What is Hypertension?
Based on the latest Clinical Practice Guideline (CPG) Management of Hypertension (5th edition) published by Malaysia Ministry of Health in the year 2018.
Hypertension is defined as a persistent elevation of systolic blood pressure (SBP) of 140mmHg or greater and/or diastolic blood pressure (DBP) of 90mmHg or greater, taken at least twice in a separate occasion.
Blood pressure (BP) is directly related to the risk of cardiovascular (CV) morbidity and mortality.
Therefore, it is important to detect, identify and treat high BP in order to reduce the risk of end-organ damage or end-organ complications such as myocardial infarction, stroke, renal failure, and premature death.
Dietary intervention in an overweight patient with mild hypertension is often recommended.
To achieve this, weight reduction and reduction of blood pressure complying to weight-reducing diet.
For instance, a 4kg reduction in body weight, to be able to achieve a blood pressure reduction on 4.5/3.2 mmHg.
Besides, there is also evidence that showed a reduction of 1kg in weight relates to 1 mmHg reduction in systolic blood pressure.
Reducing Sodium Intake
Reducing salt intake can significantly reduce blood pressure in adults.
This is because of high salt intake links with increased risk of stroke, stroke mortality, and coronary heart disease mortality.
The recommended reduction of salt intake by WHO is <2 g/day or <5g/day of salt (about one teaspoon of salt) in adults.
However, there is inadequate evidence showing that a reduction in salt intake has an effect on cardiovascular disease mortality and morbidity.
In Malaysia, the estimated mean salt intake is around 8.7 to 9.5 g of salt. This exceeds the recommended salt intake. Thus, salt reduction is recommended for most people, especially in hypertensive patients.
Reduce Alcohol Consumption
Alcohol consumption elevates blood pressure. In a more recent meta-analysis, the results show reducing alcohol intake can lower blood pressure in a dose-dependent manner with an apparent threshold. People who drink alcohol are advised to limit their alcohol consumption to <2 drinks per day.
Regular Physical Activity
Increased physical activity helps to reduce blood pressure.
However, there is a lack of data on its effect on cardiovascular events and mortality.
Meta-analyses have shown that dynamic aerobic endurance, dynamic resistance and isometric resistance training can lower blood pressure. Any form of this activity can benefit hypertensive patients.
A cumulative moderate-intensity aerobic exercise of at least 150 minutes per week is advised.
Diets rich in fruits, vegetables and low-fat dairy product with reduced saturated and total fat can significantly lower blood pressure. (11/6 mmHg in hypertensive patients and 4/2 mmHg in patients with high normal blood pressure.
Recently, meta-analysis shows that healthy dietary patterns such as Dietary Approaches to Stop Hypertension (DASH), Nordic, and Mediterranean diet significantly lowered blood pressure by 4.26/2.38 mmHg.
This achieves with a diet higher in fruit, vegetable, and legume consumption. It associates with a lower risk of non-cardiovascular and total mortality.
Cessation of Smoking
Smoking can acutely raise blood pressure.
However, the effect of chronic smoking on blood pressure is less clear.
Nevertheless, smoking cessation is important in reducing global cardiovascular risk.
Stress management is useful but evidence on relaxation interventions on blood pressure reduction has not been convincing.
In a systematic review, yoga had been shown to reduce blood pressure by 4.2/3.6 mmHg, but the quality of evidence is poor.
Dietary Potassium Intake
Meta-analyses show that increased dietary potassium intake can reduce blood pressure in adults with hypertension without affecting the blood lipid concentration, catecholamine concentrations or renal functions.
Besides, for adults with normal renal function and not at risk of hyperkalemia, increasing dietary potassium intake can reduce blood pressure by 3.49/1.96 mmHg.
Higher dietary potassium intake has a 24% lower risk of stroke. For example, eating fruits, vegetables, nuts and legumes.
Micronutrient alterations, caffeine reduction and dietary supplementation with fish oil, calcium, magnesium, garlic and fibre have less evidence for beneficial effect.
Meta-analyses have suggested that regular consumption of black tea and green tea can reduce blood pressure. However, the sample size was small, and the quality of the studies varied.
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