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.
Strong evidence supports the benefits of regular physical activity and exercise for the prevention and management of hypertension.
Reducing body weight to normal in individuals with overweight or obesity reduces the risk of hypertension, but further evidence is needed on the long-term efficacy of this strategy.
Sodium intake restriction reduces blood pressure, particularly in patients with hypertension, and the Dietary Approaches to Stop Hypertension (DASH) diet is the most effective dietary approach to prevent hypertension and to reduce blood pressure in individuals with pre-hypertension or hypertension.
Shift work, short sleep duration or poor sleep and other forms of circadian disruption might increase the risk of hypertension.
Some forms of psychological stress, such as post-traumatic stress disorder, seem to be associated with a higher risk of hypertension, but strong evidence on the potential antihypertensive benefits of stress management techniques is lacking.
In contrast to common antihypertensive medications, lifestyle interventions, especially exercise, reduce blood pressure through multisystemic and ‘non-traditional’ mechanisms (for example, not only by improving vascular health or reducing sympathetic overactivation).
Subscribe to Journal
Get full journal access for 1 year
only $4.92 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Tax calculation will be finalised during checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
Benjamin, E. J. et al. Heart disease and stroke statistics–2018 update: a report from the American Heart Association. Circulation 137, E67–E492 (2018).
Virani, S. S. et al. Heart disease and stroke statistics–2020 update: a report from the American Heart Association. Circulation 141, E139–E596 (2020).
Frieden, T. R. & Jaffe, M. G. Saving 100 million lives by improving global treatment of hypertension and reducing cardiovascular disease risk factors. J. Clin. Hypertens. 20, 208–211 (2018).
Whelton, P. K. et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 71, e13–e115 (2018).
Williams, B. et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur. Heart J. 39, 3021–3104 (2018).
Pazoki, R. et al. Genetic predisposition to high blood pressure and lifestyle factors: associations with midlife blood pressure levels and cardiovascular events. Circulation 137, 653–661 (2018).
Raichlen, D. A. et al. Physical activity patterns and biomarkers of cardiovascular disease risk in hunter-gatherers. Am. J. Hum. Biol. 29, e22919 (2017).
Kaplan, H. et al. Coronary atherosclerosis in indigenous South American Tsimane: a cross-sectional cohort study. Lancet 389, 1730–1739 (2017).
Lindeberg, S., Nilsson‐Ehle, P., Terént, A., Vessby, B. & Schertén, B. Cardiovascular risk factors in a Melanesian population apparently free from stroke and ischaemic heart disease: the Kitava study. J. Intern. Med. 236, 331–340 (1994).
Hollenberg, N. K. et al. Aging, acculturation, salt intake, and hypertension in the Kuna of Panama. Hypertension 29, 171–176 (1997).
Mueller, N. T., Noya-Alarcon, O., Contreras, M., Appel, L. J. & Dominguez-Bello, M. G. Association of age with blood pressure across the lifespan in isolated Yanomami and Yekwana villages. JAMA Cardiol. 3, 1247–1249 (2018).
Cornelissen, V. A., Buys, R. & Smart, N. A. Endurance exercise beneficially affects ambulatory blood pressure: a systematic review and meta-analysis. J. Hypertens. 31, 639–648 (2013).
Dimeo, F. et al. Aerobic exercise reduces blood pressure in resistant hypertension. Hypertension 60, 653–658 (2012).
Filippou, C. D. et al. Dietary Approaches to Stop Hypertension (DASH) diet and blood pressure reduction in adults with and without hypertension: a systematic review and meta-analysis of randomized controlled trials. Adv. Nutr. 11, 1150–1160 (2020).
He, F. J., Tan, M., Ma, Y. & MacGregor, G. A. Salt reduction to prevent hypertension and cardiovascular disease: JACC state-of-the-art review. J. Am. Coll. Cardiol. 75, 632–647 (2020).
Appel, L. J. et al. Effects of reduced sodium intake on hypertension control in older individuals: results from the trial of nonpharmacologic interventions in the elderly (TONE). Arch. Intern. Med. 161, 685–693 (2001).
Neter, J. E., Stam, B. E., Kok, F. J., Grobbee, D. E. & Geleijnse, J. M. Influence of weight reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension 42, 878–884 (2003).
Pescatello, L. S. et al. Assessing the existing professional exercise recommendations for hypertension: a review and recommendations for future research priorities. Mayo Clin. Proc. 90, 801–812 (2015).
Pescatello, L. S. et al. Physical activity to prevent and treat hypertension: a systematic review. Med. Sci. Sports Exerc. 51, 1314–1323 (2019).
Liu, X. et al. Dose-response association between physical activity and incident hypertension: a systematic review and meta-analysis of cohort studies. Hypertension 69, 813–820 (2017).
Naci, H. et al. How does exercise treatment compare with antihypertensive medications? A network meta-analysis of 391 randomised controlled trials assessing exercise and medication effects on systolic blood pressure. Br. J. Sports Med. 53, 859–869 (2019).
Valenzuela, P., Ruilope, L. & Lucia, A. Muscling in on resistant hypertension. Circulation 141, 240–242 (2020).
Diaz, K. M. et al. Healthy lifestyle factors and risk of cardiovascular events and mortality in treatment-resistant hypertension: the reasons for geographic and racial differences in stroke study. Hypertension 64, 465–471 (2014).
Ozemek, C., Tiwari, S. C., Sabbahi, A., Carbone, S. & Lavie, C. J. Impact of therapeutic lifestyle changes in resistant hypertension. Prog. Cardiovasc. Dis. 63, 4–9 (2019).
Guimaraes, G. V. et al. Heated water-based exercise training reduces 24-hour ambulatory blood pressure levels in resistant hypertensive patients: a randomized controlled trial (HEx trial). Int. J. Cardiol. 172, 434–441 (2014).
Davenport, M. H. et al. Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: a systematic review and meta-analysis. Br. J. Sports Med. 52, 1367–1375 (2018).
Magro-Malosso, E. R., Saccone, G., Di Tommaso, M., Roman, A. & Berghella, V. Exercise during pregnancy and risk of gestational hypertensive disorders: a systematic review and meta-analysis. Acta Obstet. Gynecol. Scand. 96, 921–931 (2017).
MacDonald, H. V. et al. Dynamic resistance training as stand-alone antihypertensive lifestyle therapy: a meta-analysis. J. Am. Heart Assoc. 5, e003231 (2016).
Corso, L. M. L. et al. Is concurrent training efficacious antihypertensive therapy? A meta-analysis. Med. Sci. Sports Exerc. 48, 2398–2406 (2016).
Smart, N. A. et al. Effects of isometric resistance training on resting blood pressure. J. Hypertens. 37, 1927–1938 (2019).
Jin, Y. Z., Yan, S. & Yuan, W. X. Effect of isometric handgrip training on resting blood pressure in adults: a meta-analysis of randomized controlled trials. J. Sports Med. Phys. Fit. 57, 154–160 (2017).
Boutcher, Y. N. & Boutcher, S. H. Exercise intensity and hypertension: what’s new? J. Hum. Hypertens. 31, 157–164 (2017).
Mirzababaei, A., Mozaffari, H., Shab-Bidar, S., Milajerdi, A. & Djafarian, K. Risk of hypertension among different metabolic phenotypes: a systematic review and meta-analysis of prospective cohort studies. J. Hum. Hypertens. 33, 365–377 (2019).
Hall, J. E., do Carmo, J. M., da Silva, A. A., Wang, Z. & Hall, M. E. Obesity, kidney dysfunction and hypertension: mechanistic links. Nat. Rev. Nephrol. 15, 367–385 (2019).
Kotchen, T. A. Obesity-related hypertension: epidemiology, pathophysiology, and clinical management. Am. J. Hypertens. 23, 1170–1178 (2010).
Greenfield, J. et al. Modulation of blood pressure by central melanocortinegic pathways. N. Engl. J. Med. 360, 44–52 (2009).
Vissers, D. et al. The effect of exercise on visceral adipose tissue in overweight adults: a systematic review and meta-analysis. PLoS ONE 8, e56415 (2013).
Verheggen, R. J. H. M. et al. A systematic review and meta-analysis on the effects of exercise training versus hypocaloric diet: distinct effects on body weight and visceral adipose tissue. Obes. Rev. 17, 664–690 (2016).
