Hypertensive Therapy: Part II

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Abstract
If the incidence of hypertension in the population could be reduced through lifestyle modification, much of the morbidity and mortality associated with coronary heart disease, renal disease, and stroke might be prevented.1–3 Randomized, controlled trials have shown that lifestyle modification can lower blood pressure (BP) in both hypertensive and high-risk normotensive (now called prehypertensive ) persons and can prevent hypertension in the latter group. Accordingly, lifestyle modification is recommended for all persons (Table 1), either alone or in conjunction with pharmacological therapy (Table 21–34). View this table: TABLE 1. Lifestyle Modifications to Manage Hypertension *† View this table: TABLE 2. Guidelines for Treatment of Hypertension Based on Compelling Indications for Individual Drug Classes ### Weight Loss and Maintenance of Normal Body Weight Weight loss is the most effective of all nonpharmacological measures to prevent and treat hypertension.35 This effect is independent of sodium restriction and is seen in both obese and nonobese hypertensive individuals. Clinical trial evidence suggests that weight loss interventions produce BP benefits that persist even after cessation of active therapy.3,36 Body mass index (BMI) should be maintained between 18.5 and 24.9 kg/m2. Because sustained weight reduction is extremely difficult to achieve, emphasis should be placed on prevention of weight gain, particularly in younger individuals with prehypertension and in families with a high prevalence of hypertension. ### Increased Physical Activity At least 30 minutes of moderately intense physical activity, such as brisk walking, swimming, bicycling, or yard work, carried out at least 3 times per week (preferably once per day) can lower BP in both normotensive and hypertensive individuals. Studies suggest that such moderate activity may lower systolic BP (SBP) by 4 to 9 mm Hg.37,38 Additional benefits of regular physical activity include weight loss, enhanced sense of well-being, improved functional health status, and reduced risk of cardiovascular disease (CVD) and mortality from all causes. Accordingly, regular aerobic physical activity …