Diet and lifestyle in Hypertension Management

Changes in single nutrients—such as lowering sodium—have been the primary focus on dietary interventions to prevent and treat hypertension. However, weight reduction, adopting the DASH eating pattern (which emphasizes fruits, vegetables, low-fat dairy foods, whole grains, poultry, fish and nuts and is low in saturated fat, total fat and cholesterol) and engaging in physical activity have potentially the same or greater effect on managing hypertension as sodium reduction.

The prevalence of hypertension is high and increasing worldwide. Drug therapy is effective, but for both "prehypertensive" and treated hypertensive patients, lifestyle changes are also important. Dietary modification is a key part of these changes, although skepticism about the role of diet in determining blood pressure has slowed implementation of the available guidelines. However, there is now a large body of evidence supporting a role for dietary salt, potassium, alcohol, and body mass in determining blood pressure.

Studies such as PREMIER have shown that salt restriction (<6 g/d), alcohol moderation (<2U/d in men and <1U/d in women), weight loss (if BMI>25), exercise, and a DASH (Dietary Approaches to Stop Hypertension) diet (supplying 20-30 m.mol/d of potassium) can achieve decreases in systolic blood pressure of approximately 10 to 15 mm Hg when applied together. Of the dietary changes, salt intake remains the most amenable to change. But we must further reduce salt in processed food if it is to be part of a wider strategy to lower blood pressure in the general population. Nevertheless, the message to patients must be that dietary changes made within a concerted alteration in lifestyle can have a very significant impact on their blood pressure.

Health professionals can assist clients to combine two or more lifestyle modifications to achieve even greater results.

  • Smoking cessation
  • Salt sensitivity and resistance
  • Dietary potassium
  • Lowering blood pressure
  • Maintenance therapy and reassessment
  • Resources for promoting lifestyle management to patients
  • Incorporating patient-centered lifestyle modification

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