Chronic hypertension lifestyle modification
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Hypertension Main page |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Lakshmi Gopalakrishnan , M.D.
Overview
Lifestyle modification may prevent or delay the occurrence of hypertension, reduce the blood pressure, increase the efficacy of medications, decrease risk factors for hypertension and reduce the incidence of target organ damage. Lifestyle modification should be implemented in all hypertensive patients irrespective of the hypertensive stage. 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 are provided a chance to control 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:[1]
- 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)
JNC7 Recommendations
| 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 [2][3] |
| 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 [4][5] |
| 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 [4][5][6] |
| 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 [7][8] |
| 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 [9] |
2013 ESH/ESC Guidelines For The Management of Arterial Hypertension[10]
Summary of Recommendations on Lifestyle Modification[10]
| Class I |
| "1. Salt restriction to 5-6 g per day is recommended.(Level of Evidence: A)" |
| "2. Moderation of alcohol consumption to no more than 20-30 g of ethanol per day in men and to no more than 10-20 g of ethanol per day in women is recommended. (Level of Evidence: A)" |
| "3. Increased consumption of vegetables, fruits, and low-fat dairy products is recommended.(Level of Evidence: A)" |
| "4. Reduction of weight to BMI of 25 kg/m2 and of waist circumference to <102 cm in men and <88 cm in women is recommended, unless contraindicated.(Level of Evidence: A)" |
| "5. Regular exercise, i.e. at least 30 min of moderate dynamic exercise on 5 to 7 days per week is recommended.(Level of Evidence: A)" |
| "6. It is recommended to give all smokers advice to quit smoking and to offer assistance.(Level of Evidence: A)" |
References
- ↑ Cuddy ML (2005). "Treatment of hypertension: guidelines from JNC 7 (the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 1)". J Pract Nurs. 55 (4): 17–21, quiz 22-3. PMID 16512265.
- ↑ (1997) Effects of weight loss and sodium reduction intervention on blood pressure and hypertension incidence in overweight people with high-normal blood pressure. The Trials of Hypertension Prevention, phase II. The Trials of Hypertension Prevention Collaborative Research Group. Arch Intern Med 157 (6):657-67. PMID: 9080920
- ↑ He J, Whelton PK, Appel LJ, Charleston J, Klag MJ (2000) Long-term effects of weight loss and dietary sodium reduction on incidence of hypertension. Hypertension 35 (2):544-9. PMID: 10679495
- ↑ 4.0 4.1 Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D et al. (2001) Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med 344 (1):3-10. DOI:10.1056/NEJM200101043440101 PMID: 11136953
- ↑ 5.0 5.1 Vollmer WM, Sacks FM, Ard J, Appel LJ, Bray GA, Simons-Morton DG et al. (2001) Effects of diet and sodium intake on blood pressure: subgroup analysis of the DASH-sodium trial. Ann Intern Med 135 (12):1019-28. PMID: 11747380
- ↑ Chobanian AV, Hill M (2000) National Heart, Lung, and Blood Institute Workshop on Sodium and Blood Pressure : a critical review of current scientific evidence. Hypertension 35 (4):858-63. PMID: 10775551
- ↑ Kelley GA, Kelley KS (2000) Progressive resistance exercise and resting blood pressure : A meta-analysis of randomized controlled trials. Hypertension 35 (3):838-43. PMID: 10720604
- ↑ Whelton SP, Chin A, Xin X, He J (2002) Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med 136 (7):493-503. PMID: 11926784
- ↑ Xin X, He J, Frontini MG, Ogden LG, Motsamai OI, Whelton PK (2001) Effects of alcohol reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension 38 (5):1112-7. PMID: 11711507
- ↑ 10.0 10.1 Authors/Task Force Members. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A; et al. (2013). "2013 ESH/ESC 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)". Eur Heart J. 34 (28): 2159–219. doi:10.1093/eurheartj/eht151. PMID 23771844.