A systematic review and economic evaluation of exercise referral schemes in primary care: a short report. Health Technol Assess. Anokye NK, Lord J, Fox-Rushby J. Is brief advice in primary care a cost-effective way to promote physical activity? Br J Sports Med. Douglas F, Torrance N, van Teijlingen E, Meloni S, Kerr A.

a questionnaire survey. BMC Public Health. Morgan F, Battersby A, Weightman AL, Searchfield L, Turley R, Morgan H, Jagroo J, Ellis S. Adherence to exercise referral schemes by participants — what do providers and commissioners need to know? a systematic review of barriers and facilitators.

Booth HP, Prevost TA, Wright AJ, Gulliford MC. Effectiveness of behavioural weight loss interventions delivered in a primary care setting: a systematic review and meta-analysis.

Fam Pract. Parretti HM, Jebb SA, Johns DJ, Lewis AL, Christian-Brown AM, Aveyard P. Clinical effectiveness of very-low-energy diets in the management of weight loss: a systematic review and meta-analysis of randomized controlled trials.

Daumit GL, Janssen EM, Jerome GJ, Dalcin AT, Charleston J, Clark JM, Coughlin JW, Yeh HC, Miller ER, Durkin N, et al. Cost of behavioral weight loss programs implemented in clinical practice: the POWER trial at Johns Hopkins. Transl Behav Med.

Kent S, Aveyard P, Astbury N, Mihaylova B, Jebb SA. Is doctor referral to a low-energy total diet replacement program cost-effective for the routine treatment of obesity? Gupta H. Barriers to and facilitators of long term weight loss maintenance in adult UK people: a thematic analysis.

Int J Prev Med. PubMed PubMed Central Google Scholar. Dewhurst A, Peters S, Devereux-Fitzgerald A, Hart J. Patient Educ Couns. Tham M, Young D.

The role of the general practitioner in weight management in primary care—a cross sectional study in general practice. Park HE, Billups SJ, Schilling LM: Physician perceived barriers and solutions to DASH diet recommendations for hypertension prevention and management.

Dash S, Delibasic V, Alsaeed S, Ward M, Jefferson K, Manca DP, Arcand J. Knowledge, attitudes and behaviours related to physician-delivered dietary advice for patients with hypertension.

J Community Health. Trieu K, McMahon E, Santos JA, Bauman A, Jolly KA, Bolam B, Webster J. Review of behaviour change interventions to reduce population salt intake.

Int J Behav Nutr Phys Act. Hooper L, Bartlett C, Davey Smith G, Ebrahim S. Systematic review of long term effects of advice to reduce dietary salt in adults. Ferrara AL, Pacioni D, Di Fronzo V, Russo BF, Staiano L, Speranza E, Gente R, Gargiulo F, Ferrara F.

Lifestyle educational program strongly increases compliance to nonpharmacologic intervention in hypertensive patients: a 2-year follow-up study. J Clin Hypertens Greenwich. Lin PH, Yancy WS Jr, Pollak KI, Dolor RJ, Marcello J, Samsa GP, Batch BC, Svetkey LP.

The influence of a physician and patient intervention program on dietary intake. J Acad Nutr Diet. Yamasaki T, Sadanaga T, Hirota S. Effects of single-session dietary counseling by dieticians on salt reduction in cardiology outpatients who consumed large amounts of salt.

Exp Ther Med. Bhana N, Utter J, Eyles H. Knowledge, attitudes and behaviours related to dietary salt intake in high-income countries: a systematic review. Current Nutrition Reports.

Ireland DM, Clifton PM, Keogh JB. J Am Diet Assoc. htm ]. Liem DG, Miremadi F, Zandstra EH, Keast RSJ. Health labelling can influence taste perception and use of table salt for reduced-sodium products. Public Health Nutr. pdf ]. Cohn JN, Kowey PR, Whelton PK, Prisant LM.

New guidelines for potassium replacement in clinical practice: a contemporary review by the national council on potassium in clinical practice. Filippini T, Naska A, Kasdagli MI, Torres D, Lopes C, Carvalho C, Moreira P, Malavolti M, Orsini N, Whelton PK, et al.

Potassium intake and blood pressure: a dose-response meta-analysis of randomized controlled trials. Sidhu K, Sanjanwala R, Zieroth S.

