10 ways to control high blood pressure without medicationBy making these 10 lifestyle changes, you can lower your blood pressure and reduce your risk of heart disease. By Mayo Clinic Staff

If you've been diagnosed with high blood pressure (a systolic pressure — the top number — of 140 or above or a diastolic pressure — the bottom number — of 90 or above), you might be worried about taking medication to bring your numbers down. Lifestyle plays an important role in treating your high blood pressure. If you successfully control your blood pressure with a healthy lifestyle, you may avoid, delay or reduce the need for medication. Here are 10 lifestyle changes you can make to lower your blood pressure and keep it down.  1. Lose extra pounds and watch your waistlineBlood pressure often increases as weight increases. Losing just 10 pounds (4.5 kilograms) can help reduce your blood pressure. In general, the more weight you lose, the lower your blood pressure. Losing weight also makes any blood pressure medications you're taking more effective. You and your doctor can determine your target weight and the best way to achieve it. Besides shedding pounds, you should also keep an eye on your waistline. Carrying too much weight around your waist can put you at greater risk of high blood pressure. In general: Men are at risk if their waist measurement is greater than 40 inches (102 centimeters, or

cm). Women are at risk if their waist measurement is greater than 35 inches (89 cm). Asian men are at risk if their waist measurement is greater than 36 inches (91 cm). Asian women are at risk if their waist measurement is greater than 32 inches (81 cm). 2. Exercise regularlyRegular physical activity — at least 30 to 60 minutes most days of the week — can lower your blood pressure by 4 to 9 millimeters of mercury (mm Hg). And it doesn't take long to see a difference. If you haven't been active, increasing your exercise level can lower your blood pressure within just a few weeks. If you have prehypertension — systolic pressure between 120 and 139 or diastolic pressure between 80 and 89 — exercise can help you avoid developing full-blown hypertension. If you already have hypertension, regular physical activity can bring your blood pressure down to safer levels. Talk to your doctor about developing an exercise program. Your doctor can help determine whether you need any exercise restrictions. Even moderate activity for 10 minutes at a time, such as walking and light strength training, can help. But avoid being a "weekend warrior." Trying to squeeze all your exercise in on the weekends to make up for weekday inactivity isn't a good strategy. Those sudden bursts of activity could actually be risky.  3. Eat a healthy diet

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Eating a diet that is rich in whole grains, fruits, vegetables and low-fat dairy products and skimps on saturated fat and cholesterol can lower your blood pressure by up to 14 mm Hg. This eating plan is known as the Dietary Approaches to Stop Hypertension (DASH) diet. It isn't easy to change your eating habits, but with these tips, you can adopt a healthy diet: Keep a food diary. Writing down what you eat, even for just a week, can shed surprising

light on your true eating habits. Monitor what you eat, how much, when and why. Consider boosting potassium. Potassium can lessen the effects of sodium on blood

pressure. The best source of potassium is food, such as fruits and vegetables, rather than supplements. Talk to your doctor about the potassium level that's best for you.

Be a smart shopper. Make a shopping list before heading to the supermarket to avoid picking up junk food. Read food labels when you shop and stick to your healthy-eating plan when you're dining out, too.

Cut yourself some slack. Although the DASH diet is a lifelong eating guide, it doesn't mean you have to cut out all of the foods you love. It's OK to treat yourself occasionally to foods you wouldn't find on a DASH diet menu, such as a candy bar or mashed potatoes with gravy.

 4. Reduce sodium in your dietEven a small reduction in the sodium in your diet can reduce blood pressure by 2 to 8 mm Hg. The recommendations for reducing sodium are: Limit sodium to 2,300 milligrams (mg) a day or less. A lower sodium level — 1,500 mg a day or less — is appropriate for people 51 years of age

or older, and individuals of any age who are African-American or who have high blood pressure, diabetes or chronic kidney disease.

To decrease sodium in your diet, consider these tips: Track how much salt is in your diet. Keep a food diary to estimate how much sodium is

in what you eat and drink each day. Read food labels. If possible, choose low-sodium alternatives of the foods and beverages

you normally buy. Eat fewer processed foods. Potato chips, frozen dinners, bacon and processed lunch

meats are high in sodium. Don't add salt. Just 1 level teaspoon of salt has 2,300 mg of sodium. Use herbs or spices,

rather than salt, to add more flavor to your foods. Ease into it. If you don't feel like you can drastically reduce the sodium in your diet

suddenly, cut back gradually. Your palate will adjust over time. 5. Limit the amount of alcohol you drinkAlcohol can be both good and bad for your health. In small amounts, it can potentially lower your blood pressure by 2 to 4 mm Hg. But that protective effect is lost if you drink too much alcohol — generally more than one drink a day for women and men older than age 65, or more than two a day for men age 65 and younger. Also, if you don't normally drink alcohol, you shouldn't start

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drinking as a way to lower your blood pressure. There's more potential harm than benefit to drinking alcohol. If you drink more than moderate amounts of it, alcohol can actually raise blood pressure by several points. It can also reduce the effectiveness of high blood pressure medications. Track your drinking patterns. Along with your food diary, keep an alcohol diary to track

your true drinking patterns. One drink equals 12 ounces (355 milliliters, or mL) of beer, 5 ounces of wine (148 mL) or 1.5 ounces of 80-proof liquor (45 mL). If you're drinking more than the suggested amounts, cut back.

Consider tapering off. If you're a heavy drinker, suddenly eliminating all alcohol can actually trigger severe high blood pressure for several days. So when you stop drinking, do it with the supervision of your doctor or taper off slowly, over one to two weeks.

Don't binge. Binge drinking — having four or more drinks in a row — can cause large and sudden increases in blood pressure, in addition to other health problems

6. Avoid tobacco products and secondhand smokeOn top of all the other dangers of smoking, the nicotine in tobacco products can raise your blood pressure by 10 mm Hg or more for up to an hour after you smoke. Smoking throughout the day means your blood pressure may remain constantly high. You should also avoid secondhand smoke. Inhaling smoke from others also puts you at risk of health problems, including high blood pressure and heart disease.  7. Cut back on caffeineThe role caffeine plays in blood pressure is still debatable. Drinking caffeinated beverages can temporarily cause a spike in your blood pressure, but it's unclear whether the effect is temporary or long lasting. To see if caffeine raises your blood pressure, check your pressure within 30 minutes of drinking a cup of coffee or another caffeinated beverage you regularly drink. If your blood pressure increases by five to 10 points, you may be sensitive to the blood pressure raising effects of caffeine.  8. Reduce your stressStress or anxiety can temporarily increase blood pressure. Take some time to think about what causes you to feel stressed, such as work, family, finances or illness. Once you know what's causing your stress, consider how you can eliminate or reduce stress. If you can't eliminate all of your stressors, you can at least cope with them in a healthier way. Take breaks for deep-breathing exercises. Get a massage or take up yoga or meditation. If self-help doesn't work, seek out a professional for counseling.  9. Monitor your blood pressure at home and make regular doctor's appointmentsIf you have high blood pressure, you may need to monitor your blood pressure at home. Learning to self-monitor your blood pressure with an upper arm monitor can help motivate you. Talk to your doctor about home monitoring before getting started. Regular visits to your doctor are also likely to become a part of your normal routine. These visits will help keep tabs on your blood pressure.

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Have a primary care doctor. People who don't have a primary care doctor find it harder to control their blood pressure. If you can, visit the same health care facility or professional for all of your health care needs.

Visit your doctor regularly. If your blood pressure isn't well controlled, or if you have other medical problems, you might need to visit your doctor every month to review your treatment and make adjustments. If your blood pressure is under control, you might need to visit your doctor only every six to 12 months, depending on other conditions you might have.

 10. Get support from family and friendsSupportive family and friends can help improve your health. They may encourage you to take care of yourself, drive you to the doctor's office or embark on an exercise program with you to keep your blood pressure low. Talk to your family and friends about the dangers of high blood pressure. If you find you need support beyond your family and friends, consider joining a support group. This may put you in touch with people who can give you an emotional or morale boost and who can offer practical tips to cope with your condition.

