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Managing blood pressure with non-medication-based strategies

The Bottom Line

  • Globally, over 1.1 billion people live with hypertension, a condition that puts them at greater risk of developing a variety of health issues and early death.  
  • In people with prehypertension to established hypertension, non-medication-based strategies such as Dietary Approaches to Stop Hypertension (DASH), a low-sodium and high potassium dietary approach, salt restriction, aerobic exercise, isometric exercise, breathing control, yoga, low-calorie diet, low-calorie diet plus exercise, and comprehensive lifestyle modification can reduce systolic and diastolic blood pressure. 
  • DASH appears to be the most effective non-medication-based strategy at lowering blood pressure.
  • Speak with your health care provider(s) (e.g., primary care provider or cardiologist) about both your medication and non-medication-based options to develop a treatment or prevention plan that is tailored to your individual needs. 

What do medication, dietary approaches, exercise, stress reducing practices, weight loss strategies, alcohol restriction, and comprehensive lifestyle modification have in common? The answer is they are all interventions that aim to lower blood pressure in people living with hypertension (a.k.a. high blood pressure). Non-medication-based strategies can also be used by those with an elevated risk of developing hypertension, known as prehypertension (1;2).


Worldwide, hypertension is a significant factor in the development of many diseases—such as those of the heart and brain—and the occurrence of premature death (3). Currently, over 1.1 billion people live with hypertension, with an additional four million projected to be diagnosed with high blood pressure in the next four years (1;3;4).


Given both its global prevalence and impact on the lives of individuals, it is important to examine currently available treatment options and preventative strategies with respect to their accessibility, effectiveness, and how they compare to one another. Take, for example, anti-hypertensive medications. This diverse set of medications has proven to be effective in lowering blood pressure in many people and is often the go-to treatment prescribed for hypertension (1;2). However, these medications come with side effects such as low blood pressure, kidney problems, high potassium levels, and fainting; and are costly to patients. Non-medication-based strategies, therefore, could have something to offer. This need for alternative or complementary options is further supported by the fact that not all people respond well to medication and require other approaches to get their blood pressure under control (1;5;6).


One systematic review took on the task of investigating a variety of non-medication-based strategies in people with established hypertension and prehypertension (1). So, should folks include these strategies in a comprehensive treatment or prevention plan?


What the research tells us

Low to high-quality evidence shows that non-medication-based strategies may be beneficial for adults with prehypertension to established hypertension.


The above-mentioned review specifically found that dietary approaches (i.e., Dietary Approaches to Stop Hypertension [DASH], low-sodium and high potassium, and salt restriction); physical exercise (i.e., aerobic and isometric); stress reducing practices (i.e., breathing control and yoga); weight loss interventions (i.e., low-calorie diet and low-calorie diet plus exercise); and comprehensive lifestyle modification can reduce both systolic and diastolic blood pressure compared to usual care. What’s more, the review identified DASH as the most effective strategy for reducing blood pressure amongst different non-medication-based options tested (1). For those unfamiliar with this dietary pattern, it’s one that places emphasis on the consumption of whole grains, low-fat dairy, fruits, and vegetables, while also recommending a decrease in sodium, saturated fat, and total fat content (1;7;8).


It is also important to note that different non-medication-based strategies may have different effects based on the type of blood pressure outcome you are looking at (i.e., systolic or diastolic) and whether you have established hypertension or prehypertension (1). So, take this into consideration when choosing treatment or preventative options.


What does this all mean for you? The good news is there are a variety of medication and non-medication-based strategies that can be part of your treatment or prevention approach. Talk to your primary care provider or cardiologist about these diverse options before making any changes, and collaborate on the development of a plan that meets your individual needs and increases your chances of adherence.


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References

  1. Fu J, Liu Y, Zhang L, et al. Nonpharmacologic interventions for reducing blood pressure in adults with prehypertension to established hypertension. J Am Heart Assoc. 2020; 9(19):e016804. doi: 10.1161/JAHA.120.016804. 
  2. Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering on outcome incidence in hypertension: 4. Effects of various classes of antihypertensive drugs–overview and meta-analyses. J Hypertens. 2015; 33:195-211.
  3. World Health Organization. Hypertension. [Internet] 2021. [cited April 20201]. Available from https://www.who.int/news-room/fact-sheets/detail/hypertension 
  4. Lip GYH, Coca A, Kahan T, et al. Hypertension and cardiac arrhythmias: Executive summary of a consensus document from the European Heart Rhythm Association (EHRA) and ESC Council on Hypertension, endorsed by the Heart Rhythm Society (HRS), AsiaPacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE). Eur Heart J Cardiovasc Pharmacother. 2017; 3:235-250.
  5. Albasri A, Hattle M, Koshiaris C. Association between antihypertensive treatment and adverse events: systematic review and meta-analysis. BMJ. 2021; 10;372:n189. doi: 10.1136/bmj.n189. 
  6. French MT, Mundt MP, Fleming M, et al. The cost of medical care for patients with diabetes, hypertension and both conditions: Does alcohol use play a role? J Intern Med. 2005; 258:45-54.
  7. Svetkey LP, Simons-Morton D, Vollmer WM, et al. Effects of dietary patterns on blood pressure: Subgroup analysis of the Dietary Approaches to Stop Hypertension (DASH) randomized clinical trial. Arch Intern Med. 1999; 159:285-293.
  8. Zou P, Dennis CL, Lee R, et al. Dietary approach to stop hypertension with sodium reduction for Chinese Canadians (DASHNa-CC): A pilot randomized controlled trial. J Nutr Health Aging. 2017; 21:1225-1232. 

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