Lifestyle modifications in the prevention and treatment of hypertension.

OBJECTIVE To present an objective, evidence-based review of the current literature on the role of lifestyle factors in hypertension. METHODS We discuss the reported roles of obesity and overweight, nutritional factors, alcohol, physical activity, and smoking in the prevention and treatment of hypertension. RESULTS For all age-groups and in both sexes, cross-sectional and prospective studies have shown a direct strong relationship between weight and blood pressure. In general, overweight is associated with a twofold to sixfold increase in the risk of developing hypertension. Clinical trials have proved that weight loss is effective in the primary prevention of hypertension as well as in the reduction of both systolic and diastolic blood pressure in patients with normal or high blood pressure. A decreased intake of dietary sodium has been demonstrated to have a hypotensive effect, both alone and as an adjunctive measure to pharmacologic therapy. Although no consensus currently exists about the role of potassium intake in prevention or control of hypertension, some studies support the protective value of high intake of potassium. A consistent relationship has been noted between consumption of alcohol and increased blood pressure, and reduced intake of alcohol has been shown to decrease blood pressure significantly. An inverse relationship exists between blood pressure and physical activity, independent of overweight or obesity. Moreover, increased physical activity helps lower both systolic and diastolic blood pressure. In a study of the effect of smoking and use of smokeless tobacco in healthy middle-aged men, ambulatory diastolic blood pressures were increased in both smokers and smokeless tobacco users in comparison with nonusers. CONCLUSION Ample evidence supports the beneficial effects of healthful lifestyle modifications in the prevention and management of hypertension. Therefore, physicians should be motivated to provide guidance to the population relative to lifestyle practices that can help prevent and control hypertension.