Does drinking alcohol affect your blood pressure?Drinking too much alcohol can raise blood pressure to unhealthy levels. Having more than three drinks in one sitting temporarily increases your blood pressure, but repeated binge drinking can lead to long-term increases. Heavy drinkers who cut back to moderate drinking can lower their systolic blood pressure (the top number in a blood pressure reading) by 2 to 4 millimeters of mercury (mm Hg) and their diastolic blood pressure (the bottom number in a blood pressure reading) by 1 to 2 mm Hg. Heavy drinkers who want to lower blood pressure should slowly reduce how much they drink over one to two weeks. Heavy drinkers who stop suddenly risk developing severe high blood pressure for several days. If you have high blood pressure, avoid alcohol or drink alcohol only in moderation. Moderate drinking is generally considered to be: Two drinks a day for men younger than age 65 One drink a day for men age 65 and older One drink a day for women of any ageA drink is 12 ounces (355 milliliters) of beer, 5 ounces (148 milliliters) of wine or 1.5 ounces (44 milliliters) of 80-proof distilled spirits. Keep in mind that alcohol contains calories and may contribute to unwanted weight gain — a risk factor for high blood pressure. Also, alcohol can interfere with the effectiveness and increase the side effects of some blood pressure medications

Is weightlifting safe if I have high blood pressure?Answers from Sheldon G. Sheps, M.D.

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Maybe. It depends how high your blood pressure is. According to the American Heart Association, you should not lift weights if your blood pressure is uncontrolled — meaning it's higher than 180/110 millimeters of mercury (mm Hg). If your blood pressure is between 140 to 170 mm Hg systolic or 90 to 109 mm Hg diastolic, check with your doctor before starting a weightlifting program to discuss any precautions or special considerations. Weightlifting can cause a temporary increase in blood pressure. This increase can be dramatic — depending on how much weight you lift. But, weightlifting can also have long-term benefits to blood pressure that outweigh the risk of a temporary spike for most people. Regular exercise, including moderate weightlifting, provides many health benefits, including helping to lower blood pressure in the long term. If you have high blood pressure, talk to your doctor before starting any exercise program. Your doctor can help you develop an exercise program tailored to your needs and medical conditions. If you have high blood pressure, here are some tips for getting started on a weightlifting program: Learn and use proper form when lifting to reduce the risk of injury. Don't hold your breath. Holding your breath during exertion can cause dangerous spikes in

blood pressure. Instead, breathe easily and continuously during each lift. Lift lighter weights more times. Heavier weights require more strain, which can cause a

greater increase in blood pressure. You can challenge your muscles with lighter weights by increasing the number of repetitions you lift.

Alternate between upper and lower body exercises to let your muscles rest during exercise.

Exercise: A drug-free approach to lowering high blood pressureHaving high blood pressure and not getting enough exercise are closely related. Discover how small changes in your daily routine can make a big difference. By Mayo Clinic StaffYour risk of high blood pressure (hypertension) increases with age, but getting some exercise can make a big difference. And if your blood pressure is already high, exercise can help you control it. Don't think you've got to run a marathon or join a gym. Instead, start slow and work more physical activity into your daily routine.  How exercise can lower your blood pressureHow are high blood pressure and exercise connected? Regular physical activity makes your heart stronger. A stronger heart can pump more blood with less effort. If your heart can work less to pump, the force on your arteries decreases, lowering your blood pressure. Becoming more active can lower your systolic blood pressure — the top number in a blood pressure reading — by an average of 4 to 9 millimeters of mercury (mm Hg). That's as good as some blood pressure medications. For some people, getting some exercise is enough to reduce the need for blood pressure medication.

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If your blood pressure is at a desirable level — less than 120/80 mm Hg — exercise can help keep it from rising as you age. Regular exercise also helps you maintain a healthy weight, another important way to control blood pressure. But to keep your blood pressure low, you need to keep exercising. It takes about one to three months for regular exercise to have an impact on your blood pressure. The benefits last only as long as you continue to exercise.  How much exercise do you need?Flexibility and strengthening exercises such as lifting weights are an important part of an overall fitness plan, but it takes aerobic activity to control high blood pressure. And you don't need to spend hours in the gym every day to benefit. Simply adding moderate physical activities to your daily routine will help. Any physical activity that increases your heart and breathing rates is considered aerobic exercise, including: Household chores, such as mowing the lawn, raking leaves or scrubbing the floor Active sports, such as basketball or tennis Climbing stairs Walking , Jogging, Bicycling, SwimmingThe American Heart Association recommends you get at least 150 minutes of moderate exercise, 75 minutes of vigorous exercise or a combination of both each week. Aim for at least 30 minutes of aerobic activity most days of the week. If you can't set aside that much time at once, remember that shorter bursts of activity count, too. You can break up your workout into three 10-minute sessions of aerobic exercise and get the same benefit as one 30-minute session.  Weight training and high blood pressure Weight training can cause a temporary increase in blood pressure during exercise. This increase can be dramatic — depending on how much weight you lift. But, weightlifting can also have long-term benefits to blood pressure that outweigh the risk of a temporary spike for most people. If you have high blood pressure and want to include weight training in your fitness program, remember: Learn and use proper form when lifting to reduce the risk of injury. Don't hold your breath. Holding your breath during exertion can cause dangerous spikes

in blood pressure. Instead, breathe easily and continuously during each lift. Lift lighter weights more times. Heavier weights require more strain, which can cause

a greater increase in blood pressure. You can challenge your muscles with lighter weights by increasing the number of repetitions you do.

Listen to your body. Stop your activity right away if you become severely out of breath or dizzy or if you experience chest pain or pressure.

If you'd like to try weight training exercises, make sure you have your doctor's OK. When you need your doctor's OK

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Sometimes it's best to check with your doctor before you jump into an exercise program, especially if: You're a man older than age 40 or a woman older than age 50 You smoke You're overweight or obese You have a chronic health condition, such as high blood pressure or high cholesterol You've had a heart attack You have a family history of heart-related problems before age 55 You feel pain in your chest or become dizzy with exertion You're unsure if you're in good healthIf you take any medication regularly, ask your doctor if exercising will make it work differently or change its side effects — or if your medication will affect the way your body reacts to exercise.  Keep it safeTo reduce the risk of injury while exercising, start slowly. Remember to warm up before you exercise and cool down afterward. Build up the intensity of your workouts gradually. Stop exercising and seek immediate medical care if you experience any warning signs during exercise, including: Chest pain or tightness Dizziness or faintness Pain in an arm or your jaw Severe shortness of breath An irregular heartbeat Excessive fatigue Monitor your progressThe only way to detect high blood pressure is to keep track of your blood pressure readings. Have your blood pressure checked at each doctor's visit, or use a home blood pressure monitor. If you already have high blood pressure, home monitoring can let you know if your fitness routine is helping to lower your blood pressure, and may make it so you don't need to visit the doctor to have your blood pressure checked as often. If you decide to monitor your blood pressure at home, you'll get the most accurate readings if you check your blood pressure before you exercise, or at least one hour after exercising.

The effects of the recommended dose of creatine monohydrate on kidney functionAbstractWe report a case of a heretofore healthy 18-year-old man who presented with a 2-day history of nausea, vomiting and stomach ache while taking creatine monohydrate for bodybuilding purposes. The patient had acute renal failure, and a renal biopsy was performed to determine the cause of increased creatinine and proteinuria. The biopsy showed acute tubular necrosis. In the literature, creatine

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monohydrate supplementation and acute tubular necrosis coexistence had not been reported previously. Twenty-five days after stopping the creatine supplements, the patient recovered fully. Even recommended doses of creatine monohydrate supplementation may cause kidney damage; therefore, anybody using this supplement should be warned about this possible side effect, and their renal functions should be monitored regularly. Key words

← acute renal failure

← creatine monohydrate

← renal biopsy

BackgroundCreatine supplements are used as a possible performance-enhancing substance by athletes, bodybuilders, and others who wish to gain muscle mass. Most of the studies that have examined the potential toxicity of creatine supplements have not found evidence of any side effects when consumed at recommended doses [1–4]. In the literature, creatine monohydrate supplementation and acute tubular necrosis (ATN) coexistence has not been reported previously. Here, we report a patient who had acute renal failure while taking recommended doses of creatine supplements.