Verboven, K. et al. Abdominal subcutaneous and visceral adipocyte size, lipolysis and inflammation relate to insulin resistance in male obese humans. Sci. Rep. 8, 4677 (2018).
Schlecht, I., Fischer, B., Behrens, G. & Leitzmann, M. F. Relations of visceral and abdominal subcutaneous adipose tissue, body mass index, and waist circumference to serum concentrations of parameters of chronic inflammation. Obes. Facts 9, 144–157 (2016).
Alvehus, M., Burén, J., Sjöström, M., Goedecke, J. & Olsson, T. The human visceral fat depot has a unique inflammatory profile. Obesity 18, 879–883 (2010).
da Silva, A. A. et al. Role of hyperinsulinemia and insulin resistance in hypertension: metabolic syndrome revisited. Can. J. Cardiol. 36, 671–682 (2020).
Sasaki, N., Ozono, R., Higashi, Y., Maeda, R. & Kihara, Y. Association of insulin resistance, plasma glucose level, and serum insulin level with hypertension in a population with different stages of impaired glucose metabolism. J. Am. Heart Assoc. 9, e015546 (2020).
Arshi, B. et al. Sex-specific relations between fasting insulin, insulin resistance and incident hypertension: 8.9 years follow-up in a Middle-Eastern population. J. Hum. Hypertens. 29, 260–267 (2015).
Mbanya, J., Thomas, T., Wilkinson, R., Alberti, K. & Taylor, R. Hypertension and hyperinsulinaemia: a relation in diabetes but not essential hypertension. Lancet 1, 733–734 (1988).
Swift, D. L., Houmard, J. A., Slentz, C. A. & Kraus, W. E. Effects of aerobic training with and without weight loss on insulin sensitivity and lipids. PLoS ONE 13, e0196637 (2018).
Zhang, X. et al. Effect of lifestyle interventions on glucose regulation among adults without impaired glucose tolerance or diabetes: a systematic review and meta-analysis. Diabetes Res. Clin. Pract. 123, 149–164 (2017).
Umpierre, D. et al. Physical activity advice only or structured with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA 305, 1790–1799 (2011).
Azushima, K., Morisawa, N., Tamura, K. & Nishiyama, A. Recent research advances in renin-angiotensin-aldosterone system receptors. Curr. Hypertens. Rep. 22, 22 (2020).
Povlsen, A. L., Grimm, D., Wehland, M., Infanger, M. & Krüger, M. The vasoactive Mas receptor in essential hypertension. J. Clin. Med. 9, 267 (2020).
Goessler, K., Polito, M. & Cornelissen, V. A. Effect of exercise training on the renin-angiotensin-aldosterone system in healthy individuals: a systematic review and meta-analysis. Hypertens. Res. 39, 119–126 (2016).
Bleakley, C., Hamilton, P. K., Pumb, R., Harbinson, M. & Mcveigh, G. E. Endothelial function in hypertension: victim or culprit? J. Clin. Hypertens. 17, 651–654 (2015).
Sabbahi, A., Arena, R., Elokda, A. & Phillips, S. A. Exercise and hypertension: uncovering the mechanisms of vascular control. Prog. Cardiovasc. Dis. 59, 226–234 (2016).
Renna, N. F., De Las Heras, N. & Miatello, R. M. Pathophysiology of vascular remodeling in hypertension. Int. J. Hypertens. 2013, 808353 (2013).
Green, D. J., Hopman, M. T. E., Padilla, J., Laughlin, M. H. & Thijssen, D. H. J. Vascular adaptation to exercise in humans: role of hemodynamic stimuli. Physiol. Rev. 97, 495–528 (2017).
Palatini, P., Puato, M., Rattazzi, M. & Pauletto, P. Effect of regular physical activity on carotid intima-media thickness. Results from a 6-year prospective study in the early stage of hypertension. Blood Press. 20, 37–44 (2011).
Watson, T., Goon, P. K. Y. & Lip, G. Y. H. Endothelial progenitor cells, endothelial dysfunction, inflammation, and oxidative stress in hypertension. Antioxid. Redox Signal. 10, 1079–1088 (2008).
Brandes, R. P. Recent advances in hypertension: endothelial dysfunction and hypertension. Hypertension 64, 924–928 (2014).
Taddei, S. et al. Vasoconstriction to endogenous endothelin-1 is increased in the peripheral circulation of patients with essential hypertension. Circulation 100, 1680–1683 (1999).
Guzik, T. J. & Touyz, R. M. Oxidative stress, inflammation, and vascular aging in hypertension. Hypertension 70, 660–667 (2017).
Taddei, S., Virdis, A., Ghiadoni, L., Magagna, A. & Salvetti, A. Vitamin C improves endothelium-dependent vasodilation by restoring nitric oxide activity in essential hypertension. Circulation 97, 2222–2229 (1998).
Schulz, E., Anter, E. & Keaney, J. F. Jr. Oxidative stress, antioxidants, and endothelial function. Curr. Med. Chem. 11, 1093–1104 (2004).
Ashor, A. W., Lara, J., Siervo, M., Celis-Morales, C. & Mathers, J. C. Effects of exercise modalities on arterial stiffness and wave reflection: a systematic review and meta-analysis of randomized controlled trials. PLoS ONE 9, e110034 (2014).
Ashor, A. W. et al. Exercise modalities and endothelial function: a systematic review and dose–response meta-analysis of randomized controlled trials. Sport. Med. 45, 279–296 (2015).
Pedralli, M. L. et al. Different exercise training modalities produce similar endothelial function improvements in individuals with prehypertension or hypertension: a randomized clinical trial. Sci. Rep. 10, 7628 (2020).
Vamvakis, A. et al. Impact of intensive lifestyle treatment (diet plus exercise) on endothelial and vascular function, arterial stiffness and blood pressure in stage 1 hypertension: results of the HINTreat randomized controlled trial. Nutrients 12, 1326 (2020).
Pedralli, M. L. et al. Effects of exercise training on endothelial function in individuals with hypertension: a systematic review with meta-analysis. J. Am. Soc. Hypertens. 12, e65–e75 (2018).
de Mello, V. D. F. et al. Effect of weight loss on cytokine messenger RNA expression in peripheral blood mononuclear cells of obese subjects with the metabolic syndrome. Metabolism 57, 192–199 (2008).
Hambrecht, R. et al. Regular physical activity improves endothelial function in patients with coronary artery disease by increasing phosphorylation of endothelial nitric oxide synthase. Circulation 107, 3152–3158 (2003).
Agarwal, D. et al. Role of proinflammatory cytokines and redox homeostasis in exercise-induced delayed progression of hypertension in spontaneously hypertensive rats. Hypertension 54, 1393–1400 (2009).
Francescomarino, S. D. I., Sciartilli, A., Valerio, V. D. I., Baldassarre, A. D. I. & Gallina, S. The effect of physical exercise on endothelial function. Sport. Med. 39, 797–812 (2009).
de Sousa, C. V. et al. The antioxidant effect of exercise: a systematic review and meta-analysis. Sport. Med. 47, 277–293 (2017).
Dantas, F. F. O. et al. Effect of strength training on oxidative stress and the correlation of the same with forearm vasodilatation and blood pressure of hypertensive elderly women: a randomized clinical trial. PLoS ONE 11, e0161178 (2016).
Calvillo, L., Gironacci, M. M., Crotti, L., Meroni, P. L. & Parati, G. Neuroimmune crosstalk in the pathophysiology of hypertension. Nat. Rev. Cardiol. 16, 476–490 (2019).
Jayedi, A. et al. Inflammation markers and risk of developing hypertension: a meta-analysis of cohort studies. Heart 105, 686–692 (2019).
Chamarthi, B. et al. Inflammation and hypertension: the interplay of interleukin-6, dietary sodium, and the renin-angiotensin system in humans. Am. J. Hypertens. 24, 1143–1148 (2011).
Bartoloni, E., Alunno, A. & Gerli, R. Hypertension as a cardiovascular risk factor in autoimmune rheumatic diseases. Nat. Rev. Cardiol. 15, 33–44 (2018).
