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Primary Care Hacks

Lifestyle Changes for Managing Hypertension

Guidelines presents Primary Care Hacks, a series of clinical aide-memoires across a range of topics. Developed by Dr Kevin Fernando, Primary Care Hacks aim to provide a quick and easy resource for primary healthcare professionals and ultimately help improve patients' lives.

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Lifestyle Changes for Managing Hypertension

Latest Update June 2023:

Updated evidence in the Physical Activity section on the systolic blood pressure-lowering effect of exercise among hypertensive populations.

Healthy lifestyle choices can prevent or delay the development of hypertension, reduce future cardiovascular risk, and may delay or prevent the need for pharmacological treatment for grade 1 hypertension. Lifestyle interventions are therefore considered first-line treatment for hypertension and should be discussed and implemented at all patient contacts. 

This Medscape UK Primary Care Hack outlines lifestyle changes for managing hypertension, current UK recommendations, and their approximate effect on reducing systolic and diastolic blood pressure.

Read Dr Kevin Fernando's related Guidelines in Practice article, Key Learning Points: ESC/ESH Guidance on Arterial Hypertension

Click on the link below for a downloadable PDF of the Primary Care Hack

Lifestyle Changes for Managing Hypertension

Lifestyle ChangeRecommendationsApprox. Effect on Systolic BP (mmHg)Approx. Effect on Diastolic BP (mmHg)
Alcohol Consumption[1]Current UK guidance[2] advises limiting alcohol intake to 14 units per week for women and men-4.0-2.5
Caffeine ConsumptionDrinking >4 cups of coffee per day may increase  
blood pressure
Unclear, but a recent study[3] suggests that heavy coffee consumption was associated with an increased risk of CVD mortality among people with severe hypertension, but not in those without hypertension or stage 1 hypertension
DASH (Dietary Approaches to Stop Hypertension)[4]An evidence-based eating plan (see the Useful Resources for Patients section) rich in fruits, vegetables, and low-fat dairy products, with reduced salt and saturated/trans fat content-11.0-5.5
Maintaining a Healthy WeightWeight loss of 3–9% in individuals living with overweight or obesity[5] [6]-3–8

Each kg of weight loss is associated with an average reduction in SBP of 1–2.4 mmHg

Physical ActivityAdults should aim to:[7] 
  • engage in strengthening activities that work all the major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms) on at least 2 days per week
  • engage in at least 150 minutes of moderate-intensity activity per week or 75 minutes of vigorous-intensity activity per week
  • spread exercise evenly over 4–5 days per week, or every day
  • reduce time spent sitting or lying down, and breakup long periods of inactivity

A recent network meta-analysis suggested the SBP-lowering effect of exercise among hypertensive populations appears similar to that of commonly used antihypertensive medications[8]
Potassium IntakeIncrease dietary potassium intake (e.g. tomato juice, bananas, potatoes, spinach, salmon, eggs; see the Useful Resources for Patients section) to 3.5–5.0 g daily[9]Be aware of individuals at higher risk of hyperkalaemia, where this recommendation should be individualised: those with advanced CKD, CHF, DM, and resistant hypertension-3.5-2.0
Salt IntakeAdults should eat <6 g of salt, equivalent to 2.4 g sodium per day[10] (see the Useful Resources for Patients section); 1 tsp≈5 g salt 

Salt substitutes such as LoSalt contain potassium instead of sodium, so may not be suitable for all. See the above recommendation regarding potassium intake

Soluble and effervescent preparations of analgesics have high sodium content; 8 soluble paracetamol tablets exceeds the recommended sodium intake of 6 g daily

Soluble preparations should be avoided unless the person has genuine swallowing difficulties

Smoking CessationStop smoking[11]-5.0-3.1
BP=blood pressure; CHF=chronic heart failure; CKD=chronic kidney disease; CVD=cardiovascular disease; DM=diabetes mellitus; SBP=systolic blood pressure.
  • The effects of implementing these modifications are of course individual, and combinations of 2 (or more) lifestyle modifications are synergistic
  • For comparison, the average SBP reduction from one antihypertensive drug is 12.5–15.5 mmHg[12] and around two-thirds of hypertensive individuals cannot be controlled on 1 drug and will require 2 or more antihypertensive agents from different drug classes[13]
  • Blood Pressure UK and the British and Irish Hypertension Society (BIHS) provide information for supporting those with—and healthcare professionals managing patientswith—hypertension, including home BP monitoring resources from the BIHS.
Useful Resources for Patients
This Primary Care Hack was developed by Medscape's Guidelines editorial team in conjunction with Dr Kevin Fernando, GP Partner, North Berwick Health Centre; GP with special interest in cardiovascular–renal–metabolic disorders and medical education; Content Advisor for Medscape UK and Medscape Global. Primary Care Hacks are for information for primary healthcare professionals in the UK only. They bring together currently available recommendations and/or prescribing information and indications for therapeutics licensed within Great Britain. Licensed indications and/or prescribing information for Northern Ireland may differ. You are advised to review local licensed indications before prescribing any therapeutic. Primary Care Hacks are reviewed intermittently to ensure the information is up to date at the time of publication. Primary Care Hacks are independently produced by WebMD, LLC and have not been created in conjunction with any guideline or prescribing body.