I point my fork at the veggies instead."

Take stock of how you feel after making changes, Wolf adds. "I could feel my energy level improving along with my ability to handle stress, my need for sleep diminishing, and I could see weight coming off, which eliminated chronic back and knee pain I’d been experiencing."

In May he delivered a professional keynote address comfortably wearing—for the first time in 33 years—the tuxedo he’d worn to his high school prom.


Know your numbers!

The American Heart Association recommends that you be aware of four key numbers: total cholesterol, blood pressure, blood sugar and body mass index (BMI).

These numbers are important because they’ll allow you and your healthcare provider to determine your risk for developing cardiovascular disease.

Ideal numbers for most adults are:

  • Total cholesterol: less than 180 mg/dL
  • Blood pressure: less than 120/80 mm Hg
  • Fasting blood sugar: less than 100 mg/dL
  • Body mass index (BMI): less than 25 kg/m2 (to find out what your BMI is, visit heart.org/bmi)
Edit ModuleShow Tags

AD. American Heart Association logo. Know your blood pressure numbers. And what they mean. Gain Control. button: learn more.


AD: American Heart Association logo. American Diabetes Association logo. Know diabetes by heart logo. Living with diabetes? Inspire others. Submit story button.


AD. American Heart Association Support Network. Everyone's diagnosis story is different and sharing yours can help others. Join the Support Network and share your experience. heart.org/SupportNetwork


AD: American Heart Association logo. Symptoms. Always feeling tired isn't normal. Learn the signs of Heart Valve Disease.


AD. American Heart Association logo. Know your blood pressure numbers. And what they mean. Gain Control. button: learn more.


Edit ModuleShow Tags

Special Topic Supplements

Edit ModuleShow Tags


Heart News

Heart health news you can use about new scientific findings, public policy, programs and resources.


Articles, poems and art submitted by heart disease survivors and their loved ones.

Life's Simple 7

Improving your health is as easy as minding seven simple health factors and behaviors. Tips and information to help you improve your health and enhance your quality of life.

Life Is Why

Everyone has a reason to live a longer, healthier life. These heart patients, their loved ones and others share their 'whys'. We'd love for you to share yours, too!

Simple Cooking

Cooking at home can be a daunting task, but a rewarding one for your diet and lifestyle (and your wallet). Making small changes in your diet is important to your heart health. Here are simple, healthy and affordable recipes and cooking tips.