Furman, D. et al. Chronic inflammation in the etiology of disease across the life span. Nat. Med. 25, 1822–1832 (2019).
Fedewa, M. V., Hathaway, E. D. & Ward-Ritacco, C. L. Effect of exercise training on C reactive protein: a systematic review and meta-analysis of randomised and non-randomised controlled trials. Br. J. Sports Med. 51, 670–676 (2017).
Fiuza-Luces, C. et al. Exercise benefits in cardiovascular disease: beyond attenuating traditional risk factors. Nat. Rev. Cardiol. 15, 731–743 (2018).
Starkie, R., Ostrowski, S. R., Jauffred, S., Febbraio, M. & Pedersen, B. K. Exercise and IL-6 infusion inhibit endotoxin-induced TNF-α production in humans. FASEB J. 17, 884–886 (2003).
Steensberg, A., Fischer, C. P., Keller, C., Møller, K. & Pedersen, B. K. IL-6 enhances plasma IL-1ra, IL-10, and cortisol in humans. Am. J. Physiol. Endocrinol. Metab. 285, E433–E437 (2003).
Fu, J. et al. Irisin lowers blood pressure by improvement of endothelial dysfunction via AMPK-Akt-eNOS-NO pathway in the spontaneously hypertensive rat. J. Am. Heart Assoc. 5, e003433 (2016).
Zhang, W. et al. Central and peripheral irisin differentially regulate blood pressure. Cardiovasc. Drugs Ther. 29, 121–127 (2015).
Zhang, L. J., Xie, Q., Tang, C. S. & Zhang, A. H. Expressions of irisin and urotensin II and their relationships with blood pressure in patients with preeclampsia. Clin. Exp. Hypertens. 39, 460–467 (2017).
Ebert, T. et al. Serum levels of the myokine irisin in relation to metabolic and renal function. Eur. J. Endocrinol. 170, 501–506 (2014).
Chen, K., Zhou, M., Wang, X., Li, S. & Yang, D. The role of myokines and adipokines in hypertension and hypertension-related complications. Hypertens. Res. 42, 1544–1551 (2019).
Yan, B. et al. Association of serum irisin with metabolic syndrome in obese Chinese adults. PLoS ONE 9, e94235 (2014).
Fiuza-Luces, C., Garatachea, N., Berger, N. A. & Lucia, A. Exercise is the real polypill. Physiology 28, 330–358 (2013).
Rostás, I. et al. In middle-aged and old obese patients, training intervention reduces leptin level: a meta-analysis. PLoS ONE 12, e0182801 (2017).
He, Z. et al. Myokine/adipokine response to “aerobic” exercise: is it just a matter of exercise load? Front. Physiol. 10, 691 (2019).
Ruiz-Casado, A. et al. Exercise and the hallmarks of cancer. Trends Cancer 3, 423–441 (2017).
De Souza Batista, C. M. et al. Omentin plasma levels and gene expression are decreased in obesity. Diabetes 56, 1655–1661 (2007).
Adeghate, E. An update on the biology and physiology of resistin. Cell. Mol. Life Sci. 61, 2485–2496 (2004).
Fisher, J. P. & Paton, J. F. R. The sympathetic nervous system and blood pressure in humans: implications for hypertension. J. Hum. Hypertens. 26, 463–475 (2012).
Paton, J. F. R. et al. The carotid body as a therapeutic target for the treatment of sympathetically mediated diseases. Hypertension 61, 5–13 (2013).
Besnier, F. et al. Exercise training-induced modification in autonomic nervous system: an update for cardiac patients. Ann. Phys. Rehabil. Med. 60, 27–35 (2017).
Deley, G., Picard, G. & Taylor, J. Arterial baroreflex control of cardiac vagal outflow in older individuals can be enhanced by aerobic exercise training. Hypertension 53, 826–832 (2009).
Laterza, M. C. et al. Exercise training restores baroreflex sensitivity in never-treated hypertensive patients. Hypertension 49, 1298–1306 (2007).
Poorolajal, J., Hooshmand, E., Bahrami, M. & Ameri, P. How much excess weight loss can reduce the risk of hypertension? J. Public Heal. 39, e95–e102 (2017).
Sabaka, P. et al. The effects of body weight loss and gain on arterial hypertension control: an observational prospective study. Eur. J. Med. Res. 22, 43 (2017).
Semlitsch, T. et al. Long-term effects of weight-reducing diets in people with hypertension. Cochrane Database Syst. Rev. 3, CD008274 (2016).
Chandra, A. et al. The relationship of body mass and fat distribution with incident hypertension: observations from the Dallas Heart Study. J. Am. Coll. Cardiol. 64, 997–1002 (2014).
Hall, J. E., Do Carmo, J. M., Da Silva, A. A., Wang, Z. & Hall, M. E. Obesity-induced hypertension: interaction of neurohumoral and renal mechanisms. Circ. Res. 116, 991–1006 (2015).
Zhang, M., Hu, T., Zhang, S. & Zhou, L. Associations of different adipose tissue depots with insulin resistance: a systematic review and meta-analysis of observational studies. Sci. Rep. 5, 18495 (2015).
Schneider, R., Golzman, B., Turkot, S., Kogan, J. & Oren, S. Effect of weight loss on blood pressure, arterial compliance, and insulin resistance in normotensive obese subjects. Am. J. Med. Sci. 330, 157–160 (2005).
Abd El-Kader, S. M. & Al-Jiffri, O. H. Impact of weight reduction on insulin resistance, adhesive molecules and adipokines dysregulation among obese type 2 diabetic patients. Afr. Health Sci. 18, 873–883 (2018).
Capel, F. et al. Macrophages and adipocytes in human obesity. Diabetes 58, 1558–1567 (2009).
De Mello, V. D. F. et al. Downregulation of genes involved in NFκB activation in peripheral blood mononuclear cells after weight loss is associated with the improvement of insulin sensitivity in individuals with the metabolic syndrome: The GENOBIN study. Diabetologia 51, 2060–2067 (2008).
Ho, J. T. et al. Moderate weight loss reduces renin and aldosterone but does not influence basal or stimulated pituitary-adrenal axis function. Horm. Metab. Res. 39, 694–699 (2007).
Engeli, S. et al. Weight loss and the renin-angiotensin-aldosterone system. Hypertension 45, 356–362 (2005).
Ghanim, H. et al. Decreases in neprilysin and vasoconstrictors and increases in vasodilators following bariatric surgery. Diabetes Obes. Metab. 20, 2029–2033 (2018).
Ne, J. Y. A. et al. Obesity, arterial function and arterial structure – a systematic review and meta-analysis. Obes. Sci. Pract. 3, 171–184 (2017).
Joris, P. J., Zeegers, M. P. & Mensink, R. P. Weight loss improves fasting flow-mediated vasodilation in adults: a meta-analysis of intervention studies. Atherosclerosis 239, 21–30 (2015).
Himbert, C., Thompson, H. & Ulrich, C. M. Effects of intentional weight loss on markers of oxidative stress, DNA repair and telomere length – a systematic review. Obes. Facts 10, 648–665 (2018).
Pérez, L. M. et al. ‘Adipaging’: ageing and obesity share biological hallmarks related to a dysfunctional adipose tissue. J. Physiol. 594, 3187–3207 (2016).
Aguirre, L. et al. Increasing adiposity is associated with higher adipokine levels and lower bone mineral density in obese older adults. J. Clin. Endocrinol. Metab. 99, 3290–3297 (2014).
Graßmann, S., Wirsching, J., Eichelmann, F. & Aleksandrova, K. Association between peripheral adipokines and inflammation markers: a systematic review and meta-analysis. Obesity 25, 1776–1785 (2017).
Nosalski, R. & Guzik, T. J. Perivascular adipose tissue inflammation in vascular disease. Br. J. Pharmacol. 174, 3496–3513 (2017).
Clément, K. et al. Weight loss regulates inflammation-related genes in white adipose tissue of obese subjects. FASEB J. 18, 1657–1669 (2004).
Bianchi, V. E. Weight loss is a critical factor to reduce inflammation. Clin. Nutr. ESPEN 28, 21–35 (2018).
Xydakis, A. M. et al. Adiponectin, inflammation, and the expression of the metabolic syndrome in obese individuals: the impact of rapid weight lose through caloric restriction. J. Clin. Endocrinol. Metab. 89, 2697–2703 (2004).
