Non-pharmacological Treatment
Optimal blood pressure control is associated with an average 50% decrease in incident HF and thus underlying the importance of BP-lowering strategies to prevent HF. Non-pharmacological interventions are recognized as the cornerstone of hypertension preven
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Cornelia Bala
17.1 Introduction Hypertensive men have a twofold and hypertensive women have threefold higher risk of heart failure (HF) compared with their normotensive counterparts [1], and hypertension (HTN) plays an important role in the development of heart failure in subjects with and without a history of myocardial infarction [2]. It is well-demonstrated that optimal blood pressure (BP) control is associated with an average 50% decrease in incident HF [3] and thus underlying the importance of BP-lowering strategies to prevent HF. Non-pharmacological interventions were proven to be effective in lowering BP and are recommended by current guidelines either alone for prevention of HTN and in low-grade low-risk HTN or, more often, as a complement to drug therapy [4, 5]. The interventions with the best level of evidence for lowering BP are (1) weight loss in patients who are overweight or obese, (2) adherence to a healthy dietary pattern, (3) sodium reduction, (4) potassium supplementation, (5) increased physical activity level, and (6) moderation of alcohol consumption, but whether these interventions can prevent occurrence of HF in individuals with HTN is less clear. Other non-pharmacological interventions (e.g., protein or fiber intake, probiotics, calcium and magnesium supplementation, stress management, and behavioral therapies) and their role in BP control is still a matter of debate. Smoking, although not having demonstrated chronic effects on BP levels [6], is an important risk factor for cardiovascular disease, and quitting smoking should be recommended to all patients with hypertension.
C. Bala (*) Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania e-mail: [email protected] © Springer Nature Switzerland AG 2019 M. Dorobantu et al. (eds.), Hypertension and Heart Failure, Updates in Hypertension and Cardiovascular Protection, https://doi.org/10.1007/978-3-319-93320-7_17
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C. Bala
17.2 Weight Loss, BP Control, and Risk of HF Total and abdominal adiposity is shown to be correlated with risk of hypertension [7–9]. Numerous studies demonstrate that weight loss is associated with a decrease in BP values in both hypertensive and normotensive individuals. In a meta-analysis of 25 randomized controlled trials (RCTs) using as interventions energy restriction, increased physical activity, or both and having a mean duration of intervention of 66 weeks, it was shown that in the overall population, for each 1 kg of weight loss, a decrease of approximately 1 mmHg is obtained for systolic and diastolic BP [10]. The effect of weight loss on both systolic BP (SBP) and diastolic BP (DBP) was larger in subgroups treated with antihypertensive medication than in untreated populations (−7.00 mmHg vs. −3.77 mmHg and −5.49 mmHg vs. −2.97 mmHg, respectively). When subgroups with a baseline BP
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