ABSTRACT
Lifestyle changes should be instituted, whenever appropriate, in all hypertensive patients, as well as in individuals with a BP 140/90 mmHg in whom there is a high or very high risk condition, because, under these circumstances, drug-induced BP reductions have been shown to be beneficial (10-13). This is because their implementation may lower BP, reduce the number and doses of the drugs that may have to be subsequently employed, and favorably affect total cardiovascular risk. The lifestyle measures that should be considered are (i) smoking cessation, (ii) weight reduction in overweight patients, (iii) moderation of alcohol consumption, (iv) physical activity, (v) reduction of salt intake, and (vi) increase in fruit and vegetable intake together with a reduction in saturated and total fat intake (9). It should, however not be forgotten that lifestyle measures have never been tested for their activity to prevent cardiovascular complications. Furthermore, their BP lowering effect is small and, for some measures, absent in the long-term, with a high between-patients variability in the response. Salt restriction, for example, lowers BP in a fraction of hypertensive patients, has no effect in
an additional fraction, and rarely causes a BP increase due to stimulation of the sympathetic and the renin-angiotensin systems (14). Finally, long-term compliance with lifestyle changes is extremely low (15). Thus, there should be no fideist approach to this strategy. On the contrary, when lifestyle changes represent the main therapeutic option, patients follow-up should be intensified to avoid their living without an adequate BP reduction, and be prepared to timely institute drug treatment when lack of BP control is detected.
