Lifestyle management of hypertension: International Society of Hypertension position paper endorsed by the World Hypertension League and European Society of Hypertension

Fadi J Charchar^{1

2

3}, Priscilla R Prestes¹, Charlotte Mills⁴, Siew Mooi Ching^{5

6}, Dinesh Neupane⁷, Francine Z Marques^{8

9}, James E Sharman¹⁰, Liffert Vogt¹¹, Louise M Burrell¹², Lyudmila Korostovtseva¹³, Manja Zec^{14

15}, Mansi Patil^{16

17}, Martin G Schultz¹¹, Matthew P Wallen¹⁸, Nicolás F Renna¹⁹, Sheikh Mohammed Shariful Islam²⁰, Swapnil Hiremath²¹, Tshewang Gyeltshen²², Yook-Chin Chia^{23

24}, Abhinav Gupta²⁵, Aletta E Schutte^{26

27

28}, Britt Klein¹, Claudio Borghi²⁹, Colette J Browning¹, Marta Czesnikiewicz-Guzik^{30

31}, Hae-Young Lee³², Hiroshi Itoh³³, Katsuyuki Miura³⁴, Mattias Brunström³⁵, Norm R C Campbell³⁶, Olutope Arinola Akinnibossun¹, Praveen Veerabhadrappa³⁷, Richard D Wainford^{38

39}, Ruan Kruger^{40

41}, Shane A Thomas¹, Takahiro Komori⁴², Udaya Ralapanawa⁴³, Véronique A Cornelissen⁴⁴, Vikas Kapil^{45

46}, Yan Li⁴⁷, Yuqing Zhang⁴⁸, Tazeen H Jafar^{49

50}, Nadia Khan⁵¹, Bryan Williams⁵², George Stergiou⁵³, Maciej Tomaszewski^{54

55}

Affiliations

¹ Health Innovation and Transformation Centre, Federation University Australia, Ballarat, Australia.
² Department of Physiology, University of Melbourne, Melbourne, Australia.
³ Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
⁴ Department of Food and Nutritional Sciences, University of Reading, Reading, UK.
⁵ Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang.
⁶ Department of Medical Sciences, School of Medical and Live Sciences, Sunway University, Bandar Sunway, Selangor, Malaysia.
⁷ Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA.
⁸ Hypertension Research Laboratory, School of Biological Sciences, Monash University.
⁹ Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne.
¹⁰ Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
¹¹ Department of Internal Medicine, Section Nephrology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Microcirculation, Amsterdam, The Netherlands.
¹² Department of Medicine, University of Melbourne, Austin Health, Melbourne, Australia.
¹³ Department of Hypertension, Almazov National Medical Research Centre, St Petersburg, Russia.
¹⁴ School of Nutritional Sciences and Wellness, University of Arizona, Tucson, USA.
¹⁵ Colorado Program for Musculoskeletal Research, Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, USA.
¹⁶ Department of Nutrition and Dietetics, Asha Kiran JHC Hospital, Chinchwad.
¹⁷ Hypertension and Nutrition, Core Group of IAPEN India, India.
¹⁸ Caring Futures Institute, Flinders University, Adelaide, Australia.
¹⁹ Unit of Hypertension, Hospital Español de Mendoza, School of Medicine, National University of Cuyo, IMBECU-CONICET, Mendoza, Argentina.
²⁰ Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia.
²¹ Department of Medicine, University of Ottawa and the Ottawa Hospital, Ottawa, Canada.
²² Graduate School of Public Health, St. Luke's International University, Tokyo, Japan.
²³ Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Selangor.
²⁴ Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
²⁵ Department of Medicine, Acharya Shri Chander College of Medical Sciences and Hospital, Jammu, India.
²⁶ School of Population Health, University of New South Wales, The George Institute for Global Health, Sydney, New South Wales, Australia.
²⁷ Hypertension in Africa Research Team, SAMRC Unit for Hypertension and Cardiovascular Disease, North-West University.
²⁸ SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.
²⁹ Department of Medical and Surgical Sciences, Faculty of Medicine, University of Bologna, Bologna, Italy.
³⁰ School of Medicine, Dentistry and Nursing-Dental School, University of Glasgow, UK.
³¹ Department of Periodontology, Prophylaxis and Oral Medicine; Jagiellonian University, Krakow, Poland.
³² Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
³³ Department of Internal Medicine (Nephrology, Endocrinology and Metabolism), Keio University, Tokyo.
³⁴ NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan.
³⁵ Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
³⁶ Libin Cardiovascular Institute, Department of Medicine, University of Calgary, Calgary, Canada.
³⁷ Kinesiology, Division of Science, The Pennsylvania State University, Reading, Pennsylvania.
³⁸ Department of Pharmacology and Experimental Therapeutics, The Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston.
³⁹ Division of Cardiology, Emory University, Atlanta, USA.
⁴⁰ Hypertension in Africa Research Team (HART), North-West University, Potchefstroom.
⁴¹ MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.
⁴² Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
⁴³ Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
⁴⁴ Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
⁴⁵ William Harvey Research Institute, Centre for Cardiovascular Medicine and Devices, NIHR Barts Biomedical Research Centre, BRC, Faculty of Medicine and Dentistry, Queen Mary University London.
⁴⁶ Barts BP Centre of Excellence, Barts Heart Centre, Barts Health NHS Trust, London, UK.
⁴⁷ Department of Cardiovascular Medicine, Shanghai Institute of Hypertension, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai.
⁴⁸ Department of Cardiology, Fu Wai Hospital, Chinese Academy of Medical Sciences, Chinese Hypertension League, Beijing, China.
⁴⁹ Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
⁵⁰ Duke Global Health Institute, Duke University, Durham, North Carolina, USA.
⁵¹ Department of Medicine, University of British Columbia, Vancouver, Canada.
⁵² University College London (UCL), Institute of Cardiovascular Science, National Institute for Health Research (NIHR), UCL Hospitals Biomedical Research Centre, London, UK.
⁵³ Hypertension Centre STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece.
⁵⁴ Division of Cardiovascular Sciences, Faculty of Medicine, Biology and Health, University of Manchester.
⁵⁵ Manchester Academic Health Science Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK.