Case reportA heretofore healthy 18-year-old man presented with a 2-day history of nausea, vomiting and stomach ache while consuming induction (20 g/day for 5 days) and maintenance (1 g/day for the next 6 weeks) dosages of creatine monohydrate for bodybuilding purposes. He did not have any significant past medical or family history. At physical examination, he weighed 74 kg, and his BMI was 24.18 kg/m2. His blood pressure was 150/90 mmHg, and he had abdominal tenderness. The initial laboratory studies were as follows: serum urea 39.98 mmol/L (normal 0–36 mmol/L), serum creatinine 201.55 mmol/L (normal 44.2–106 mmol/L), uric acid 0.37 mmol/L (normal 0–0.33 mmol/L), potassium 3.56 mmol/L (normal 3.5–5.0 mmol/L), sodium 148 mmol/L (normal 136–145 mmol/L), pH 7.36 (normal 7.35–7.45), Hct 36.8 (normal 37–52) and total protein 64.87 g/L (normal 64–87 g/L). Urinalysis revealed only proteinuria, and daily protein excretion was 284 mg. The other biochemical parameters and blood count were normal.

The patient was hospitalized, and the creatine supplements were discontinued. Intravenous fluids were administered. During hospitalization, his serum creatinine level increased to 403.10 mmol/L (Figure 1). Serology revealed negative antinuclear, anti-double-stranded DNA and anti-neutrophil cytoplasmic antibodies. The spiral computed tomographic scan and ultrasonography revealed no abnormalities in the kidneys.

Fig. 1 Time course of serum creatinine level.The renal biopsy revealed focal tubular injury with dilatation of tubular lumina and flattening of the tubular epithelial cells. Some of them had hyperchromatic nuclei and prominent nucleoli with occasional mitotic figures. There were sloughed epithelial cells, leucocytes and cellular debris in the tubular lumina; however, there were no pigmented casts. The glomeruli appeared to be normal. Immune complex deposition was not identified with immunoflourescence staining. With these features, the renal biopsy diagnosed acute tubular necrosis (Figure 2).

Fig. 2

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Renal biopsy showing revealed focal tubular injury with dilatation of tubular lumina and flattening of the tubular epithelial cells. Twenty-five days after stopping the creatine supplements, the patient's blood pressure (120/70 mmHg), serum creatinine (88.4 mmol/L) and proteinuria (82 mg/day) normalized, and the patient was discharged from the hospital with a weight of 72 kg.

DiscussionCreatine monohydrate is a performance-enhancing substance. The majority (> 90%) of creatine supplementation ingested is removed from the plasma by the kidney and excreted in the urine [5]. Extensive research over the last decade has shown that oral creatine supplementation appears to be safe when used by healthy adults at recommended loading (20 g/day for 5 days) and maintenance doses (< 3 g/day), and it was largely devoid of adverse side effects [6,7]. The potential side effect of creatine supplementation, kidney damage, was based on case reports only and was associated especially with high doses of creatine supplementation or renal disease [8–10]. In our case, though the patient was using the recommended doses of creatine monohydrate, he developed renal failure. Furthermore; he also did not have a history of any renal disease or use of any nephrotoxic drugs or herbs. There is less concern today than there used to be about possible kidney damage from creatine, although there are reports of kidney damage, such as interstitial nephritis. Therefore, patients with kidney disease should avoid using this supplement. But still, some studies have shown little or no adverse impact on kidney function with the use of oral creatine supplementation [11–13]. In our patient, the renal biopsy showed acute tubular necrosis. In the literature, creatine monohydrate supplementation and ATN coexistence has not been reported previously. After stopping the creatine supplements, the patient recovered completely. He was discharged without any complaints on the 25th day. In conclusion, it must be kept in mind that even the recommended doses of creatine monohydrate supplementation may cause kidney damage. Therefore, anyone using this supplement should be warned about this possible side effect, and the renal functions should be regularly controlled during this period. Can I Take Creatine With High Blood Pressure?Do not take creatine if you have high blood pressure. Photo Credit Jupiterimages/Photos.com/Getty Images Creatine supplementation is popular among people wanting to increase muscle mass, with Americans spending an estimated $14 million on the supplement annually. (Reference 2) Creatine is safe and beneficial for you to use if you have naturally low creatine levels in your body. One example is if you are a vegetarian. However, creatine supplementation may present a danger to you if you suffer from high blood pressure, also known as hypertension.

Serum Creatinine LinkWhen creatine is metabolized by your body it produces the waste product creatinine, which your kidneys expel. A 10-year study published in the "American Journal of Hypertension" examined the correlation between serum creatinine levels and predicting the development of hypertension in 229 Japanese adults aged 30 to 69. Though it was one of the few studies ever published examining the link between creatine and high blood pressure, the researchers concluded that elevated creatinine levels have the potential to predict future hypertension. (Reference 4)More research is needed to determine if creatine supplementation directly affects hypertension, however

10 Best Supplements to Take for High Blood PressureSymptoms go unnoticed with high blood pressure or hypertension, but over time high blood pressure can have devastating effects. Having high blood pressure increases the risk of heart disease and stroke. Typically, it takes years for high blood pressure to develop and cause damage.

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It is easily detected and can be managed through diet alone or in combination with medications. Check with your health-care team before adding any supplement to your routine.

Alpha-Linolenic Acid (ALA)ALA is a type of omega-3 fatty acid found in plants such as flax and walnuts. According to the U.S National Library of Medicine and the National Institutes of Health, there is strong scientific evidence that suggests supplementation of omega-3 fatty acids results in small reductions in blood pressure.

Docosahexaenoic Acid (DHA) and Eicosapentaenoic Acid (EPA)Similar to ALA, these essential fatty acids may decrease blood pressure slightly. Rather than coming from plant sources, these come from animal sources. Omega-3 supplements, cod liver oil and fatty fish are good sources of DHA and EPA.

Creatine and High Blood Pressure | Ask The Fitness NerdCan Creatine increase your blood pressure? The Fitness Nerd takes a closer look.

Hello Fitness Nerd,I was inquiring into the possible connection between creatine use, and high blood pressure.  I had been using creatine for about 4 weeks, not over-doing it, just a scoop a day after every workout.  Recently, I applied for a Police Force in my city, and when they took my blood pressure, they were somewhat shocked. 

Assuming I was nervous (which I wasn’t), they told me to take a few deeeeeeep breaths, in through your nose, out your mouth, yada yada yada…even calmer now, they took my blood pressure again, and they said, “it actually went up!”  They were unable to let me do the fitness part of the test based on this, and I find it quite embarrassing since I don’t smoke, and I’m 5′ 10″ 175lbs.  I know we have a history of high blood pressure in our family (not something I’m going to put on my resume exactly!), but I think this is different. How can I feel calm, yet my bp says otherwise?  I went to a drug store last night, feeling pretty calm….my score was 133/69….heart rate 71….   From what I understand, that is unusual.  I took it a few minutes. later, it was 122/something…so I wasn’t sure if it went down, or it was just the machine giving inaccurate numbers… Any help you’re willing to offer is appreciated. Brian.

While the literature on creatine has found it generally safe for use among healthy adults, there are a number of reported side-effects associated with creatine supplementation. And guess what? One of them is high blood pressure.So the elevated blood pressure that you saw at the Police Academy certainly could bethe result of creatine use.But before I get into creatine and its possible impact on blood pressure, let’s talk a little bit about about creatine for my readers who may be new to it.