Hyperkalemia in heart failure. Curr Opin Cardiol. Greer RC, Marklund M, Anderson CAM, Cobb LK, Dalcin AT, Henry M, Appel LJ. Potassium-enriched salt substitutes as a means to lower blood pressure. Neal B, Wu Y, Feng X, Zhang R, Zhang Y, Shi J, Zhang J, Tian M, Huang L, Li Z, et al.

Effect of salt substitution on cardiovascular events and death. Lamming L, Pears S, Mason D, Morton K, Bijker M, Sutton S, Hardeman W. What do we know about brief interventions for physical activity that could be delivered in primary care consultations?

a systematic review of reviews. Prev Med. Morgan F, Turley RL, Morgan HE, Searchfield L, Weightman AL, Elliot E, Murphy S: Exercise referral schemes to promote physical activity: NICE; Pavey TG, Taylor AH, Fox KR, Hillsdon M, Anokye N, Campbell JL, Foster C, Green C, Moxham T, Mutrie N et al: Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: systematic review and meta-analysis.

Bmj , nov04 2 :dd Lion A, Vuillemin A, Thornton JS, Theisen D, Stranges S, Ward M. Physical activity promotion in primary care: a Utopian quest? Health Promot Int. Eden KB, Orleans CT, Mulrow CD, Pender NJ, Teutsch SM.

Does counseling by clinicians improve physical activity? a summary of the evidence for the U. preventive services task force. Cochrane Database of Systematic Reviews 9.

Sousa Junior AE, Macêdo GAD, Schwade D, Sócrates J, Alves JW, Farias-Junior LF, Freire YA, Lemos T, Browne RAV, Costa EC. Physical activity counseling for adults with hypertension: a randomized controlled pilot trial. Int J Environ Res Public Health. Lin JS, O'Connor EA, Evans CV, Senger CA, Rowland MG, Groom HC: U.

Preventive Services Task Force Evidence Syntheses, formerly Systematic Evidence Reviews. In: Behavioral Counseling to Promote a Healthy Lifestyle for Cardiovascular Disease Prevention in Persons With Cardiovascular Risk Factors: An Updated Systematic Evidence Review for the US Preventive Services Task Force.

Rockville MD : Agency for Healthcare Research and Quality US ; Patrick K, Pratt M, Sallis RE: The Healthcare Sector's Role in the U. National Physical Activity Plan. Pool AC, Kraschnewski JL, Cover LA, Lehman EB, Stuckey HL, Hwang KO, Pollak KI, Sciamanna CN.

The impact of physician weight discussion on weight loss in US adults. Obes Res Clin Pract. Wadden TA, Volger S, Tsai AG, Sarwer DB, Berkowitz RI, Diewald LK, Carvajal R, Moran CH, Vetter M. Group P-UR: Managing obesity in primary care practice: an overview with perspective from the POWER-UP study.

Int J Obes Lond. Astbury NM, Aveyard P, Nickless A, Hood K, Corfield K, Lowe R, Jebb SA. Doctor referral of overweight people to low energy total diet replacement treatment DROPLET : pragmatic randomised controlled trial.

Tsai AG, Wadden TA. The evolution of very-low-calorie diets: an update and meta-analysis. Semlitsch T, Jeitler K, Berghold A, Horvath K, Posch N, Poggenburg S, Siebenhofer A. Long-term effects of weight-reducing diets in people with hypertension.

Gulsin GS, Swarbrick DJ, Athithan L, Brady EM, Henson J, Baldry E, Argyridou S, Jaicim NB, Squire G, Walters Y, et al. Effects of low-energy diet or exercise on cardiovascular function in working-age adults with type 2 Diabetes: a prospective, randomized, open-label.

Blinded End Point Trial Diabetes Care. Brown A, Leeds AR. Very low-energy and low-energy formula diets: effects on weight loss, obesity co-morbidities and type 2 diabetes remission — an update on the evidence for their use in clinical practice. Nutr Bull. Wadden TA, Butryn ML, Hong PS, Tsai AG.

Behavioral treatment of obesity in patients encountered in primary care settings: a systematic review. Gay HC, Rao SG, Vaccarino V, Ali MK.

