Life style guidelines in the management of hypertension.

Main Article Content

Osama M Osman
Yassir El-Wazir

Abstract

Abstract
It has been increasingly evident that modulating the life style can have a great impact in the successful
management of hypertension to the extent that in some cases no need for the intake of drugs. This paper
reviews some of the factors that have been proven by experimental and epidemiological studies to have a
favourable effect on the management of hypertension. The items reviewed include weight reduction, regular
physical exercise, low sodium intake, increase intake of potassium, calcium, olive oil, fish oil and vitamin C.

Article Details

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Review

References

References
Kearney PM, Whelton M, Reynolds K, 1.
Muntner P, Whelton PK, He J. Global burden of
hypertension: analysis of worldwide data. Lancet
2005; 365:217-23.
Hassan Abu-Aisha, Elwaleed AM Elhassan, 2.
Ammar Hassan Khamis, Adil Abu-Elmaali.
Hypertension and obesity in police forces
households in Khartoum, Sudan: A pilot report -
part of the «Police Forces Hypertension, Diabetes,
Renal Insufficiency and Thyroid Derangements
(HyDRIT) Study», Sudan. Sudanese Journal of
Public Health 2008; 3:17.
Whelton PK. Epidemiology of hypertension. 3.
Lancet 1994;344:101–6.
Vasan RS, Larson MG, Leip EP, et al. Impact 4.
of high-normal blood pressure on the risk of
cardiovascular disease. N Engl J Med 2001;
345:1291–7.
Schotte DE, Stunkard AJ. The effects of weight 5.
reduction on blood pressure in 301 obese patients.
Arch Intern Med1990; 150:1701-4.
Langford HG, Davis BR, Blaufox D, et al. Effect 6.
of drug and diet treatment of mild hypertension
on diastolic blood pressure. Hypertension 1991;
17: 210-7.
Obesity in Scotland. Integrating prevention with 7.
weight management. A national clinical guideline
recommended for use in Scotland. Edinburgh,
Scottish Intercollegiate Guidelines Network
1996.
Hall JE. Pathophysiology of obesity hypertension. 8.
Curr Hypertens Rep 2000; 2: 139-47.
Bravo PE, Morse S, Borne DM, Aguilar EA, 9.
Reisin E. Leptin and hypertension in obesity.
Vasc Health Risk Manag 2006; 2:163-9.
Yach D, Stuckler D, Brownell KD. Epidemiologic 10.
and economic consequences of the global
epidemics of obesity and diabetes. Nat Med
2006; 12:62-6.
Montoye HJ, Metzner HL, Keller JB, Johnson 11.
BC, Epstein FH. Habitual physical activity and
blood pressure. Med Sci Sports 1972; 4:175181.
Reaven
PD, Barrett-Connor E, Edelstein S. 12.
Relation between leisure-time physical activity
and blood pressure in older women. Circulation
1991; 83:559-565.
Parker E D, Schmitz KH, Jacobs Jr DR. Dengel 13.
DR, Schreiner PJ. Physical Activity in Young
Adults and Incident Hypertension Over 15 Years
of Follow-Up: The CARDIA Study. Am J Public
Health 2007; 97: 703-709.
Paffenbarger RS Jr, Wing AL, Hyde RT, Jung DL. 14.
Physical activity and incidence of hypertension in
college alumni. Am J Epidemiol 1983; 117:245-
257.
Blair SN, Goodyear NN, Gibbons LW, Cooper 15.
KH. Physical fitness and incidence of hypertension
in healthy normotensive men and women. JAMA
1984; 252:487-490.
American College of Sports Medicine Position 16.
Stand: Physical activity, physical fitness, and
hypertension. Med Sci Sports Exerc 1993; 25:
i-x.
Kokkinos PF, Narayan P, Colleran JA, et al. 17.
Effects of Regular Exercise on Blood Pressure
and Left Ventricular Hypertrophy in AfricanAmerican

