Chronic hypertension lifestyle modification: Difference between revisions

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==Lifestyle Modification==
==Lifestyle Modification==
* [[weight loss|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.  
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.


* Reducing [[sodium chloride|sodium (salt)]] [[Dieting|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.
According to JNC 7, lifestyle measures or interventions include the following, by order of effect on SBP reduction:<ref name="pmid16512265">{{cite journal| author=Cuddy ML| title=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). | journal=J Pract Nurs | year= 2005 | volume= 55 | issue= 4 | pages= 17-21; quiz 22-3 | pmid=16512265 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16512265 }} </ref>


* 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.
* Maintenance of normal body weight: BMI 18.5-24.9 kg/m<sup>2</sup>. 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.


* Relaxation therapy, such as meditation, that reduces environmental stress, [[Noise health effects|high sound levels]] and [[over-illumination]] can be an additional method of ameliorating hypertension. [[Biofeedback]] is also used [http://www.mayoclinic.org/news2006-rst/3334.html] particularly device guided paced breathing [http://www.emaxhealth.com/106/5912.html] [http://www.medscape.com/viewarticle/539099]. Obviously, the effectiveness of relaxation therapy relies on the patient's attitude and compliance.
* “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 <ref name="pmid14656957">Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14656957 Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.] ''Hypertension'' 42 (6):1206-52. [http://dx.doi.org/10.1161/01.HYP.0000107251.49515.c2 DOI:10.1161/01.HYP.0000107251.49515.c2] PMID: [http://pubmed.gov/14656957 14656957]</ref>===
===JNC- Seventh Report Recommendations: Lifestyle Modifications <ref name="pmid14656957">Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14656957 Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.] ''Hypertension'' 42 (6):1206-52. [http://dx.doi.org/10.1161/01.HYP.0000107251.49515.c2 DOI:10.1161/01.HYP.0000107251.49515.c2] PMID: [http://pubmed.gov/14656957 14656957]</ref>===


Revision as of 05:32, 5 November 2013

Hypertension Main page

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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:[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)

JNC- Seventh Report Recommendations: Lifestyle Modifications [2]

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 [3][4]
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 [5][6]
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 [5][6][7]
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 [8][9]
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 [10]

Guidelines Resources

References

  1. ↑ 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.
  2. ↑ Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al. (2003) Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 42 (6):1206-52. DOI:10.1161/01.HYP.0000107251.49515.c2 PMID: 14656957
  3. ↑ (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
  4. ↑ 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
  5. ↑ 5.0 5.1 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
  6. ↑ 6.0 6.1 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
  7. ↑ 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
  8. ↑ 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
  9. ↑ 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
  10. ↑ 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

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