Effects of different dietary interventions on blood pressure. Kolasa KM. Dietary approaches to stop hypertension DASH in clinical practice: a primary care experience.

Clin Cardiol. Blumenthal JA, Babyak MA, Hinderliter A, Watkins LL, Craighead L, Lin P-H, Caccia C, Johnson J, Waugh R, Sherwood A. Effects of the DASH diet alone and in combination with exercise and weight loss on blood pressure and cardiovascular biomarkers in men and women with high blood pressure: the ENCORE study.

Lin P-H, Appel LJ, Funk K, Craddick S, Chen C, Elmer P, McBurnie MA, Champagne C. The PREMIER intervention helps participants follow the dietary approaches to stop hypertension dietary pattern and the current dietary reference intakes recommendations.

Wong MCS, Wang HHX, Kwan MWM, Fong BCY, Chan WM, Zhang DX, Li STS, Yan BP, Coats AJS, Griffiths SM. Dietary counselling has no effect on cardiovascular risk factors among Chinese Grade 1 hypertensive patients: a randomized controlled trial.

Kim H, Andrade FCD. Diagnostic status of hypertension on the adherence to the dietary approaches to stop hypertension DASH diet.

Prev Med Rep. R Mahdavi Bagheri asl A, Abadi MAJ, Namazi N: Perceived Barriers to Following Dietary Recommendations in Hypertensive Patients J Am Coll Nutr 36 3 Conversano C, Orrù G, Pozza A, Miccoli M, Ciacchini R, Marchi L, Gemignani A.

Is mindfulness-based stress reduction effective for people with hypertension? a systematic review and meta-analysis of 30 years of evidence. Xie C, Cui L, Zhu J, Wang K, Sun N, Sun C. Coffee consumption and risk of hypertension: a systematic review and dose-response meta-analysis of cohort studies.

Mahdavi-Roshan M, Salari A, Ghorbani Z, Ashouri A. The effects of regular consumption of green or black tea beverage on blood pressure in those with elevated blood pressure or hypertension: a systematic review and meta-analysis. Complement Ther Med. Wolff M, Sundquist K, Lonn SL, Midlov P.

Impact of yoga on blood pressure and quality of life in patients with hypertension - a controlled trial in primary care, matched for systolic blood pressure. BMC Cardiovasc Disord. Wolff M, Rogers K, Erdal B, Chalmers JP, Sundquist K, Midlov P.

Impact of a short home-based yoga programme on blood pressure in patients with hypertension: a randomized controlled trial in primary care. Dhungana RR, Pedisic Z, Joshi S, Khanal MK, Kalauni OP, Shakya A, Bhurtel V, Panthi S, Ramesh Kumar KC, Ghimire B, et al. Effects of a health worker-led 3-month yoga intervention on blood pressure of hypertensive patients: a randomised controlled multicentre trial in the primary care setting.

Momeni J, Omidi A, Raygan F, Akbari H. J Am Soc Hypertens. Demarzo MMP, Montero-Marin J, Cuijpers P, Zabaleta-del-Olmo E, Mahtani KR, Vellinga A, Vicens C, López-del-Hoyo Y, García-Campayo J. The efficacy of mindfulness-based interventions in primary care: a meta-analytic review.

Ann Fam Med. PHR Santiago Valle Serra e Meira LR, Colussi CF: Feasibility evaluation of a mindfulness-based stress reduction program for primary care professionals in Brazilian national health system Complement Ther Clin Pract 35 8 Download references. Institute for Health and Sport, Victoria University, Melbourne, Australia.

Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia. You can also search for this author in PubMed Google Scholar. RRD and ZP conceptualised the study. RRD interpreted the findings and prepared the first draft. MdC and ZP interpreted the findings, revised the draft and contributed to writing the manuscript.

All authors read and approved the final manuscript. Correspondence to Raja Ram Dhungana. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Open Access This article is licensed under a Creative Commons Attribution 4. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

Reprints and permissions. Dhungana, R. Implementation of non-pharmacological interventions for the treatment of hypertension in primary care: a narrative review of effectiveness, cost-effectiveness, barriers, and facilitators.

BMC Prim. Care 23 , Download citation. Received : 05 April Accepted : 13 October Published : 24 November Anyone you share the following link with will be able to read this content:.

Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Abstract Background The current guidelines for the prevention, detection, evaluation, and management of hypertension recommend six types of non-pharmacological interventions: alcohol reduction, salt intake reduction, increased potassium intake, physical activity, weight loss, and heart-healthy diets.

Methods A thorough literature search was conducted in Embase, Google Scholar, and PubMed databases, to identify the most recent reviews or, in their absence, primary studies on alcohol reduction, salt intake reduction, potassium supplementation, physical activity, weight reduction, heart-healthy diets, and other non-pharmacological interventions for the treatment of hypertension in primary care.

Results Alcohol reduction is a non-pharmacological intervention for the treatment of hypertension in primary care with proven effectiveness, feasibility, and acceptability. Conclusions Available evidence suggests that more pragmatic, clinically feasible, and logistically simple interventions are required for sodium intake reduction, physical activity, and weight reduction in primary care settings.

Background There is a wealth of literature on alcohol intake, high salt intake, low potassium intake, physical inactivity, obesity, and unhealthy diet as key determinants of high blood pressure.

Methods A thorough literature search was conducted in Embase, Google Scholar, and PubMed databases. Alcohol reduction Brief alcohol interventions with the aim to reduce alcohol consumption have shown to be effective when delivered in the primary care setting [ 38 ]. Table 1 Summary of findings on non-pharmacological interventions for the treatment of hypertension in primary care Full size table.

Salt intake reduction Informational interventions and dietary counselling are the most common strategies applied to reduce salt intake in hypertensive patients [ 77 ]. Potassium intake The common potassium supplementation interventions in hypertensive individuals include increasing potassium intake from fruit and vegetables or using potassium supplements [ 19 , 62 ].

Physical activity Brief Intervention and exercise referral schemes are two common physical activity promoting approaches in primary care patients.

Weight reduction Behaviour change interventions and restrictive diet are commonly used with the aim to reduce weight of primary care patients. Heart-healthy diets Heart-healthy diets typically include the diets with high intake of fruits and vegetables, low fat intake, consumption of whole grains, and low sodium intake.

Other promising non-pharmacological interventions Emerging evidence suggests that other non-pharmacological interventions such as yoga, stress reduction, and healthy drinks could be beneficial for reducing blood pressure [ 27 , 30 , 34 ]. Conclusion Non-pharmacological interventions for the treatment of hypertension in primary care with proven effectiveness include alcohol reduction.

Availability of data and materials All data generated or analysed during this study are included in this article. References Roerecke M, Tobe SW, Kaczorowski J, Bacon SL, Vafaei A, Hasan OSM, Krishnan RJ, Raifu AO, Rehm J.

Article PubMed Google Scholar Kieneker LM, Gansevoort RT, Mukamal KJ, de Boer RA, Navis G, Bakker SJ, Joosten MM. Article CAS PubMed Google Scholar Al Tunaiji H, Davis JC, Mansournia MA, Khan KM. Article PubMed PubMed Central Google Scholar Jayedi A, Rashidy-Pour A, Khorshidi M, Shab-Bidar S.

Article CAS PubMed Google Scholar Schwingshackl L, Schwedhelm C, Hoffmann G, Knüppel S, Iqbal K, Andriolo V, Bechthold A, Schlesinger S, Boeing H. Article PubMed Google Scholar Jayedi A, Soltani S, Abdolshahi A, Shab-Bidar S. Article CAS PubMed Google Scholar Zhang Y, Zhang DZ.

Article CAS PubMed Google Scholar Xin X, He J, Frontini Maria G, Ogden Lorraine G, Motsamai Oaitse I, Whelton Paul K. Article CAS PubMed Google Scholar Roerecke M, Kaczorowski J, Tobe SW, Gmel G, Hasan OSM, Rehm J.

Article PubMed PubMed Central Google Scholar Midgley JP, Matthew AG, Greenwood CMT, Logan AG. Article CAS PubMed Google Scholar Cutler JA, Follmann D, Allender PS. Article Google Scholar Graudal NA, Galloe AM, Garred P.

Article CAS PubMed Google Scholar He F, MacGregor GA. Article CAS PubMed Google Scholar Graudal NA, Hubeck-Graudal T, Jurgens G: Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride.

