How effective are lifestyle changes for controlling hypertension?

Lifestyle changes are advocated as first-line therapy for hypertension. This review examines the evidence on exercise, dietary interventions, weight loss, alcohol moderation, and smoking cessation. Average systolic blood pressure (SBP) and diastolic blood pressure (DBP) changes are reported in the TABLE. Exercise. A well-done systematic review and meta-analysis from 2002 (including 15 studies with 770 participants) concluded that for hypertensive patients, aerobic exercise with at least one 40-minute session of moderate intensity per week is associated with a drop in SBP of about 5 mm Hg and a drop in DBP of about 4 mm Hg. DASH diet. The Dietary Approaches to Stop Hypertension (DASH) diet is a diet rich in fish, chicken, lean meat, low-fat dairy, fruits, vegetables, whole grains, legumes, nuts, and seeds. In a high-quality RCT, the DASH diet lowered SBP for hypertensive patients by an average of 11 mm Hg and DBP by an average of 5.5 mm Hg compared with the control group. Participants were provided with all food during the entire 8-week length of the trial. Weight loss. A Cochrane review of 18 trials with 2611 participants concluded that for overweight hypertensive patients, weight loss of 3% to 9% of body weight is associated with 3 mm Hg decreases in both SBP and DBP. Salt reduction. A Cochrane review of 17 trials with 734 participants concluded that for individuals with hypertension, a reduced-salt diet results in a mean SBP and DBP reductions of 5 mm Hg and 3 mm Hg, respectively. Alcohol moderation. A well-done meta-analysis of alcohol reduction and blood pressure included 7 studies with 415 hypertensive patients. Mean baseline alcohol consumption was 3 to 6 alcoholic drinks per day, and the mean reduction in consumption was 67%. For this patient population, the average improvement was almost 4 mm Hg for SBP and nearly 2.5 mm Hg for DBP. Smoking cessation. No high-quality studies show a long-term effect of smoking cessation on blood pressure. Smoking cessation has other well-documented health benefits and should still be recommended for patients with hypertension. Multifactorial interventions. Thirteen randomized controlled trials of community-based interventions involving various combinations of lifestyle change advice show mixed results. In general, studies of interventions that were more intensive (ie, longer in duration, larger number of sessions, small group or one-on-one as opposed to large group lectures) and studies with shorter follow-up periods showed more positive results. The magnitude of the blood pressure improvements tended to be lower than for each individual intervention described above. (References are located in the APPENDIX on our web site at www.jfoponline.com.