II. Prevention: Habit Changes
-
Weight Reduction (if over weight)
- BP may normalize with 10 pound weight loss alone
- Weight loss of 10 kg (22 lb) may reduce SBP up to 5-20 mmHg
-
Alcohol consumption moderated (limit to <1 ounce/day)
- Beer (<24 ounces/day)
- Wine (<8 ounces/day)
- Whiskey 100-Proof (<2 ounces/day)
- Dynamic Aerobic Exercise
- Exercise 3 times per week, 30 to 40 minutes per session
- Exercise 150 minutes moderate activity per week
- Or Exercise at least 75 minutes vigorous activity per week (70% of Maximal Heart Rate)
- Smoking Cessation
- Stress Reduction
- Yoga or meditation
- Muscle relaxation
- Biofeedback
-
Home Blood Pressure Monitor
- Effective in short-term (lowers SBP 2-8 mmHg at 12 months)
- Long-term Blood Pressure effects are unclear
- Uhlig (2013) Ann Intern Med 159(3): 185-94 [PubMed]
III. Prevention: General Diet
-
DASH Diet encompasses key nutritional approaches
- See Hypertension Resources for education materials
- High fiber, Potassium, Calcium, Magnesium
- Low salt, Cholesterol and saturated fat
- Reduce Saturated fat intake
- Decrease Sodium intake (see below)
- Increase fruits and vegetables (see below)
- Supplements do not offer consistent or substantial Blood Pressure reduction
- Insufficient evidence for Garlic or cocoa
- Also insufficient evidence for Vitamin C, Coenzyme Q10, Omega-3 Fatty Acids, Magnesium
IV. Prevention: Increase Fruits and Vegetables (High Potassium Diet)
- Caution if Hyperkalemia risk
- Chronic Kidney Disease Stage 4 and 5
- Study: Fruit and Vegetable with Low Fat Diet (n=459)
- Overall (compared with standard "American diet")
- Reduced Systolic Blood Pressure 5.5 mmHg
- Reduced Diastolic Blood Pressure 3.0 mmHg
- Hypertensives (Baseline Blood Pressure >140/90)
- Reduced Systolic Blood Pressure 11.4 mmHg
- Reduced Diastolic Blood Pressure 5.5
- Reference
V. Prevention: Sodium Restriction
-
Sodium Limits
- No added salt diet (<3000-4000 mg, 135-180 meq/day)
- Hypertension
- Cardiovascular disease
- Congestive Heart Failure
- Acute and Chronic Renal Failure
- Restrictive diet (<2000 mg or 90 meq/day)
- Liver Cirrhosis or other liver failure
- Pulmonary Edema
- Moderate to severe Congestive Heart Failure
- No added salt diet (<3000-4000 mg, 135-180 meq/day)
- Salt sensitive (Accounts for 50% of hypertensives)
- Black Ethnicity
- Advanced Age
- Older
- Obese
- Low renin
- Intersalt Study reanalyzed (n=10000, 32 countries)
- Each 100 mml increase in 24 hour Sodium excretion
- Systolic Blood Pressure rises 3-6 mmHg
- SBP rises 10-11 mmHg if age over 55 years
- Reference
- Each 100 mml increase in 24 hour Sodium excretion