Manual of Clinical Nutrition

Hypertension

Manual of Clinical Nutrition Management III- 65 Copyright © 2013 Compass Group, Inc.

Table III- 16 : Evidence Supporting Lifestyle Modifications to Manage Hypertension
Lifestyle Modification
Factor

Rationale

Tobacco avoidance Although not directly related to hypertension, tobacco use may impair the protective
effect of antihypertensive medications on coronary heart disease (2).

Weight reduction(if
heavier than ideal
weight)

Research has shown a direct positive correlation between body weight or body mass

index and blood pressure (2,14,15). Weight reduction by energy restriction may result in

a substantial decrease in blood pressure. As little as 4.5 kg of weight loss is associated

with reductions of 4 to 5 mm Hg systolic and 2 to 4 mm Hg diastolic pressure (16).

Reductions of 5 to 20 mm Hg systolic blood pressure occur with every 10 kg of

weight loss (Grade IV) (12-15).

Moderate alcohol intake
Moderate consumption of alcohol (<30 g of ethanol per day or two drinks per day) is
not associated with blood pressure increases (2). Larger amounts of alcohol
ingestion have a dose-related effect on blood pressure in both hypertensive and
normotensive subjects (8). Consumption of more than 2 oz of ethanol per day may
cause elevated blood pressure and resistance to antihypertensive treatment (2).
Hypertensive patients should limit their alcohol consumption. Hypertensive men
should consume no more than 1 oz of ethanol per day (equivalent to two drinks)
(Grade IV) (2,12). Hypertensive women should consume no more than 0.5 oz of ethanol
(one drink) per day (Grade IV) (2,12). A reduction in alcohol consumption may reduce
systolic blood pressure by approximately 2 to 4 mm Hg (Grade IV) (12). One drink is
equivalent to 12 oz of beer, 5 oz of wine, or 1.5 oz of 80-proof liquor (2). Rebound
hypertension frequently occurs during alcohol withdrawal, but it generally reverses
within a few days to 6 weeks (17).

Physical activity Regular aerobic activities, such as walking, jogging, or swimming, may aid in the
prevention and treatment of hypertension (2). Regular physical activity can enhance
weight loss, reduce the risk of coronary heart disease (17), and prevent the increase
in blood pressure that is associated with aging (17). Regular exercise can reduce
systolic blood pressure by approximately 4 to 9 mm Hg (Grade IV) (12,17,18). Since
exercise can initially increase blood pressure, patients should consult their
physician before beginning an exercise program (1,17). The JNC 7 guidelines are
consistent with other national guidelines and recommend at least 30 minutes of
aerobic activity on most days of the week (Grade IV) (2,12).

Moderate sodium intake
Dietary sodium intake should be limited to 2,300 mg/day (100 mmol/day) or less
(Grade I) (2,12). African Americans, older people, and patients who have hypertension
or diabetes tend to be more sensitive to dietary changes in sodium intake (2,13,19,20).
The Dietary Guidelines for Americans suggests that persons who are 51 and older
and those of any age who are African Americans or have hypertension, diabetes or
chronic kidney disease should not consume more than 1,500 mg/day of sodium (21).
Dietary sodium reduction is associated with a 2 to 8 mm Hg reduction in systolic
blood pressure (Grade I) (12,13,19,20). According the Academy, if a patient demonstrates
adherence to a 2,300 mg/day sodium diet but has not achieved the treatment goal,
then the DASH dietary pattern or a reduction in sodium to 1,600 mg/day can
further reduce blood pressure (Grade I) (12). (See “Sodium-Controlled Diet” in Section
IF.)

Adequate calcium intake
Population studies have shown an inverse association between blood pressure and
calcium intake (2,13,22). However, no evidence suggests that the calcium intake should
be increased beyond the Dietary Reference Intake (DRI) (2,12,20). Epidemiological
studies have found that dietary patterns that do not meet the DRI for calcium are
associated with increased blood pressure (Grade II) (12). The DASH eating plan, which
significantly reduces blood pressure, provides 1,240 mg/day of calcium based on a
2,000 kcal combination diet (23).