New approaches to management of high blood pressure highlighted in large review

Mindfulness practices such as meditation and yoga should be recommended to people with high blood pressure, according to a comprehensive review of lifestyle changes that can help prevent and manage the condition, which is co-authored by UCLH Director of Research and hypertension specialist Professor Bryan Williams.

People should also be advised to get quality sleep and reduce their exposure to air pollution, according to the wide-ranging position paper from the International Society of Hypertension (ISH).

For the paper, published in the Journal of Hypertension, an international panel of experts from 18 countries made recommendations on effective lifestyle changes for blood pressure control, based on the latest clinical and scientific evidence.

The paper highlights perhaps less obvious strategies such as stress management and sleep quality alongside long-standing recommendations to:

• maintain a healthy weight 
• exercise regularly 
• eat a healthy diet 
• reduce consumption of salt 
• stop smoking 
• limit (ideally stop) alcohol consumption. 

Hypertension affects around 4 in 10 people worldwide. There are effective medications for high blood pressure, but the best approach is often to start with lifestyle interventions, before introducing drug treatment if needed.

The authors of the paper said healthcare professionals should consider stress reduction and mindfulness-based therapies for people with high blood pressure, pointing to evidence that practices such as meditation, muscle relaxation, yoga and deep breathing techniques can all lower blood pressure.

They also said healthcare professionals should explore all aspects of a patient’s sleep, including duration, quality and timing, and they recommend population-based awareness campaigns advocating for better sleep quality.

Evidence shows a strong, dose-response, relationship between exposure to air pollution and blood pressure. The authors of the paper said that, where possible, people should aim to reduce their exposure to outdoor air pollution, for instance by exercising in gardens and parks away from busy roadways.

But the authors said that, in this area, the greatest benefits would be seen by governmental action to improve air quality.

For physical activity, the authors make recommendations around aerobic activity (brisk walking, running), strength training, and isometric training (static exercises such as squeezing a hand grip).

They emphasise salt and sugar intake should be limited, with alcohol consumption ideally zero.

Professor Williams, who is Director of the NIHR BRC at UCLH, said: “There are so many things people can do to reduce their chances of developing high blood pressure, and to lower their blood pressure if they develop hypertension.

“Patients around the world should be given the information they need to make changes to their lifestyle, and health systems and governments should enable access to services which can help people make changes to their lifestyle and create an environment where it is easier to make these lifestyle changes.”

Lead author of the paper, Professor Fadi Charchar, said: “Our aim was to provide a holistic set of recommendations for changes to lifestyle, which focus on all areas of health, including movement and bodyweight, food and drink, the body and mind, as well as other factors such as exposure to air pollution.

The paper also highlights the role new digital technologies could play in lifestyle interventions.

Co-lead author of the paper Dr Priscilla Prestes said: “The increasing use of apps and wearable technologies can help people track their movement, sleep and diet, as well as promote behaviour change, such as prompting a person to increase exercise, especially incidental exercise. So we should use these new technologies to our advantage.”

Read the full paper.