Article PubMed Google Scholar Graudal NA, Hubeck-Graudal T, Jurgens G. PubMed Google Scholar World Health Organization: Effect of increased potassium intake on blood pressure, renal function, blood lipids and other potential adverse effects.

Article PubMed Google Scholar Cornelissen VA, Fagard RH. Article CAS PubMed Google Scholar Cornelissen VA, Fagard RH, Coeckelberghs E, Vanhees L. Article CAS PubMed Google Scholar Owen A, Wiles J, Swaine I. Article CAS PubMed Google Scholar Inder JD, Carlson DJ, Dieberg G, McFarlane JR, Hess NC, Smart NA.

Article PubMed Google Scholar Zeigler ZS, Mullane SL, Crespo NC, Buman MP, Gaesser GA. Article PubMed Google Scholar Zeigler ZS, Swan PD, Bhammar DM, Gaesser GA.

It's advice from our physicians delivered to you on your time. Sign up for the Health and Wellness Newsletter. Request an Appointment. Hand Foot and Mouth Disease The Truth About Wrinkles. About this Blog Get information on a variety of health conditions, disease prevention, and our services and programs.

Date Archives Year Author Archives Select Author Eileen K Carpenter, MD Manasija Rath, MD Nadia Hasan, DO Nitin Ahuja, MD, MS Paula S Barry, MD, MHA, FACP Robyn S Medina, DO. Share This Page: Post Tweet. Close myPennMedicine PENN Home For Patients and Visitors Close I Want To: How to Make an Appointment at Penn Medicine Find A Doctor Find a Location Access myPennMedicine Pay My Bill.

Penn Medicine Locations Hospitals Multispecialty Centers Practices Outpatient Labs. Patient Information Conditions Treated A-Z Wellness and Patient Support Getting A Second Opinion Clinical Trials Insurance and Billing Traffic and Parking Alerts Patient Access to Health Information.

Find a Program or Service. Close I Want To: Refer My Patient Find A Doctor Find a Location Request Medical Records. For Physicians All Physician Services Education and Resources Transfer a Patient Physician Career Opportunities. For Nurses and Advanced Practice Advanced Practice Providers Education and Professional Development Nursing Career Opportunities.

Many studies have linked high salt intake with high blood pressure and heart events, including stroke 5 , 6. However, other research indicates that the relationship between sodium and high blood pressure is less clear 7.

One reason for this may be genetic differences in how people process sodium. About half of people with high blood pressure and a quarter of people with typical levels seem to have a sensitivity to salt 8.

Swap processed foods for fresh ingredients and try seasoning with herbs and spices rather than salt. Bottom line: Most guidelines for lowering blood pressure recommend reducing sodium intake. However, that recommendation might make the most sense for people who are sensitive to the effects of salt.

Drinking alcohol can raise blood pressure and increase the risk of several chronic health conditions, including high blood pressure 9. While some research has suggested that low to moderate amounts of alcohol consumption may protect the heart, those benefits may be offset by negative effects In the United States, moderate alcohol consumption is defined as no more than one drink per day for females and two drinks per day for males.

If you drink more than that, it might be best to consider reducing your intake Bottom line: Drinking any amount of alcohol may raise your blood pressure. Potassium is an important mineral that helps your body get rid of sodium and eases pressure on your blood vessels To get a better balance of potassium and sodium in your diet, focus on eating fewer processed foods and more fresh, whole foods.

Foods that are particularly high in potassium include 14 :. Bottom line: Eating fresh fruits and vegetables, which are rich in potassium, can help lower blood pressure. In fact, people who drink caffeinated coffee or tea tend to have a lower risk of heart disease, including high blood pressure, than those who do not drink it Bottom line: Caffeine can cause a short-term spike in blood pressure.

However, for many people, it does not cause a lasting increase. Stress is a key driver of high blood pressure. On a physical level, that means a faster heart rate and constricted blood vessels When you experience stress, you might also be more likely to engage in habits that can have negative effects on blood pressure, such as drinking alcohol and eating processed foods Several studies have explored how reducing stress can help lower blood pressure.

Here are two evidence-based tips to try:. Bottom line: Chronic stress can contribute to high blood pressure.

