These recommendations are presented in abbreviated form. Readers should refer to the complete guideline document1 for a detailed discussion of each of the following topics.
Lifestyle measures should be instituted whenever appropriate in all patients, including subjects with high normal blood pressure and patients who require drug treatment. The purpose is to lower blood pressure and to control other risk factors and clinical conditions present. The lifestyle measures that are widely agreed to lower blood pressure or cardiovascular risk, and that should be considered in all patients, are:
- smoking cessation
- weight reduction
- reduction of excessive alcohol intake
- physical exercise
- reduction of salt intake
- increase in fruit and vegetable intake and decrease in saturated and total fat intake.
Healthy eating should always be promoted. However, lifestyle measures have not been shown to prevent cardiovascular complications in hypertensive patients, and should never delay unnecessarily the initiation of drug treatment, especially in patients at higher levels of risk, or detract from compliance with drug treatment.
Moderation of alcohol consumption
There is a linear relationship between alcohol consumption, blood pressure levels and the prevalence of hypertension in populations. Beyond that, high levels of alcohol consumption are associated with a high risk of stroke; this is particularly so for binge drinking.
Weight reduction and physical exercise
Excess body fat predisposes to raised blood pressure and hypertension. Weight reduction reduces blood pressure in overweight patients and has beneficial effects on associated risk factors such as insulin resistance, diabetes, hyperlipidaemia and left ventricular hypertrophy.
Physical fitness is a rather strong predictor of cardiovascular mortality independent of blood pressure and other risk factors. Thus, sedentary patients should be advised to take up modest levels of aerobic exercise on a regular basis, such as walking, jogging or swimming for 30–45 min, three to four times a week.
Reduction of high salt intake and other dietary changes
Epidemiological studies suggest that dietary salt intake is a contributor to blood pressure elevation and to the prevalence of hypertension.
Hypertensive patients should also be advised to eat more fruit and vegetables, to eat more fish and to reduce their intake of saturated fat and cholesterol.
1. Adapted from: 2003 European Society of Hypertension–European Society of Cardiology guidelines for the management of arterial hypertension. Journal of Hypertension 2003, 21:1011–1053. Available at: http://www.eshonline.org/