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[email protected] Current Hypertension Reviews, 2015, 11, 000-000
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Nutrition and Physical Activity on Hypertension: Implication of Current Evidence and Guidelines Iran Castro1, Gustavo Waclawovsky2 and Aline Marcadenti1,3,* 1
Postgraduate Program in Health Sciences: Cardiology, Institute of Cardiology of Rio Grande do Sul (IC/FUC), Porto Alegre, Rio Grande do Sul, Brazil; 2Postgraduate Program in Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil; 3Department of Nutrition, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil Abstract: Hypertension (HTN) is the leading cause of worldwide mortality and is responsible for approximately 40% of deaths from cardiovascular disease, chronicle kidney disease (CKD) and type 2 diabetes mellitus (T2DM) according to the World Health Organization (WHO). It is known that A. Marcadenti about 80% of all mortality from cardiovascular disorders could be prevented if a healthy diet and higher levels of physical activity were included among general population’s lifestyle. Besides, guidelines for the treatment and control of HTN were recently modified for adequate nutritional and physical activity recommendations highlighted in meta-analysis and strong evidences such as randomized clinical trials. Therefore, to discuss nutrition and physical activity in the context of HTN seems to be crucial.
Keywords: Blood pressure, diet, dietary, exercise, hypertension, muscle stretching exercises, sodium. INTRODUCTION Hypertension (HTN) is an important public health problem. According to World Health Organization (WHO) HTN is the leading cause of worldwide mortality [1], being responsible for 13.5% of premature deaths (7.6 million individuals) and 92 million DALYs (disability-adjusted life years), as well as 54% of the incidence of stroke and 47% of the cases of ischemic heart disease (IHD) [2]. Approximately 29% of the world population will be diagnosed with HTN until 2025 (about 1.56 billion of individuals affected), and around 25% of them will be concentrated in developing countries [3]. Physical inactivity and overweight/obesity are the fourth and fifth modifiable risk factors that more contribute to mortality rates in the world [4]. Unhealthy diet is involved in the genesis of most cardiovascular risk factors and in chronic diseases such as cancer [5]. Besides, adherence to a higher diet quality is associated with decreased risk of all-cause, cardiovascular and cancer mortality [6]. It is known that about 80% of all mortality from cardiovascular disorders could be prevented if obesity, unhealthy diet and physical inactivity were excluded from general population [7]. HNT is a multifactorial disease that has overweight, physical inactivity and the lack/excess of some nutrients intake involved in its etiology [8]. All guidelines for *Address correspondence to this author at the 245 Sarmento Leite Street, Department of Nutrition, Porto Alegre, RS, Brazil, zip code 90050-170; Tel: +55(51)33038830; Fax: +55(51)33038810; E-mail:
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treatment and control of high blood pressure suggest lifestyle modifications including a healthy diet and physical activity; recently, some of the nutritional recommendations were modified and highlighted in meta-analysis and strong evidences were provided such as randomized clinical trials. Therefore, the aim of this article is to review the dietary factors and exercise as non-pharmacological interventions in HTN. LIFESTYLE CHANGES AND WEIGHT LOSS Lifestyle changes can reduce blood pressure (BP) levels, prevent or delay the incidence of HTN, improve the effectiveness of antihypertensive medications and decrease cardiovascular risk. The reduction in alcohol intake by 30 g/day for men and 20 g/day for women, to stop smoking and adopt measures to control anxiety and depression are important recommendations to be followed. The combination of two (or more) lifestyle modifications can further improve the control of BP and reduce cardiovascular outcomes [9]. Lifestyle changes should precede pharmacological interventions in individuals with prehypertension or stage 1 HTN in order to control BP levels [10]. However, in patients who have higher BP and/or additional risk factors for cardiovascular disease such as T2DM or CKD the drug therapy must be the first choice, for quickly and effectively controlling BP levels. Since BP is well controlled in these subjects, the lifestyle changes should be strongly advised; and if there is an adequate BP control, then the reduction of drugs’ dosage can be possible [9]. Despite all substantial health benefits associated with smoking cessation (especially among individuals with pre© 2015 Bentham Science Publishers
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existing cardiovascular disease), weight gain is cited as a primary reason for not trying to quit smoking. Weight change after smoking cessation (mainly from increased subcutaneous adipose tissue) appears to be influenced by underlying genetic factors; the mechanism of weight gain also includes increased energy intake, decreased resting metabolic rate, decreased physical activity and increased lipoprotein lipase activity [11]. Meta-analysis showed that dietary interventions (very-low caloric diets) are able to reduce post cessation weight gain in the short term, but not at long time; in contrast, exercise interventions significantly reduce weight gain in the long term, but not the short time. Therefore, both diet and physical activities concomitant seems to be important to reduce and to maintain the post smoking cessation weight gain in general population [12]. Weight loss can decrease around 4.5 mmHg in systolic blood pressure (SBP) and 3.2 mmHg in diastolic blood pressure (DBP) [13]. Besides, a weight loss of 5% increase with 15% chance of incidence of BP normalization in hypertensive patients [14]. The maintenance of a BMI
