management and prevention for Hypertension

Prevention

The degree to which hypertension can be prevented depends on a number of features including current blood pressure level, sodium/potassium balance, detection and omission of environmental toxins, changes in end/target organs (retina, kidney, heart, among others), risk factors for cardiovascular diseases and the age at diagnosis of prehypertension or at risk for hypertension. A prolonged assessment in which repeated measurements of blood pressure are taken provides the most accurate assessment of blood pressure levels. Following this, lifestyle changes are recommended to lower blood pressure, before the initiation of prescription drug therapy. The process of managing prehypertension according the guidelines of theBritish Hypertension Society suggest the following lifestyle changes:

• Weight reduction and regular aerobic exercise (e.g., walking): Regular exercise improves blood flow and helps to reduce the resting heart rate and blood pressure.^[47]
• Reducing dietary sugar intake
• Reducing sodium (salt) in the diet: This step decreases blood pressure in about 33% of people (see above). Many people use a salt substitute to reduce their salt intake.^[48]
• Additional dietary changes beneficial to reducing blood pressure include the DASH diet (dietary approaches to stop hypertension) which is rich in fruits and vegetables and low-fat or fat-free dairy products. This diet has been shown to be effective based on research sponsored by the National Heart, Lung, and Blood Institute.^[49] In addition, an increase in dietarypotassium, which offsets the effect of sodium has been shown to be highly effective in reducing blood pressure.^[50]
• Discontinuing tobacco use and alcohol consumption has been shown to lower blood pressure. The exact mechanisms are not fully understood, but blood pressure (especially systolic) always transiently increases following alcohol or nicotine consumption. Abstaining from cigarette smoking reduces the risk of stroke and heart attack which are associated with hypertension.^[51]

Limiting alcohol intake to less than 2 standard drinks per day can reduce systolic blood pressure by between 2-4mmHg.^[52]

• Reducing stress, for example with relaxation therapy, such as meditation and other mindbody relaxation techniques,^[53] by reducing environmental stress such as high sound levelsand over-illumination can also lower blood pressure. Jacobson's Progressive Muscle Relaxation and biofeedback are also beneficial,^[54] such as device-guided paced breathing,^[55][56]although meta-analysis suggests it is not effective unless combined with other relaxation techniques.^[57]

Increasing omega 3 fatty acids can help lower hypertension. Fish oil is shown to lower blood pressure in hypertensive individuals. The fish oil may increase sodium and water excretion.^[58]