AKA: Lifestyle Modification for Hypertension; Nonpharmacologic Management of Hypertension
Lifestyle modifications are recommended for all patients with hypertension.
- Diet – A diet rich in vegetables, fruits, and whole grains is recommended. E.g. DASH. “Compared with a typical American diet of the 1990s, the DASH diet lowers SBP by 5 to 6 mm Hg and DBP by 3 mm Hg.” AAFP 2015
- Lower Sodium Intake – “There is strong and consistent evidence that reducing sodium intake reduces blood pressure.” Limit sodium intake to more than 2,400 mg per day (about 1 teaspoon of table salt). Further reduction of sodium intake to 1,500 mg per day is desirable because it is associated with an even greater reduction in blood pressure. The average blood pressure reduction in patients consuming a sodium-restricted diet of 2,400 mg per day is 2/1 mm Hg, or 7/3 mm Hg for those restricting sodium to 1,500 mg per day.12,13 Reducing baseline sodium intake by at least 1,000 mg per day will lower blood pressure even if the desired daily sodium intake is not yet achieved.” AAFP 2015
- Physical Activity. In addition to lowering BP, exercise also leads to reduced rates of all-cause mortality, coronary heart disease, stroke, type 2 diabetes, metabolic syndrome, colon cancer, breast cancer, and depression. Rx: “Moderate to vigorous aerobic physical activity 3 or 4 times per week for an average of 40 minutes per session to lower blood pressure. Most health benefits occur with at least 150 minutes per week of moderate-intensity physical activity, such as brisk walking.”
- Weight loss. Weight loss causes a SBP decrease of about 0.5-2mmHg / kg of weight lost. From Jan to June 2015, I lost 50 pounds as a result of a lifestyle change and saw my BP drop significantly.
- Smoking Cessation. “Cigarette smoking is the leading preventable cause of death in the United States and significantly increases the risk of cardiovascular disease.Smoking causes an immediate increase in sympathetic nervous activity, which in turn increases myocardial oxygen demand through increased blood pressure, heart rate, and myocardial contractility.” AFP 2015. Smoking Cessation lowers BP.
- Alcohol Consumption.“Moderate alcohol consumption has been shown to lower blood pressure. However, excessive alcohol consumption can raise blood pressure, and persons who do not drink alcohol should not be encouraged to start for the purposes of lowering blood pressure. For potentially beneficial health effects, alcohol consumption should be limited to two drinks per day for most men and one drink per day for women and lighter-weight men”
- Treating your OSA. Using CPAP to tx OSA lowers BP.
- Self-Measured Blood Pressure Monitoring. “Self-measured blood pressure monitoring—with or without additional support such as education, counseling, telemedicine, home visits, or Web-based logging—lowers blood pressure compared with usual care. Self-monitoring of blood pressure resulted in a mean reduction in systolic blood pressure of 3.9 mm Hg at six months, and self-monitoring of blood pressure with additional support resulted in a reduction in systolic blood pressure of 2.1 to 8.3 mm Hg, which remained significant at 12 months.” AAFP 2015
- Relaxation Techniques. Relaxation techniques lower BP. MOA is not yet known. “Evidence shows that transcendental meditation may modestly lower blood pressure. Biofeedback techniques have been proven effective and may be considered in clinical practice to lower blood pressure.”
- Dietary Supplements. Garlic and Cocoa have been shown to lower BP. However, more studies needed to help clarify how that knowledge can be applied in clinical practice.
References
Arch Intern Med. 1999 Feb 8;159(3):285-93. https://www.ncbi.nlm.nih.gov/pubmed/9989541 (DASH diet lowers BP independent of weight loss or lowering sodium).
N Engl J Med. 1997 Apr 17;336(16):1117-24. https://www.ncbi.nlm.nih.gov/pubmed/9099655 (Also shows DASH diet lowers BP)
Am Fam Physician. 2015 Jun 1;91(11):772-776.
http://hyper.ahajournals.org/content/33/1/586