Ellsworth, D. L. et al. Importance of substantial weight loss for altering gene expression during cardiovascular lifestyle modification. Obesity 23, 1312–1319 (2015).
Fenske, W. K. et al. Effect of bariatric surgery-induced weight loss on renal and systemic inflammation and blood pressure: a 12-month prospective study. Surg. Obes. Relat. Dis. 9, 559–568 (2013).
Bussey, C. E., Withers, S. B., Aldous, R. G., Edwards, G. & Heagerty, A. M. Obesity-related perivascular adipose tissue damage is reversed by sustained weight loss in the rat. Arterioscler. Thromb. Vasc. Biol. 36, 1377–1385 (2016).
Lambert, E. A. et al. Obesity-associated organ damage and sympathetic nervous activity. Hypertension 73, 1150–1159 (2019).
Wofford, M. R. et al. Antihypertensive effect of α- and β-adrenergic blockade in obese and lean hypertensive subjects. Am. J. Hypertens. 14, 694–698 (2001).
Shariq, O. A. & Mckenzie, T. J. Obesity-related hypertension: a review of pathophysiology, management, and the role of metabolic surgery. Gland. Surg. 9, 80–93 (2020).
Grassi, G. et al. Effect of central and peripheral body fat distribution on sympathetic and baroreflex function in obese normotensives. J. Hypertens. 22, 2363–2369 (2004).
Khan, S. A. et al. Obesity depresses baroreflex control of renal sympathetic nerve activity and heart rate in Sprague Dawley rats: role of the renal innervation. Acta Physiol. 214, 390–401 (2015).
Lohmeier, T. E. et al. Chronic interactions between carotid baroreceptors and chemoreceptors in obesity hypertension. Hypertension 68, 227–235 (2016).
Pedrosa, R. P. et al. Obstructive sleep apnea: the most common secondary cause of hypertension associated with resistant hypertension. Hypertension 58, 811–817 (2011).
Dewan, N. A., Nieto, F. J. & Somers, V. K. Intermittent hypoxemia and OSA: implications for comorbidities. Chest 147, 266–274 (2015).
Straznicky, N. E. et al. Comparable attenuation of sympathetic nervous system activity in obese subjects with normal glucose tolerance, impaired glucose tolerance, and treatment naïve type 2 diabetes following equivalent weight loss. Front. Physiol. 7, 516 (2016).
Flores, L. et al. Longitudinal changes of blood pressure after weight loss: factors involved. Surg. Obes. Relat. Dis. 11, 215–221 (2015).
Straznicky, N. E. et al. Sympathetic neural adaptation to hypocaloric diet with or without exercise training in obese metabolic syndrome subjects. Diabetes 59, 71–79 (2010).
Costa, J., Moreira, A., Moreira, P., Delgado, L. & Silva, D. Effects of weight changes in the autonomic nervous system: a systematic review and meta-analysis. Clin. Nutr. 38, 110–126 (2019).
Huang, L. et al. Effect of dose and duration of reduction in dietary sodium on blood pressure levels: systematic review and meta-analysis of randomised trials. BMJ 368, m315 (2020).
Graudal, N., Hubeck-Graudal, T., Jürgens, G. & Taylor, R. S. Dose-response relation between dietary sodium and blood pressure: a meta-regression analysis of 133 randomized controlled trials. Am. J. Clin. Nutr. 109, 1273–1278 (2019).
Graudal, N. A., Hubeck-Graudal, T. & Jurgens, G. Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride. Cochrane Database Syst. Rev. 11, CD004022 (2017).
Graudal, N., Jürgens, G., Baslund, B. & Alderman, M. H. Compared with usual sodium intake, low- and excessive-sodium diets are associated with increased mortality: a meta-analysis. Am. J. Hypertens. 27, 1129–1137 (2014).
Zhu, Y. et al. Association of sodium intake and major cardiovascular outcomes: a dose-response meta-analysis of prospective cohort studies. BMC Cardiovasc. Disord. 18, 192 (2018).
Cook, N. R., Appel, L. J. & Whelton, P. K. Sodium intake and all-cause mortality over 20 years in the trials of hypertension prevention. J. Am. Coll. Cardiol. 68, 1609–1617 (2016).
He, F. J. & MacGregor, G. A. Role of salt intake in prevention of cardiovascular disease: controversies and challenges. Nat. Rev. Cardiol. 15, 371–377 (2018).
Graudal, N. & Jürgens, G. Conflicting evidence on health effects associated with salt reduction calls for a redesign of the salt dietary guidelines. Prog. Cardiovasc. Dis. 61, 20–26 (2018).
Cordain, L. et al. Origins and evolution of the Western diet: health implications for the 21st century. Am. J. Clin. Nutr. 81, 341–354 (2005).
Turck, D. et al. Dietary reference values for potassium. EFSA J. 14, e04592 (2016).
World Health Organization. Potassium intake for adults and children (WHO, 2012).
National Academies of Sciences, Engineering, and Medicine. Dietary reference intakes for sodium and potassium (National Academies Press, 2019).
Binia, A., Jaeger, J., Hu, Y., Singh, A. & Zimmermann, D. Daily potassium intake and sodium-to-potassium ratio in the reduction of blood pressure: a meta-analysis of randomized controlled trials. J. Hypertens. 33, 1509–1520 (2015).
Aburto, N. J. et al. Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses. BMJ 346, f1378 (2013).
Bernabe-Ortiz, A. et al. Effect of salt substitution on community-wide blood pressure and hypertension incidence. Nat. Med. 26, 374–378 (2020).
World Health Organization. Guideline: sodium intake for adults and children (WHO, 2012).
Appel, L. J. et al. A clinical trial of the effects of dietary patterns on blood pressure. N. Engl. J. Med. 336, 1117–1124 (1997).
Appel, L. J. et al. Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. JAMA 289, 2083–2093 (2003).
Blumenthal, J. A. et al. Effects of the DASH diet alone and in combination with exercise and weight loss on blood pressure and cardiovascular biomarkers in men and women with high blood pressure: the ENCORE study. Arch. Intern. Med. 170, 126–135 (2010).
Ozemek, C., Laddu, D. R., Arena, R. & Lavie, C. J. The role of diet for prevention and management of hypertension. Curr. Opin. Cardiol. 33, 388–393 (2018).
Hinderliter, A. L. et al. The long-term effects of lifestyle change on blood pressure: one-year follow-up of the ENCORE study. Am. J. Hypertens. 27, 734–741 (2014).
De Pergola, G. & D’Alessandro, A. Influence of Mediterranean diet on blood pressure. Nutrients 10, 1700 (2018).
Núñez-Córdoba, J. M., Valencia-Serrano, F., Toledo, E., Alonso, A. & Martínez-González, M. A. The Mediterranean diet and incidence of hypertension: the Seguimiento Universidad de Navarra (SUN) study. Am. J. Epidemiol. 169, 339–346 (2009).
Estruch, R. et al. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann. Intern. Med. 145, 1–11 (2006).
Toledo, E. et al. Effect of the Mediterranean diet on blood pressure in the PREDIMED trial: results from a randomized controlled trial. BMC Med. 11, 207 (2013).
Davis, C. R. et al. A Mediterranean diet lowers blood pressure and improves endothelial function: results from the MedLey randomized intervention trial. Am. J. Clin. Nutr. 105, 1305–1313 (2017).
Jennings, A. et al. Mediterranean-style diet improves systolic blood pressure and arterial stiffness in older adults: results of a 1-year European multi-center trial. Hypertension 73, 578–586 (2019).
Lopez, P. D., Cativo, E. H., Atlas, S. A. & Rosendorff, C. The effect of vegan diets on blood pressure in adults: a meta-analysis of randomized controlled trials. Am. J. Med. 132, 875–883.e7 (2019).
Ge, L. et al. Comparison of dietary macronutrient patterns of 14 popular named dietary programmes for weight and cardiovascular risk factor reduction in adults: systematic review and network meta-analysis of randomised trials. BMJ 369, m696 (2020).
Gay, H. C., Rao, S. G., Vaccarino, V. & Ali, M. K. Effects of different dietary interventions on blood pressure: systematic review and meta-analysis of randomized controlled trials. Hypertension 67, 733–739 (2016).
