Lifestyle modifications


  • 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)


  • 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)


  • 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)


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


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


  • 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)


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


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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