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. Non-pharmacologic management of hypertension should be prescribed to all patients with elevated blood pressure or hypertension; however, not all patients diagnosed with hypertension require pharmacologic therapy.

1. NON-PHARMACOLOGIC
MANAGEMENT OF HYPERTENSION

2. • 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.
• Non-pharmacologic management of hypertension should be
prescribed to all patients with elevated blood pressure or
hypertension; however, not all patients diagnosed with
hypertension require pharmacologic therapy.

5. OVERWEIGHT, OBESITY, AND WEIGHT
REDUCTION IN HYPERTENSION
• Increased adiposity, whether assessed as higher body mass index
(BMI), higher weight, larger waist circumference, or longitudinal
weight gain, is strongly associated with higher blood pressure and
development of hypertension
• Excess body weight (including overweight and obesity) accounts
for a larger attributable fraction of hypertension.

6. OVERWEIGHT, OBESITY, AND WEIGHT
REDUCTION IN HYPERTENSION

7. OVERWEIGHT, OBESITY, AND WEIGHT
REDUCTION IN HYPERTENSION
• Overweight and obesity may raise blood pressure through a variety
of mechanisms, including renal injury, insulin resistance, sleep-
disordered breathing, and increased sympathetic activity induced
by the leptin-melanocortin pathway
• Weight loss can lower blood pressure and, along with other
lifestyle interventions, is recommended in hypertensive patients
who are overweight or obese
• Beta blockers may make weight reduction more difficult to

8. DIET IN THE TREATMENT AND PREVENTION
OF HYPERTENSION
• A diet that is rich in fruits, vegetables, legumes, and low-fat dairy
products and low in snacks, sweets, and meats (such as the
Dietary Approaches to Stop Hypertension [DASH] diet) may lower
BP and prevent hypertension.
• Low intake of sodium and high intake of potassium (or potassium
supplementation) can reduce BP.
• High-dose, but not low-dose, fish oil supplements may reduce
systemic BP.

9. DIET IN THE TREATMENT AND PREVENTION
OF HYPERTENSION
• Other dietary interventions that may be associated with reduced BP
include dietary fiber, magnesium, soy (vegetable) or dairy protein
intake, folate, and possibly polyphenols (eg, flavonoids).
• Dietary calcium and calcium supplements have a relatively small
effect on BP. The effect of supplemental calcium on BP is too small
to recommend the use of calcium supplements for the therapy or
prevention of hypertension.
• High-dose, but not low-dose, fish oil supplements may reduce
systemic BP.

10. • Exercise is classified as dynamic aerobic, dynamic resistance, and
isometric resistance.
• Most patients who are capable of exercising, whether
normotensive or hypertensive, should be advised to perform
moderate-intensity and/or vigorous-intensity dynamic aerobic
exercise. Aerobic exercise lowers blood pressure in normotensive
individuals and is associated with a reduced incidence of
hypertension and a lower mortality rate

11. • Aerobic exercise lowers blood pressure in normotensive
individuals and is associated with a reduced incidence of
hypertension and a lower mortality rate

12. • A medical evaluation is usually unnecessary prior to either
prescribing exercise or reinforcing the patient's current level of
physical activity (if adequate).
• There is no one exercise prescription for all adults. In general,
reasonable weekly goals for dynamic aerobic exercise are at least
150 minutes of moderate-intensity physical activity
(approximately 30 minutes per day, five or more days per week) or
at least 75 minutes of vigorous-intensity physical activity
(approximately 30 minutes per day, three or more days per week).

13. • Exercise testing is recommended in some, but not most, patients
who start an exercise program. In general, sedentary patients with
known or, based upon signs and symptoms, suspected
cardiovascular disease, diabetes, or kidney disease should
undergo exercise testing before embarking on an exercise plan
• Among those already engaged in moderate- or vigorous-intensity
physical activity, new signs or symptoms of cardiovascular disease
should prompt a cessation of exercise until further testing can be
done

14. • The available evidence supports dynamic aerobic exercise as a
means to lower blood pressure and prevent and control
hypertension. The evidence supporting resistance exercise is less
compelling.
• There is no one exercise prescription that is appropriate for all
adults. The prescription should be individualized to the patient's
capabilities and to prevent injuries and maximize incentives for
maintaining a consistent regimen.