Schwingshackl, L. et al. Comparative effects of different dietary approaches on blood pressure in hypertensive and pre-hypertensive patients: a systematic review and network meta-analysis. Crit. Rev. Food Sci. Nutr. 59, 2674–2687 (2019).
Schwingshackl, L. et al. Food groups and risk of hypertension: a systematic review and dose-response meta-analysis of prospective studies. Adv. Nutr. An. Int. Rev. J. 8, 793–803 (2017).
Zhang, Y. & Zhang, D. Z. Red meat, poultry, and egg consumption with the risk of hypertension: a meta-analysis of prospective cohort studies. J. Hum. Hypertens. 32, 507–517 (2018).
Wang, M. X., Wong, C. H. & Kim, J. E. Impact of whole egg intake on blood pressure, lipids and lipoproteins in middle-aged and older population: a systematic review and meta-analysis of randomized controlled trials. Nutr. Metab. Cardiovasc. Dis. 29, 653–664 (2019).
Jovanovski, E. et al. Effect of high-carbohydrate or high-monounsaturated fatty acid diets on blood pressure: a systematic review and meta-analysis of randomized controlled trials. Nutr. Rev. 77, 19–31 (2019).
Te Morenga, L. A., Howatson, A. J., Jones, R. M. & Mann, J. Dietary sugars and cardiometabolic risk: systematic review and meta-analyses of randomized controlled trials of the effects on blood pressure and lipids. Am. J. Clin. Nutr. 100, 65–79 (2014).
Komnenov, D., Levanovich, P. E. & Rossi, N. F. Hypertension associated with fructose and high salt: renal and sympathetic mechanisms. Nutrients 11, 569 (2019).
Griep, L. M. O. et al. Association of raw fruit and fruit juice consumption with blood pressure: the INTERMAP study. Am. J. Clin. Nutr. 97, 1083–1091 (2013).
Jayalath, V. H. et al. Total fructose intake and risk of hypertension: a systematic review and meta-analysis of prospective cohorts. J. Am. Coll. Nutr. 33, 328–339 (2014).
Ha, V. et al. Effect of fructose on blood pressure: a systematic review and meta-analysis of controlled feeding trials. Hypertension 59, 787–795 (2012).
Kim, Y. & Je, Y. Prospective association of sugar-sweetened and artificially sweetened beverage intake with risk of hypertension. Arch. Cardiovasc. Dis. 109, 242–253 (2016).
Chen, L. et al. Reducing consumption of sugar-sweetened beverages is associated with reduced blood pressure: a prospective study among United States adults. Circulation 121, 2398–2406 (2010).
Roerecke, M. et al. Sex-specific associations between alcohol consumption and incidence of hypertension: a systematic review and meta-analysis of cohort studies. J. Am. Heart Assoc. 7, e008202 (2018).
Wood, A. M. et al. Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies. Lancet 391, 1513–1523 (2018).
Roerecke, M. et al. The effect of a reduction in alcohol consumption on blood pressure: a systematic review and meta-analysis. Lancet Public Health 2, e108–e120 (2017).
Hall, K. D. et al. Ultra-processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake. Cell Metab. 30, 67–77.e3 (2019).
Samocha-Bonet, D. et al. Overfeeding reduces insulin sensitivity and increases oxidative stress, without altering markers of mitochondrial content and function in humans. PLoS ONE 7, e36320 (2012).
Tam, C. S. et al. Short-term overfeeding may induce peripheral insulin resistance without altering subcutaneous adipose tissue macrophages in humans. Diabetes 59, 2164–2170 (2010).
Martínez Steele, E., Popkin, B. M., Swinburn, B. & Monteiro, C. A. The share of ultra-processed foods and the overall nutritional quality of diets in the US: evidence from a nationally representative cross-sectional study. Popul. Health Metr. 15, 6 (2017).
Dibaba, D. T., Xun, P., Fly, A. D., Yokota, K. & He, K. Dietary magnesium intake and risk of metabolic syndrome: a meta-analysis. Diabet. Med. 31, 1301–1309 (2014).
Veronese, N. et al. Effect of magnesium supplementation on glucose metabolism in people with or at risk of diabetes: a systematic review and meta-analysis of double-blind randomized controlled trials. Eur. J. Clin. Nutr. 70, 1354–1359 (2016).
Simental-Mendía, L. E., Sahebkar, A., Rodríguez-Morán, M. & Guerrero-Romero, F. A systematic review and meta-analysis of randomized controlled trials on the effects of magnesium supplementation on insulin sensitivity and glucose control. Pharmacol. Res. 111, 272–282 (2016).
Zhang, X. et al. Effects of magnesium supplementation on blood pressure: a meta-analysis of randomized double-blind placebo-controlled trials. Hypertension 68, 324–333 (2016).
Asbaghi, O. et al. The effects of magnesium supplementation on blood pressure and obesity measure among type 2 diabetes patient: a systematic review and meta-analysis of randomized controlled trials. Biol. Trace Elem. Res. https://doi.org/10.1007/s12011-020-02157-0 (2020).
Uribarri, J. et al. Advanced glycation end products in foods and a practical guide to their reduction in the diet. J. Am. Diet. Assoc. 110, 911–916.e12 (2010).
Sergi, D., Boulestin, H., Campbell, F. M. & Williams, L. M. The role of dietary advanced glycation end products in metabolic dysfunction. Mol. Nutr. Food Res. https://doi.org/10.1002/mnfr.201900934 (2020).
De Courten, B. et al. Diet low in advanced glycation end products increases insulin sensitivity in healthy overweight individuals: a double-blind, randomized, crossover trial. Am. J. Clin. Nutr. 103, 1426–1433 (2016).
Baye, E., Kiriakova, V., Uribarri, J., Moran, L. J. & De Courten, B. Consumption of diets with low advanced glycation end products improves cardiometabolic parameters: meta-analysis of randomised controlled trials. Sci. Rep. 7, 43–51 (2017).
Zhang, Y. et al. Eplerenone restores 24-h blood pressure circadian rhythm and reduces advanced glycation end-products in rhesus macaques with spontaneous hypertensive metabolic syndrome. Sci. Rep. 6, 23957 (2016).
He, F. J., Markandu, N. D. & MacGregor, G. A. Importance of the renin system for determining blood pressure fall with acute salt restriction in hypertensive and normotensive whites. Hypertension 38, 321–325 (2001).
He, F. J., Li, J. & MacGregor, G. A. Effect of longer term modest salt reduction on blood pressure: Cochrane systematic review and meta-analysis of randomised trials. BMJ 346, f1325 (2013).
MacGregor, G. A. et al. Moderate sodium restriction with angiotensin converting enzyme inhibitor in essential hypertension: a double blind study. BMJ 294, 531–534 (1987).
Maris, S. et al. Interactions of the DASH diet with the renin-angiotensin-aldosterone system. Curr. Dev. Nutr. 3, nzz091 (2019).
Ibsen, H. et al. The influence of chronic high alcohol intake on blood pressure, plasma noradrenaline concentration and plasma renin concentration. Clin. Sci. 61, 377–379 (1981).
Puddey, I. B., Vandongen, R., Beilin, L. J. & Rouse, I. L. Alcohol stimulation of renin release in man: its relation to the hemodynamic, electrolyte, and sympatho-adrenal responses to drinking. J. Clin. Endocrinol. Metab. 61, 37–42 (1985).
Terker, A. S. et al. Potassium modulates electrolyte balance and blood pressure through effects on distal cell voltage and chloride. Cell Metab. 21, 39–50 (2015).
Nomura, N., Shoda, W. & Uchida, S. Clinical importance of potassium intake and molecular mechanism of potassium regulation. Clin. Exp. Nephrol. 23, 1175–1180 (2019).
Tzemos, N., Lim, P. O., Wong, S., Struthers, A. D. & MacDonald, T. M. Adverse cardiovascular effects of acute salt loading in young normotensive individuals. Hypertension 51, 1525–1530 (2008).
DuPont, J. J. et al. High dietary sodium intake impairs endothelium-dependent dilation in healthy salt-resistant humans. J. Hypertens. 31, 530–536 (2013).
