Challenges: Lifestyle Changes for Treatment of Hypertension

The following lifestyle modifcations are recommended for reducing blood pressure in all patients with hypertension and prehypertension:

■Lose weight if overweight. Because most obese people are hypertensive, losing weight helps bring blood pressure down in these individuals. Even losing 10 pounds helps improve blood pressure, but the more excess weight lost, the better the improvement. Weight loss is the most important behavioral step in reducing hypertension.

■Restrict salt intake. Because cutting down on salt intake can reduce blood pressure, and because a high salt intake, independent of its effect on blood pressure, is linked with an increased lifetime risk of heart attack, strokes, and kidney disease, experts now recommend no more than 1.5 g of sodium (Na) (equivalent to 3.8 g of salt) per day for those who already have high blood pressure or are at high risk (African American or older than 40 years old) and an average of 2.3 g of Na1 (5.8 g of salt) per day for everyone else. Yet Americans currently consume 3.4 to 4 g of Na1 (or 8.5 to 10 g of salt) per day. One teaspoon of salt has 2.3 g of a1. Most salt consumption is not from our saltshakers but hidden in processed foods (such as lunch meats, canned soups, frozen dinners, and potato chips); fast foods; and many restaurant meals.

■ Follow the DASH eating plan.

■ Exercise regularly. Moderate aerobic exercise performed for 30 minutes per day on at least four days per week can help reduce blood pressure. If more convenient, the total exercise time on a given day may even be split up into smaller sessions and still provide the same benefts.

■ Limit alcohol consumption. Limiting alcohol intake to one drink per day for women and men older than 65, or two per day for men younger than 65, is recommended for optimal blood pressure control.

■ Avoid tobacco products. Smokers are advised to quit smoking and everyone is urged to avoid secondhand smoke. Nicotine in smoke raises blood pressure by activating the sympathetic nervous system and promoting epinephrine release.

■ Reduce stress. Preventing, reducing, and/or successfully coping with stressful situations (such as through relaxation techniques) can move blood pressure toward normal by cutting down on stressinduced sympathetic discharge.