Chronic hypertension lifestyle modification: Difference between revisions
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Rim Halaby (talk | contribs) (/* JNC7 Recommendations: Lifestyle Modifications 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. H...) |
Rim Halaby (talk | contribs) (/* JNC7 Recommendations: Lifestyle Modifications 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. H...) |
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===JNC7 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>=== | ===JNC7 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>=== | ||
{| border=" | {| border="1" style="border-collapse:collapse; text-align:center; font-size:120%;" cellpadding="5" align="center" width="950px" | ||
|- align="center" | |- align="center" | ||
| bgcolor="#67e1ff"|'''Modification''' | | bgcolor="#67e1ff"|'''Modification''' | ||
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| bgcolor="#67e1ff"|'''Approximate SBP Reduction (Range)''' | | bgcolor="#67e1ff"|'''Approximate SBP Reduction (Range)''' | ||
|- align="left" | |- align="left" | ||
| Weight reduction | | bgcolor="#f3f3f3"|Weight reduction | ||
| Maintain normal body weight ([[body mass index]] 18.5–24.9 kg/m2) | | Maintain normal body weight ([[body mass index]] 18.5–24.9 kg/m2) | ||
| align="center" | 5–20 mmHg / 10 kg weight loss <ref name="pmid9080920"> (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9080920 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: [http://pubmed.gov/9080920 9080920]</ref><ref name="pmid10679495">He J, Whelton PK, Appel LJ, Charleston J, Klag MJ (2000) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10679495 Long-term effects of weight loss and dietary sodium reduction on incidence of hypertension.] ''Hypertension'' 35 (2):544-9. PMID: [http://pubmed.gov/10679495 10679495]</ref> | | align="center" | 5–20 mmHg / 10 kg weight loss <ref name="pmid9080920"> (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9080920 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: [http://pubmed.gov/9080920 9080920]</ref><ref name="pmid10679495">He J, Whelton PK, Appel LJ, Charleston J, Klag MJ (2000) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10679495 Long-term effects of weight loss and dietary sodium reduction on incidence of hypertension.] ''Hypertension'' 35 (2):544-9. PMID: [http://pubmed.gov/10679495 10679495]</ref> | ||
|- align="left" | |- align="left" | ||
| Adopt DASH eating plan | | bgcolor="#f3f3f3"|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. | | Consume a diet rich in fruits, vegetables, and low-fat dairy products with a reduced content of saturated and total fat. | ||
| align="center" | 8–14 mmHg <ref name="pmid11136953">Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D et al. (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11136953 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. [http://dx.doi.org/10.1056/NEJM200101043440101 DOI:10.1056/NEJM200101043440101] PMID: [http://pubmed.gov/11136953 11136953]</ref><ref name="pmid11747380">Vollmer WM, Sacks FM, Ard J, Appel LJ, Bray GA, Simons-Morton DG et al. (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11747380 Effects of diet and sodium intake on blood pressure: subgroup analysis of the DASH-sodium trial.] ''Ann Intern Med'' 135 (12):1019-28. PMID: [http://pubmed.gov/11747380 11747380]</ref> | | align="center" | 8–14 mmHg <ref name="pmid11136953">Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D et al. (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11136953 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. [http://dx.doi.org/10.1056/NEJM200101043440101 DOI:10.1056/NEJM200101043440101] PMID: [http://pubmed.gov/11136953 11136953]</ref><ref name="pmid11747380">Vollmer WM, Sacks FM, Ard J, Appel LJ, Bray GA, Simons-Morton DG et al. (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11747380 Effects of diet and sodium intake on blood pressure: subgroup analysis of the DASH-sodium trial.] ''Ann Intern Med'' 135 (12):1019-28. PMID: [http://pubmed.gov/11747380 11747380]</ref> | ||
|- align="left" | |- align="left" | ||
| Dietary sodium reduction | | bgcolor="#f3f3f3"|Dietary sodium reduction | ||
| Reduce dietary sodium intake to no more than 100 mmol per day (2.4 g sodium or 6 g sodium chloride). | | Reduce dietary sodium intake to no more than 100 mmol per day (2.4 g sodium or 6 g sodium chloride). | ||