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What Is Creatine?Creatine is a naturally-occurring amino acid that is plentiful in skeletal tissue like muscle.  Fifty percent of the creatine in your body comes from diet (primarily from the consumption of red meat and poultry) and the remaining 50% is produced in the liver, kidney, and pancreas.About one-third of the creatine in your body is bound-up with phosphate (also known as creatine phosphate or phosocreatine) and circulates freely in your body.Your body essentially uses creatine to fuel high-intensity, short-duration exercise like weight lifting or sprinting.  Creatine phosphate plays a critical role in regenerating ATP, which is the process that the body uses to fuel muscle contraction, as well as protein production.Creatine supplementation (typically via creatine monohydrate or one of its variations) basically increases the pool of available creatine phosphate, and in theory, reduces the amount of time required to regenerate the necessary levels of ATP to fuel an additional muscle contraction.So people who supplement with creatine report being able to pump out an additional rep or two before fatiguing. It’s important to stress that creatine is not an anabolic steroid, but rather a natural vehicle for increasing the ability to perform work without fatiguing — which eventually may lead to increased muscle mass and athletic performance by performing more work, and progressively overloading the muscles.Creatine also draws water into the muscle, which is one of the reasons that people often not only experience body weight gain during supplementation, but also observe an increase in the appearance of muscle volume. This may also be a mechanism for increasing blood pressure (since the body is retaining more water, which may impact blood volume — and thus, blood pressure.) However, a review of the scientific research cannot confirm this.A lot of people who try creatine report that it makes them look larger, but not necessarily more “ripped.” This is because much of the initial gain comes from water retention in muscle tissue — and not from additional muscle mass. However, over time, the gains in additional work performed during weight training, can increase muscle growth and size (hypertrophy) that persist even after stopping creatine supplementation.Creatine Supplementation and Sports/AthleticsCreatine is an allowed supplement by the International Olympic Committee (ICC.)However, a number of organizations prohibit — or at least disapprove of the use of creatine. These include: The National Collegiate Athletic Association (NCAA) – Prohibits The French Agency of Medical Security for Food (AFSSA) – Disapproves The Healthy Competition Foundation (Blue Cross and Blue Shield) – DisapprovesSo if you are partaking in athletic activities with any of these organizations, you may want to reconsider your use of creatine supplementation.

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Is Creatine Safe?Not everyone who tries creatine supplements reports similar results.Vegetarians, or people who eat minimal red meat, tend to experience the most profound results from creatine supplementation. This is because free-form creatine levels are already low as a result of diet.If those foods are already abundant in your diet, you probably won’t see as dramatic results. At some point, your system become saturated with creatine, and excretes the excess via urine. If you are already maxed out, your gains will be marginal. This is why many creatine supplement manufacturers will encourage cycling on-and-off creatine at regular intervals.In terms of safety — as I mentioned earlier — creatine supplementation is generally considered safe for people in good health. The long-term health effects of creatine supplementation have not been widely studied, nor have the effects of creatine in teenagers.Possible Side Effects of CreatineThere are a number of possible side effects of creatine supplementation. They include: muscle cramps muscle strains and pulls stomach upset diarrhea dizziness high blood pressure liver dysfunction kidney damageHowever, it’s important to note that many of these side-effects are disputed in the scientific literature, and are non-conclusive. Many people supplement with creatine with zero side effects and no acute impact on their health. Others may experience some or all of the above creatine side-effects. You just have to take it case-by-case.Clinical Research on Creatine Supplementation and High Blood PressureAn extensive review of the scientific literature did not produce any conclusive link between creatine supplements and increased blood pressure.  In fact, I was only able to locate one study that specifically looked at creatine supplementation and high blood pressure.A February 2002 study published in the journal Medicine and Science in Sports &

Exerciseexamined 15 males and 15 females in a randomized, double-blind experiment that administered 20 grams of creatine per day for five days. There was no increase in blood pressure among the subjects receiving creatine. Considering the limited amount of clinical studies in this area, this single study should not be interpreted as conclusive.

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Creatine and High Blood Pressure: My AdviceBrian, in terms of the acute high blood pressure you experienced, my first advice would be to drop the creatine and see if your blood pressure levels return to normal. This is Occam’s Razor at its best. Look for the simplest, most obvious explanation and eliminate or confirm it.If after two weeks, your blood pressure is still high, go see your doctor. There can be lot of different factors impacting BP. Because you claim that you are in good overall health — but have a family history of high blood pressure — the best advice is to get it checked out. Even if the high blood pressure goes away after cessation of creatine supplementation, I would still recommend having it regularly checked — especially based on your family history.Also, know that grocery store/pharmacy high blood pressure machines can be notoriously inaccurate depending on how they are maintained and calibrated. Don’t rely on them alone for accurate BP readings — go into you doctor to be sure.High blood pressure can put you at risk for all kinds of problems later in life, including a higher risk of developing heart disease.  Based on your family history, take this seriously, and don’t mess around.

Acute creatine loading increases fat-free mass, but does not affect blood pressure, plasma creatinine, or CK activity in men and women.

AbstractCreatine monohydrate (CrM) administration may enhance high intensity exercise performance and increase body mass, yet few studies have examined for potential adverse effects, and no studies have directly considered potential gender differences.PURPOSE: The purpose of this study was to examine the effect of acute creatine supplementation upon total and lean mass and to determine potential side effects in both men and women.METHODS: The effect of acute CrM (20 g x d(-1) x 5 d) administration upon systolic, diastolic, and mean BP, plasma creatinine, plasma CK activity, and body composition was examined in 15 men and 15 women in a randomized, double-blind experiment. Additionally, ischemic isometric handgrip strength was measured before and after CrM or placebo (PL).RESULTS: CrM did not affect blood pressure, plasma creatinine, estimated creatinine clearance, plasma CK activity, or handgrip strength (P > 0.05). In contrast, CrM significantly increased fat-free mass (FFM) and total body mass (P < 0.05) as compared with PL, with no changes in body fat. The observed mass changes were greater for men versus women.CONCLUSIONS: These findings suggest that acute CrM administration does not affect blood pressure, renal function, or plasma CK activity, but increases FFM. The effect of CrM upon FFM may be greater in men as compared with that in women.

High Blood Pressure and SmokingDid you know that smoking and heart disease are related? Or that smoking increases blood pressure? Most people associate cigarette smoking with breathing problems and lung cancer. But people who smoke are more also likely to develop hypertension and heart disease.

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About 30% of all deaths from heart disease in the U.S. are directly related to cigarette smoking. That's because smoking is a major cause of coronary artery disease, especially in younger people.Recommended Related to HypertensionSide Effects of High Blood Pressure MedicationsAny medication can cause side effects, and high blood pressure (HBP) medications are no exception. However, many people do not have side effects from taking hypertension drugs, and often the side effects are mild. Still, it's important to stay informed and work closely with your doctor to manage any side effects you may have. There's no reason to "suffer in silence." Today there are more medication options than ever for managing high blood pressure (hypertension). This article lists the side effects...Read the Side Effects of High Blood Pressure Medications article > >

A person's risk of heart attack greatly increases with the number of cigarettes he or she smokes and the longer a person smokes, the greater their risk of heart attack. People who smoke a pack of cigarettes a day have more than twice the risk of heart attack than non-smokers. Women who smoke and also take birth control pills increase several times their risk of heart attack, stroke, and peripheral vascular disease.How Does Smoking Increase Heart Disease Risk?The nicotine present in tobacco products causes:

Decreased oxygen to the heart Increased blood pressure and heart rate Increase in blood clotting Damage to cells that line coronary arteries and other blood vessels

How Can Quitting Smoking Be Helpful?If you quit smoking, you will:

Prolong your life Reduce your risk of disease (including heart disease, heart attack, high blood pressure,

lung cancer, throat cancer, emphysema, ulcers, gum disease, and other conditions) Feel healthier; after quitting, you won't cough as much, you'll have fewer sore throats and

you will increase your stamina Look better; quitting can help you prevent face wrinkles, get rid of stained teeth, and

improve your skin's appearance. Improve your sense of taste and smell Save money

How to Quit SmokingThere's no one way to quit smoking that works for everyone. To quit, you must be ready both emotionally and mentally. You must also want to quit smoking for yourself and not to please your friends or family. It helps to plan ahead. This guide may help get you started.What Should I Do First to Stop Smoking?Pick a date to stop smoking and then stick to it.Write down your reasons for quitting. Read over the list every day, before and after you quit. Here are some other tips:

Write down when you smoke, why you smoke, and what you are doing when you smoke. You will learn what triggers you to smoke.

Stop smoking in certain situations (such as during your work break or after dinner) before actually quitting.

Make a list of activities you can do instead of smoking. Be ready to do something else when you want to smoke.

Ask your doctor about using nicotine gum or patches. Some people find these aids helpful. Join a smoking cessation support group or program. Call your local chapter of the American

Lung Association. Talk to your physician who may recommend medications to help combat nicotine craving

and also help with information on using nicotine substitutes, such as a patch or gum.How Can I Avoid Relapsing?

Don't carry a lighter, matches, or cigarettes. Keep all of these smoking reminders out of sight.

