Lifestyle modifications are the foundation for preventing hypertension, and they are an important component of first-line therapy in all patients treated with antihypertensive drug therapy.
The overarching goal of treating patients with hypertension is to reduce associated morbidity and mortality (also called cardiovascular or CV events).
These manifest as hypertension associated complications which include coronary artery disease, carotid artery disease, peripheral arterial disease, abdominal aortic aneurysm, and other forms of cardiovascular diseases (CVDs).
Lifestyle advice should include:
1. Weight loss if overweight or obese, ideally attaining a body mass index (BMI) less than 25 kg/m2 or maintaining a desirable BMI (18.5–24.9 kg/m2) if not overweight or obese.
2. Adoption of the Dietary Approaches to Stop Hypertension (DASH) eating plan, that is, consumption of a diet rich in fruits and vegetables (8–10 servings/day), rich in low-fat dairy products (2–3 servings/day) with reduced saturated and total fat.
3. Dietary sodium restriction ideally to 1.5 g/day (3.8 g/day sodium chloride).
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4. Increase daily dietary potassium intake to 120 mmol/day (4.7 g/day), which is the amount provided in a DASH-type diet.
5. Regular aerobic physical activity (at least 30 min/day, most days of the week but preferable daily).
6. Moderation of alcohol consumption (2 drinks/day in men and 1 drink/day in women and lighter-weight persons).
7. Smoking cessation.
In order to maximize potential benefit, patients should receive clear and unambiguous advice, including written information they can digest in their own time.
- Antman, E. and Sabatine, M. (2013). Cardiovascular Therapeutics: A Companion to Braunwald’s Heart Disease (4th ed.). Philadelphia: Saunders.
- James, P., Oparil S., Carter B., Cushman W., Dennison-Himmelfarb C., Handler J. et al. (2014) Evidence-based guidelines for the management of high blood pressure in adults. JAMA,311(5):507–520.
- Wells, B., DiPiro, J., Schwinghammer, T. and DiPiro, C. (2017). Pharmacotherapy Handbook. (10th ed.). New York: McGraw-Hill Education.
- Whittlesea, C. and Hodson, K. (2019). Clinical Pharmacy and Therapeutics (6th ed.). London: Elsevier Limited.
- Zeind, C. and Carvalho, M. (2018). Applied Therapeutics: The Clinical Use of Drugs (11th ed.). New York: Wolters Kluwer.
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