Lifestyle management of hypertension
Nancy Huang, National Manager – Clinical Programs, National Heart Foundation of
Australia, Melbourne; Karen Duggan, Director, Hypertension Service, South Western
Sydney Area Health Service, and Chair, National Blood Pressure and Vascular Disease
Advisory Committee; and Jenni Harman, Medical Writer, Meducation, Sydney
Summary Elevated blood pressure and smoking are the two most
important risk factors for subarachnoid haemorrhage in the
Recently updated Australian guidelines recommend Asia-Pacific region. The risk of myocardial infarction is 2–6 times
that advice on smoking, nutrition, alcohol use, higher and the risk of stroke is three times higher in people who
physical activity and body weight should be part smoke, compared with non-smokers.1
of routine management of hypertension for all Smoking cessation markedly reduces overall cardiovascular
patients, regardless of drug therapy. Smoking risk, including the risk of coronary heart disease and stroke,
compared with continued smoking. In patients with coronary
cessation is recommended to reduce overall
heart disease, smoking cessation is associated with a 36%
cardiovascular risk. Healthy eating, reducing
reduction in the risk of all-cause mortality.3 Although smoking
dietary sodium and alcohol intake, regular physical is known to increase the risk of developing hypertension, there
activity and achieving a healthy body weight are all is currently no evidence that smoking cessation directly reduces
effective in lowering blood pressure. blood pressure in people with hypertension.2
Key words: alcohol, cardiovascular disease, diet, physical activity,
smoking cessation. Nutrition
(Aust Prescr 2008;31:150–3) Determining the influence of various nutrients on blood
pressure and cardiovascular risk is a complex and evolving
Introduction research area. While some relationships between food and
Hypertension is a major risk factor for stroke and coronary heart cardiovascular health have not yet been clearly quantified,
disease, and is a major contributor to the onset and progression there is sufficient evidence to recommend that people with
of chronic heart failure and chronic kidney failure. Guidelines hypertension should avoid salty foods and aim for a healthy
by the National Heart Foundation of Australia1 recommend that eating pattern.
doctors caring for patients with hypertension should routinely
provide advice on smoking, nutrition, alcohol use, physical Restricting salt intake
activity and body weight. High dietary sodium intake is associated with an increased
Lifestyle modification is indicated for all patients with incidence of stroke, and with increased risk of death due to
hypertension, regardless of drug therapy, because it may coronary heart disease or cardiovascular disease.4 Reducing
reduce or even abolish the need for antihypertensive drugs. dietary sodium by approximately 1700 mg (75 mmol) per day
In addition to the immediate goal of lowering blood pressure, can lower systolic blood pressure by 4–5 mmHg in hypertensive
the recommended lifestyle changes confer a range of health individuals and 2 mmHg in normotensive individuals.4,5 This
benefits, including better outcomes of common chronic may reduce the need for antihypertensive drugs. Responses
diseases. Effective approaches to promoting lifestyle changes in vary between individuals and are generally greatest among the
primary care are listed in Box 1. elderly and those with severe hypertension.
There is weak evidence suggesting that weight loss combined
Smoking
with reduced dietary sodium may be more effective at lowering
Smoking is a strong independent risk factor for cardiovascular blood pressure than salt avoidance alone.4 Reduced-salt diets
disease. Quitting is acknowledged to be one of the most in combination with thiazide diuretics may predispose elderly
effective lifestyle interventions for preventing cardiovascular patients to hyponatraemia, so electrolytes should be monitored
disease and premature deaths. regularly.