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If you live with a smoker, ask that person not to smoke in your presence. Don't focus on what you are missing. Think about the healthier way of life you are gaining. When you get the urge to smoke, take a deep breath. Hold it for 10 seconds and release it

slowly. Repeat this several times until the urge to smoke is gone. Keep your hands busy. Doodle, play with a pencil or straw, or work on a computer. Change activities that were connected to smoking. Take a walk or read a book instead of

taking a cigarette break. When you can, avoid places, people, and situations associated with smoking. Hang out

with non-smokers or go to places that don't allow smoking, such as the movies, museums, shops, or libraries.

Don't substitute food or sugar-based products for cigarettes. Eat low-calorie, healthful foods (such as carrot or celery sticks, sugar-free hard candies) or chew gum when the urge to smoke strikes so you can avoid weight gain.

Drink plenty of fluids, but limit alcoholic and caffeinated beverages. They can trigger urges to smoke.

Exercise. It will help you relax. Get support for quitting. Tell others about your milestones with pride. Work with your doctor to develop a plan using over-the-counter or prescription nicotine-

replacement aids.

Association Between Smoking and Blood Pressure Evidence From the Health Survey for EnglandAbstractCigarette smoking causes acute blood pressure (BP) elevation, although some studies have found similar or lower BPs in smokers compared with nonsmokers. Cross-sectional data from 3 years (1994 to 1996) of the annual Health Survey for England were used to investigate any difference in BP between smokers and nonsmokers in a nationally representative sample of adults (≥16 years old). Randomly selected adults (33 860; 47% men) with valid body mass index (BMI) and BP measurements provided data on smoking status (never, past, or current) and were stratified into younger (16 to 44 years old) and older (≥45 years old) age groups. Analyses provided between 89% and 94% power to detect a difference of 2 mm Hg systolic BP between smokers and nonsmokers in the 4 age/gender strata (α=0.05). Older male smokers had higher systolic BP adjusted for age, BMI, social class, and alcohol intake than did nonsmoking men. No such differences were seen among younger men or for diastolic blood pressure in either age group. Among women, light smokers (1 to 9 cigarettes/d) tended to have lower BPs than heavier smokers and never smokers, significantly so for diastolic BP. Among men, a significant interaction between BMI and the BP-smoking association was observed. In women, BP differences between nonsmokers and light smokers were most marked in those who did not drink alcohol. These data show that any independent chronic effect of smoking on BP is small. Differences between men and women in this association are likely to be due to complex interrelations among smoking, alcohol intake, and BMI. Key Words:

← blood pressure← smoking← epidemiology

IntroductionOverwhelming evidence supports the conclusion that cigarette smoking causes various adverse cardiovascular events1 2 and acts synergistically with hypertension and dyslipidemia to increase the risk of coronary heart disease.3

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Smoking causes an acute increase in blood pressure (BP) and heart rate and has been found to be associated with malignant hypertension.4 Nicotine acts as an adrenergic agonist, mediating local and systemic catecholamine release and possibly the release of vasopressin.5 Paradoxically, several epidemiological studies have found that BP levels among cigarette smokers were the same as or lower than those of nonsmokers.6 7 However, in a study of 24-hour ambulatory BP monitoring, smokers maintained a higher mean daytime ambulatory systolic BP (SBP) than nonsmokers, even though office BP levels were similar.8 These findings reflect the fact that patients do not smoke during measurement of office BPs and hence the BP that is recorded may not represent the subject’s usual BP. Given the importance of smoking, BP, and their interaction in the determination of cardiovascular risk, we investigated BP levels among smokers and nonsmokers with data from the Health Survey for England (HSE). MethodsThe HSE is an annual nationwide household survey.9 Members of a stratified random sample that is sociodemographically representative of the English population are invited to participate. The annual household response rate is ≈78% overall but slightly lower in men and in inner city residents. Data collection involves an interviewer’s visit (which includes height and weight measurements), followed by a visit from a nurse, who measures BP, records current use of prescribed medicines, and takes a blood sample. Overall, 48 307 adults aged ≥16 years were interviewed in the 1994, 1995, and 1996 surveys. BP was measured with the automated Dinamap 8100 monitor.10 With an appropriately sized cuff, 3 BP readings were taken on the right arm with the informant in a seated position after a 5-minute. Informants who had eaten, drunk alcohol, or smoked in the 30 minutes before the measurement were excluded from analysis. Data used in this study are based on the mean of the second and third measurements. Detailed information on smoking habits was collected. Past smokers were defined as subjects who had stopped smoking >1 year ago; those who stopped within 1 year (n=868) and those with missing data on smoking status (n=81) were excluded. Current smokers were further categorized according to number of cigarettes smoked per day (light 1 to 9, moderate 10 to 19, heavy ≥20). In 1994 and 1996 (but not 1995), blood samples were analyzed for serum cotinine levels. Body mass index (BMI) was defined as weight (kg)/height (m)2. Respondents were classified into 1 of 4 categories of BMI: ≤20 kg/m2, underweight; >20 to 25 kg/m2, normal weight; >25 to 30 kg/m2, overweight; and >30 kg/m2, obese. Respondents were asked about the frequency, quantity, and type of alcoholic drink consumed during the past 12 months. Consumption in units per week was categorized as (1) none, past drinking, or <1 unit; (2) 1 to 10 units for men or 1 to 7 units for women; (3) 11 to 21 units for men and 8 to 14 units for women; and (4) >21 units for men or >14 units for women. Social class was assigned on the basis of occupation of the head of the household, with the Registrar General’s standard classification.11 Social classes were further grouped into manual (skilled manual, partly skilled, and unskilled occupations) and nonmanual (professional, managerial and technical, and skilled occupations). The psychosocial measures included in the HSE have varied each year. The self-administered General Health Questionnaire (GHQ12), designed to detect possible psychiatric morbidity, was included in 1994 and 1995. A score of ≥4 was used to identify possible psychiatric disorders. In 1994, physical activity levels and serum cholesterol levels were assessed. Physical activity was categorized as inactive (those informants who reported <12 occasions of moderate or vigorous activity during the 4 weeks before the interview) and active (the remainder). Total serum cholesterol was categorized as normal (<6.5 mmol/L) and raised (≥6.5 mmol/L). Separate analyses that included these covariates were run only for 1994.

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Analyses are presented for the 33 860 persons (70% of those interviewed) who provided data on smoking status and had valid BMI and BP measurements, of whom 11 222, 14 063, and 8575 were never, past, and current smokers, respectively. Statistical MethodsThe relationship between smoking and BP was assessed with linear and logistic regression. The dependent variables in the linear regression were the continuous variables SBP and DBP, whereas that for the logistic regression was the odds of being on antihypertensive medication. The explanatory or independent variables used in both models were age (used both as a continuous variable and in 10-year age groups), BMI, smoking status, social class, and alcohol consumption, plus cholesterol levels, physical activity, and mental health status when data were available. Data from HSE show that although cigarette smoking prevalence decreased with age, mean consumption per smoker increased up to age 45 to 54 before decreasing.12 Given these differences in smoking patterns by age and that SBP remained fairly constant up to the mid 40s, 13

SBP and DBP were adjusted for age (through linear regression) after stratification into 1 of 2 age groups: 16 to 44 years (younger) and >44 years (older). The analyses provided 89% to 94% power to detect at 5% significance a difference in SBP of 2 mm Hg between smokers and nonsmokers in each of the 4 age/gender strata studied. Tests for interaction were carried out with multiple regression analyses, fitting a smoking×BMI interaction term in the appropriate model, with smoking fitted as a 5-category variable (never, past, light, moderate, and heavy) and BMI as a binary variable (overweight and obese or underweight and normal). ResultsThe mean ages of male and female respondents were 46.6 years (range 16 to 97 years) and 47.1 years (range 16 to 97 years) respectively. Among men, past smokers were older (mean [SEM] age 52.4 [0.2] years) than never (41.5 [0.2] years) and current (41.9 [0.2] years) smokers. Past smokers also made up the oldest group of women (51.0 [0.2] years), whereas current smokers made up the youngest group (42.6 [0.2] years) and never smokers had a mean age of 46.1 (0.2) years. Among current smoking men and women, heavy smokers tended to be older. Table 1⇓ shows age-adjusted characteristics of the men and women studied according to smoking status. Similar rates of current smoking were found in men and women, although among current smokers, more men than women were heavy smokers. On average, among men and women, current smokers had significantly lower BMIs than did never and past smokers. However, heavy smokers had the same mean BMI as never smokers. In both genders, there was a higher proportion of heavy drinkers among current smokers than among never smokers, whereas alcohol consumption among past smokers was between that of never and current smokers. The age-adjusted proportion of heavy alcohol consumption was higher among heavy smokers than among light smokers. The proportion of men and women from manual social classes was higher among current smokers than among never or past smokers, and the proportion increased with the number of cigarettes smoked. The proportion of both men and women who scored ≥4 on the GHQ12 questionnaire was higher in smokers than in nonsmokers. Table 1. Age-Adjusted Characteristics of the Study Group by Smoking StatusTable 2⇓ shows the effect of various characteristics on age-adjusted BPs. In men, increasing alcohol consumption was positively associated with BP. In women, mean SBP and DBP showed a U-shaped relationship with alcohol intake. Increasing BMI, manual social class, raised cholesterol level, physical inactivity, and normal GHQ12 score were associated with increasing BP. Table 2. Age-Adjusted Mean SBP and DBP by Confounding Variables

