Non-Pharmacological Management of Hypertension

Introduction:

Non-pharmacological management of hypertension is indicated in individuals who are prehypertensive. Prehypertension is systolic blood pressure between 120 to 139 mm Hg and diastolic blood pressure between 80 to 89 mm Hg. These patients should be tried with lifestyle modification for at least three months before starting medications.

What Is the Non-pharmacological Management of Hypertension?

Great importance is being given to lifestyle modifications because of definite benefits observed in patients who follow this. Lifestyle changes have advantages not only in the control of hypertension but also in the management of dyslipidemia and diabetes.

In a prehypertensive individual, the following things have to be taken care of:

1) Tobacco:

While the major effects of tobacco are in the development of atherosclerotic heart disease, its role in the management of hypertension cannot be forgotten. The pressure effect of tobacco is so strong that the blood pressure comes down immediately after the stoppage of smoking. Tobacco is one of the agents that induce the clustering of risk factors.

2) Bodyweight:

Lowering excess body weight can lower blood pressure. In one of the studies, it was found that a decrease of 1 kg of body weight is associated with an average fall of 1.6 mm Hg. Indeed, in many instances, it would be possible to discontinue medications after effective weight control.

3) Diet:

A diet that is rich in fruits, vegetables, and whole grains is mostly advised. Further suggested foods are consuming poultry, low-fat dairy by-products, non-tropical vegetable oils, fish, legumes, and nuts. In addition, limit the intake of sugar-sweetened drinks, sweets, and red meat. Also, this dietary habit should be adapted to:

• Personal and cultural food preferences.

• Appropriate calorie requirements.

• Nutritional therapy for other medical conditions.

The best way to achieve this is by following the plan of:

• Dietary approaches to stop hypertension (DASH) diet.

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• U.S. Department of Agriculture (USDA) Food Patterns.

• AHA (American Heart Association) diet.

The DASH diet lowers diastolic blood pressure by 3 mm Hg and systolic blood pressure by 5 to 6 mm Hg, and its dietary approaches to stop hypertension are:

a) High Consumption:

• Four or five servings of fruit (medium size) per day and a quarter cup of dried fruit.

• Four or five servings of vegetables per day - One cup of raw green leafy vegetables and a half cup of cooked vegetables.

• Seven or eight servings of whole grains per day - One slice of whole wheat bread, one cup of whole-grain cereal, and a half cup of cooked rice or pasta.

b) Moderate Consumption:

• Two or three servings of low-fat dairy by-products per day - Four cups of low-fat milk and one cup of low-fat yogurt per day.

• Two servings of lean meat per day - Cooked lean ground beef, skinless poultry, trimmed pork chops, and fish.

• Four or five servings of nuts, seeds, and beans per week - 200 grams of nuts, one tablespoon of seeds, and half a cup of cooked beans.

• Two or three servings of oils per day - One teaspoon margarine, low-fat mayonnaise, vegetable oil, and 2 tablespoons of light salad dressing.

c) Low Consumption:

• Take only 2 egg whites.

• Fat-free chips per day.

• Do not take more than five servings of sweets or sweetened beverages per week.

4) Sodium Intake:

Restriction of dietary sodium is one of the most useful methods of controlling hypertension. This fact should be emphasized because of the increasing use of fast foods, which have high salt content. It has to be admitted that this cannot be achieved easily. Norman Kaplan, a renowned cardiologist, gives the following practical suggestions.

• Sodium consumption should be less than 1500 mg per day, and an average individual consumes 8 to 10 times more sodium than required.

• If salt is desired, add half sodium and half potassium chloride preparations.

• Avoid fast foods.

• Be careful about the sodium content of some medications and specifically read the labels indicating sodium content in your food.

5) Alcohol:

Alcohol consumption of more than 30 mL of ethanol is found to increase blood pressure. Hence, moderation is recommended. One of the major hazards of drinking is the usually associated consumption of high salt savories, which are an unseen source of salt. Instead, use less salted food. However, due to a rise in blood pressure with increased alcohol-consuming persons, we should not encourage the persons who do not drink alcohol for the purpose of lowering their blood pressure levels.

6) Exercise:

Regular physical exercise has been found to induce a reduction in blood pressure. Strenuous exercise should be done 45 minutes a day for at least six days a week. A healthy body and mind could be acquired through moderate-intensity physical activity by practicing for at least two and half hours per week. It is said that getting some physical activity is better than having none, so there would be best results on performing more activity. Examples of some moderate exercises are:

• Brisk walking.

• Bicycling.

• Aerobic exercises.

• Dancing.

• Moderate-intensity swimming.

• Jogging

• Gardening.

• Golfing without using a cart.

• Tennis.

In addition, the health benefits of exercise are:

• Reduced all-cause mortality rates.

• Coronary heart disease.

• Hypertension.

• Stroke.

• Type 2 diabetes mellitus.

• Metabolic syndrome.

• Colon cancer.

• Breast cancer.

• Depression.

7) Relaxation Techniques:

The mechanism behind the relaxation techniques to lower blood pressure is indistinct. There have been various reports as to the efficacy of yoga, transcendental meditation, etc., but none of these were accepted on the basis of statistical studies. In addition, it has been suggested that relaxation techniques help lower the stress which is produced by the autonomic nervous system, thereby lowering blood pressure levels. However, it is widely accepted that relaxation techniques, along with other reductions in risk factors, do definitely decrease the incidence of cardiovascular complications. Transcendental meditation modestly lowers blood pressure, but there is no distinctive approach that has been proven worthwhile. Also, due to the mixed results during the trials, yoga or acupuncture have not been recommended to lower blood pressure levels.

Conclusion:

Hypertension should be watched carefully and treated with prescribed medicines. People with hypertension should not skip their medications as it can lead to serious complications such as stroke. However, if diagnosed with prehypertension, the doctor might try to treat it with the above-mentioned non-pharmacological management. So, if you are in a pre-hypertensive stage or a borderline stage 1 hypertensive patient, follow all the doctor-suggested instructions and get on monthly follow-ups.