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.

Overview

The importance of lifestyle modification lies in its ability to reduce the blood pressure, prevent or delay the occurrence of hypertension, increase the efficacy of medications, and decrease risk factors for hypertension and the incidence of target organ damage. Lifestyle measures are required of all hypertensive patients irrespective of the hypertension stage and cardiovascular level. Significantly, lifestyle changes alone can be considered as initial antihypertensive measure in patients with stage 1 hypertension, even in the presence of up to 1 or 2 risk factors (excluding diabetes or metabolic syndrome or established target organ damage). In these patients, pharmacologic therapy can wait for three to six months until lifestyle changes alone fail to control the blood pressure.

Lifestyle Modification

The importance of lifestyle modification lies in its ability to reduce BP, prevent or delay the occurrence of hypertension, increase the efficacy of medications, and decrease risk factors for hypertension and the incidence of target organ damage. Lifestyle measures are required of all hypertensive patients irrespective of the hypertension stage and cardiovascular level. Significantly, lifestyle changes alone can be considered as initial antihypertensive measure in patients with stage 1 hypertension, even in the presence of up to 1 or 2 risk factors (excluding diabetes or metabolic syndrome or established target organ damage). In these patients, pharmacologic therapy can wait for three to six months until lifestyle changes alone fail to control BP.

According to JNC 7, lifestyle measures or interventions include the following, by order of effect on SBP reduction:

• Maintenance of normal body weight: BMI 18.5-24.9 kg/m². It is considered the most important lifestyle modification step in reduction or maintenance of blood pressure.
• Weight loss: As little as 4.5 kg can reduce BP. Estimated SBP reduction is 5-20 mmHg per 10 kg.

• “Dietary Approaches to Stop Hypertension (DASH)” Diet: Rich in vegetables and fruits, low in fatty components with reduced sodium intake to less than 100 mmol per day (2.4 g of sodium per day or 6 g of sodium chloride salt).
• Regular aerobic physical activity: Brisk walking at least 30 minutes per day most days of the week
• Alcohol intake limitation

• • Men: No more than 1 oz (30 mL) of ethanol per day (2 drinks per day)
  • Women: No more than 0.5 oz (15 mL) of ethanol per day (1 drink per day)

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)