Smoking causes an immediate increase in blood pressure and
heart rate that persists for more than 15 minutes after one Dietary potassium
cigarette. People who smoke show higher ambulatory blood Some clinical trials suggest that increasing dietary potassium by
pressure levels than non-smokers.2 approximately 2100 mg (54 mmol) per day can reduce systolic
150 | Vo l u m e 3 1 | N UMB ER 6 | D EC EM B E R 2 0 0 8
Nancy Huang, National Manager – Clinical Programs, National Heart Foundation of
Australia, Melbourne; Karen Duggan, Director, Hypertension Service, South Western
Sydney Area Health Service, and Chair, National Blood Pressure and Vascular Disease
Advisory Committee; and Jenni Harman, Medical Writer, Meducation, Sydney
Summary Elevated blood pressure and smoking are the two most
important risk factors for subarachnoid haemorrhage in the
Recently updated Australian guidelines recommend Asia-Pacific region. The risk of myocardial infarction is 2–6 times
that advice on smoking, nutrition, alcohol use, higher and the risk of stroke is three times higher in people who
physical activity and body weight should be part smoke, compared with non-smokers.1
of routine management of hypertension for all Smoking cessation markedly reduces overall cardiovascular
patients, regardless of drug therapy. Smoking risk, including the risk of coronary heart disease and stroke,
compared with continued smoking. In patients with coronary
cessation is recommended to reduce overall
heart disease, smoking cessation is associated with a 36%
cardiovascular risk. Healthy eating, reducing
reduction in the risk of all-cause mortality.3 Although smoking
dietary sodium and alcohol intake, regular physical is known to increase the risk of developing hypertension, there
activity and achieving a healthy body weight are all is currently no evidence that smoking cessation directly reduces
effective in lowering blood pressure. blood pressure in people with hypertension.2
Key words: alcohol, cardiovascular disease, diet, physical activity,
smoking cessation. Nutrition
(Aust Prescr 2008;31:150–3) Determining the influence of various nutrients on blood
pressure and cardiovascular risk is a complex and evolving
Introduction research area. While some relationships between food and
Hypertension is a major risk factor for stroke and coronary heart cardiovascular health have not yet been clearly quantified,
disease, and is a major contributor to the onset and progression there is sufficient evidence to recommend that people with
of chronic heart failure and chronic kidney failure. Guidelines hypertension should avoid salty foods and aim for a healthy
by the National Heart Foundation of Australia1 recommend that eating pattern.
doctors caring for patients with hypertension should routinely
provide advice on smoking, nutrition, alcohol use, physical Restricting salt intake
activity and body weight. High dietary sodium intake is associated with an increased
Lifestyle modification is indicated for all patients with incidence of stroke, and with increased risk of death due to
hypertension, regardless of drug therapy, because it may coronary heart disease or cardiovascular disease.4 Reducing
reduce or even abolish the need for antihypertensive drugs. dietary sodium by approximately 1700 mg (75 mmol) per day
In addition to the immediate goal of lowering blood pressure, can lower systolic blood pressure by 4–5 mmHg in hypertensive
the recommended lifestyle changes confer a range of health individuals and 2 mmHg in normotensive individuals.4,5 This
benefits, including better outcomes of common chronic may reduce the need for antihypertensive drugs. Responses
diseases. Effective approaches to promoting lifestyle changes in vary between individuals and are generally greatest among the
primary care are listed in Box 1. elderly and those with severe hypertension.
There is weak evidence suggesting that weight loss combined
Smoking
with reduced dietary sodium may be more effective at lowering
Smoking is a strong independent risk factor for cardiovascular blood pressure than salt avoidance alone.4 Reduced-salt diets
disease. Quitting is acknowledged to be one of the most in combination with thiazide diuretics may predispose elderly
effective lifestyle interventions for preventing cardiovascular patients to hyponatraemia, so electrolytes should be monitored
disease and premature deaths. regularly.
Smoking causes an immediate increase in blood pressure and
heart rate that persists for more than 15 minutes after one Dietary potassium
cigarette. People who smoke show higher ambulatory blood Some clinical trials suggest that increasing dietary potassium by
pressure levels than non-smokers.2 approximately 2100 mg (54 mmol) per day can reduce systolic
150 | Vo l u m e 3 1 | N UMB ER 6 | D EC EM B E R 2 0 0 8
