In general practice (and in secondary care), we discuss at length lifestyle modifications that aid blood pressure lowering. But exactly how effective are the various strategies?

There are 5 things we could do to reduce our blood pressure, without medications.

1. Salt restriction

Reduction to 5g/day = 4-5/- mmHg drop

2. Weight loss

5kg weight loss = 4.4/3.6 mmHg drop

3. Exercise

Aerobic endurance training = 7/5 mmHg drop

4. Reduce alcohol intake

Reduction to £2 (males) or £1 (females) standard drinks = 4/- mmHg drop

5. Smoking cessation

Notes:

- Usual salt intake in many countries is between 9 and 12 g per day. A reduction to 5g/day has a modest (1-2mmHg) systolic BP lowering effect in normotensive individuals, but a more pronounced effect of 4-5mmHg in hypertensive individuals.

- Aerobic endurance training reduces resting SBP and DBP by 3.0/2.4 mmHg overall and even by 6.9/4.9 mmHg in hypertensive participants. Even regular physical activity of lower intensity and duration has been shown to be associated with about a 20% decrease in mortality in cohort studies.Hypertensive patients should be advised to participate in at least 30 min of moderate-intensity dynamic aerobic exercise (walking, jogging, cycling or swimming) on 5–7 days per week

Reference

- Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC Jr, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA Sr, Williamson JD, Wright JT Jr. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2017

Author: Andrew To