| align="center" | 2–8 mmHg <ref name="pmid11136953">Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D et al. (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11136953 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. [http://dx.doi.org/10.1056/NEJM200101043440101 DOI:10.1056/NEJM200101043440101] PMID: [http://pubmed.gov/11136953 11136953]</ref><ref name="pmid11747380">Vollmer WM, Sacks FM, Ard J, Appel LJ, Bray GA, Simons-Morton DG et al. (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11747380 Effects of diet and sodium intake on blood pressure: subgroup analysis of the DASH-sodium trial.] ''Ann Intern Med'' 135 (12):1019-28. PMID: [http://pubmed.gov/11747380 11747380]</ref><ref name="pmid10775551">Chobanian AV, Hill M (2000) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10775551 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: [http://pubmed.gov/10775551 10775551]</ref> | | align="center" | 2–8 mmHg <ref name="pmid11136953">Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D et al. (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11136953 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. [http://dx.doi.org/10.1056/NEJM200101043440101 DOI:10.1056/NEJM200101043440101] PMID: [http://pubmed.gov/11136953 11136953]</ref><ref name="pmid11747380">Vollmer WM, Sacks FM, Ard J, Appel LJ, Bray GA, Simons-Morton DG et al. (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11747380 Effects of diet and sodium intake on blood pressure: subgroup analysis of the DASH-sodium trial.] ''Ann Intern Med'' 135 (12):1019-28. PMID: [http://pubmed.gov/11747380 11747380]</ref><ref name="pmid10775551">Chobanian AV, Hill M (2000) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10775551 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: [http://pubmed.gov/10775551 10775551]</ref> | ||
|- align="left" | |- align="left" | ||
| Physical activity | | bgcolor="#f3f3f3"|Physical activity | ||
| Engage in regular aerobic physical activity such as brisk walking (at least 30 min per day, most days of the week). | | Engage in regular aerobic physical activity such as brisk walking (at least 30 min per day, most days of the week). | ||
| align="center" | 4–9 mmHg <ref name="pmid10720604">Kelley GA, Kelley KS (2000) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10720604 Progressive resistance exercise and resting blood pressure : A meta-analysis of randomized controlled trials.] ''Hypertension'' 35 (3):838-43. PMID: [http://pubmed.gov/10720604 10720604]</ref><ref name="pmid11926784">Whelton SP, Chin A, Xin X, He J (2002) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11926784 Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials.] ''Ann Intern Med'' 136 (7):493-503. PMID: [http://pubmed.gov/11926784 11926784]</ref> | | align="center" | 4–9 mmHg <ref name="pmid10720604">Kelley GA, Kelley KS (2000) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10720604 Progressive resistance exercise and resting blood pressure : A meta-analysis of randomized controlled trials.] ''Hypertension'' 35 (3):838-43. PMID: [http://pubmed.gov/10720604 10720604]</ref><ref name="pmid11926784">Whelton SP, Chin A, Xin X, He J (2002) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11926784 Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials.] ''Ann Intern Med'' 136 (7):493-503. PMID: [http://pubmed.gov/11926784 11926784]</ref> | ||
|- align="left" | |- align="left" | ||
| Moderation of alcohol consumption | | bgcolor="#f3f3f3"|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. | | 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. | ||
| align="center" | 2–4 mmHg <ref name="pmid11711507">Xin X, He J, Frontini MG, Ogden LG, Motsamai OI, Whelton PK (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11711507 Effects of alcohol reduction on blood pressure: a meta-analysis of randomized controlled trials.] ''Hypertension'' 38 (5):1112-7. PMID: [http://pubmed.gov/11711507 11711507]</ref> | | align="center" | 2–4 mmHg <ref name="pmid11711507">Xin X, He J, Frontini MG, Ogden LG, Motsamai OI, Whelton PK (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11711507 Effects of alcohol reduction on blood pressure: a meta-analysis of randomized controlled trials.] ''Hypertension'' 38 (5):1112-7. PMID: [http://pubmed.gov/11711507 11711507]</ref> | ||
Revision as of 05:41, 5 November 2013
|
Hypertension Main page |
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)
JNC7 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] |
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.
- ↑ 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
- ↑ (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
- ↑ 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
- ↑ 6.0 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
- ↑ 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