Lifestyle management of hypertension: International Society of Hypertension position paper endorsed by the World Hypertension League and European Society of Hypertension

Abstract

Hypertension, defined as persistently elevated systolic blood pressure (SBP) >140 mmHg and/or diastolic blood pressure (DBP) at least 90 mmHg (International Society of Hypertension guidelines), affects over 1.5 billion people worldwide. Hypertension is associated with increased risk of cardiovascular disease (CVD) events (e.g. coronary heart disease, heart failure and stroke) and death. An international panel of experts convened by the International Society of Hypertension College of Experts compiled lifestyle management recommendations as first-line strategy to prevent and control hypertension in adulthood. We also recommend that lifestyle changes be continued even when blood pressure-lowering medications are prescribed. Specific recommendations based on literature evidence are summarized with advice to start these measures early in life, including maintaining a healthy body weight, increased levels of different types of physical activity, healthy eating and drinking, avoidance and cessation of smoking and alcohol use, management of stress and sleep levels. We also discuss the relevance of specific approaches including consumption of sodium, potassium, sugar, fibre, coffee, tea, intermittent fasting as well as integrated strategies to implement these recommendations using, for example, behaviour change-related technologies and digital tools.

Insulin resistance, C-reactive protein, diastolic to systolic blood pressure ratio and epicardial fat are related to sedentary time, and inversely related to physical activity in school-aged children

“…In general, PA is associated with a lower heart rate on a long-term scale that could allow for sufficient time for diastolic left ventricular filling and coronary flow, therefore improving arterial compliance and lowering blood pressure ( 30 , 37 ). Furthermore, it is worthy to emphasize that the World Hypertension League and the European Society of Hypertension recommended regular PA across the lifespan (including childhood) because of its well-established antihypertensive effects, as well as its favorable impact on other modifiable CVD risk factors ( 38 ). Moreover, they highlighted an inverse dose–response relationship between PA levels and CVD, i.e., the incidence of stroke, coronary artery disease and overall mortality ( 38 ).…”

“…Furthermore, it is worthy to emphasize that the World Hypertension League and the European Society of Hypertension recommended regular PA across the lifespan (including childhood) because of its well-established antihypertensive effects, as well as its favorable impact on other modifiable CVD risk factors ( 38 ). Moreover, they highlighted an inverse dose–response relationship between PA levels and CVD, i.e., the incidence of stroke, coronary artery disease and overall mortality ( 38 ). Finally, EF was negatively related to PA in our study suggesting that more PA will potentially contribute to less EF.…”

Social Determinants of Health and Disparities in Hypertension and Cardiovascular Diseases

“…34 Moreover, a low-sodium diet rich in fruits, vegetables, grains, and low-fat dairy products is recommended for lowering BP. 35 However, in impoverished neighborhoods, food insecurity is compounded by unfavorable trade policies, making fresh produce unaffordable. For example, in LMICs, the cost of recommended fruit and vegetable servings can account for up to half of household income, while in HICs, it is < 2%.…”

“…43 Low Physical Activity, Tobacco, and Alcohol Use Physical activity is an established protective factor against hypertension and CVD events. 35 However, people with low socioeconomic position (SEP), characterized by lower income, education, and employment, are less physically active due to factors like time constraints, lack of motivation, neighborhood safety, and limited recreational facilities. 44,45 While tobacco may not be a direct hypertension risk factor, it significantly increases the risk for all CVD subtypes, especially in individuals with hypertension.…”

Effects of a single session of isometric handgrip exercise on blood pressure in hypertensive women: a randomized crossover trial

“…Isometric handgrip training has been recommended for prevention and treatment of hypertension by American Heart Association, Exercise and Sports Science Australia [1], Hypertension Canada [2] and the World Hypertension League and European Society of Hypertension [3], as it has been shown to reduce systolic blood pressure by 8 mmHg and diastolic blood pressure by 4 mmHg [4][5][6].…”