Lifestyle management of hypertension: International Society of Hypertension position paper endorsed by the World Hypertension League and European Society of Hypertension

Author:

Charchar Fadi J.123,Prestes Priscilla R.1,Mills Charlotte4,Ching Siew Mooi56,Neupane Dinesh7,Marques Francine Z.89,Sharman James E.10,Vogt Liffert11,Burrell Louise M.12,Korostovtseva Lyudmila13,Zec Manja1415,Patil Mansi1617,Schultz Martin G.11,Wallen Matthew P.18,Renna Nicolás F.19,Islam Sheikh Mohammed Shariful20,Hiremath Swapnil21,Gyeltshen Tshewang22,Chia Yook-Chin2324,Gupta Abhinav25,Schutte Aletta E.262728,Klein Britt1,Borghi Claudio29,Browning Colette J.1,Czesnikiewicz-Guzik Marta3031,Lee Hae-Young32,Itoh Hiroshi33,Miura Katsuyuki34,Brunström Mattias35,Campbell Norm R.C.36,Akinnibossun Olutope Arinola1,Veerabhadrappa Praveen37,Wainford Richard D.3839,Kruger Ruan4041,Thomas Shane A.1,Komori Takahiro42,Ralapanawa Udaya43,Cornelissen Véronique A.44,Kapil Vikas4546,Li Yan47,Zhang Yuqing48,Jafar Tazeen H.4950,Khan Nadia51,Williams Bryan52,Stergiou George53,Tomaszewski Maciej5455

Affiliation:

1. Health Innovation and Transformation Centre, Federation University Australia, Ballarat, Australia

2. Department of Physiology, University of Melbourne, Melbourne, Australia

3. Department of Cardiovascular Sciences, University of Leicester, Leicester, UK

4. Department of Food and Nutritional Sciences, University of Reading, Reading, UK

5. Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang

6. Department of Medical Sciences, School of Medical and Live Sciences, Sunway University, Bandar Sunway, Selangor, Malaysia

7. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA

8. Hypertension Research Laboratory, School of Biological Sciences, Monash University

9. Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne

10. Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia

11. Department of Internal Medicine, Section Nephrology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Microcirculation, Amsterdam, The Netherlands

12. Department of Medicine, University of Melbourne, Austin Health, Melbourne, Australia

13. Department of Hypertension, Almazov National Medical Research Centre, St Petersburg, Russia

14. School of Nutritional Sciences and Wellness, University of Arizona, Tucson, USA

15. Colorado Program for Musculoskeletal Research, Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, USA

16. Department of Nutrition and Dietetics, Asha Kiran JHC Hospital, Chinchwad

17. Hypertension and Nutrition, Core Group of IAPEN India, India

18. Caring Futures Institute, Flinders University, Adelaide, Australia

19. Unit of Hypertension, Hospital Español de Mendoza, School of Medicine, National University of Cuyo, IMBECU-CONICET, Mendoza, Argentina

20. Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia

21. Department of Medicine, University of Ottawa and the Ottawa Hospital, Ottawa, Canada

22. Graduate School of Public Health, St. Luke's International University, Tokyo, Japan

23. Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Selangor

24. Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

25. Department of Medicine, Acharya Shri Chander College of Medical Sciences and Hospital, Jammu, India

26. School of Population Health, University of New South Wales, The George Institute for Global Health, Sydney, New South Wales, Australia

27. Hypertension in Africa Research Team, SAMRC Unit for Hypertension and Cardiovascular Disease, North-West University

28. SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa

29. Department of Medical and Surgical Sciences, Faculty of Medicine, University of Bologna, Bologna, Italy

30. School of Medicine, Dentistry and Nursing-Dental School, University of Glasgow, UK

31. Department of Periodontology, Prophylaxis and Oral Medicine; Jagiellonian University, Krakow, Poland

32. Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea

33. Department of Internal Medicine (Nephrology, Endocrinology and Metabolism), Keio University, Tokyo

34. NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan

35. Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden

36. Libin Cardiovascular Institute, Department of Medicine, University of Calgary, Calgary, Canada

37. Kinesiology, Division of Science, The Pennsylvania State University, Reading, Pennsylvania

38. Department of Pharmacology and Experimental Therapeutics, The Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston

39. Division of Cardiology, Emory University, Atlanta, USA

40. Hypertension in Africa Research Team (HART), North-West University, Potchefstroom

41. MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa

42. Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan

43. Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka

44. Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium

45. William Harvey Research Institute, Centre for Cardiovascular Medicine and Devices, NIHR Barts Biomedical Research Centre, BRC, Faculty of Medicine and Dentistry, Queen Mary University London

46. Barts BP Centre of Excellence, Barts Heart Centre, Barts Health NHS Trust, London, UK

47. Department of Cardiovascular Medicine, Shanghai Institute of Hypertension, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai

48. Department of Cardiology, Fu Wai Hospital, Chinese Academy of Medical Sciences, Chinese Hypertension League, Beijing, China

49. Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore

50. Duke Global Health Institute, Duke University, Durham, North Carolina, USA

51. Department of Medicine, University of British Columbia, Vancouver, Canada

52. University College London (UCL), Institute of Cardiovascular Science, National Institute for Health Research (NIHR), UCL Hospitals Biomedical Research Centre, London, UK

53. Hypertension Centre STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece

54. Division of Cardiovascular Sciences, Faculty of Medicine, Biology and Health, University of Manchester

55. Manchester Academic Health Science Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK

Abstract

Hypertension, defined as persistently elevated systolic blood pressure (SBP) >140 mmHg and/or diastolic blood pressure (DBP) at least 90 mmHg (International Society of Hypertension guidelines), affects over 1.5 billion people worldwide. Hypertension is associated with increased risk of cardiovascular disease (CVD) events (e.g. coronary heart disease, heart failure and stroke) and death. An international panel of experts convened by the International Society of Hypertension College of Experts compiled lifestyle management recommendations as first-line strategy to prevent and control hypertension in adulthood. We also recommend that lifestyle changes be continued even when blood pressure-lowering medications are prescribed. Specific recommendations based on literature evidence are summarized with advice to start these measures early in life, including maintaining a healthy body weight, increased levels of different types of physical activity, healthy eating and drinking, avoidance and cessation of smoking and alcohol use, management of stress and sleep levels. We also discuss the relevance of specific approaches including consumption of sodium, potassium, sugar, fibre, coffee, tea, intermittent fasting as well as integrated strategies to implement these recommendations using, for example, behaviour change-related technologies and digital tools.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine,Physiology,Internal Medicine

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