Lifestyle: Evidence and Practical Use

All patients with hypertension should be encouraged to take the following lifestyle measures:

Patients with pre-existing cardiac disease may be at risk of precipitating cardiac events if too vigorous an exercise program is started. Lifestyle measures, particularly smoking cessation, will have general benefits for health in addition to their effects on blood pressure.

Patients should be reviewed regularly when lifestyle advice is first given to assess compliance with lifestyle measures, and monitor the effects on blood pressure.

Patient and caregiver information
All patients who smoke should be made aware of the great risks attached to smoking, and the benefits to blood pressure and general health that will result from giving up
Patients should be advised about suitable exercise programs for their existing levels of fitness; overambitious targets can be demoralizing (and even dangerous) in patients with pre-existing cardiovascular disease
Patients who find it difficult to cut down on salt added to food should be encouraged to use alternative ways of flavoring food (e.g. pepper, garlic, chillies, herbs), and should be reassured that most people soon get used to unsalted food


Lifestyle changes have been shown to effectively reduce blood pressure and decrease the risk of cardiovascular disease.

Weight-reducing diets.

Salt reduction.

Potassium supplementation.

Fish oil supplementation.

Calcium supplementation.

Magnesium supplementation.


Alcohol reduction.

Other lifestyle adjustments

Stress Relief

Stress relief is clearly one of the major risk factors in cardiovascular disease, and methods for dealing with stress are very important (see Chap. 86)

Stress may lead to hypertension through repeated blood pressure elevations and by increasing the amount of vasoconstricting hormones (see Chap. 40). Stress factors leading to hypertension include job strain, social environment, emotional stress, race, and white coat hypertension. In the Framingham study,[4] hypertension was involved in over 80 percent of all cardiovascular deaths. In addition, hypertension was at least twice as strong a predictor of death as smoking or elevated blood cholesterol level. Over 50 million Americans are currently hypertensive.

Stress Management

Pet ownership reduces stress and can convey a sense of companionship and purpose. Pet ownership has been shown to increase heart rate variability in patients with cardiovascular disease.

Mindfulness-based stress reduction (MBSR) uses the techniques of mindfulness meditation, gentle yoga, and coordinated deep breathing to decrease pain and anxiety. In a meta-analysis, MBSR has been shown to help individuals alleviate stress and suffering associated with various diseases.

Reiki, an ancient Japanese healing art, in the Western world sometimes referred to as 'Touch to Heal', is a technique that can be applied by a practitioner as well as by the patient him/herself. The underlying mechanisms are still unclear, yet is has proven to be an effective tool in creating self- and health awareness and relaxation, thus improving blood pressure.

Guided imagery is a therapeutic technique that allows a person to use his or her own imagination to connect body and mind to achieve desirable outcomes, such as decreased pain perception and reduced anxiety. Guided imagery has been studied for patients both pre- and postsurgical intervention. A recent study of cardiothoracic surgery patients demonstrated that both pain and anxiety decreased significantly with guided imagery. An ongoing trial at Scripps Clinic using guided imagery and healing touch pre- and postcardiothoracic surgery has demonstrated a 50 percent reduction in pain and anxiety in the treatment group.

Transcendental meditation (TM) offers a unique technique for meditation and relaxation and is one of the most studied CAM therapies, with research dating back to the 1970s. TM has been shown not only to improve blood pressure but also the insulin resistance components of the metabolic syndrome and cardiac autonomic nervous system tone.

Biofeedback is a technique to train people to change habitual reactions to stress. In patients with coronary artery disease, biofeedback increases heart rate variability (HRV).