PMID: 37712135
PMCID: PMC10713007
DOI: 10.1097/HJH.0000000000003563

Lifestyle management of hypertension: International Society of Hypertension position paper endorsed by the World Hypertension League and European Society of Hypertension

Fadi J Charchar et al. J Hypertens. 2024.

. 2024 Jan 1;42(1):23-49.

doi: 10.1097/HJH.0000000000003563. Epub 2023 Sep 12.

Authors

Affiliations

¹ Health Innovation and Transformation Centre, Federation University Australia, Ballarat, Australia.
² Department of Physiology, University of Melbourne, Melbourne, Australia.
³ Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
⁴ Department of Food and Nutritional Sciences, University of Reading, Reading, UK.
⁵ Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang.
⁶ Department of Medical Sciences, School of Medical and Live Sciences, Sunway University, Bandar Sunway, Selangor, Malaysia.
⁷ Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA.
⁸ Hypertension Research Laboratory, School of Biological Sciences, Monash University.
⁹ Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne.
¹⁰ Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
¹¹ Department of Internal Medicine, Section Nephrology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Microcirculation, Amsterdam, The Netherlands.
¹² Department of Medicine, University of Melbourne, Austin Health, Melbourne, Australia.
¹³ Department of Hypertension, Almazov National Medical Research Centre, St Petersburg, Russia.
¹⁴ School of Nutritional Sciences and Wellness, University of Arizona, Tucson, USA.
¹⁵ Colorado Program for Musculoskeletal Research, Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, USA.
¹⁶ Department of Nutrition and Dietetics, Asha Kiran JHC Hospital, Chinchwad.
¹⁷ Hypertension and Nutrition, Core Group of IAPEN India, India.
¹⁸ Caring Futures Institute, Flinders University, Adelaide, Australia.
¹⁹ Unit of Hypertension, Hospital Español de Mendoza, School of Medicine, National University of Cuyo, IMBECU-CONICET, Mendoza, Argentina.
²⁰ Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia.
²¹ Department of Medicine, University of Ottawa and the Ottawa Hospital, Ottawa, Canada.
²² Graduate School of Public Health, St. Luke's International University, Tokyo, Japan.
²³ Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Selangor.
²⁴ Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
²⁵ Department of Medicine, Acharya Shri Chander College of Medical Sciences and Hospital, Jammu, India.
²⁶ School of Population Health, University of New South Wales, The George Institute for Global Health, Sydney, New South Wales, Australia.
²⁷ Hypertension in Africa Research Team, SAMRC Unit for Hypertension and Cardiovascular Disease, North-West University.
²⁸ SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.
²⁹ Department of Medical and Surgical Sciences, Faculty of Medicine, University of Bologna, Bologna, Italy.
³⁰ School of Medicine, Dentistry and Nursing-Dental School, University of Glasgow, UK.
³¹ Department of Periodontology, Prophylaxis and Oral Medicine; Jagiellonian University, Krakow, Poland.
³² Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
³³ Department of Internal Medicine (Nephrology, Endocrinology and Metabolism), Keio University, Tokyo.
³⁴ NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan.
³⁵ Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
³⁶ Libin Cardiovascular Institute, Department of Medicine, University of Calgary, Calgary, Canada.
³⁷ Kinesiology, Division of Science, The Pennsylvania State University, Reading, Pennsylvania.
³⁸ Department of Pharmacology and Experimental Therapeutics, The Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston.
³⁹ Division of Cardiology, Emory University, Atlanta, USA.
⁴⁰ Hypertension in Africa Research Team (HART), North-West University, Potchefstroom.
⁴¹ MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.
⁴² Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
⁴³ Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
⁴⁴ Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
⁴⁵ William Harvey Research Institute, Centre for Cardiovascular Medicine and Devices, NIHR Barts Biomedical Research Centre, BRC, Faculty of Medicine and Dentistry, Queen Mary University London.
⁴⁶ Barts BP Centre of Excellence, Barts Heart Centre, Barts Health NHS Trust, London, UK.
⁴⁷ Department of Cardiovascular Medicine, Shanghai Institute of Hypertension, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai.
⁴⁸ Department of Cardiology, Fu Wai Hospital, Chinese Academy of Medical Sciences, Chinese Hypertension League, Beijing, China.
⁴⁹ Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
⁵⁰ Duke Global Health Institute, Duke University, Durham, North Carolina, USA.
⁵¹ Department of Medicine, University of British Columbia, Vancouver, Canada.
⁵² University College London (UCL), Institute of Cardiovascular Science, National Institute for Health Research (NIHR), UCL Hospitals Biomedical Research Centre, London, UK.
⁵³ Hypertension Centre STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece.
⁵⁴ Division of Cardiovascular Sciences, Faculty of Medicine, Biology and Health, University of Manchester.
⁵⁵ Manchester Academic Health Science Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK.

