Chronic hypertension lifestyle modification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Lakshmi Gopalakrishnan , M.D.

Lifestyle Modification (nonpharmacologic treatment)

• Weight reduction and regular aerobic exercise (e.g. jogging) are recommended as the first steps in treating mild to moderate hypertension. Regular mild exercise improves blood flow and helps to reduce resting heart rate and blood pressure. These steps are highly effective in reducing blood pressure, although drug therapy is still necessary for many patients with moderate or severe hypertension to bring their blood pressure down to a safe level.

• Reducing sodium (salt) diet is proven very effective: it decreases blood pressure in about 60% of people (see above). Many people choose to use a salt substitute to reduce their salt intake.

• Additional dietary changes beneficial to reducing blood pressure includes the DASH diet (Dietary Approaches to Stop Hypertension), which is rich in fruits and vegetables and low fat or fat-free dairy foods. This diet is shown effective based on National Institutes of Health sponsored research. In addition, an increase in daily calcium intake has also been shown to be highly effective in reducing blood pressure. Fruits, vegetables, and nuts have the added benefit of increasing dietary potassium, which theoretically can offset the effect of sodium and act on the kidney to decrease blood pressure.

• Discontinuing tobacco smoking and alcohol drinking has been shown to lower blood pressure. The exact mechanisms are not fully understood, but blood pressure (especially systolic) always transiently increases following alcohol and/or nicotine consumption. Besides, abstention from cigarette smoking is important for people with hypertension because it reduces the risk of many dangerous outcomes of hypertension, such as stroke and heart attack. Note that coffee drinking (caffeine ingestion) also increases blood pressure transiently, but does not produce chronic hypertension.

• Relaxation therapy, such as meditation, that reduces environmental stress, high sound levels and over-illumination can be an additional method of ameliorating hypertension. Biofeedback is also used [2] particularly device guided paced breathing [3] [4]. Obviously, the effectiveness of relaxation therapy relies on the patient's attitude and compliance.

JNC- Seventh Report Recommendations: Lifestyle modifications

Modification	Recommendation	Approximate SBP Reduction (Range)
Weight reduction	Maintain normal body weight (body mass index 18.5–24.9 kg/m2)	5–20 mmHg / 10 kg weight loss
Adopt DASH eating plan	Consume a diet rich in fruits, vegetables, and low-fat dairy products with a reduced content of saturated and total fat.	8–14 mmHg
Dietary sodium reduction	Reduce dietary sodium intake to no more than 100 mmol per day (2.4 g sodium or 6 g sodium chloride).	2–8 mmHg
Physical activity	Engage in regular aerobic physical activity such as brisk walking (at least 30 min per day, most days of the week).	4–9 mmHg
Moderation of alcohol consumption	Limit consumption to no more than consumption 2 drinks (1 oz or 30 mL ethanol; e.g., 24 oz beer, 10 oz wine, or 3 oz 80-proof whiskey) per day in most men and to no more than 1 drink per day in women and lighter weight persons.	2–4 mmHg

Guidelines Resources

• The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

• Treatment of Hypertension in the Prevention and Management of Ischemic Heart Disease : A Scientific Statement From the American Heart Association Council for High Blood Pressure Research and the Councils on Clinical Cardiology and Epidemiology and Prevention

• 2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)