Greaney, J. L. et al. Dietary sodium loading impairs microvascular function independent of blood pressure in humans: role of oxidative stress. J. Physiol. 590, 5519–5528 (2012).
Clarke, R. E., Dordevic, A. L., Tan, S. M., Ryan, L. & Coughlan, M. T. Dietary advanced glycation end products and risk factors for chronic disease: a systematic review of randomised controlled trials. Nutrients 8, 125 (2016).
Mozaffarian, D., Aro, A. & Willett, W. C. Health effects of trans-fatty acids: experimental and observational evidence. Eur. J. Clin. Nutr. 63, S5–S21 (2009).
Kellow, N. J. & Savige, G. S. Dietary advanced glycation end-product restriction for the attenuation of insulin resistance, oxidative stress and endothelial dysfunction: a systematic review. Eur. J. Clin. Nutr. 67, 239–248 (2013).
Jackson, J. K., Patterson, A. J., MacDonald-Wicks, L. K., Oldmeadow, C. & McEvoy, M. A. The role of inorganic nitrate and nitrite in cardiovascular disease risk factors: a systematic review and meta-analysis of human evidence. Nutr. Rev. 76, 348–371 (2018).
Blekkenhorst, L. C. et al. Nitrate, the oral microbiome, and cardiovascular health: a systematic literature review of human and animal studies. Am. J. Clin. Nutr. 107, 504–522 (2018).
Senkus, K. E. & Crowe-White, K. M. Influence of mouth rinse use on the enterosalivary pathway and blood pressure regulation: a systematic review. Crit. Rev. Food Sci. Nutr. https://doi.org/10.1080/10408398.2019.1665495 (2019).
Marques, B. C. A. A. et al. Effects of oral magnesium supplementation on vascular function: a systematic review and meta-analysis of randomized controlled trials. High. Blood Press. Cardiovasc. Prev. 27, 19–28 (2020).
Zehr, K. R. & Walker, M. K. Omega-3 polyunsaturated fatty acids improve endothelial function in humans at risk for atherosclerosis: a review. Prostaglandins Other Lipid Mediat. 134, 131–140 (2018).
Schwingshackl, L., Christoph, M. & Hoffmann, G. Effects of olive oil on markers of inflammation and endothelial function—a systematic review and meta-analysis. Nutrients 7, 7651–7675 (2015).
Yubero-Serrano, E. M., Lopez-Moreno, J., Gomez-Delgado, F. & Lopez-Miranda, J. Extra virgin olive oil: more than a healthy fat. Eur. J. Clin. Nutr. 72 (Suppl. l), 8–17 (2019).
Moreno-Luna, R. et al. Olive oil polyphenols decrease blood pressure and improve endothelial function in young women with mild hypertension. Am. J. Hypertens. 25, 1299–1304 (2012).
Sun, Y., Zimmermann, D., De Castro, C. A. & Actis-Goretta, L. Dose-response relationship between cocoa flavanols and human endothelial function: a systematic review and meta-analysis of randomized trials. Food Funct. 10, 6322–6330 (2019).
García-Conesa, M. T. et al. Meta-analysis of the effects of foods and derived products containing ellagitannins and anthocyanins on cardiometabolic biomarkers: analysis of factors influencing variability of the individual responses. Int. J. Mol. Sci. 19, 694 (2018).
Raman, G. et al. Dietary intakes of flavan-3-ols and cardiometabolic health: systematic review and meta-analysis of randomized trials and prospective cohort studies. Am. J. Clin. Nutr. 110, 1067–1078 (2019).
Huang, Y. et al. Effect of oral nut supplementation on endothelium-dependent vasodilation – a meta-analysis. Vasa 47, 203–208 (2018).
Tsuji, S. et al. Ethanol stimulates immunoreactive endothelin-1 and -2 release from cultured human umbilical vein endothelial cells. Alcohol. Clin. Exp. Res. 16, 347–349 (1992).
Husain, K., Vazquez, M., Ansari, R. A., Malafa, M. P. & Lalla, J. Chronic alcohol-induced oxidative endothelial injury relates to angiotensin II levels in the rat. Mol. Cell. Biochem. 307, 51–58 (2008).
Husain, K., Ferder, L., Ansari, R. A. & Lalla, J. Chronic ethanol ingestion induces aortic inflammation/oxidative endothelial injury and hypertension in rats. Hum. Exp. Toxicol. 30, 930–939 (2011).
Dickinson, S., Hancock, D., Petocz, P., Ceriello, A. & Brand-Miller, J. High-glycemic index carbohydrate increases nuclear factor-κB activation in mononuclear cells of young, lean healthy subjects. Am. J. Clin. Nutr. 87, 1188–1193 (2008).
Quintanilha, B. J. et al. Circulating plasma microRNAs dysregulation and metabolic endotoxemia induced by a high-fat high-saturated diet. Clin. Nutr. 39, 554–562 (2020).
Baer, D. J., Judd, J. T., Clevidence, B. A. & Tracy, R. P. Dietary fatty acids affect plasma markers of inflammation in healthy men fed controlled diets: a randomized crossover study. Am. J. Clin. Nutr. 79, 969–973 (2004).
Van Der Lugt, T. et al. Dietary advanced glycation endproducts induce an inflammatory response in human macrophages in vitro. Nutrients 10, 1868 (2018).
Müller, D. N., Wilck, N., Haase, S., Kleinewietfeld, M. & Linker, R. A. Sodium in the microenvironment regulates immune responses and tissue homeostasis. Nat. Rev. Immunol. 19, 243–254 (2019).
Targoński, R., Sadowski, J., Price, S. & Targoński, R. Sodium-induced inflammation–an invisible player in resistant hypertension. Hypertens. Res. 43, 629–633 (2020).
Mousavi, S. M., Djafarian, K., Mojtahed, A., Varkaneh, H. K. & Shab-Bidar, S. The effect of zinc supplementation on plasma C-reactive protein concentrations: a systematic review and meta-analysis of randomized controlled trials. Eur. J. Pharmacol. 834, 10–16 (2018).
Simental-Mendia, L., Sahebkar, A., Rodriguez-Moran, M., Zambrano-Galvan, G. & Guerrero-Romero, F. Effect of magnesium supplementation on plasma C-reactive protein concentrations: a systematic review and meta-analysis of randomized controlled trials. Curr. Pharm. Des. 23, 4678–4686 (2017).
Dibaba, D. T., Xun, P. & He, K. Dietary magnesium intake is inversely associated with serum C-reactive protein levels: meta-analysis and systematic review. Eur. J. Clin. Nutr. 68, 510–516 (2014).
Wen, W. et al. Potassium supplementation inhibits IL-17A production induced by salt loading in human T lymphocytes via p38/MAPK-SGK1 pathway. Exp. Mol. Pathol. 100, 370–377 (2016).
Rangel-Huerta, O. D., Aguilera, C. M., Mesa, M. D. & Gil, A. Omega-3 long-chain polyunsaturated fatty acids supplementation on inflammatory biomakers: a systematic review of randomised clinical trials. Br. J. Nutr. 107, S159–S170 (2012).
Hosseini, B. et al. Effects of fruit and vegetable consumption on inflammatory biomarkers and immune cell populations: a systematic literature review and meta-analysis. Am. J. Clin. Nutr. 108, 136–155 (2018).
Schwingshackl, L. & Hoffmann, G. Long-term effects of low glycemic index/load vs. high glycemic index/load diets on parameters of obesity and obesity-associated risks: a systematic review and meta-analysis. Nutr. Metab. Cardiovasc. Dis. 23, 699–706 (2013).
Abdel-Rahman, A. A. & Wooles, W. R. Ethanol-induced hypertension involves impairment of baroreceptors. Hypertension 10, 67–73 (1987).
Zhang, X., Abdel-Rahman, A. A. & Wooles, W. R. Impairment of baroreceptor reflex control of heart rate but not sympathetic efferent discharge by central neuroadministration of ethanol. Hypertension 14, 282–292 (1989).
Grassi, G. M., Somers, V. K., Renk, W. S., Abboud, F. M. & Mark, A. L. Effects of alcohol intake on blood pressure and sympathetic nerve activity in normotensive humans: a preliminary report. J. Hypertens. Suppl. 7, S20–S21 (1989).
