13, 17 Some of the alternative approaches outlined in this document may in theory be more readily adopted and thus serve as practical adjuvants to help lower BP. First, adherence to dietary strategies has often been shown to be difficult to maintain. There are several reasons why these strategies are likely to become increasingly important and commonly used tools in the management of high BP. 9, 15, 16 For the purposes of this scientific statement, these therapies are called alternative approaches and are broadly classified into 3 categories: behavioral therapies, noninvasive procedures or devices, and exercise-based regimens. 12 Given the high prevalence of BP levels above optimal 13 and the 90% lifetime risk for developing hypertension among middle-aged adults with normal blood pressure, 14 these dietary recommendations apply not only to individuals with hypertension but also to individuals with prehypertension and to a large portion of the general populace.īeyond dietary strategies, certain additional nonpharmacological treatments may have the capacity to lower BP. 11 These strategies were later endorsed by the American Society of Hypertension. 7 – 10 In this regard, the American Heart Association (AHA) published a scientific statement in 2006 outlining these dietary approaches to treat and prevent hypertension. 4 – 6 Proven approaches promoted by the guidelines include weight loss, reduced sodium intake, adoption of a Dietary Approaches to Lower Hypertension–style eating pattern, aerobic exercise for 30 minutes on most days per week, and moderation of alcohol intake. 3Īn important component of the overall strategy to prevent the adverse health consequences of hypertension is the recommendation promulgated by formal guidelines for individuals to adopt lifestyle changes that reduce BP. 1, 2 Given the monotonic relationship between cardiovascular events and BP even down to optimal levels (115/75 mm Hg), the global hypertension-related public health burden is enormous. 1, 2 Half of all strokes and ischemic heart disease events are attributable to high blood pressure (BP). 1, 2 Moreover, its prevalence is projected to grow to affect >1.5 billion people by 2025. It ranks as the leading chronic risk factor for mortality, accounting for 13.5% of all deaths. Hypertension is one of the most common disorders, affecting ≈26.4% of the adult population worldwide. Finally, recommendations for future research priorities are outlined. A suggested management algorithm is provided, along with recommendations for prioritizing the use of the individual approaches in clinical practice based on their level of evidence for blood pressure lowering, risk-to-benefit ratio, potential ancillary health benefits, and practicality in a real-world setting. It is the consensus of the writing group that it is reasonable for all individuals with blood pressure levels >120/80 mm Hg to consider trials of alternative approaches as adjuvant methods to help lower blood pressure when clinically appropriate. Exercise-based regimens, including aerobic ( Class I, Level of Evidence A), dynamic resistance ( Class IIA, Level of Evidence B), and isometric handgrip ( Class IIB, Level of Evidence C) modalities, had relatively stronger supporting evidence. Between the noninvasive procedures and devices evaluated, device-guided breathing ( Class IIA, Level of Evidence B) had greater support than acupuncture ( Class III, Level of Evidence B). Among behavioral therapies, Transcendental Meditation ( Class IIB, Level of Evidence B), other meditation techniques ( Class III, Level of Evidence C), yoga ( Class III, Level of Evidence C), other relaxation therapies ( Class III, Level of Evidence B), and biofeedback approaches ( Class IIB, Level of Evidence B) generally had modest, mixed, or no consistent evidence demonstrating their efficacy. This American Heart Association scientific statement aims to summarize the blood pressure–lowering efficacy of several alternative approaches and to provide a class of recommendation for their implementation in clinical practice based on the available level of evidence from the published literature. However, these nondietary, nondrug treatments, collectively called alternative approaches, have generally undergone fewer and less rigorous trials. Over the past few decades, numerous additional modalities have been evaluated in regard to their potential blood pressure–lowering abilities. Many antihypertensive medications and lifestyle changes are proven to reduce blood pressure. Customer Service and Ordering Information.Stroke: Vascular and Interventional Neurology.Journal of the American Heart Association (JAHA).Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB).
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