Finding ways to manage stress can help. A review of studies found that flavonoid-rich cocoa may reduce short-term blood pressure levels in healthy adults For the strongest effects, use non-alkalized cocoa powder, which is especially high in flavonoids and has no added sugars.

Bottom line: Dark chocolate and cocoa powder contain plant compounds that help relax blood vessels, which may lower blood pressure. In people who are overweight, losing weight can make a big difference to heart health. The effect is even greater when weight loss is paired with exercise Losing weight can help your blood vessels do a better job of expanding and contracting, making it easier for the left ventricle of your heart to pump blood Bottom line: Losing weight can significantly lower high blood pressure.

This effect is even more pronounced when you exercise. Among the many reasons to quit smoking is that the habit is a strong risk factor for heart disease. Every puff of cigarette smoke causes a slight, temporary increase in blood pressure.

The chemicals in tobacco are also known to damage blood vessels. This could be because people who smoke regularly develop a tolerance over time Still, since both smoking and high blood pressure raise the risk of heart disease, quitting smoking can help lessen that risk A research review found that increased consumption of sugar-sweetened beverages was linked to higher blood pressure levels in children and adolescents Some studies have shown that low carb diets may also help reduce blood pressure.

In fact, one review of 12 studies showed that following a low carb diet could reduce systolic and diastolic blood pressure, along with several other risk factors for heart disease Bottom line: Consuming refined carbs, especially sugar, may raise blood pressure.

Some studies have shown that low carb diets may help lower your blood pressure levels. Polyphenols can reduce the risk of stroke, heart conditions, and diabetes and improve blood pressure, insulin resistance, and systemic inflammation In one study, researchers assigned people with high blood pressure to a low polyphenol diet or a high polyphenol diet containing berries, chocolate, fruits, and vegetables

The intervention group had a 2. A later study 12 assessed the impact on blood pressure of three levels of daily sodium intake: , , and 50 mEq per L 3. Results demonstrated a graded blood pressure response, with a correlation between greater reduction in blood pressure and lower sodium consumption.

The recommended sodium intake is less than mEq per L per day for all patients with hypertension or prehypertension. Aerobic exercise has positive effects on blood pressure whether or not a person has hypertension, producing average reductions of 4 mm Hg in systolic blood pressure and 3 mm Hg in diastolic blood pressure.

If a patient finds it difficult to make time to exercise, one suggestion might be a brisk walk at lunch, which helps break up the day and requires no additional time commitment.

Physicians also could suggest that patients listen to books on tape while walking, which may help to maintain interest level. It is recommended that patients with prehypertension or hypertension exercise for 30 minutes on most days of the week. Limiting alcohol consumption is an important lifestyle modification for reducing blood pressure.

One meta-analysis 14 indicated a dose-response relationship between decreased alcohol consumption and blood pressure reduction. Pooled results showed reductions of 3 mm Hg in systolic blood pressure and 2 mm Hg in diastolic blood pressure for patients in the alcohol reduction groups average reduction of 67 percent from an average intake of three to six drinks per day at baseline.

The DASH eating plan outlines a diet rich in fruits and vegetables; high in low-fat dairy products, potassium, magnesium, and calcium; and low in total saturated fats Table 1.

In the PREMIER clinical trial, 15 researchers assessed the impact on blood pressure of comprehensive lifestyle changes i. Participants in the lifestyle changes only group had a greater reduction in blood pressure than those in the usual care group, and this was further enhanced with the addition of the DASH eating plan.

This was the first trial to demonstrate that all recommended lifestyle changes can be combined to reduce blood pressure successfully. Potassium and sodium fluctuate antagonistically—a decrease in potassium leads to sodium retention, whereas an increase in potassium leads to sodium excretion, thereby promoting diuresis and natriuresis.

Weight loss is an important lifestyle modification in reducing blood pressure. A reduction of 10 lb can help reduce blood pressure or prevent hypertension.

Nicotine released while smoking cigarettes is believed to impact blood pressure through arousal of the sympathetic nervous system followed by the release of norepinephrine and epinephrine. Hypertension is a well-documented risk factor for cardiovascular disease and stroke. Studies have shown that men with high blood pressure who smoke have an increased risk of total, ischemic, and hemorrhagic stroke, and that this risk is related to the number of cigarettes smoked.

