From the Guidelines
Maintaining a healthy BMI is crucial for managing hypertension, and weight loss in overweight or obese individuals can lower blood pressure by approximately 1 mmHg for every 1 kg of weight lost, as recommended by the 2020 international society of hypertension global hypertension practice guidelines 1. To achieve a healthy BMI, it is essential to adopt a balanced diet rich in whole grains, fruits, vegetables, polyunsaturated fats, and dairy products, while reducing sodium, processed foods, and alcohol.
- Key components of a healthy diet include:
- Eating a diet rich in whole grains, fruits, vegetables, polyunsaturated fats, and dairy products
- Reducing food high in sugar, saturated fat, and trans fats
- Increasing intake of vegetables high in nitrates, such as leafy vegetables and beetroot
- Consuming foods high in magnesium, calcium, and potassium, such as avocados, nuts, seeds, legumes, and tofu Regular physical activity is also crucial, with a recommendation of at least 150 minutes of moderate exercise weekly, such as brisk walking, swimming, or cycling, as well as strength training on 2-3 days per week 1.
- Additional lifestyle modifications that can help manage hypertension include:
- Reducing salt intake
- Moderating alcohol consumption
- Quitting smoking
- Reducing stress and inducing mindfulness
- Getting regular aerobic and resistance exercise Weight loss helps reduce hypertension by decreasing blood volume, improving insulin sensitivity, reducing inflammation, and enhancing blood vessel function, ultimately resulting in lower pressure on arterial walls, as supported by the aha dietary guidelines: revision 2000 1 and aha dietary guidelines: revision 2000: a statement for healthcare professionals from the nutrition committee of the american heart association 1. Even modest weight loss of 5-10% of body weight can yield significant blood pressure improvements, often reducing systolic pressure by 5-20 mmHg 1.
From the Research
Relationship Between Low BMI and Hypertension
- A low Body Mass Index (BMI) is associated with a lower risk of hypertension, as higher BMI is linked to an increased risk of developing hypertension 2.
- Studies have shown that lifestyle modifications, including weight loss, can help lower blood pressure and reduce the risk of cardiovascular disease 3, 4.
- Adults with normal BMI (less than 25 kg/m2) are less likely to be aware they have hypertension and have controlled blood pressure compared to those with overweight or obesity 2.
Mechanisms of BMI Reduction on Hypertension
- Weight loss, particularly when achieved through a combination of diet and exercise, can lead to improvements in vascular health, reduced sympathetic overactivation, and increased secretion of myokines, all of which can contribute to lower blood pressure 4.
- Regular physical activity, such as aerobic exercise, can also help reduce blood pressure and decrease the risk of cardiovascular disease 5, 6.
- A decrease of 5 mmHg in systolic blood pressure, which can be achieved through regular exercise, may reduce mortality due to coronary heart disease by 9%, stroke by 14%, and all-cause mortality by 7% 5.
Comparative Efficacy of Lifestyle Interventions
- While antihypertensive medications are often more effective than exercise in reducing blood pressure, there is insufficient evidence to suggest that first-line medications significantly reduce blood pressure to a greater extent than exercise interventions 6.
- Exercise, particularly aerobic training and dynamic resistance training, can be a viable alternative for low-risk hypertension patients who prefer a non-pharmacological approach 6.
- Lifestyle modifications, including weight loss and regular physical activity, should be considered as a first-line therapy for hypertension, in conjunction with or instead of medication, depending on the individual's risk profile and preferences 3, 4.