Summary of Non-Pharmacological Interventions for Blood Pressure Management and Dietary Sodium Intake Assessment

Since the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) Blood Pressure (BP) Guideline, significant findings have emerged regarding hypertension's prevention, detection, and management. This review summarizes key observational studies, clinical trials, and meta-analyses from January 2018 to March 2021, addressing BP measurement, secondary hypertension evaluation, cardiovascular risk assessment, treatment thresholds, management strategies for various patient populations, and optimizing healthcare approaches. These insights aim to improve awareness and control of hypertension, which is vital for preventing cardiovascular disease and reducing mortality.

Various environmental factors influence BP, notably diet, physical activity, and alcohol consumption. Adjusting these factors can lead to significant changes in BP, with evidence supporting six key interventions: adopting a healthy diet, lowering sodium intake, losing weight, increasing potassium consumption, engaging in physical activity, and moderating or abstaining from alcohol. These strategies are effective for preventing and treating hypertension, enhancing the effects of antihypertensive medications, and reducing the number of medications needed for BP control. A recent meta-analysis highlighted the effectiveness of non-pharmacological strategies for hypertension prevention in low- and middle-income countries.

Fu et al. conducted a meta-analysis examining the effectiveness of 22 interventions for lowering BP in different adult groups, concluding that the Dietary Approaches to Stop Hypertension (DASH) diet was superior to usual care and other non-pharmacological methods. However, differences in study designs and methodologies complicate fair comparisons. The main challenge in accepting DASH's superiority lies in the fact that its trials were feeding studies, while most other interventions involved behavior change, which are more practical in real-world settings.

In a behavioral change trial, both the established interventions and the addition of the DASH diet effectively reduced BP compared to usual care, but the DASH diet did not significantly enhance outcomes when combined with other interventions. It may be more effective to consider a combination of non-pharmacological approaches, particularly for individuals with higher initial BP levels, tailoring recommendations based on specific lifestyle issues.

One of the most promising public health strategies is the gradual reduction of sodium in food processing and preparation. Collaborative efforts led by organizations like the World Health Organization aim for global sodium reduction. A recent study using advanced statistical methods demonstrated a clear dose-response relationship between sodium intake and BP, supporting lower sodium intake targets than currently recommended.

Additionally, another analysis identified a U-shaped relationship between potassium intake and BP, suggesting optimal benefits occur at specific potassium levels, particularly for those with hypertension and higher sodium intakes. It's also noted that using spot urine tests to estimate 24-hour sodium intake can be misleading, often providing inaccurate results. The World Hypertension League advocates for 24-hour urine collections as the most reliable method for assessing dietary sodium intake, yet spot urine estimates continue to be published in research despite their known inaccuracies.

Source:Carey RM, Wright JT Jr, Taler SJ, Whelton PK. Guideline-Driven Management of Hypertension: An Evidence-Based Update. Circ Res. 2021 Apr 2;128(7):827-846. doi: 10.1161/CIRCRESAHA.121.318083. Epub 2021 Apr 1. PMID: 33793326; PMCID: PMC8034801.