Hypertension is a silent killer and if not regulated properly leads to various cardiovascular diseases and eventually death. Hypertension is a more prevalent chronic condition than diabetes and it is surprisingly more common even among young adults in India according to a nationally representative study of 1.3 Million individuals1.
The hypertension prevalence estimates were higher in younger Indians compared to those of Central and Eastern Europe. This unexpected high prevalence of hypertension in India which if ineffectively treated leads to higher rates of cardiovascular diseases in the future2.
There are many risk factors for the development of hypertension which are modifiable such as
- consumption of food containing too much salt and fat, and not eating enough fruit and vegetables
- harmful levels of alcohol use
- physical inactivity and lack of exercise
- poor stress management.
- being overweight or obese.
Non-modifiable risk factors include a family history of hypertension, age over 65 years, and co-existing diseases such as diabetes or kidney disease.
Lifestyle modifications have shown a significant impact on lowering blood pressure, thereby improving the effectiveness of antihypertensive drugs and reducing the risk of developing cardiovascular diseases3.
A healthy lifestyle for patients with hypertension includes eating healthy, being physically active, avoiding the harmful use of alcohol, quitting smoking, and managing stress. Apart from this, a balanced diet with low salt intake is highly recommended for hypertensive individuals4. In most countries, the average intake of salt per person is between 9 to 12 grams per day which is too high for a normal5.
WHO recommends that adults should consume less than 2 grams of sodium or 5 grams of salt per day6.
Severe hypertension can cause fatigue, nausea, vomiting, confusion, anxiety, chest pain, and muscle tremors whereas uncontrolled hypertension leads to complications such as
- Chest pain (also called angina)
- Heart attack, which occurs when the blood supply to the heart is blocked and heart muscle cells die due to lack of oxygen. The longer the blood flow is blocked, the greater the damage to the heart.
- Heart failure, which occurs when the heart cannot pump enough blood and oxygen to other vital body organs.
- An irregular heartbeat (can lead to sudden death).
Hypertension can also burst or block arteries that supply blood and oxygen to the brain, causing a stroke. Besides over a period of time hypertension can cause kidney damage, leading to kidney failure7.
Modest salt reduction leads to a decrease in blood pressure levels. A meta-analysis conducted by He and Mac Gregor assessed the effect of modest salt reduction on blood pressure reduction with a duration of more than 4 weeks. A total of 17 trials in hypertensive subjects and 11 trials in non-hypertensive subjects were done. After assessing the blood pressure it was found that in hypertensive subjects there was a decrease in systolic pressure by 5.0 mm Hg and diastolic pressure by 2.7 mm Hg. Whereas, in non-hypertensive subjects, the systolic blood pressure was decreased by 2.0 mm Hg and diastolic pressure decreased by 0.3 mm Hg8.
In a randomized controlled study conducted by Edgar et al 44 patients with hypertension and obesity were subjected to a low calorie, low sodium diet for 9 weeks and followed. The result was a decrease in mean body weight by 4.5kgs and an overall reduction in the blood pressure levels9.
The Dietary Approaches to Stop Hypertension (DASH) study evaluated the effects on blood pressure of three dietary patterns a control diet that was similar to a traditional American diet, a diet high in fruit and vegetables, the DASH diet, which was higher in fruits, vegetables, and low-fat dairy products and lower in total fat, saturated fat, and cholesterol. However, there was no change in sodium intake, physical activity, and body weight. After a review, it was found that both test diets lowered blood pressure compared to that of the control diet and the DASH diet reduced the systolic and diastolic pressure by 8 and 6 mm Hg respectively10.
In two randomized controlled trials conducted to evaluate the efficacy of multiple lifestyle modifications such as sodium reduction, weight loss, the DASH diet, and regular physical activity it was found that at the end of 9 weeks there is a net reduction in 24-hour ambulatory systolic and diastolic blood pressure by 9.5 and 5.3 mm Hg and changes in daytime systolic and diastolic blood pressure by 12.1 and 6.6 mm Hg, respectively11.
Normal ranges for blood pressure as per WHO12.
|Category||SYSTOLIC mm Hg||DIASTOLIC mm Hg|
|High Blood Pressure (Stage 1)||140-159||90-99|
|High Blood Pressure (Stage 2)||160-179||100-109|
|High Blood Pressure (Stage 3)||>180||>110|
Pascal Geldsetzer, MBChB; Jennifer Manne-Goehler, MD; Michaela Theilmann, BA; Justine I. Davies, MD;Ashish Awasthi, PhD; Sebastian Vollmer, PhD; LindsayM. Jaacks, PhD; Till Bärnighausen, MD; Rifat Atun, FRCP, Diabetes and Hypertension in India, JAMA Intern Med. 2018 Mar; 178(3): 363–372.
World Health Organization. Raised blood pressure (SBP140 OR DBP90), Age-Standardized (%)—Estimates by Country. Geneva, Switzerland: World Health Organization; Noncommunicable diseases: Risk factors 2017.
Whitworth JA, Chalmers J. World health organisation-international society of hypertension (WHO/ISH) hypertension guidelines 2004 Oct-Nov;26(7-8):747-752.
Non-communicable disease education manual for primary healthcare professionals and patients. Healthy lifestyles for patients with hypertension. Western Pacific Region World Health Organisation 2017
Reducing salt intake in populations - Report of a WHO Forum and Technical Meeting. Geneva, World Health Organization, 2007.
Sodium intake for adults and children
Hypertension Fact Sheet
He FJ, MacGregor GA: Effect of modest salt reduction on blood pressure: a meta-analysis of randomized trials: implications for public health.J Hum Hypertens 16:761 –770, 2002
Edgar R. Miller3rd, Thomas P. Erlinger, Deborah R. Young, Megan Jehn, Jeanne Charleston, Donna Rhodes, Sharmeel K. Wasan, and Lawrence J. Appell, Results of the Diet, Exercise, and Weight Loss Intervention Trial (DEW-IT) Oct 2002, Hypertension. 2002;40:612–618
Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetky LP, Sacks FM, Bray GA, Vogt TM, Cutler JA, Windhauser MM, Lin PH, Karanja N, The DASH Collaborative Research Group: A clinical trial of the effects of dietary pattern on blood pressure. N Engl J Med 336:1117–1124, 1997
Appel LJ, Champagne CM, Harsha DW, Cooper LS, Obarzanek E, Elmer PJ, Stevens VJ, Vollmer WM, Lin PH, Svetkey LP, Stedman SW, Young DR, Writing Group of the PREMIER Collaborative Research Group: Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. JAMA 289:2083–2093, 2003
Manisha Dubey, Sanjay Rastogi & Ashish Awasthi, WHO | Hypertension prevalence as a function of different guidelines, India 97(12), December 2019, 799-809