Lifestyle modifications

INTRODUCTION

  • Stage 1 hypertension (130-139/80-89) with low cardiovascular disease risk can be managed with lifestyle changes alone for the first 3-6 months and then re-evaluated. However, many will require medications (1)

NUTRITION

  • Limit daily sodium intake to < 1.5g (1)
  • A potassium rich diet unless contraindicated (1)
  • Dietary approaches to stop hypertension (DASH) diet: 8-10 servings of fruit and vegetables daily, whole grains, low sodium, low-fat proteins (1)
  • Limit alcohol intake to max 20-30g/d for men, or 10-20g/d for women (1). Excessive alcohol intake increases blood pressure (3)
  • Avoid excessive intake of coffee or other caffeine rich products (5)
  • Beetroot: A daily intake of 70-250 ml beetroot juice reduces systolic blood pressure in people with arterial hypertension (2)
  • A high intake of dietary fiber reduces blood pressure (4)
  • Replacing carbohydrates with soy protein or dairy protein has been shown to reduce blood pressure (4)

PHYSICAL ACTIVITY

  • Regular physical activity, preferably 30 minutes of moderate intensity aerobic exercise 5 days a week or 150 min / week (1)
  • Regular aerobic or resistance training may reduce blood pressure on average 4-6 mmHg (3)

SLEEP

  • Insufficient sleep (< 7 hours) is a risk factor for hypertension, and increasing the amount of sleep may lower blood pressure  (3)

SMOKING

  • Smoking cessation for maintaining good vascular health. However smoking cessation is not associated with reduced blood pressure (1)

WEIGHT

  • Weight loss if obese (1)
  • Weight circumference for men: < 102cm. 
  • Weight circumference for women: < 88cm
  • For every kg weight loss blood pressure is reduced by 0.5 – 2 mmHg (3)

References

1) https://bestpractice.bmj.com/topics/en-us/26

2) https://www.frontiersin.org/articles/10.3389/fnut.2022.823039/full

3) https://www.uptodate.com/contents/overview-of-hypertension-in-adults

4) https://www.uptodate.com/contents/diet-in-the-treatment-and-prevention-of-hypertension

5) https://www.nice.org.uk/guidance/NG136/chapter/recommendations#treating-and-monitoring-hypertension

Resources

ARTICLE: Top 10 Natural Ways To Lower Blood Pressure

List of factors that reduce blood pressure
Top 10 most effective natural methods for blood pressure reduction

EXPLANATION TO EVIDENCE PRESENTATION

Figure: Evidence pyramid

​Evidence based on guidelines and evidence based Clinical Decision Systems is written in BOLD font

​Evidence based on meta analysis or systematic reviews is written in BOLD and CURSIVE font

​Evidence based on randomized controlled trials is written in PLAIN font

​Evidence based on observational / cohort studies is written in CURSIVE font