Vitamin C, omega-3 fatty acids, coenzyme Q10, and magnesium have been purported to reduce blood pressure. However, their use in management of hypertension is not recommended because of the lack of data from well-designed randomized controlled trials.

Meditation includes a variety of techniques, such as repetition of a word or phrase the mantra and careful attention to the process of breathing, to achieve a state of inner calm, detachment, and focus. Meditation was shown to reduce blood pressure in one well-designed study that addressed baseline blood pressure measurements adequately, 23 although other studies have been inconsistent.

Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. American Heart Association.

Heart disease and stroke statistics— update. Dallas, Tex. Fields LE, Burt V, Cutler JA, Hughes J, Roccella EJ, Sorlie P. The burden of adult hypertension in the United States to a rising tide. Hajjar I, Kotchen TA.

Trends in prevalence, awareness, treatment, and control of hypertension in the United States, — Berlowitz DR, Ash AS, Hickey EC, Friedman RH, Glickman M, Kader B, et al.

Inadequate management of blood pressure in a hypertensive population. N Engl J Med. Whelton PK, He J, Appel LJ, Cutler JA, Havas S, Kotchen TA, et al.

Primary prevention of hypertension: clinical and public health advisory from the National High Blood Pressure Education Program. He J, Whelton PK, Appel LJ, Charleston J, Klag MJ.

Long-term effects of weight loss and dietary sodium reduction on incidence of hypertension. Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, et al. A clinical trial of the effects of dietary patterns on blood pressure. Vollmer WM, Sacks FM, Ard J, Appel LJ, Bray GA, Simons-Morton DG, et al.

Effects of diet and sodium intake on blood pressure: subgroup analysis of the DASH-sodium trial. Ann Intern Med. National Heart, Lung, and Blood Institute. The DASH eating plan. Bethesda, Md. Department of Health and Human Services, Whelton PK, Appel LJ, Espeland MA, Applegate WB, Ettinger WH, Kostis JB, et al.

Sodium reduction and weight loss in the treatment of hypertension in older persons: a randomized controlled trial of non-pharmacologic interventions in the elderly TONE [published correction appears in JAMA ;]. Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension DASH diet.

Whelton SP, Chin A, Xin X, He J. Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Xin X, He J, Frontini MG, Ogden LG, Motsamai OI, Whelton PK. Effects of alcohol reduction on blood pressure: a meta-analysis of randomized controlled trials.

Appel LJ, Champagne CM, Harsha DW, Cooper LS, Obarzanek E, Elmer PJ, et al. Most people eat too much salt without realizing it. The American Heart Association estimates that the average American eats about 3, mg of sodium a day.

However, the recommended daily intake is 2, mg, with an ideal limit of less than 1, mg per day, especially for those with high blood pressure. Not only does potassium help regulate heart rate, it can also reduce the effects of sodium in the body.

The most effective way to increase your potassium intake is by adjusting your diet, as opposed to taking supplements. Potassium-rich foods include:. Also, if you have significant kidney disease, you should avoid consuming too much potassium, because your kidneys may not be able to eliminate it.

Some research shows that drinking alcohol in moderation can benefit your heart. However, too much alcohol consumed at one time can cause a sudden spike in your blood pressure. If you do drink, the American Heart Association recommends that men limit their alcohol consumption to two drinks per day and women limit their alcohol intake to one drink per day.

A drink is considered one 12 oz. beer, 4 oz. of wine, 1. of proof spirits or 1 oz. of proof spirits. We all have stress in our day-to-day lives—a flat tire in the middle of rush hour, a looming deadline at work—that can cause a temporary spike in blood pressure.

In most cases, once the stressful situation is resolved, your heart rate and blood pressure return to normal. However, chronic stress may put you at risk for a variety of long-term health issues, including high blood pressure, heart disease and stroke.

Stress can also increase your blood pressure levels if your coping mechanisms involve eating unhealthy food, drinking alcohol or smoking. Talk to your doctor for specific advice on how to lower your blood pressure. Get information on a variety of health conditions, disease prevention, and our services and programs.

It's advice from our physicians delivered to you on your time. Sign up for the Health and Wellness Newsletter.