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.
2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults
"1. Weight loss is recommended to reduce BP in adults with elevated BP or hypertension who are overweight or obese.(Level of Evidence: A) "
"2. A heart-healthy diet, such as the DASH (Dietary Approaches to Stop Hypertension) diet, that facilitates achieving a desirable weight is recommended for adults with elevated BP or hypertension.(Level of Evidence: A) "
"3. Sodium reduction is recommended for adults with elevated BP or hypertension.(Level of Evidence: A) "
"4. Potassium supplementation, preferably in dietary modification, is recommended for adults with elevated BP or hypertension, unless contraindicated by the presence of chronic kidney disease (CKD) or use of drugs that reduce potassium excretion.(Level of Evidence: A) "
"5. Increased physical activity with a structured exercise program is recommended for adults with elevated BP or hypertension.(Level of Evidence: A) "
"6. Adult men and women with elevated BP or hypertension who currently consume alcohol should be advised to drink no more than 2 and 1 standard drinks* per day, respectively.(Level of Evidence: A) "
In the United States, 1 “standard” drink contains roughly 14 g of pure alcohol, which is typically found in 12 oz of regular beer (usually about 5% alcohol), 5 oz of wine (usually about 12% alcohol), and 1.5 oz of distilled spirits (usually about 40% alcohol)
"1. Effective behavioral and motivational strategies to achieve a healthy lifestyle (i.e., tobacco cessation, weight loss, moderation in alcohol intake, increased physical activity, reduced sodium intake, and consumption of a healthy diet) are recommended for adults with hypertension.(Level of Evidence: C-EO) "
Structured, Team-Based Care Interventions for Hypertension Control
"1. Telehealth strategies can be useful adjuncts to interventions shown to reduce BP for adults with hypertension.(Level of Evidence: A) "
"2. Use of performance measures in combination with other quality improvement strategies at patient-, provider-, and system-based levels is reasonable to facilitate optimal hypertension control.(Level of Evidence: B-NR) "
"1. Financial incentives paid to providers can be useful in achieving improvements in treatment and management of patient populations with hypertension.(Level of Evidence: B-R) "
"1. Health system financing strategies (e.g., insurance coverage and copayment benefit design) can be useful in facilitating improved medication adherence and BP control in patients with hypertension.(Level of Evidence: B-NR) "
"1. Every adult with hypertension should have a clear, detailed, and current evidence-based plan of care that ensures the achievement of treatment and self-management goals, encourages effective management of comorbid conditions, prompts timely follow-up with the healthcare team, and adheres to CVD guideline-directed medical therapy (GDMT).(Level of Evidence: C-EO) "
2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk
Recommendations for Lifestyle Management to Reduce Blood Pressure
"1. 1. Consume a dietary pattern that emphasizes intake of vegetables, fruits, and whole grains; includes low-fat dairy products, poultry, fish, legumes, nontropical vegetable oils, and nuts; and limits intake of sweets, sugar-sweetened beverages, and red meats.
a. Adapt this dietary pattern to appropriate calorie requirements, personal and cultural food preferences, and nutrition therapy for other medical conditions (including diabetes).
b. Achieve this pattern by following plans such as the DASH dietary pattern, the USDA Food Pattern, or the AHA Diet.(Level of Evidence: A)"
b. Further reduction of sodium intake to 1,500 mg/d can result in even greater reduction in BP; and c. Even without achieving these goals, reducing
sodium intake by at least 1,000 mg/d lowers BP. (Level of Evidence: B)"
"1. In general, advise adults to engage in aerobic physical activity to lower BP: 3–4 sessions per wk, lasting on average 40 min per session, and involving moderate- to vigorous-intensity physical activity. (Level of Evidence: A)"
2013 ESH/ESC Guidelines For The Management of Arterial Hypertension
Summary of Recommendations on Lifestyle Modification
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.