Men with Severe Hypertension. N
Engl J Med1995; 333:1462-7.
Duncan JJ, Farr JE, Upton SJ, et al. The effects 18.
of aerobic exercise on plasma catecholamines
and blood pressure in patients with mild essential
hypertension. JAMA 1985; 254:2609-13.
Arvola P, Wu X, Kähönen M, et al. Exercise 19.
enhances vasorelaxation in experimental obesity
associated hypertension. Cardiovascular Research
1999; 43: 992-1002.
Gokce N, Vita JA, Bader DS, et al. Effects of 20.
exercise on upper and lower extremity endothelial
function in patients with coronary artery disease.
American Journal of Cardiology 2002; 90:124127.
Foy
CG, Foley KL, D>Agostino RB Jr, et 21.
al. Physical activity, insulin sensitivity, and
hypertension among US adults: findings from
the Insulin Resistance Atherosclerosis Study.
American Journal of Epidemiology 2006;
163:921-928.
Krieger EM, Brum PC, Negrão CE.Influence 22.
of Exercise Training on Neurogenic Control of
Blood Pressure in Spontaneously Hypertensive
Rats. Hypertension 1999; 34; 720-723.
Amaral SL, Silveira NP, Zorn TM, Michelini LC. 23.
Exercise training causes skeletal muscle venular
growth and alters hemodynamic responses in
spontaneously hypertensive rats. J Hypertens
2001; 19:931–940.
Cléroux J, Feldman RD, Petrella RJ. 24.
Recommendations on physical exercise training.
CMAJ 1999; 160 Suppl 9:S21-8.
Page LB, Damon A, Moellering RC Jr. Antecedents 25.
of cardiovascular disease in six Solomon Islands
Societies. Circulation1974; 44:1132-46.
Stamler J. The INTERSALT Study: background, 26.
methods, findings, and implications. Am J Clin
Nutr 1997; 65 Suppl 2:626S-642S.
Frankel DH. Just a DASH of salt please. Lancet 27.
2000; 355:1891.
Cutler JA, Follmann D, Allender PS. Randomized 28.
trials of sodium reduction: an overview. Am J
Clin Nutr 1997; 65 Suppl 2:643S-651S
Lewis HK. Less Salt Intake or More Salt 29.
Excretion: Is Hypertension Preventable? J Clin
Hypertension 2001; 3:32-36.
147
148
Grobbee DE, Hofman A. Does sodium restriction 30.
lower blood pressure? Br Med J (Clin Res Ed)
1986;293:27-9.
Katori M, Majima M. A missing link between a 31.
high salt intake and blood pressure increase. J
Pharmacol Sci 2006; 100:370-90.
Feldstein C, Romero C. Role of endothelins in 32.
hypertension. Am J Ther 2007;14:147-53.
Haddy FJ: Role of dietary salt in hypertension: 33.
Life Sci 2006; 79:1585-92.
Franco V and Oparil S: Salt sensitivity, a 34.
determinant of blood pressure, cardiovascular
disease and survival. J Am Coll Nutr 2006; 25
Suppl 3:247S-255S.
Coruzzi P, Brambilla L, Brambilla V, et al. 35.
Potassium depletion and salt sensitivity in
essential hypertension. J Clin Endocrinol Metab
2001; 86:2857-62.
Cappuccio FP, MacGregor GA. Does potassium 36.
supplementation lower blood pressure? A metaanalysis
of published trials. J Hypertens 1991;
9:465-73.
Brancati FL, Appel LJ, Seidler AJ, Whelton, 37.
PK. Effect of potassium supplementation on
blood pressure in African Americans on a lowpotassium
diet: a randomized, double-blind,
placebo-controlled trial. Arch Intern Med 1996;
156:61-7.
Appel L, Moore T, Obarzanek E. A clinical trial of 38.
the effects of dietary patterns on blood pressure.
New Eng J Med 1997; 336:117-1124.
Barri YM, Wingo CS. The effects of potassium 39.
depletion and supplementation on blood pressure:
a clinical review. Am J Med Sci 1997; 314:3740.
McCarron

DA. Calcium. Symposium Notes: 40.
Nonpharmacologic Management of Hypertension.
National Kidney Foundation 1994:34-38.
(41) Morris, C.D. and M.E. Reusser. Calcium 41.
Intake and Blood Pressure: Epidemiology
Revisited. Seminars in Nephrology.1995;
15:490-5.
Atallah AN, Hofmeyr GJ, Duley L. Calcium 42.
supplementation during pregnancy for preventing
hypertensive disorders and related problems
(Cochrane Review).Cochrane Database Syst Rev
2002;(1):CD001059.
McCarron D.A. Role of Adequate Dietary Calcium 43.
Intake in the Prevention and Management of SaltSensitive Hypertension. Am J Clin Nutr 1997; 65
suppl 2:712S-716S.
Jolma
P, Kalliovalkama J, Tolvanen JP, et al. 44.
High-calcium diet enhances vasorelaxation in
nitric oxide-deficient hypertension. Am J Physiol
Heart Circ Physiol 2000; 279:H1036-43.
Ferrara LA, Raimondi AS, d>Episcopo L, et al. 45.
Olive oil and reduced need for antihypertensive
medications. Arch Intern Med 2000; 160:83742.
Osama M Osman and Yassir El-Wazir
Andriambelson E, Mangier C, Haan-archipoff G, 46.
et al. Natural dietary polyphenolic compounds
cause endothelium-dependent vasorelaxation in
rat thoracic aorta. J nut 1998; 128:2324-33.
Radack K, Deck C, Huster G. The effects of low 47.
doses of n-3 fatty acid supplementation on blood
pressure in hypertensive subjects. A randomized
controlled trial. Arch Intern Med 1991; 151:117380.
Morris MC, Sacks F, Rosner B. Does fish oil lower 48.

blood pressure? A meta-analysis of controlled
trials. Circulation 1993; 88:523-33.
Frenoux JM, Prost ED, Belleville JL, Prost JL.A 49.
polysaturated fatty acid diet lowes blood pressure
and improves antioxidant status in spontaneously
hypertensive rats. J Nutr 2001; 131:39-45.
Triboulot C, Hichami A Denys A, Khan NA. 50.
Dietary (n-3) polyunsaturated fatty acids exert
antihypertensive effects by modulating calcium
signaling in T cells of rats. J nut 2001; 131:23649.
Duffy SJ, Gokce N, Holbrook M, et al. Treatment 51.
of hypertension with ascorbic acid.Lancet
1999;354:2048-2049.
Moran JP, Cohen L, Greene JM, et al. Plasma 52.
ascorbic acid concentrations relate inversely to
blood pressure in human subjects. Am J Clin
Nutr 1993; 57:213-7.
Ness AR, Khaw KT, Bingham S, Day NE. Vitamin 53.
C status and blood pressure. J Hypertension 1996;
14:503-8.
Taddei S, Virdis A, Ghiadoni L, Magagna A, 54.
Salvetti A. Vitamin C improves endotheliumdependent
vasodilation by restoring nitric oxide
activity in essential hypertension. Circulation
1998; 97:2222-9.