Non-pharmacological treatment of hypertension

Non-pharmacological treatment of hypertension

November 7, 2019 0 By Bertrand Dibbert


Sometimes hypertension doesn’t mean that
a patient should immediately start to take the drugs. Lifestyle modification may lead to long-term
stabilization of the blood pressure. In this video we will speak about non-pharmacological
interventions for the treatment of hypertension according to the current guidelines. According to current guidelines, lifestyle
interventions should be used in treatment of the hypertension or elevated blood pressure
together with drugs or in some cases alone. Lifestyle interventions can prevent or delay
the onset of hypertension, prevent or delay the need for the drug therapy, improve efficiency
of the pharmacological therapy and reduce the cardiovascular risk. But many patients are poorly adherent to the
lifestyle changes, and they stop it quickly. Healthy diet shows the most significant effect
on blood pressure lowering. Diet is rich in vegetables, fruits, whole
grains, fish, nut and unsaturated fatty acids. Sugar-sweetened drinks should be restricted
as they are associated with overweight, metabolic syndrome, diabetes mellitus, and increased
cardiovascular risk. The views on coffee and tea consumption are
controversial: despite the direct vasopressor effect, their intake may be associated with
better cardiovascular prognosis. But tea has some blood pressure-lowering effect. Products containing large amount of saturated
fat as well as trans-fat should be restricted. This all are characteristic to the DASH-diet
that is commonly used in USA, and Mediterranean diet that is widely used in Europe. Such diet reduces blood pressure, glucose
and lipid levels. Dietary sodium restriction is also important. High sodium intake is associated with increased
risk of mortality and cardiovascular events. Less than 1.5 g of sodium a day is an important
goal in normalization of the blood pressure. According to ESC recommendations, salt restriction
to less than 5 g per day is recommended. Enhanced intake of the dietary potassium is
associated with blood pressure reduction and reduced risk of cardiovascular diseases. It’s recommended to intake from 3500 to
5500 mg of potassium a day, but it should be not considered in the patients with an
significantly impaired renal function. Weight reduction is another important method
of non-pharmacological interventions. Ideal body weight should be the main target. This means that body mass index should range
from 20 to 25 kg/m2. But at least 1 kg reduction in the body weight
is very important for overweight people. Moderation in the alcohol consumption is recommended
to reduce blood pressure. In the USA, consumption of alcohol is advised
up to 2 drinks daily for men and up to 1 drink daily for women. 1 drink contains 14 grams of pure alcohol. According to ESC recommendations, alcohol
consumption should be limited up to 14 units a week for men and 8 units a week for women. 1 unit equals 10 mL of pure alcohol. Smoking significantly increases risk of stroke,
angina, myocardial infarction, peripheral artery disease and cancer. Also, regular physical activity should be
recommended. According to ACC/AHA guideline, aerobic dynamic
exercises (for example, walking, swimming, cycling) for 90-150 min a week is advised,
for additional benefit in people with elevated blood pressure gradual increase in duration
of aerobic physical activity up to 300 min a week is recommended;
for these patients intensive aerobic physical activity with duration of 150 min a week may
be considered. According to ESC guideline aerobic exercises
at least 30 min of moderate dynamic exercise on 5-7 days a week is recommended. Dynamic resistance training with duration
of 90-150 min a week is recommended. Role of isometric exercises is less established. They are performed for 4 exercises per session
with the duration of 2 min of each exercise; 1 min rest is spent between exercises. 3 sessions per week are performed. Regular physical activity is associated with
a reduced mortality. According to ESC guideline lifestyle advice
is recommended for all patients with the blood pressure of 130/85 mm Hg or higher. In a patient with high-normal blood pressure
(130-139/85-89 mm Hg) lifestyle changes are recommended. But if a patient has very high cardiovascular
risk due to cardiovascular disease, pharmacological treatment may be considered. A patient with grade 1 hypertension (blood
pressure of 140-159/90-99 mm Hg) should be recommended to do lifestyle interventions. If a patient has low or moderate cardiovascular
risk without hypertension-mediated organ damage, only lifestyle interventions should be advised. But if this patient remains hypertensive after
3-6 months of lifestyle interventions, blood pressure lowering drugs should be prescribed. If a patient with grade 1 hypertension has
high or very high cardiovascular risk, cardiovascular disease, renal disease or hypertension-mediated
organ damage, pharmacological treatment should be used immediately in combination with lifestyle
interventions. Immediate blood pressure-lowering drug treatment
in combination with lifestyle advice is recommended for patients with grade 2 and grade 3 hypertension. According to ACC/AHA guidelines, patients
with elevated blood pressure are recommended to do lifestyle interventions. In patients with stage 1 hypertension (blood
pressure 130-139/80-89 mm Hg) 10-year cardiovascular risk should be estimated by ASCVD calculator. If it’s less than 10% only lifestyle interventions
with following reassessment in 3-6 months should be recommended. If it’s 10% and more lifestyle modifications
should be combined with pharmacological treatment. Combination of lifestyle modifications and
pharmacological treatment is recommended for patients with stage 2 hypertension. It’s important that lifestyle interventions
should never delay blood pressure-lowering therapy, when it’s indicated. In patients with white coat hypertension,
lifestyle interventions should be recommended. If masked hypertension is detected, lifestyle
interventions in combination with blood pressure-lowering treatment is recommended.