The AHA Guidelines and Scientific Statements Handbook

Chapter 11 Hypertension

Lifestyle modifi cations

The reader is referred to the American Heart Asso-
ciation Scientifi c Statement “Dietary Approaches to
Prevent and Treat Hypertension” published in 2006
[5], from which the following recommendations are
derived.
A substantial body of evidence strongly supports
the concept that many components of the diet can
affect BP [5]. Dietary patterns based on the “Dietary
Approaches to Stop Hypertension” (DASH) diet
[24], which is rich in fruits, vegetables and low-fat
dairy foods, with reduced saturated and total fat,
together with a reduction in dietary sodium, may
help in the management of hypertension. Physical
exercise, weight loss in those who are overweight or
obese, and moderation of alcohol consumption,
have also emerged as appropriate strategies to lower
BP (Table 11.6).
African-Americans are especially sensitive to the
BP lowering effects of a reduced salt intake, increased
potassium intake, and the DASH diet. Older indi-
viduals, a group at high-risk for BP-related cardio-
vascular or renal diseases, can make and sustain
dietary changes. In “pre-hypertensive” individuals,

dietary changes can lower BP and prevent hyperten-

sion. In hypertensive patients dietary changes are an

important adjunct to drug therapy.

Pharmacologic treatment

In 2007 the American Heart Association published

a Scientifi c Statement “Treatment of Hypertension

in the Prevention and Management of Ischemic

Heart Disease; a Scientifi c Statement from the

American Heart Association Council for High Blood

Pressure Research and the Councils on Clinical Car-

diology and Epidemiology and Prevention” [4]. The

following are the recommendations of that Scientifi c

Statement. The reader is referred to the original

publication for the clinical trials data and other evi-

dence that support these recommendations.

Table 11.7 is a summary of the recommendations.

Uncomplicated hypertension

For the primary prevention of cardiovascular events,

renal failure, and other complications of hyperten-

sion, aggressive BP lowering is appropriate, with a

Table 11.6 JNC 7 Lifestyle modifi cations to prevent and manage hypertension

Modifi cation Recommendation Approximate SBP reduction (range)

Weight reduction Maintain normal body weight (body mass index
18.5–24.9 kg/m^2 ).

5–20 mm Hg/10 kg

Adopt DASH eating plan Consume a diet rich in fruits, vegetables, and low-fat
dairy products with a reduced content of saturated
and total fat.

8–14 mm Hg

Dietary sodium reduction Reduce dietary sodium intake to no more than 100 mmol
per day (2.4 g sodium or 6 g sodium chloride).

2–8 mm Hg

Physical activity Engage in regular aerobic physical activity such as brisk
walking (at least 30 minutes per day, most days of the
week).

4–9 mm Hg

Moderation of alcohol consumption Limit consumption to no more than 2 drinks (e.g., 24 oz
beer, 10 oz wine, or 3 oz 80-proof whiskey) per day in
most men and to no more than 1 drink per day in
women and lighter-weight persons.

2–4 mm Hg

DASH indicates Dietary Approaches to Stop Hypertension.
For overall cardiovascular risk reduction, stop smoking.
The effects of implementing these modifi cations are dose- and time-dependent and could be greater for some individuals.
Reproduced, with permission, from Chobanian et al. [1].