I. Lifestyle Management
A Physical Exercise
1) For non-hypertensive individuals (to reduce the possibility of becoming hypertensive) or for hypertensive patients (to reduce their blood pressure) prescribe the accumulation of 30 to 60 minutes of moderate intensity dynamic exercise (such as walking, jogging, cycling or swimming) 4 -7 days per week in addition to the routine activities of daily living (Grade D). Higher intensities of exercise are no more effective (Grade D).
B Weight Reduction
1) Height, weight, and waist circumference (WC) should be measured and body mass index (BMI) calculated for all adults (Grade D).
2) Maintenance of a healthy body weight (BMI 18.5 to 24.9 kg/m² and waist circumference of less than 102 cm for men and less than 88 cm for women; waist circumference less than 90 cm for South Asian men and less than 80 cm for South Asian women) is recommended for non-hypertensive individuals to prevent hypertension (Grade C) and for hypertensive patients to reduce blood pressure (Grade B). All overweight hypertensive individuals should be advised to lose weight (Grade B).
3) Weight loss strategies should employ a multidisciplinary approach that includes dietary education, increased physical activity and behavioral intervention (Grade B).
C Alcohol Consumption
1) To reduce blood pressure, alcohol consumption should be in accordance with Canadian low-risk drinking guidelines in both normotensive and hypertensive individuals. Healthy adults should limit alcohol consumption to 2 drinks or less per day, and consumption should not exceed 14 standard drinks per week for men and 9 standard drinks per week for women (Grade B).
(Note: one standard drink is considered 13.6 g or 17.2 ml of ethanol, or approximately 44mL of 80 proof (40%) spirits, 355 mL beer or 148 mL of 12% wine.)
D Dietary Recommendations
1) It is recommended that hypertensive patients and normotensive individuals at increased risk of developing hypertension consume a diet that emphasizes fruits, vegetables and low-fat dairy products, dietary and soluble fiber, whole grains and protein from plant sources and that is reduced in saturated fat and cholesterol (Dietary Approaches to Stop Hypertension [DASH] diet) see Table 1 (Grade B).
E Salt Intake
1) For prevention of hypertension, in addition to a well balanced diet, a dietary sodium intake of less than 100 mmol (2,300 mg) per day is recommended (Grade B).
2) In hypertensive patients, dietary sodium intake should be limited to 65 mmol to 100 mmol (1495 mg to 2300 mg) per day (Grade B).
F Potassium, Calcium and Magnesium Intake
1) Supplementation of potassium, calcium and magnesium is not recommended for the prevention or treatment of hypertension (Grade B).
G Stress management
1) In hypertensive patients in whom stress may be contributing to blood pressure elevation, stress management should be considered as an intervention (Grade D). Individualized cognitive behavioral interventions are more likely to be effective when relaxation techniques are employed (Grade B).