This article examines the management of hypertension and blood pressure in general through lifestyle changes.

Genes, general environmental influences, and personal lifestyle factors such as diet, including alcohol consumption, and physical activity significantly influence blood pressure levels. But are there non-pharmaceutical interventions for preventing and managing hypertension?

NUTRITION

A comprehensive review which included 50 clinical trials and corresponding meta-analyses of different dietary patterns, reported a reduction in blood pressure with many of the diets studied, with the DASH (Dietary Approaches to Stop Hypertension) diet and low-salt diets being recognized as those with the best evidence for reducing blood pressure.

A more recent systematic review from 2023, based on 37 clinical trials, reported a reduction in blood pressure with a range of plant-based diets, including vegetarian diets and the DASH, Mediterranean, and Nordic diets.

An even larger review of 2023, which included 341 meta-analyses of randomized controlled trials and 70 meta-analyses of observational studies, reported a reduction in blood pressure with a wide range of dietary interventions, but concluded that the best results can be achieved with the DASH diet, the Mediterranean diet, low-salt diets, and reducing alcohol consumption.

WEIGHT MANAGEMENT

Weight management, at least in the short term, also appears to help manage blood pressure.

This meta-analysis of 2023 of 35 weight loss studies, limited to participants with a BMI ≥24 kg/m2, reported an average weight loss of 2.3 kg over 8 months of follow-up and a corresponding reduction in systolic blood pressure of 5.8 mm Hg and diastolic blood pressure of 3.4 mm Hg. The reduction in blood pressure was greater in those who lost more weight and in those who received medical treatment compared to behavioral weight loss interventions.

In another meta-analysis from 2023 of 25 weight loss studies reporting an average weight loss of 5.1 kg and an average duration of 66.6 months, systolic and diastolic blood pressure decreased by 1.05 mm Hg and 0.92 mm Hg per kilogram. Again, the reduction in blood pressure was greater in those who lost more weight and in those who took antihypertensive drugs compared to untreated populations.

It is important to note here that long-term studies are few and their results are inconsistent. For example, one of the most enigmatic studies is the 8-year follow-up of the Swedish Obese Subjects study. Three hundred and forty-six participants with obesity underwent gastric surgery to reduce obesity and were compared with a control group consisting of other individuals with obesity who did not undergo surgery. Over the course of 8 years, no weight loss was observed in the control group, while participants who underwent surgery experienced a significant weight loss of 20.1 kg. A significant reduction in the risk of diabetes was observed, as has been noted in other studies on bariatric surgery. Surprisingly, however, there was no reduction in the incidence of hypertension or blood pressure levels over time between the two groups.

In short, although weight management is important, it seems that it must be accompanied by other lifestyle changes.

SALT, POTASSIUM, AND ALCOHOL

The literature on the effectiveness of reducing sodium intake (most of which the average person gets from salt) from the diet, alone or in combination with potassium supplements, for the prevention and management of hypertension is extensive, and we may refer to more relevant articles in the future. Therefore, in this article, we will limit ourselves to a few indicative studies.

A 2021 dose-response meta-analysis identified an almost linear relationship between dietary sodium intake, as calculated from changes in sodium excretion or total sodium excretion, and blood pressure.

obesity, weight loss, slimming, fat loss, losing weight, losing fat, diet, longevity, long life, health, metabolic syndrome, exercise, sports, health, Exercise, Blood Pressure, Pressure, Hypertension, Nutrition, Mediterranean Diet, DASH, Salt, Sodium, Potassium, Alcohol, Alcoholic Beverages, Alcoholic Drinks, Salt Substitutes — Dose-response meta-analysis of changes in systolic and diastolic blood pressure (mm Hg) according to sodium excretion achieved in the treatment and control groups at the end of the trials, separated by hypertension status (non-hypertensive and hypertensive). Source: Filippini T, Malavolti M, Whelton PK, Naska A, Orsini N, Vinceti M. Blood Pressure Effects of Sodium Reduction: Dose-Response Meta-Analysis of Experimental Studies. Circulation. 2021 Apr 20;143(16):1542-1567. doi: 10.1161/CIRCULATIONAHA.120.050371. Epub 2021 Feb 15. PMID: 33586450; PMCID: PMC8055199.

The linear dose-response pattern was generally repeated across all subgroups studied, including those with and without hypertension.

The reduction in blood pressure with sodium reduction was more pronounced in individuals with hypertension compared to those without hypertension.

This 2020 dose-response meta-analysis discovered a progressively greater reduction in systolic blood pressure with higher dietary potassium intake, as calculated from changes in potassium excretion.

This effect appeared to become hypertensive with very high potassium intakes, although these trials were few and, consequently, the statistical accuracy of these estimates should be considered limited.

In absolute terms, the effect of reducing systolic pressure increased until a 24-hour potassium excretion of approximately 90 mmol (~3500 mg)/day was achieved, but after that it was progressively less apparent until it was no longer apparent with 24-hour potassium excretions greater than 150 mmol (~5850 mg)/day.

In stratified analyses, there were indications of a greater effect on blood pressure in individuals with hypertension, as well as in individuals with higher sodium intake prior to the dietary intervention, and in individuals with lower potassium intake prior to the dietary intervention.

In 2021, The Salt Substitute and Stroke Study (SSaSS) was published, which examined the value of a salt «substitute» with 25% replacement of sodium with potassium in 20,995 Chinese adults with or at high risk of stroke in 300 intervention villages compared to 300 control villages whose residents used regular salt.

During the comparison, which lasted almost 5 years, the intervention resulted in a clinically significant reduction of 14% in the primary outcome of recurrent stroke, as well as a reduction of 13% in cardiovascular events and a reduction of 12% in all-cause mortality.

There were no statistically significant differences in the rate of serious adverse events attributed to hyperkalemia in those randomized to the salt substitute compared with regular salt.

Finally, in two large cohort meta-analyses, an almost linear association was observed between alcohol consumption and blood pressure, as well as hypertension, across the entire spectrum of alcohol consumption in the general population (with demographic differences).

These findings are consistent with WHO recommendations to abstain from alcohol consumption.

EXERCISE

In recent years, numerous trials and meta-analyses on physical activity have been published, some of which we have covered, such as here, here and here.

Physical activity tends to increase blood pressure, especially systolic blood pressure, at least initially, but this is quickly followed by lowering blood pressure.

The exact mechanisms for the effects of physical activity on lowering blood pressure are not well understood, but may include neurohormonal, hemodynamic, and metabolic changes, improved endothelial function with increased nitric oxide production, induction of proangiogenic pathways, and increased insulin sensitivity, and inhibition of the sympathetic nervous system and the renin-angiotensin-aldosterone system, as well as inhibition of endothelin production.

The final result appears to be a reduction in peripheral vascular resistance, which supports a reduction in blood pressure.

In summary:

Diets based on or rich in plant products, low in salt and alcohol are useful in managing blood pressure.
Weight management also appears to be beneficial, but it must be accompanied by other lifestyle changes for long-term benefits.
Limiting sodium/salt intake in combination with adequate potassium intake (e.g., by using salt substitutes) and abstaining from alcohol consumption are among the most important tools in this area.
Exercise is also a very important tool that can help control hypertension and blood pressure.

-Suprastratum: The authority on health, fitness and nutrition

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Author: Nick Krontiris

Founder, Suprastratum View all posts by Nick Krontiris

HYPERTENSION: STRATEGIES FOR Α HEALTHY BLOOD PRESSURE

NUTRITION

WEIGHT MANAGEMENT

SALT, POTASSIUM, AND ALCOHOL

EXERCISE

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