Lifestyle interventions for the prevention and treatment of hypertension

In this Review, Lucia and colleagues discuss the epidemiological evidence on the benefits of major lifestyle interventions in the prevention and adjuvant treatment of hypertension, including regular physical exercise, body weight management, healthy diet, adequate sleep patterns, circadian entrainment and stress management. The authors also describe the main physiological mechanisms underlying these benefits. Hypertension affects approximately one third of the world's adult population and is a major cause of premature death despite considerable advances in pharmacological treatments. Growing evidence supports the use of lifestyle interventions for the prevention and adjuvant treatment of hypertension. In this Review, we provide a summary of the epidemiological research supporting the preventive and antihypertensive effects of major lifestyle interventions (regular physical exercise, body weight management and healthy dietary patterns), as well as other less traditional recommendations such as stress management and the promotion of adequate sleep patterns coupled with circadian entrainment. We also discuss the physiological mechanisms underlying the beneficial effects of these lifestyle interventions on hypertension, which include not only the prevention of traditional risk factors (such as obesity and insulin resistance) and improvements in vascular health through an improved redox and inflammatory status, but also reduced sympathetic overactivation and non-traditional mechanisms such as increased secretion of myokines.