Non-pharmacological management of essential hypertension

Lifestyle modifications are universally accepted, not only as the first step in the management of hypertension but also a way to prevent hypertension. The INTERSALT study of 52 communities worldwide showed that weight, among all measured characteristics except age, had the strongest, significant, most consistent and independent correlation with blood pressure. INTERSALT epidemiological data had demonstrated a positive association between sodium intake and level of blood pressure. A rigorous analysis of 23 randomly controlled trials showed that 100 mmol/day reduction in sodium intake was associated with a decline of 5-7 mm Hg (systolic)/2.7 mm Hg (diastolic) in hypertensive subjects. Excessive alcohol consumption is another important risk factor for hypertension and has been reported to account for 5-30% of all hypertension. Moderately intense exercise at 40 to 60% of maximum oxygen consumption e.g., 30 to 45 minutes of brisk walking on 4-5 days a week, can lower blood pressure. The incidence of stroke and coronary artery disease in hypertensive patients who smoke is 2-3 times greater than in non-smoking patients with comparable blood pressure and stopping smoking rapidly reduces this risk. There have been several studies showing the stress reduction with various behavioural procedures, such as yoga, relaxation biofeedback, transcedental mediation and psychotherapy benefit hypertensive patients by lowering their blood pressure.