Part 2 NonPharmacologicalManagement Of Hypertension

Abstract

Hypertension is an insidious disease which predisposes to cardiovascular complications and if not treated properly can lead to various serious complications. Economic limitations, 

having additional benefits with few or almost no side effects have made non‐pharmacological management of hypertension 

an attractive approach for dealing with hypertension, in developed and developing countries alike. A MEDLINE search was done for relevant references with emphasis on original studies, randomized controlled trials, and meta‐analyses for this review paper. Lifestyle modifications including changes in the dietary pattern, adopting special diets with low sodium, saturated fat and high calcium, magnesium and potassium and trying the new methods like time restricted meal intake which work in tandem with the circadian rhythm are opening new vistas in the field of non‐pharmacological management of hypertension. Lifestyle modifications that effectively lower blood pressure are increased physical activity, weight loss, limited alcohol consumption, relaxation techniques of Yoga, Acupuncture, Tai chi, mindfulness‐based stress‐reduction program, and Transcendental Meditation. Air pollution of the

 surrounding air is linked with poor health outcomes and is a major contributor to the global burden of disease. Fine particulate matter <2.5 μm in diameter (PM2.5) is strongly associated with 

cardiovascular morbidity and mortality. Short‐term PM exposure (hours to weeks) increases the likelihood of adverse cardiovascular events including myocardial infarction, stroke, and heart failure, and longer‐term exposure multiplies that risk. Non‐pharmacological methods should be initiated early phase of disease and should be continued with medication

Diet 

To reduce BP, a diet consisting of whole grains, more vegetables, and fruits is recommended. (⁸ , ⁹ )Other recommendations include consuming low‐fat dairy products, poultry, fish, legumes, non‐tropical vegetable oils, and nuts; and reducing intake of sweets, sugar‐sweetened beverages, and red meat. Dietary pattern is also influenced by appropriate calorie requirements, personal and cultural food preferences, and nutritional therapy for other medical conditions, such as diabetes mellitus and chronic kidney disease. This can be achieved by various dietary plans. One way to achieve this is by following plans such as the Dietary Approaches to Stop Hypertension diet, US Department of Agriculture Food Patterns, or the American Heart Association diet. The Dietary Approaches to Stop Hypertension diet emphasized consuming more fruits and vegetables, but less dairy products, saturated fats red meat and less sweets, and sugar‐sweetened beverages. With the Dietary Approaches to Stop Hypertension diet, a lowering of SBP by 5.5 mm Hg and DBP by 3 mm Hg ¹⁰ , ¹¹ , ¹² was seen. Results from the EPIC(European Prospective Investigation into Cancer and Nutrition) study showed that for 7061 non‐hypertensive women (35‐64 years), body weight, waist circumference, body mass index, processed meat, and wine and potatoes consumption correlated directly with BP values; while increased eating of vegetables, yoghurt, and eggs was inversely associated with SBP (and consumption of oil with DBP levels. ¹³ Another study showed a negative association between BP levels and a Mediterranean diet of fruits and vegetables ¹⁴ The long‐term effects of Dietary Approaches to Stop Hypertension diet in overweight hypertensive individuals in the ENCORE Exercise and Nutritional Interventions for Cardiovascular Health study, where a follow‐up 8 months after the end of their 16 weeks treatment, showed some beneficial impact on BP, exercise, and body weight control. However, effective methods that promote permanent lifestyle modification are needed. ¹⁵ In the SUN ("Seguimiento Universidad de Navarra") project study, involving 9408 men and women followed for six years, the implementation of the Mediterranean diet was associated with a decrease in SBP and DBP values. Moderate implementation of the Mediterranean diet showed a decrease of 2.4 mmHg for SBP and 1.3 mmHg for DBP; while more systematic application decreased SBP and DBP by 3.1 and 1.9 mmHg, respectively. ¹⁶ Additionally, the adoption of the Mediterranean diet in 772 subjects (55‐80 years), in high risk for cardiovascular disease, resulted in SBP reduction of 7.1 mmHg

. 2021 Mar 18;23(7):1275–1283. doi: 10.1111/jch.14236

Non‐pharmacological management of hypertension

Narsingh Verma ^1,✉, Smriti Rastogi ¹, Yook‐Chin Chia ², Saulat Siddique ³, Yuda Turana ⁴, Hao‐min Cheng ⁵, Guru Prasad Sogunuru ⁶, Jam Chin Tay ⁷, Boon Wee Teo ⁸, Tzung‐Dau Wang ⁹, Kelvin Kam Fai TSOI ¹⁰, Kazuomi Kario ¹¹

PMCID: PMC8678745  PMID: 33738923