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Overall, age-adjusted BPs did not differ importantly among never, past, and current smokers (Table 3⇓⇓), although in men, a small significant difference was observed in mean SBP between never smokers (139.9 mm Hg) and current smokers (140.7 mm Hg) (P<0.05), and heavy smokers (141.4 mm Hg) (P<0.05). In women, the lowest BPs were observed among light smokers, who had significantly lower levels than never smokers (135.5/72.4 and 136.8/73.6 mm Hg, respectively; P<0.05). Table 3. Observed and Age-Adjusted Mean SBP and DBP (mm Hg) by Smoking StatusMean BP levels after adjustment for age, BMI, alcohol intake, and social class are shown stratified by age and smoking status in Table 4⇓. Among women of both age groups, the lowest BPs were found among light smokers, whereas in men, the lowest mean BPs were found among past smokers. In most age/gender strata, the highest BPs among current smokers were found in the heaviest smokers. However, only among older men and women (>44 years) were SBPs of current smokers greater than SBPs of never smokers and only significantly so for men. No significant differences were seen between DBPs of never and heavy smokers for either gender. The data shown in Table 4⇓ were unaffected by the exclusion of social class from the analytic models. Table 4. Mean SBP and DBP Adjusted for Age, BMI, Alcohol Intake, and Social ClassAmong men with normal weight, no association was seen between smoking and SBP, whereas in women of normal weight, past smokers had a mean SBP that was 0.9 mm Hg lower than that of nonsmokers (P=0.04). Among overweight or obese people, male moderate and heavy smokers had an SBP that was 2.1 and 1.8 mm Hg, respectively, higher than that of nonsmokers (P<0.01), whereas no significant differences were observed among women (Figure⇓). A formal test for interaction between BMI and the smoking-SBP relationship was significant in men (P=0.02). Figure 1. Differences (and 95% CI) in mean SBP between the smoking groups (reference, nonsmokers) in persons with normal weight and overweight or obese. In both never and heavy smoking men, alcohol intake showed a graded effect on mean SBP (P<0.05), and smoking was associated with higher SBP levels only among alcohol drinkers, although the association did not reach statistical significance (Table 5⇓). Further adjustment of these data for BMI did not alter BP patterns by alcohol intake and smoking strata. In nonsmoking women, SBP was lower in moderate than in nondrinkers and heavy drinkers, whereas among light smokers, SBP increased with increasing alcohol intake. Light smokers had lower SBPs than never smokers in all 3 strata of alcohol intake but only significantly so among nondrinkers. The difference in SBP levels between never and light smokers was reduced after adjustment for BMI, regardless of alcohol intake but remained statistically significant among nondrinkers. Table AB3B. ContinuedPatterns in BPs in the 1994 survey, including additional adjustment for cholesterol levels, physical activity, and GHQ12 scores, were essentially the same as those seen in Tables 4⇑ and 5⇑. No association between smoking and use of antihypertensive agents was observed in either gender after adjustment for age, alcohol consumption, BMI, and social class, and the results shown in Table 4⇑ did not change substantially when the analyses were repeated and excluded those on antihypertensive treatment (data not shown). DiscussionThe results of the present study, the largest to investigate this issue to date, show that any independent chronic effect of smoking on BP is small. After adjustment for age, BMI, alcohol, and social class, we found only in older men significantly higher SBPs in heavy and moderate smokers than in never smokers, whereas no such differences were seen for DBP. Therefore, at least in men, our findings do not support those from other studies, which observed lower BPs at increasing

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levels of cigarette consumption.6 7 The finding of elevated SBP, but not DBP, only in older men is an important new observation that is compatible with effects expected in association with chronically enhanced atherogenesis in large capacitance vessels, with which smoking is associated and which produces isolated systolic hypertension.14 15 In women, we showed lower mean BP levels in light smokers than in nonsmokers and heavier smokers, although the differences reached statistical significance only for DBP in the younger age group. Because of the strong interrelationships among smoking, alcohol, and BMI and because an interaction was detected, it was important to examine the relationship between smoking and SBP according to BMI categories. Previous studies have been of insufficient size to adjust data appropriately for the potential confounding effects of these other variables. No association between smoking and SBP was seen in men of normal weight, whereas in overweight and obese men, not only heavy, but also moderate, smokers showed a significant increase in SBP. These differences were not observed in women. Among smokers, a U-shaped relationship between the number of cigarette smoked and relative body weight has been found in several studies, with those smoking 10 to 20 cigarettes/d being the leanest.16 Although this seems paradoxical given that smoking is associated with increased 24-hour energy expenditure,17 heavy smokers may weigh more because of other habits, such as high alcohol and saturated fat intakes. Other dietary variables, such as electrolyte intake, may further confound the BP-smoking association, because smokers have been reported to have different diets than nonsmokers.18 We did not have dietary data but showed that heavy smokers tend to drink more than nonsmokers or lighter smokers and, in the 1994 survey, had higher cholesterol levels. Alcohol intake, which is strongly associated with smoking,12 also appears to affect the smoking-BP relationship: a difference in the relationship between alcohol consumption and BP among smokers and nonsmokers was observed in 3 German cross-sectional studies.19 20 In 1 of these studies,19

effect modification by smoking was stronger in men than in women. Moreover, BMI, which has well-established effects on BP,21 is also affected by alcohol intake, and this, too, must be taken into account when assessing the relationship between smoking and BP because of the apparent opposing effects that alcohol and smoking exert on body weight. Given these complex interrelationships, we examined the relationship between smoking and SBP separately by alcohol intake status, before and after adjustments for BMI. Among men, we observed higher levels of SBP with increasing alcohol intake at each level of smoking, whereas in nondrinkers, heavy smokers did not have higher SBPs. In contrast, among women, SBP was lower among light smokers than among never smokers regardless of alcohol intake, and alcohol showed only a small dose-response effect on SBP among light smokers and not among never smokers. Hence, differences in the BP-smoking association observed between men and women appear to be due to the stronger interrelation between smoking and drinking in men. For any given smoking category, women tend to consume smaller amounts of alcohol than men. Among men, adjustment for BMI did not affect the increase in SBP with increasing alcohol intake among never or heavy smokers: the effect of smoking on SBP was small, variable in direction, and nonsignificant. In women, the difference in SBP levels between never and light smokers was reduced, but still significant, after adjustment for BMI in nondrinkers, appearing to be in part due to the confounding effect of body weight. One of the possible limitations of the study is that the HSE collects information by means of a questionnaire, and therefore some of the risk factor data are self-reported, which may be inaccurate.22 However, agreement between self-reported smoking status and serum cotinine levels was good: only 3.5% of men and 0.8% of women who reported never smoking had a cotinine level of ≥20 ng/mL, a level that is strongly suggestive of smoking. Reclassification of these respondents as smokers did not affect the observed results for SBP and DBP (data not

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shown). The use of the Dinamap 8100 for BP measurement has been challenged.23 However, this machine is considered to be suitable and sufficiently accurate in the setting of a large multicenter survey.10 In summary, these data from a large nationally representative database suggest that there are no consistent independent differences of clinical significance in BP values between smokers and nonsmokers. The BP differences associated with smoking that were observed in this study differed with age and between men and women and may well be explained at least in part by differential confounding effects of BMI and alcohol intake. However, because smoking and BP have been shown to exert a synergistic adverse effect on the risk of coronary heart disease,3 it is critical that persons with raised BP are advised to stop smoking. Furthermore, because BP levels in smokers are rarely recorded during or immediately after smoking when acute rises in BP occur, usual BP levels of smokers tend to be systematically underestimated.

