What is the Nobel-prize winning formula to manage hypertension?

From the Guidelines

The most effective approach to managing hypertension is through lifestyle intervention, including a Dietary Approaches to Stop Hypertension (DASH)-style eating pattern, weight loss, moderation of alcohol intake, and increased physical activity, as recommended by the 2022 standards of medical care in diabetes 1. This approach is based on the latest evidence and prioritizes morbidity, mortality, and quality of life as the primary outcomes. The DASH diet, which is rich in fruits, vegetables, whole grains, and low-fat dairy products, has been shown to lower blood pressure and enhance the effectiveness of antihypertensive medications.

Key components of the lifestyle intervention include:

• Reducing excess body weight through caloric restriction
• Restricting sodium intake to less than 2,300 mg/day
• Increasing consumption of fruits and vegetables to 8-10 servings per day
• Increasing consumption of low-fat dairy products to 2-3 servings per day
• Avoiding excessive alcohol consumption, with no more than 2 servings per day in men and no more than 1 serving per day in women
• Increasing activity levels to at least 150 minutes per week of moderate exercise or 75 minutes of vigorous exercise

The World Health Organization guidelines for hypertension pharmacological treatment in adults also emphasize the importance of lifestyle modification counseling prior to initiating pharmacological therapy 1. However, the most recent and highest-quality study prioritizes lifestyle intervention as the primary approach to managing hypertension, with pharmacological therapy initiated only when necessary.

Overall, the evidence suggests that a comprehensive lifestyle intervention, including a DASH-style diet and regular physical activity, is the most effective approach to managing hypertension and improving cardiovascular health. By prioritizing lifestyle intervention, individuals with hypertension can lower their blood pressure, reduce their risk of cardiovascular disease, and improve their overall quality of life 1.

From the Research

Lifestyle Modifications for Hypertension Management

• Weight loss in overweight persons 2, 3, 4, 5
• Increased physical activity 2, 3, 4, 5
• Moderation of alcohol intake 2, 3, 4
• Consumption of a diet that is higher in fruits, vegetables, and low-fat dairy products and lower in sodium content than the average American diet 2, 3, 4, 6
• Dietary sodium reduction and potassium supplementation 2, 6
• Healthy dietary pattern, including the Dietary Approaches to Stop Hypertension (DASH) diet 6
• Management of stress and sleep levels 4
• Avoidance and cessation of smoking 4

Pharmacologic Therapy for Hypertension

• First-line drug therapy for hypertension consists of a thiazide or thiazidelike diuretic, an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and a calcium channel blocker 2
• The decision to initiate antihypertensive medication should be based on the level of BP and the presence of high atherosclerotic CVD risk 2
• BP-lowering effects of individual lifestyle components are partially additive and enhance the efficacy of pharmacologic therapy 2

Blood Pressure Targets

• SBP/DBP target of <130/80 mm Hg for adults <65 years and SBP <130 mm Hg in adults ≥65 years 2
• Reduction of SBP by 10 mm Hg decreases risk of CVD events by approximately 20% to 30% 2

Resistant Hypertension

• Lifestyle modifications, including aerobic exercise, weight loss, and dietary modification, can reduce clinic and ambulatory blood pressure in patients with resistant hypertension 5
• Multi-component trials involving exercise and dietary modification and weight management can facilitate lifestyle change, reduce clinic and ambulatory blood pressure, and improve biomarkers of cardiovascular risk 5