Schroeder, B. O. & Bäckhed, F. Signals from the gut microbiota to distant organs in physiology and disease. Nat. Med. 22, 1079–1089 (2016).
Ge, X. et al. The gut microbial metabolite trimethylamine N-oxide and hypertension risk: a systematic review and dose–response meta-analysis. Adv. Nutr. 11, 66–76 (2019).
Li, Y. et al. High-salt diet-induced gastritis in C57BL/6 mice is associated with microbial dysbiosis and alleviated by a buckwheat diet. Mol. Nutr. Food Res. 64, e1900965 (2020).
Dong, Z. et al. The effects of high-salt gastric intake on the composition of the intestinal microbiota in Wistar rats. Med. Sci. Monit. 26, e922160 (2020).
He, J., Zhang, F. & Han, Y. Effect of probiotics on lipid profiles and blood pressure in patients with type 2 diabetes: a meta-analysis of RCTs. Medicine 96, e9166 (2017).
Khalesi, S., Sun, J., Buys, N. & Jayasinghe, R. Effect of probiotics on blood pressure: a systematic review and meta-analysis of randomized, controlled trials. Hypertension 64, 897–903 (2014).
Zota, A. R., Phillips, C. A. & Mitro, S. D. Recent fast food consumption and bisphenol A and phthalates exposures among the U.S. population in NHANES, 2003–2010. Environ. Health Perspect. 124, 1521–1528 (2016).
Wang, T. et al. Association of bisphenol A exposure with hypertension and early macrovascular diseases in Chinese adults: a cross-sectional study. Medicine 94, e1814 (2015).
Bae, S., Kim, J. H., Lim, Y. H., Park, H. Y. & Hong, Y. C. Associations of bisphenol a exposure with heart rate variability and blood pressure. Hypertension 60, 786–793 (2012).
Jiang, S. et al. Association of bisphenol A and its alternatives bisphenol S and F exposure with hypertension and blood pressure: a cross-sectional study in China. Environ. Pollut. 257, 113639 (2020).
Shankar, A. & Teppala, S. Urinary bisphenol A and hypertension in a multiethnic sample of US adults. J. Environ. Public Health 2012, 481641 (2012).
Bae, S. & Hong, Y. C. Exposure to bisphenol A from drinking canned beverages increases blood pressure: randomized crossover trial. Hypertension 65, 313–319 (2015).
Hsu, C. N., Lin, Y. J. & Tain, Y. L. Maternal exposure to bisphenol A combined with high-fat diet-induced programmed hypertension in adult male rat offspring: effects of resveratrol. Int. J. Mol. Sci. 20, 4382 (2019).
Han, C. & Hong, Y. C. Bisphenol A, hypertension, and cardiovascular diseases: epidemiological, laboratory, and clinical trial evidence. Curr. Hypertens. Rep. 18, 11 (2016).
Saura, M. et al. Oral administration of bisphenol A induces high blood pressure through angiotensin II/CaMKII-dependent uncoupling of eNOS. FASEB J. 28, 4719–4728 (2014).
Douma, L. G. & Gumz, M. L. Circadian clock-mediated regulation of blood pressure. Free Radic. Biol. Med. 119, 108–114 (2018).
Dolan, E. et al. Superiority of ambulatory over clinic blood pressure measurement in predicting mortality: the Dublin outcome study. Hypertension 46, 156–161 (2005).
Sega, R. et al. Prognostic value of ambulatory and home blood pressures compared with office blood pressure in the general population: follow-up results from the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study. Circulation 111, 1777–1783 (2005).
Kikuya, M. et al. Ambulatory blood pressure and 10-year risk of cardiovascular and noncardiovascular mortality: the Ohasama study. Hypertension 45, 240–245 (2005).
Hansen, T. W., Jeppesen, J., Rasmussen, S., Ibsen, H. & Torp-Pedersen, C. Ambulatory blood pressure and mortality: a population-based study. Hypertension 45, 499–504 (2005).
Fagard, R. H. et al. Daytime and nighttime blood pressure as predictors of death and cause-specific cardiovascular events in hypertension. Hypertension 51, 55–61 (2008).
Gorostidi, M. et al. Ambulatory blood pressure monitoring in daily clinical practice – the Spanish ABPM Registry experience. Eur. J. Clin. Invest. 46, 92–98 (2016).
De La Sierra, A. et al. Nocturnal hypertension or nondipping: which is better associated with the cardiovascular risk profile? Am. J. Hypertens. 27, 680–687 (2014).
Cuspidi, C. et al. Clinical correlates and subclinical cardiac organ damage in different extreme dipping patterns. J. Hypertens. 38, 858–863 (2020).
Yang, W. Y. et al. Association of office and ambulatory blood pressure with mortality and cardiovascular outcomes. JAMA 322, 409–420 (2019).
Manohar, S., Thongprayoon, C., Cheungpasitporn, W., Mao, M. A. & Herrmann, S. M. Associations of rotational shift work and night shift status with hypertension: a systematic review and meta-analysis. J. Hypertens. 35, 1929–1937 (2017).
Kitamura, T. et al. Circadian rhythm of blood pressure is transformed from a dipper to a non-dipper pattern in shift workers with hypertension. J. Hum. Hypertens. 16, 193–197 (2002).
Morris, C. J., Purvis, T. E., Hu, K. & Scheer, F. A. J. L. Circadian misalignment increases cardiovascular disease risk factors in humans. Proc. Natl Acad. Sci. USA 113, E1402–E1411 (2016).
Sutton, E. F. et al. Early time-restricted feeding improves insulin sensitivity, blood pressure, and oxidative stress even without weight loss in men with prediabetes. Cell Metab. 27, 1212–1221.e3 (2018).
Wilkinson, M. J. et al. Ten-hour time-restricted eating reduces weight, blood pressure, and atherogenic lipids in patients with metabolic syndrome. Cell Metab. 31, 92–104.e5 (2019).
De Cabo, R. & Mattson, M. P. Effects of intermittent fasting on health, aging, and disease. N. Engl. J. Med. 381, 2541–2551 (2019).
De La Iglesia, H. O. et al. Ancestral sleep. Curr. Biol. 26, R271–R272 (2016).
Gangwisch, J. E. A review of evidence for the link between sleep duration and hypertension. Am. J. Hypertens. 27, 1235–1242 (2014).
Staessen, J., Bulpitt, C. J., Brien, E. O., Cox, J. & Fagard, R. The diurnal blood pressure profile. Am. J. Hypertens. 5, 386–392 (1992).
National Sleep Foundation. 2013 international bedroom poll. SleepFoundation.org https://www.sleepfoundation.org/professionals/sleep-americar-polls/2013-international-bedroom-poll (2013).
Lunn, R. M. et al. Health consequences of electric lighting practices in the modern world: a report on the National Toxicology Program’s workshop on shift work at night, artificial light at night, and circadian disruption. Sci. Total. Environ. 607–608, 1073–1084 (2017).
Lanfranchi, P. A. et al. Nighttime blood pressure in normotensive subjects with chronic insomnia: implications for cardiovascular risk. Sleep 32, 760–766 (2009).
Han, B., Chen, W. Z., Li, Y. C., Chen, J. & Zeng, Z. Q. Sleep and hypertension. Sleep Breath. 24, 351–356 (2020).
Itani, O., Jike, M., Watanabe, N. & Kaneita, Y. Short sleep duration and health outcomes: a systematic review, meta-analysis, and meta-regression. Sleep Med. 32, 246–256 (2017).
Jiang, W., Hu, C., Li, F., Hua, X. & Zhang, X. Association between sleep duration and high blood pressure in adolescents: a systematic review and meta-analysis. Ann. Hum. Biol. 45, 457–462 (2018).
Lo, K., Woo, B., Wong, M. & Tam, W. Subjective sleep quality, blood pressure, and hypertension: a meta-analysis. J. Clin. Hypertens. 20, 592–605 (2018).
Fung, M. M. et al. Decreased slow wave sleep increases risk of developing hypertension in elderly men. Hypertension 58, 596–603 (2011).
Matthews, K. A. et al. Sleep and risk for high blood pressure and hypertension in midlife women: the SWAN (Study of Women’s Health Across the Nation) sleep study. Sleep Med. 15, 203–208 (2014).