15. Copyrights apply

16. REDUCED INTAKE OF DIETARY SODIUM
• A high dietary intake of sodium is associated with elevated blood
pressure (BP) and the development of hypertension.

17. REDUCED INTAKE OF DIETARY SODIUM
• In general, the extent of BP reduction as a
result of reduced sodium intake is greater in
Black patients, middle- and older-aged
persons, individuals with hypertension, and,
likely, patients with diabetes or kidney disease.
• In hypertensive individuals, a reasonable goal
is to reduce daily sodium intake to <100 mEq
(2.3 g of sodium or 6 g of sodium
chloride)/day. Further reduction to
approximately 50 mmol/day has an even

18. CARDIOVASCULAR RISKS AND BENEFITS OF
MODERATE ALCOHOL CONSUMPTION
• The 2020 to 2025 Dietary Guidelines for Americans define
moderate drinking as having up to one drink per day for females
and up to two drinks per day for males.
• Definitions of a "standard drink" differ, both within and between
countries, with a standard drink containing from as few as 8
grams of alcohol to as many as 20 grams of alcohol.

19. CARDIOVASCULAR RISKS AND BENEFITS OF
MODERATE ALCOHOL CONSUMPTION

20. CARDIOVASCULAR RISKS AND BENEFITS OF
MODERATE ALCOHOL CONSUMPTION
• Multiple studies have shown an association between excess
alcohol intake and the development of hypertension. However,
light to moderate alcohol consumption may be beneficial in
reducing the risk of hypertension.
• In a meta-analysis of 36 trials, a decrease in alcohol intake
reduced blood pressure in people who drank more than two drinks
per day; however, a reduction was not seen in those consuming
two or fewer drinks per day

21. CARDIOVASCULAR RISKS AND BENEFITS OF
MODERATE ALCOHOL CONSUMPTION
• On the other hand, moderate alcohol intake appears to have a
cardioprotective effect, even in patients with preexisting
hypertension.
• A 2014 meta-analysis of nine cohort studies including over
390,000 patients with hypertension found that, compared with
abstainers or occasional drinkers, those who consumed 8 to 10
grams of alcohol per day had a decreased risk for all-cause
mortality (RR 0.82, 95% CI 0.76-0.88).

22. CARDIOVASCULAR RISKS AND BENEFITS OF
MODERATE ALCOHOL CONSUMPTION
• Individuals who are not currently drinking, or those who have a
personal preference to avoid alcohol, should not be advised to
consume alcohol solely for the purpose of CVD risk reduction.
• Patients who have an underlying medical condition that precludes
alcohol use (e.g., alcohol use disorder, liver disease, etc.) should not
be advised to consume alcohol and seek counseling, if needed, to
abstain from alcohol.
• Patients who choose to drink moderate amounts of alcohol, such as
those who drink alcohol less than one unit per day (or less than 15 g

23. SMOKING AND HYPERTENSION
• The acute effects of cigarette
smoking are related to sympathetic
nervous system overactivity, which
leads to an increase in blood
pressure, heart rate, myocardial
contractility, and myocardial oxygen
consumption.
• The rise in blood pressure with each
cigarette is transient, even among
those who smoke regularly; this
transient blood pressure increase

24. SMOKING AND HYPERTENSION
• There are inconsistent data that tobacco smoking raises blood pressure
chronically or increases the incidence of hypertension. Those who smoke
habitually often have lower blood pressure than nonsmokers, which
might be related to a generally lower body weight compared with
nonsmokers and the vasodilatory effects of cotinine, the major
metabolite of nicotine.
• However, cigarette smoking increases the risk of masked hypertension
(normal blood pressure in the office but elevated blood pressure outside
of the office environment), renovascular hypertension, severe

25. SMOKING AND HYPERTENSION
• Acute e-cigarette use appears to be associated with a mild, short-term
increase in diastolic blood pressure and a mild, short-term increase or
no effect on systolic blood pressure. Data are limited on the chronic
blood pressure effects of e-cigarettes.
• Indirect and direct evidence suggest that smoking by hookah has blood
pressure and other cardiovascular effects that are similar to traditional
cigarette smoking.

26. SUMMARY