Table 1 Comparison between three major lifestyle modifications in the hypertension guidelines
| Â | ESH/ESC Guideline 2018 [6] | ACC/AHA Guideline 2017 [7] | JSH Guideline 2014 [8] |
|---|---|---|---|
Dietary sodium restriction | Salt restriction to < 5 g/day | Optimal goal is < 1500 mg/day, but aim for at least a 1000 mg/day reduction in most adults. | The target of salt reduction is < 6 g/day. |
Other dietary changes | Increased consumption of vegetables, fresh fruits, fish, nuts, and unsaturated fatty acids (olive oil); low consumption of red meat; and consumption of low-fat dairy products | A heart-healthy diet, such as the DASH diet, that facilitates achieving a desirable weight is recommended for adults with elevated BP or hypertension. Potassium supplementation, preferably in dietary modification, is recommended for adults with elevated BP or hypertension, unless contraindicated by the presence of CKD or use of drugs that reduce potassium excretion. | Dietary pattern: fruit/vegetable intake should be increased, and cholesterol/saturated fatty acid intake should be reduced. Fish (fish oil) intake should also be increased. |
Weight reduction | Body-weight control is indicated to avoid obesity (BMI > 30 kg/m2 or waist circumference > 102 cm [men] and > 88 cm [women], as is aiming at healthy BMI (about 20–25 kg/m2) and waist circumference (< 94 cm [men] and < 80 cm [women]) | Weight loss is recommended to reduce BP in adults with elevated BP or hypertension who are overweight or obese. | The target body mass index is < 25 kg/m2. Even when the target is not reached, a significant decrease in blood pressure can be achieved by reducing body weight by approximately 4 kg. |
Regular physical activity | Regular aerobic exercise (e.g., at least 30 min of moderate dynamic exercise on 5–7 days/week) | Increased physical activity with a structured exercise program is recommended for adults with elevated BP or hypertension. | Primarily periodic (30 min or longer daily if possible) and aerobic exercise should be practiced. |
Smoking cessation | Smoking cessation, supportive care, and referral to smoking cessation programs | Quit cigarette smoking and second-hand smoking. | Smoking cessation should be promoted, and passive smoking must be avoided. |
Moderate alcohol consumption | Men: < 14 units/week Women: < 8 units/week Avoid binge drinking | Adult men and women with elevated BP or hypertension who currently consume alcohol should be advised to drink no more than 28 g/day and 24 g/day as ethanol, respectively. | Alcohol intake should be restricted. < 20–30 mL/day in men and < 10–20 mL/day in women as ethanol. |