Lifestyle Changes for Patients with High Blood Pressure

This week, the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) published new guidelines in relation to the diagnosis and management of high blood pressure. This welcome development comes out before the long awaited US guidelines which are being produced by the Joint National Committee (JNC) on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC-8), which are expected later this year.

Targets for those patients with high blood pressure have been simplified. For most people with high blood pressure the recommendations are now to treat to keep systolic blood pressure below 140mmHg. Although certain subgroups have different recommendations: e.g. the elderly, those with existing heart or kidney problems and those with diabetes for example.

However, the European societies have been clear to state that these guidelines are just that, guidelines. They are not expected to apply in every case and they are not meant to be restrictive to physicians’ management practice. Indeed whilst encouraging a holistic approach, the new guidelines are clear that management options need to be in line with cardiovascular disease risk analysis.

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Interestingly, lifestyle changes for lowering blood pressure have been addressed in the new guidelines. This will likely be of interest to those individuals who have undergone a health screening program. The guidelines have this to say about lifestyle changes: “Appropriate lifestyle changes are the cornerstone for the prevention of hypertension. “and “lifestyle modifications can be equivalent to drug monotherapy”. In addition, “Beside the BP-lowering effect, lifestyle changes contribute to the control of other CV risk factors and clinical conditions.”

For those who have a once-off elevated blood pressure reading during their health screen it may not be appropriate to diagnose hypertension depending on the blood pressure result. However as there is little down side to changing lifestyle, then here is a quick recap on some recommendations from the new ESH/ESC guidelines:

1.       Moderate salt intake: typical figures in the European context are a daily intake of 9 to 12g per day of salt. Ideally this should be limited to 5-6g/day.

2.       Moderate alcohol intake: a few days alcohol free and less alcohol if possible. Limit consumption to 21 units for men and 14 for women.

3.       High consumption of vegetables and fruits and other low-fat foods and diets.
Two diets have been in the news a lot recently: these are the Mediterranean diet and the DASH diet. Both have similar recommendations. For example to eat more vegetables, use low-fat dairy products, eat more dietary and soluble fibre, whole-grains, fruit and protein from plant sources. Fish, eaten twice per week, is also recommended.

4.       Optimise weight: This is tricky. Currently two measures are used to give an indication of whether a person is over-weight, these are BMI and waist circumference. Both are frequently used in health assessment although there are limitations with both measures. Nonetheless the new guidelines would advise getting the BMI to below 25kg/m² and for waist circumference the recommendation is <102cm for men and <88cm in woman. These are the targets but getting there will involve a mixture of dietary and exercise changes.

5.       Increase in regular physical exercise: the ESH/ESC guidelines recommend at least 30 minutes of moderate intensity dynamic aerobic exercise on 5-7 days per week.

6.       Smoking cessation: Smoking causes an acute increase in BP and if stopped has multiple good effects in lowering overall cardiovascular risk. The recommendation is to advise to stop and for physicians to offer assistance where possible.

If you have had a health check recently and your blood pressure was up, you should try to implement some of the above recommendations. They will likely help and it would surely be better than having a heart attack or stroke.