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Hypertension and lifestyle advice

Mike Rich
Chief Executive
Blood Pressure Association

Hypertension has reached epidemic proportions. It has been estimated that around 15 million people in the UK are currently hypertensive with that number set to increase as we become less active and more overweight

Thousands of people are diagnosed as being hypertensive on a weekly basis. Unless immediately necessary, most clinicians will look to see if lifestyle changes can be introduced to reduce the need for medication.

Many people come to the Blood Pressure Association having been told by their clinician that they need to change their lifestyle to improve their blood pressure. Often, they are looking to improve their lifestyle quickly in the hope of avoiding the need for medication. For others, it is hoped that a change in lifestyle might help them to reduce the need for medication over time or enhance their existing blood pressure management.

For most people, however, lifestyle change is difficult, particularly for people with high blood pressure who experience no symptoms and feel quite well; so it is important that we emphasise the real impact of lifestyle change and the difference it can make to people's health - both cardiovascular and general.

We know that an unhealthy lifestyle will raise blood pressure over time and the higher blood pressure becomes, the higher the risk of a stroke or heart attack in the future. However, the good news is that high blood pressure can be significantly lowered simply by making some healthy lifestyle changes.
People will start to feel healthier after they have made changes, but the impact that this is having on their blood pressure will not be clear unless they are getting it monitored on a regular basis. For that reason, people who are undertaking lifestyle changes may well benefit from more frequent blood pressure monitoring - at home or in the surgery. Seeing real differences will also encourage people to continue the changes.

Lifestyle changes to lower blood pressure
Eat less salt
Too much salt raises blood pressure, so it is important to eat as little salt as possible. In fact, some people with high blood pressure may be able to avoid blood pressure medicines by cutting down on salt. Most of the salt people eat is not what is added to food, but is in prepared foods like bread, breakfast cereals and ready meals. People should be encouraged not to add salt to food in cooking or at the table and to check labels when they are out shopping for food, choosing low-salt options when possible. Does it work? Yes, an average person who cuts down their salt intake to 6 g from the average of 9 g or more that most of us eat could see their systolic blood pressure come down by as many as 8 mmHg.

Eat more fruit and vegetables
Eating more fruit and vegetables helps to lower blood pressure. Adults should eat at least five portions of fruit and vegetables every day. A portion is 80 g, or roughly the size of your fist. Encourage people to try to eat a range of different fruits and vegetables. Dried, frozen and tinned are fine, but watch out for added salt, sugar or fats. For real achievement the target should be 8 or more portions a day, but it is important to remember that even small changes in the right direction will have an impact. Dietary interventions can again make a real difference and can reduce systolic blood pressure by as much as 14 mmHg. A combination of eating more fruit and vegetables together with salt reduction can make a real difference to blood pressure.

Keep to a healthy weight
Losing weight, if needed, will help lower blood pressure and reduce the risk of health problems. The best way to lose weight is to choose more low-fat and low-calorie foods, and increase physical activity. It is important that realistic goals are set for weight loss and to remember that small changes to eating habits and activity levels can make a real difference. It has been estimated that an individual who is overweight can reduce their blood pressure by 1 mmHg for every kilogram that they lose - that's over 6 mmHg for every stone lost.

Drink less alcohol
If people drink too much alcohol, this will raise blood pressure over time. The current recommended limits are 21 units of alcohol a week for men, and 14 units a week for women. A unit is roughly half a pint of beer or cider, a small glass of wine, or a single pub measure of spirits. Reducing alcohol intake can lower blood pressure by an average of between 2 and 4 mmHg.

Get more active
Being moderately active for 30 minutes five times a week can keep a heart healthy, and can lower blood pressure. If it's not possible for people to find 30 minutes in a day, increasing activity by even a small amount can help - for instance, three small sessions of 10 minutes can be of help. Get people to think about how they can be more active in their daily life. Any activity that leaves them feeling warm and slightly out of breath is ideal.

Many people are concerned about the possibility of spending the rest of their life on an anti-hypertensive medicine and, for these individuals, the opportunity to possibly avoid this through lifestyle change is very attractive and can work. The important thing is to make sure that people are doing the right thing - and doing enough of it. A programme of lifestyle change and more intense blood pressure monitoring at home to help confirm success of the changes can make a tremendous difference to the way people approach their high blood pressure and can help put them in control of their health. Even for individuals who have to take medication, it should be emphasised that the medication alone is not the whole answer and for better health any medication should be combined with an improved lifestyle.

Blood Pressure Association