PMID: 37712135
PMCID: PMC10713007
DOI: 10.1097/HJH.0000000000003563

Abstract

Hypertension, defined as persistently elevated systolic blood pressure (SBP) >140 mmHg and/or diastolic blood pressure (DBP) at least 90 mmHg (International Society of Hypertension guidelines), affects over 1.5 billion people worldwide. Hypertension is associated with increased risk of cardiovascular disease (CVD) events (e.g. coronary heart disease, heart failure and stroke) and death. An international panel of experts convened by the International Society of Hypertension College of Experts compiled lifestyle management recommendations as first-line strategy to prevent and control hypertension in adulthood. We also recommend that lifestyle changes be continued even when blood pressure-lowering medications are prescribed. Specific recommendations based on literature evidence are summarized with advice to start these measures early in life, including maintaining a healthy body weight, increased levels of different types of physical activity, healthy eating and drinking, avoidance and cessation of smoking and alcohol use, management of stress and sleep levels. We also discuss the relevance of specific approaches including consumption of sodium, potassium, sugar, fibre, coffee, tea, intermittent fasting as well as integrated strategies to implement these recommendations using, for example, behaviour change-related technologies and digital tools.

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Conflict of interest statement

L.V. reports employment with Amsterdam University Medical Centers; consultancy agreements with AstraZeneca, Bayer BV Netherlands, Boehringer Ingelheim and Vifor Pharma; research funding from Dutch Kidney Foundation and Health Holland. Y.C.C. has received, on behalf of the Malaysian Society for World Action on Salt, Sugar and Health (MyWASSH), an unrestricted educational grant from Medtronic.

Figures

**FIGURE 1**
Lifestyle changes recommended in this position paper. In green are changes that should be encouraged, increased, and adhered to, for example, consumption of dietary fibre, improved sleep habits, increased exercise and adoption of mindfulness strategies. In red are changes to decrease or avoid, for example, smoking and alcohol use, sedentarism, consumption of refined sugars and salt and pollution exposure.

See this image and copyright information in PMC

References

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Lifestyle management of hypertension: International Society of Hypertension position paper endorsed by the World Hypertension League and European Society of Hypertension

Affiliations

Lifestyle management of hypertension: International Society of Hypertension position paper endorsed by the World Hypertension League and European Society of Hypertension

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

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Grants and funding

LinkOut - more resources

Full Text Sources

Medical