ABSTRACT
LIFESTYLE CHANGES Lifestyle changes should be considered whenever appropriate, that is, the abnormality in lifestyle may contribute to the BP elevation or oppose the effects of antihypertensive drugs or both (1,9). Candidates are not only patients with a BP ≥ 140/90 mmHg but also those in the high-normal BP range in whom lifestyle can reduce cardiovascular risk and delay or prevent future onset of hypertension (10). The lifestyle measures that should be considered have been known for many years, and they are (i) weight reduction in overweight or obese patients, (ii) moderation of excessive alcohol consumption, (iii) physical activity, (iv) moderation of an excessive salt intake, (v) increase in fruits and vegetables intake with a reduction in saturated and total fat, and (vi) smoking cessation. These measures can lower BP and reduce the number of doses of the drugs, which may have to be subsequently used, with favorable effects also of glucose and lipid metabolism that help in lowering the total cardiovascular risk. However, it should not be forgotten that the overall BP-lowering effect is small, the patient response is variable, and long-term adherence to healthy lifestyle recommendations is poor. This means that when this represents the main treatment option, follow-up should be intensified to timely add antihypertensive drugs if no clinically relevant BP reduction or BP control is detected. Adherence to lifestyle measures may be improved by dietary and other types of counseling offered by nurses or other specialized caregiver personnel (1).
