How to reduce diastolic blood pressure?

From the Guidelines

To reduce diastolic blood pressure, it is essential to prioritize lifestyle modifications, including adopting a healthy and balanced diet such as the Mediterranean or DASH diets, as recommended by the 2024 ESC guidelines 1.

Key Lifestyle Modifications

• Adopting the DASH diet, which is rich in fruits, vegetables, and low-fat dairy products, as suggested by both the seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure 1 and the 2024 ESC guidelines 1
• Reducing sodium intake to no more than 100 mmol per day (2.4 g of sodium) as recommended by 1
• Limiting alcohol consumption to less than 100 g/week of pure alcohol, with a preference to avoid alcohol consumption altogether for best health outcomes 1
• Engaging in regular aerobic physical activity, such as brisk walking at least 30 minutes per day, most days of the week 1
• Maintaining a healthy weight, with a goal to lose at least 10 lbs (4.5 kg) if overweight, as this can reduce BP and/or prevent hypertension 1
• Practicing stress management techniques like meditation or deep breathing

Pharmacological Interventions

If lifestyle modifications are insufficient, pharmacological treatment may be necessary. The 2024 ESC guidelines recommend the following as first-line treatments to lower BP:

• ACE inhibitors (like lisinopril)
• ARBs (such as losartan)
• Dihydropyridine CCBs
• Diuretics (thiazides and thiazide-like drugs such as chlorthalidone and indapamide) 1 Combination therapy, preferably in a single-pill combination, is recommended for most patients with confirmed hypertension, with a preferred combination being a RAS blocker with a dihydropyridine CCB or diuretic 1.

Ongoing Management

Consistency is key, as blood pressure control requires ongoing management. Regular monitoring with a home blood pressure device is recommended to track progress and adjust strategies as needed. It is also recommended to maintain BP-lowering drug treatment lifelong, even beyond the age of 85 years, if well tolerated 1.

From the FDA Drug Label

The antihypertensive effects of losartan were demonstrated principally in 4 placebo-controlled, 6- to 12-week trials of dosages from 10 to 150 mg per day in patients with baseline diastolic blood pressures of 95 to 115 Doses of 50 mg, 100 mg and 150 mg once daily gave statistically significant systolic/diastolic mean decreases in blood pressure, compared to placebo in the range of 5.5 to 10.5/3.5 to 7. 5 mmHg, with the 150-mg dose giving no greater effect than 50 mg to 100 mg. Addition of a low dose of hydrochlorothiazide (12. 5 mg) to losartan 50 mg once daily resulted in placebo-adjusted blood pressure reductions of 15.5/9. 2 mmHg. In controlled clinical studies of patients with mild to moderate hypertension, patients were treated with lisinopril 20 mg to 80 mg daily, hydrochlorothiazide 12. 5 mg to 50 mg daily or atenolol 50 mg to 200 mg daily; and in other studies of patients with moderate to severe hypertension, patients were treated with lisinopril 20 mg to 80 mg daily or metoprolol 100 mg to 200 mg daily. Lisinopril demonstrated superior reductions of systolic and diastolic compared to hydrochlorothiazide in a population that was 75% Caucasian Amlodipine besylate tablets is indicated for the treatment of hypertension, to lower blood pressure.

To reduce diastolic pressure, the following options can be considered:

• Losartan: 50 mg to 100 mg once daily, with a significant reduction in diastolic blood pressure of 3.5 to 7.5 mmHg compared to placebo 2
• Lisinopril: 20 mg to 80 mg daily, with superior reductions of systolic and diastolic blood pressure compared to hydrochlorothiazide in a population that was 75% Caucasian 3
• Amlodipine: as part of a comprehensive cardiovascular risk management, including lipid control, diabetes management, antithrombotic therapy, smoking cessation, exercise, and limited sodium intake 4
• Combination therapy: addition of a low dose of hydrochlorothiazide (12.5 mg) to losartan 50 mg once daily, resulting in placebo-adjusted blood pressure reductions of 15.5/9.2 mmHg 2

From the Research

Methods to Reduce Diastolic Pressure

• Regular physical exercise, such as aerobic and resistance exercise, can effectively reduce blood pressure, including diastolic pressure 5, 6
• Lifestyle interventions, including regular physical exercise, body weight management, and healthy dietary patterns, can help prevent and treat hypertension 7
• Breathing exercises, such as slow breathing, can be used as an alternative, non-pharmacological therapy to reduce blood pressure in hypertensive patients 8
• Yoga, particularly when it includes breathing techniques and meditation/mental relaxation, can be an effective antihypertensive lifestyle therapy, reducing diastolic blood pressure by 3-6 mmHg 9

Recommended Exercise Programs

• Moderate-intensity aerobic exercise for at least 30 minutes on at least 3 days of the week or resistance exercise on 2-3 days of the week 5
• Exercise sessions can be continuous for 30 minutes or composed of at least 10 minutes of short exercise duration to a daily total of 30 minutes 5
• An 8- to 12-week treadmill exercise program with a target lactate of 2.0±0.5 mmol/L can significantly decrease diastolic daytime ambulatory blood pressure 6

Potential Blood Pressure Reduction

• Regular exercise may ensure an overall 5 mmHg decrease in blood pressure, which can lead to a 9% decrease in mortality due to coronary heart disease, a 14% decrease in mortality due to stroke, and a 7% decrease in all-cause mortality 5
• Breathing exercises can reduce systolic blood pressure by 4-54.22 mmHg and diastolic blood pressure by 3-17 mmHg 8
• Yoga can reduce diastolic blood pressure by 3-6 mmHg, with greater reductions seen when breathing techniques and meditation/mental relaxation are included 9