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Adherence to healthy lifestyle in hypertensive patients: ample room for improvement?

Journal of Human Hypertension volume 24, pages 559–560 (2010)Cite this article

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It is well established that dietary intake and other lifestyle factors have an important function in hypertension,1 both in the management of elevated blood pressure and to reduce overall cardiovascular risk. Current guidelines suggest that hypertensive patients should lose weight, restrict alcohol and salt intake, reduce smoking and incorporate regular physical activity into their lifestyle.2 Recent data from intervention trials based on Dietary Approaches to Stop Hypertension show that adopting multiple lifestyle changes may lead to even greater reductions in blood pressure and other cardiovascular risk factors.3, 4, 5

Despite the wealth of evidence regarding the benefits of a healthy lifestyle, the available data suggest that adherence to these recommendations among hypertensive patients is poor. For example, participants that reported hypertension from the English Longitudinal Study of Ageing had lower smoking rates but were more likely to report heavy alcohol intake and low physical activity levels compared with normotensives.6 In several other population studies, there were high rates of obesity, smoking, physical inactivity and poor dietary habits in participants reporting hypertension.7, 8 In the National Health and Nutrition Examination, only 19.4% of hypertensive participants adhered to Dietary Approaches to Stop Hypertension dietary guidelines.8 In this issue of the Journal of Human Hypertension, Scheltens et al.9 provide further cause for concern. Among 8779 well-characterized hypertensive participants from the European Investigation into Cancer and Nutrition cohort, those that were aware of their condition more often adhered to several dietary guidelines (including intake of fat, fibre and alcohol) compared with unaware hypertensives, although there were no differences in other important behaviours including smoking and physical activity. The proportion of aware and unaware hypertensives meeting guidelines for physical activity was 76.1 and 77.5%, respectively, and similarly the rates for non-smoking was 73.1 and 73.3%, respectively. On average, aware and unaware hypertensives met 5 and 4.8 target guidelines, respectively, out of a possible 10. The proportion of adults meeting guidelines for physical activity (30 min per day) in this study was at least encouraging. Nevertheless, these figures might be misleading as it is becoming apparent that adherence to physical activity recommendations according to self-reported activity is substantially overestimated when compared with objective assessments.10 Overall, the conclusions that can be drawn from Scheltens et al.9 are that knowledge of the presence of hypertension has little impact on behaviour change and there is much room for improvement in meeting the guidelines. Of course, all of the aforementioned studies have been cross-sectional, thus we do not yet have definitive evidence about how a diagnosis of hypertension effect changes in health behaviour.

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  1. Department of Epidemiology and Public Health, University College London, London, UK

    M Hamer

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Hamer, M. Adherence to healthy lifestyle in hypertensive patients: ample room for improvement?. J Hum Hypertens 24, 559–560 (2010). https://doi.org/10.1038/jhh.2010.61

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