Non-pharmacological factors for hypertension management: a systematic review of international guidelines.
Study Goal
The researchers aimed to systematically review hypertension guidelines to assess recommendations on non-pharmacological factors, including salt intake, for hypertension prevention and treatment.
Results Summary
The guidelines consistently recommended reduced salt intake as part of lifestyle modifications for hypertension management, highlighting its importance in prevention and treatment. Some areas of disagreement were noted regarding other factors, but salt reduction was widely supported.
Population
General population and hypertensive patients.
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
reduced salt intake | decrease | hypertension prevention and treatment | hypertensive patients and general population | - | consistent in recommendations | #1 |
weight management | decrease | hypertension prevention and treatment | hypertensive patients and general population | - | consistent in recommendations | #2 |
dietary patterns | neutral | hypertension prevention and treatment | hypertensive patients and general population | - | consistent in recommendations | #3 |
increased physical activity | increase | hypertension prevention and treatment | hypertensive patients and general population | - | consistent in recommendations | #4 |
smoking cessation | decrease | hypertension prevention and treatment | hypertensive patients and general population | - | consistent in recommendations | #5 |
limiting alcohol intake | decrease | hypertension prevention and treatment | hypertensive patients and general population | - | consistent in recommendations | #6 |
stress management | neutral | hypertension prevention and treatment | - | - | areas of disagreement were identified | #7 |
air pollution reduction | neutral | hypertension prevention and treatment | - | - | areas of disagreement were identified | #8 |
alcohol intake thresholds | neutral | hypertension prevention and treatment | - | - | areas of disagreement were identified | #9 |
meat consumption | neutral | hypertension prevention and treatment | - | - | areas of disagreement were identified | #10 |
coffee consumption | neutral | hypertension prevention and treatment | - | - | areas of disagreement were identified | #11 |
tea consumption | neutral | hypertension prevention and treatment | - | - | areas of disagreement were identified | #12 |
refined sugars consumption | neutral | hypertension prevention and treatment | - | - | areas of disagreement were identified | #13 |
Lifestyle modifications are one of the cornerstones of hypertension prevention and treatment. We aimed to systematically review hypertension guidelines on their recommendations on non-pharmacological factors including lifestyle interventions, to highlight strength of evidence, similarities, and differences. This systematic review was registered with the international Prospective Register of Systematic Reviews (CRD42021288815). Publications in MEDLINE and EMBASE databases over 10 years since January 2010 to June 2020 were identified. We also included the search from websites of organizations responsible for guidelines development. Two reviewers screened the titles and abstracts to identify relevant guidelines. Two reviewers independently assessed rigour of guideline development using the AGREE II instrument, and one reviewer extracted recommendations. Of the identified guidelines, 10 showed good rigour of development (AGREE II ≥ 60%) and were included in the systematic review. The guidelines were consistent in most recommendations (reduced salt intake, weight, dietary patterns, increased physical activity and smoking cessation, and limiting alcohol intake). Some areas of disagreement were identified, regarding recommendations on novel psychological and environmental factors such as stress or air pollution, alcohol intake thresholds, meat, coffee and tea consumption and refined sugars. Current guidelines agree on the importance of lifestyle in the treatment and prevention of hypertension. Consensus on smoking cessation, limited salt intake, increased physical activity support their integration in management of hypertensive patients and in public health measurements in general population as preventative measurements. Further research into the role of environmental and psychological factors may help clarify future recommendations.