How Does Smoking Affect the Heart and Blood Vessels?Cigarette smoking causes about 1 in every 5 deaths in the United States each year. It's the main preventable cause of death and illness in the United States.Smoking harms nearly every organ in the body, including the heart, blood vessels, lungs, eyes, mouth, reproductive organs, bones, bladder, and digestive organs. This article focuses on how smoking affects the heart and blood vessels.Other Health Topics articles, such as COPD (chronic obstructive pulmonary disease), Bronchitis, and Cough, discuss how smoking affects the lungs.OverviewSmoking and Your Heart and Blood VesselsThe chemicals in tobacco smoke harm your blood cells. They also can damage the function of your heart and the structure and function of your blood vessels. This damage increases your risk of atherosclerosis (ath-er-o-skler-O-sis).Atherosclerosis is a disease in which a waxy substance called plaque (plak) builds up in the arteries. Over time, plaque hardens and narrows your arteries. This limits the flow of oxygen-rich blood to your organs and other parts of your body.Coronary heart disease (CHD) occurs if plaque builds up in the coronary (heart) arteries. Over time, CHD can lead to chest pain, heart attack, heart failure, arrhythmias (ah-RITH-me-ahs), or even death.Smoking is a major risk factor for heart disease. When combined with other risk factors—such as unhealthy blood cholesterol levels, high blood pressure, and overweight or obesity—smoking further raises the risk of heart disease.Smoking also is a major risk factor for peripheral arterial disease (P.A.D.). P.A.D. is a condition in which plaque builds up in the arteries that carry blood to the head, organs, and limbs. People who have P.A.D. are at increased risk for heart disease, heart attack, and stroke.Smoking and AtherosclerosisThe image shows how smoking can affect arteries in the heart and legs. Figure A shows the location of coronary heart disease and peripheral arterial disease. Figure B shows a detailed view of a leg artery with atherosclerosis—plaque buildup that's partially blocking blood flow. Figure C shows a detailed view of a coronary (heart) artery with atherosclerosis.

Any amount of smoking, even light smoking or occasional smoking, damages the heart and blood vessels. For some people, such as women who use birth control pills and people who have diabetes, smoking poses an even greater risk to the heart and blood vessels.Secondhand smoke also can harm the heart and blood vessels. Secondhand smoke is the smoke that comes from the burning end of a cigarette, cigar, or pipe. Secondhand smoke also refers to smoke that's breathed out by a person who is smoking.Secondhand smoke contains many of the same harmful chemicals that people inhale when they smoke. Secondhand smoke can damage the hearts and blood vessels of people who don't smoke in the same way that active smoking harms people who do smoke. Secondhand smoke greatly increases adults' risk of heart attack and death.

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Secondhand smoke also raises children and teens' risk of future CHD because it: Lowers HDL cholesterol (sometimes called "good" cholesterol) Raises blood pressure Damages heart tissues

The risks of secondhand smoke are especially high for premature babies who have respiratory distress syndrome (RDS) and children who have conditions such as asthma.Researchers know less about how cigar and pipe smoke affects the heart and blood vessels than they do about cigarette smoke.However, the smoke from cigars and pipes contains the same harmful chemicals as the smoke from cigarettes. Also, studies have shown that people who smoke cigars are at increased risk for heart disease.Benefits of Quitting Smoking and Avoiding Secondhand SmokeOne of the best ways to reduce your risk of heart disease is to avoid tobacco smoke. Don't ever start smoking. If you already smoke, quit. No matter how much or how long you've smoked, quitting will benefit you.Also, try to avoid secondhand smoke. Don't go to places where smoking is allowed. Ask friends and family members who smoke not to do it in the house and car.Quitting smoking will reduce your risk of developing and dying from heart disease. Over time, quitting also will lower your risk of atherosclerosis and blood clots.If you smoke and already have heart disease, quitting smoking will reduce your risk of sudden cardiac death, a second heart attack, and death from other chronic diseases.Researchers have studied communities that have banned smoking at worksites and in public places. The number of heart attacks in these communities dropped quite a bit. Researchers think these results are due to a decrease in active smoking and reduced exposure to secondhand smoke.OutlookSmoking or exposure to secondhand smoke damages the heart and blood vessels in many ways. Smoking also is a major risk factor for developing heart disease or dying from it.Quitting smoking and avoiding secondhand smoke can help reverse heart and blood vessel damage and reduce heart disease risk right away.Quitting smoking is possible, but it can be hard. Millions of people have successfully quit smoking and remained nonsmokers. A variety of strategies, programs, and medicines are available to help you quit smoking.Not smoking is an important part of a heart healthy lifestyle. A heart healthy lifestyle also includes following a healthy diet, maintaining a healthy weight, and being physically active.What Are the Risks of Smoking?The chemicals in tobacco smoke harm your heart and blood vessels in many ways. For example, they:

Thicken your blood and make it harder for your blood to carry oxygen. Increase your blood pressure and heart rate, making your heart work harder than normal. Lower your HDL cholesterol (sometimes called "good" cholesterol) and raise your LDL

cholesterol (sometimes called "bad" cholesterol). Smoking also increases your triglyceride level. Triglycerides are a type of fat found in the blood.

Disturb normal heart rhythms. Damage blood vessel walls, making them stiff and less elastic (stretchy). This damage

narrows the blood vessels and adds to the damage caused by unhealthy cholesterol levels. Contribute to inflammation, which may trigger plaque buildup in your arteries.

Smoking and Heart Disease RiskSmoking is a major risk factor for coronary heart disease (CHD). CHD is a condition in which plaque builds up inside the coronary arteries. These arteries supply your heart muscle with oxygen-rich blood.When plaque builds up in the arteries, the condition is called atherosclerosis.Plaque narrows the arteries and reduces blood flow to your heart muscle. The buildup of plaque also makes it more likely that blood clots will form in your arteries. Blood clots can partially or completely block blood flow.

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Over time, smoking contributes to atherosclerosis and increases your risk of having and dying from heart disease, heart failure, or a heart attack.Compared with people who don't smoke, people who smoke can be up to two to three times more likely to have heart disease and twice as likely to have a heart attack. The risk of having or dying from a heart attack is even higher among people who smoke and already have heart disease.For some people, such as women who use birth control pills and people who have diabetes, smoking poses an even greater risk to the heart and blood vessels.Smoking is a major risk factor for heart disease. When combined with other risk factors—such as unhealthy blood cholesterol levels, high blood pressure, and overweight or obesity—smoking further raises the risk of heart disease.Any amount of smoking, even light or occasional smoking, harms your body. Research suggests that smoking can even cancel out the benefits of other efforts to reduce heart disease risk, such as taking aspirin or medicines to lower cholesterol.Smoking and Peripheral Arterial Disease RiskPeripheral arterial disease (P.A.D.) is a disease in which plaque builds up in the arteries that carry blood to your head, organs, and limbs. Smoking is a major risk factor for P.A.D. Your risk of P.A.D. increases by four if you smoke or have a history of smoking.P.A.D. usually affects the arteries that carry blood to your legs. Blocked blood flow in the leg arteries can cause cramping, pain, weakness, and numbness in your hips, thighs, and calf muscles.Blocked blood flow also can raise your risk of getting an infection in the affected limb. Your body might have a hard time fighting the infection.If severe enough, blocked blood flow can cause gangrene (tissue death). In very serious cases, this can lead to leg amputation.If you have P.A.D., your risk of heart disease and heart attack is six to seven times greater than the risk for people who don't have P.A.D.Smoking even one or two cigarettes a day can interfere with P.A.D. treatments. People who smoke and people who have diabetes are at highest risk for P.A.D. complications, including gangrene in the leg from decreased blood flow.Secondhand Smoke RisksSecondhand smoke is the smoke that comes from the burning end of a cigarette, cigar, or pipe. Secondhand smoke also refers to smoke that's breathed out by a person who is smoking.Secondhand smoke contains many of the same harmful chemicals that people inhale when they smoke. It can damage the hearts and blood vessels of people who don't smoke in the same way that active smoking harms people who do smoke. Secondhand smoke greatly increases adults' risk of heart attack and death.Secondhand smoke also raises children and teens' risk of future CHD because it:

