New directions in management of high blood pressure – position paper from the ISH
15 September 2023: Mindfulness practices such as meditation and yoga should be recommended to people with high blood pressure, according to a comprehensive review of lifestyle changes that can help prevent and manage the condition.
People should also be advised to get quality sleep and reduce their exposure to air pollution, according to the wide-ranging position paper from the International Society of Hypertension (ISH).
For the paper, published in the Journal of Hypertension, the ISH convened an international panel of experts from 18 countries to make recommendations on effective lifestyle changes for blood pressure control, based on the latest clinical and scientific evidence.
The position paper is endorsed by the European Society of Hypertension and the World Hypertension League.
The paper highlights perhaps less obvious strategies such as stress management and sleep quality alongside long-standing recommendations to:
- maintain a healthy weight
- exercise regularly
- eat a healthy diet
- reduce consumption of salt
- stop smoking
- limit (ideally stop) alcohol consumption.
Specific details are given for each recommendation, such as timing and frequency of exercise.
Hypertension affects around 4 in 10 people worldwide. There are effective medications for high blood pressure, but the best approach is often to start with lifestyle interventions, before introducing drug treatment if needed.
Lead author of the ISH position paper, Professor Fadi Charchar, said: “Our aim was to provide a holistic set of recommendations for changes to lifestyle, which focus on all areas of health, including movement and bodyweight, food and drink, the body and mind, as well as other factors such as exposure to air pollution.
“Our recommendations apply across the whole life span. They are designed to help people with hypertension manage their condition, as well as help prevent the onset of the condition. The recommendations are for everyone.”
The authors of the paper said healthcare professionals should consider stress reduction and mindfulness-based therapies for people with high blood pressure, pointing to evidence that practices such as meditation, muscle relaxation, yoga and deep breathing techniques can all lower blood pressure.
They also said healthcare professionals should explore all aspects of a patient’s sleep, including duration, quality and timing, and they recommend population-based awareness campaigns advocating for better sleep quality.
Evidence shows a strong, dose-response, relationship between exposure to air pollution and blood pressure. The authors of the paper said that, where possible, people should aim to reduce their exposure to outdoor air pollution, for instance by exercising in gardens and parks away from busy roadways.
But the authors said that, in this area, the greatest benefits would be seen by governmental action to improve air quality.
For physical activity, the authors make recommendations around aerobic activity (brisk walking, running), strength training, and isometric training (static exercises such as squeezing a hand grip).
They emphasise salt and sugar intake should be limited, with alcohol consumption ideally zero.
The position paper also highlighted the role new digital technologies could play in lifestyle interventions.
Co-lead author of the paper Dr Priscilla Prestes said: “The increasing use of apps and wearable technologies can help people track their movement, sleep and diet, as well as promote behaviour change, such as prompting a person to increase exercise, especially incidental exercise. So we should use these new technologies to our advantage.”
President of the ISH Professor Bryan Williams said: “There are so many things people can do to reduce their chances of developing high blood pressure, and to lower their blood pressure if they develop hypertension.
“Patients around the world should be given the information they need to make changes to their lifestyle, and health systems and governments should enable access to services which can help people make changes to their lifestyle and create an environment where it is easier to make these lifestyle changes.”
Prof Paul K Whelton, President of the World Hypertension League (WHL), said: “Congratulations to Professor Charchar and the entire writing committee. The World Hypertension League strongly supports recommendations aimed at lifestyle improvement, especially well-proven strategies such as weight loss, improved diet, sodium reduction, enhanced potassium intake through diet, physical activity, and abstinence or at least a reduction in alcohol consumption. Adverse patterns of these factors seem to be the underlying cause of most high blood pressure and deserve close attention by clinicians and public health practitioners.”
Prof Guido Grassi, President of the European Society of Hypertension (ESH), said: “The European Society of Hypertension wholeheartedly endorses this position paper. Changes to lifestyle have a hugely important role to play in blood pressure control, and in reducing the burden of hypertension and its associated conditions globally. Healthcare professionals, health systems and policymakers around the world should take note of these recommendations.”
Professor Maciej Tomaszewski, Immediate Past President of ISH, commenting on WHL and ESH support for paper, said: “I am delighted that both partner Societies continue supporting ISH’s mission to reduce global burden of hypertension through promoting education on lifestyle-related drivers of high blood pressure. This joint affiliation symbolises the commitment of the Societies to the global collaboration on adoption of healthy lifestyle by those at risk or living with high blood pressure.”
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