Lowers HDL cholesterol (good cholesterol) Raises blood pressure Damages heart tissues

The risks of secondhand smoke are especially high for premature babies who have respiratory distress syndrome (RDS) and children who have conditions such as asthma.Cigar and Pipe Smoke RisksResearchers know less about how cigar and pipe smoke affects the heart and blood vessels than they do about cigarette smoke.However, the smoke from cigars and pipes contains the same harmful chemicals as the smoke from cigarettes. Also, studies have shown that people who smoke cigars are at increased risk of heart disease.What Are the Benefits of Quitting Smoking?One of the best ways to reduce your risk of coronary heart disease is to avoid tobacco smoke. Don't ever start smoking. If you already smoke, quit. No matter how much or how long you've smoked, quitting will benefit you.Also, try to avoid secondhand smoke. Don't go to places where smoking is allowed. Ask friends and family members to not smoke in the house and car.Quitting smoking will benefit your heart and blood vessels. For example:

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Heart disease risk associated with smoking begins to decrease soon after you quit. It continues to decrease over time. Your risk is cut in half 1 year after quitting. If you have not developed heart disease within 15 years of quitting, your risk is nearly the same as the risk in someone who has never smoked.

Deaths from heart disease are reduced by one-third in people who quit smoking compared with people who continue smoking. Repeat heart attacks are reduced by about the same amount.

People who smoke and already have heart disease lower their risk of sudden cardiac death, second heart attacks, and death from other chronic diseases by as much as half if they quit smoking.

Your risk of atherosclerosis and blood clots declines over time after you quit smoking.Quitting smoking can lower your risk of heart disease as much as, or more than, common medicines used to lower heart disease risk, including aspirin, statins, beta-blockers, and ACE inhibitors.In recent years, communities in Montana, Colorado, New York, Massachusetts, Indiana, and Ohio have banned smoking at worksites and in public places. Some countries, including Italy, Ireland, Norway, Scotland, and France, have put similar bans in place.Studies of these communities show a rapid drop in the number of heart attacks within the first year of the ban. The number of heart attacks continues to decrease as time goes on.Researchers think these results are due to a decrease in active smoking and reduced exposure to secondhand smoke.Strategies To Quit SmokingQuitting smoking is possible, but it can be hard. Millions of people have successfully quit smoking and remain nonsmokers. Surveys of current adult smokers find that 70 percent say they want to quit.There are a few ways to quit smoking, including quitting all at once (going "cold turkey") or slowly cutting back your number of cigarettes before quitting completely. Use the method that works best for you. Below are some strategies to help you quit.Get Ready To QuitIf you want to quit smoking, try to get motivated. Make a list of your reasons for wanting to quit. Write a contract to yourself that outlines your plan for quitting.If you've tried to quit smoking in the past, think about those attempts. What helped you during that time, and what made it harder?Know what triggers you to smoke. For example, do you smoke after a meal, while driving, or when you're stressed? Develop a plan to handle each trigger.Get SupportSet a quit date and let those close to you know about it. Ask your family and friends for support in your effort to quit smoking.Get Medicine and Use It CorrectlyTalk with your doctor and pharmacist about medicines and over-the-counter products that can help you quit smoking. These medicines and products are helpful for many people.You can buy nicotine gum, patches, and lozenges from a drug store. Other medicines that can help you quit smoking are available by prescription.Learn New Skills and BehaviorsTry new activities to replace smoking. For example, instead of smoking after a meal, take a brisk walk in your neighborhood or around your office building. Try to be physically active regularly.Take up knitting, carpentry, or other hobbies and activities that keep your hands busy. Try to avoid other people who smoke. Ask those you can't avoid to respect your efforts to stop smoking and not smoke around you.Remove cigarettes, ashtrays, and lighters from your home, office, and car. Don't smoke at all—not even one puff. Also, try to avoid alcohol and caffeine. (People who drink alcohol are more likely to start smoking again after quitting.)Be Prepared for Withdrawal and RelapseBe prepared for the challenge of withdrawal. Withdrawal symptoms often lessen after only 1 or 2 weeks of not smoking, and each urge to smoke lasts only a few minutes.

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You can take steps to cope with withdrawal symptoms. If you feel like smoking, wait a few minutes for the urge to pass. Remind yourself of the benefits of quitting. Don't get overwhelmed—take tasks one step at a time.If you relapse (slip and smoke after you've quit), consider what caused the slip. Were you stressed out or unprepared for a situation that you associate with smoking? Make a plan to avoid or handle this situation in the future.Getting frustrated with your slip will only make it harder to quit in the future. Accept that you slipped, learn from the slip, and recommit to quit smoking.If you start smoking regularly again, don't get discouraged. Instead, find out what you need to do to get back on track so you can meet your goals. Set a new quit date, and ask your family and friends to help you. Most people who smoke make repeated attempts to quit before doing so successfully.Many smokers gain weight after they quit, but the average weight gain is 10 pounds or less. You can control weight gain with a healthy diet and physical activity. Remember the bright side—food smells and tastes better if you aren't smoking.Not Smoking as Part of a Heart Healthy LifestyleNot smoking is an important part of a heart healthy lifestyle. A heart healthy lifestyle also includes following a healthy diet, maintaining a healthy weight, and being physically active.Following a Healthy DietA healthy diet includes a variety of vegetables and fruits. These foods can be fresh, canned, frozen, or dried. A good rule is to try to fill half of your plate with vegetables and fruits.A healthy diet also includes whole grains, fat-free or low-fat dairy products, and protein foods, such as lean meats, eggs, poultry without skin, seafood, nuts, seeds, beans, and peas.Choose and prepare foods with little sodium (salt). Too much salt can raise your risk for high blood pressure. Studies show that following the Dietary Approaches to Stop Hypertension (DASH) eating plan can lower blood pressure.Try to avoid foods and drinks that are high in added sugars. For example, drink water instead of sugary drinks, such as soda.Also, limit the amount of solid fats and refined grains that you eat. Solid fats are saturated fat and trans fatty acids. Refined grains come from processing whole grains, which results in a loss of nutrients (such as dietary fiber). Examples of refined grains include white rice and white bread.If you drink alcohol, do so in moderation. Too much alcohol can raise your blood pressure and triglyceride level. (Triglycerides are a type of fat found in the blood.) Alcohol also adds extra calories, which can cause weight gain.Maintaining a Healthy WeightBeing overweight or obese increases your risk of heart disease, even if you have no other risk factors. Overweight or obesity also raises your risk for other diseases that play a role in heart disease, such as diabetes and high blood pressure.Your weight is the result of a balance between energy IN and energy OUT. Energy IN is the energy, or calories, you take in from food. Energy OUT is the energy you use for things like breathing, digestion, and physical activity.If you have:

The same amount of energy IN and energy OUT over time, your weight stays the same More energy IN than energy OUT over time, you'll gain weight More energy OUT than energy IN over time, you'll lose weight

To maintain a healthy weight, your energy IN and energy OUT should balance each other. They don't have to be the same every day; it's the balance over time that's important.Being Physically ActivePhysical activity also is part of a heart healthy lifestyle. Physical activity is good for many parts of your body and can lower your risk for health problems.Many Americans are not active enough. The good news, though, is that even modest amounts of physical activity are good for your health. The more active you are, the more you'll benefit.The four main types of physical activity are aerobic, muscle-strengthening, bone strengthening, and stretching. You can do physical activity with light, moderate, or vigorous intensity. The level of intensity depends on how hard you have to work to do the activity.

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For major health benefits, adults should do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity or 75 minutes (1 hour and 15 minutes) of vigorous-intensity aerobic activity each week. Another option is to do a combination of both.You don't have to do the activity all at once. You can break it up into shorter periods of at least 10 minutes each. Running, swimming, walking, bicycling, dancing, and doing jumping jacks are examples of aerobic activity.If you have a heart problem or chronic disease, such as heart disease, diabetes, or high blood pressure, talk with your doctor about what types of physical activity are safe for you.You also should talk with your doctor about safe physical activities if you have symptoms such as chest pain or dizziness.

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