Thomas, S. J. & Calhoun, D. Sleep, insomnia, and hypertension: current findings and future directions. J. Am. Soc. Hypertens. 11, 122–129 (2017).
Sánchez-de-la-Torre, M., Campos-Rodríguez, F. & Barbé, F. Obstructive sleep apnoea and cardiovascular disease. Lancet Respir. Med. 1, 61–72 (2013).
Fernandez-Mendoza, J. et al. Objective short sleep duration increases the risk of all-cause mortality associated with possible vascular cognitive impairment. Sleep Heal. 6, 71–78 (2020).
Pengo, M. F. et al. Obstructive sleep apnoea treatment and blood pressure: which phenotypes predict a response? A systematic review and meta-analysis. Eur. Respir. J. 55, 1901945 (2020).
Haack, M. et al. Increasing sleep duration to lower beat-to-beat blood pressure: a pilot study. J. Sleep Res. 22, 295–304 (2013).
McGrath, E. R. et al. Sleep to lower elevated blood pressure: a randomized controlled trial (SLEPT). Am. J. Hypertens. 30, 319–327 (2017).
Wu, Y., Zhai, L. & Zhang, D. Sleep duration and obesity among adults: a meta-analysis of prospective studies. Sleep Med. 15, 1456–1462 (2014).
Hart, C. N. et al. Changes in children’s sleep duration on food intake, weight, and leptin. Pediatrics 132, e1473–e1480 (2013).
Riegel, B. et al. Shift workers have higher blood pressure medicine use, but only when they are short sleepers: a longitudinal UK biobank study. J. Am. Heart Assoc. 8, e013269 (2019).
Waterhouse, J., Buckley, P., Edwards, B. & Reilly, T. Measurement of, and some reasons for, differences in eating habits between night and day workers. Chronobiol. Int. 20, 1075–1092 (2003).
Souza, R. V., Sarmento, R. A., de Almeida, J. C. & Canuto, R. The effect of shift work on eating habits: a systematic review. Scand. J. Work. Environ. Heal. 45, 7–21 (2019).
Holmbäck, U. et al. Metabolic responses to nocturnal eating in men are affected by sources of dietary energy. J. Nutr. 132, 1892–1899 (2002).
Spiegel, K., Tasali, E., Penev, P. & Van Cauter, E. Brief communication: sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann. Intern. Med. 141, 846–850 (2004).
Zhu, B., Shi, C., Park, C. G., Zhao, X. & Reutrakul, S. Effects of sleep restriction on metabolism-related parameters in healthy adults: a comprehensive review and meta-analysis of randomized controlled trials. Sleep Med. Rev. 45, 18–30 (2019).
Liu, W. et al. Long sleep duration predicts a higher risk of obesity in adults: a meta-analysis of prospective cohort studies. J. Public Health 41, e158–e168 (2019).
Jike, M., Itani, O., Watanabe, N., Buysse, D. J. & Kaneita, Y. Long sleep duration and health outcomes: a systematic review, meta-analysis and meta-regression. Sleep Med. Rev. 39, 25–36 (2018).
Broussard, J., Ehrmann, D., Van Cauter, E., Tasali, E. & Brady, M. Impaired insulin signaling in human adipocytes after experimental sleep restriction. Ann. Intern. Med. 157, 549–558 (2012).
Wilms, B. et al. Sleep loss disrupts morning-to-evening differences in human white adipose tissue transcriptome. J. Clin. Endocrinol. Metab. 104, 1687–1696 (2019).
Broussard, J. L., Wroblewski, K., Kilkus, J. M. & Tasali, E. Two nights of recovery sleep reverses the effects of short-term sleep restriction on diabetes risk. Diabetes Care 39, e40–e41 (2016).
Leproult, R., Holmbäck, U. & Van Cauter, E. Circadian misalignment augments markers of insulin resistance and inflammation, independently of sleep loss. Diabetes 63, 1860–1869 (2014).
Murck, H., Schüssler, P. & Steiger, A. Renin-angiotensin-aldosterone system: the forgotten stress hormone system: relationship to depression and sleep. Pharmacopsychiatry 45, 83–95 (2012).
Jin, Z. N. & Wei, Y. X. Meta-analysis of effects of obstructive sleep apnea on the renin-angiotensin-aldosterone system. J. Geriatr. Cardiol. 13, 333–343 (2016).
Fletcher, E. C., Orolinova, N. & Bader, M. Blood pressure response to chronic episodic hypoxia: the renin-angiotensin system. J. Appl. Physiol. 92, 627–633 (2002).
Fletcher, E. C., Bao, G. & Li, R. Renin activity and blood pressure in response to chronic episodic hypoxia. Hypertension 34, 309–314 (1999).
Lam, S. Y. et al. Upregulation of a local renin-angiotensin system in the rat carotid body during chronic intermittent hypoxia. Exp. Physiol. 99, 220–231 (2014).
Nicholl, D. D. M. et al. Evaluation of continuous positive airway pressure therapy on renin-angiotensin system activity in obstructive sleep apnea. Am. J. Respir. Crit. Care Med. 190, 572–580 (2014).
Dettoni, J. L. et al. Cardiovascular effects of partial sleep deprivation in healthy volunteers. J. Appl. Physiol. 113, 232–236 (2012).
Bironneau, V. et al. Sleep apnoea and endothelial dysfunction: an individual patient data meta-analysis. Sleep Med. Rev. 52, 101309 (2020).
Wang, J. et al. Impact of obstructive sleep apnea syndrome on endothelial function, arterial stiffening, and serum inflammatory markers: an updated meta-analysis and metaregression of 18 studies. J. Am. Heart Assoc. 4, e002454 (2015).
Jelic, S. et al. Inflammation, oxidative stress, and repair capacity of the vascular endothelium in obstructive sleep apnea. Circulation 117, 2270–2278 (2008).
Stiefel, P. et al. Obstructive sleep apnea syndrome, vascular pathology, endothelial function and endothelial cells and circulating microparticles. Arch. Med. Res. 44, 409–414 (2013).
Trzepizur, W., Martinez, M. C. & Priou, P. Microparticles and vascular dysfunction in obstructive sleep apnoea. Eur. Respir. J. 44, 207–216 (2014).
Morris, C. J., Purvis, T. E., Mistretta, J., Hu, K. & Scheer, F. A. J. L. Circadian misalignment increases C-reactive protein and blood pressure in chronic shift workers. J. Biol. Rhythm. 32, 154–164 (2017).
Irwin, M. R., Olmstead, R. & Carroll, J. E. Sleep disturbance, sleep duration, and inflammation: a systematic review and meta-analysis of cohort studies and experimental sleep deprivation. Biol. Psychiatry 80, 40–52 (2016).
Ogawa, Y. et al. Total sleep deprivation elevates blood pressure through arterial baroreflex resetting: a study with microneurographic technique. Sleep 26, 986–989 (2003).
Sauvet, F. et al. Effect of acute sleep deprivation on vascular function in healthy subjects. J. Appl. Physiol. 108, 68–75 (2010).
Liu, M. Y., Li, N., Li, W. A. & Khan, H. Association between psychosocial stress and hypertension: a systematic review and meta-analysis. Neurol. Res. 39, 573–580 (2017).
Kivimäki, M. & Steptoe, A. Effects of stress on the development and progression of cardiovascular disease. Nat. Rev. Cardiol. 15, 215–229 (2018).
Ogedegbe, G. et al. The misdiagnosis of hypertension: the role of patient anxiety. Arch. Intern. Med. 168, 2459–2465 (2008).
Cohen, B., Marmar, C., Ren, L., Berthental, D. & Seal, K. Association of cardiovascular risk factors with mental health diagnoses in Iraq and Afghanistan War veterans using VA health care. J. Am. Med. Assoc. 302, 489–492 (2009).
Sumner, J. A. et al. Post-traumatic stress disorder symptoms and risk of hypertension over 22 years in a large cohort of younger and middle-aged women. Psychol. Med. 46, 3105–3116 (2016).
Burg, M. M. et al. Risk for incident hypertension associated with posttraumatic stress disorder in military veterans and the effect of posttraumatic stress disorder treatment. Psychosom. Med. 79, 181–188 (2017).
Mann, S. J. Psychosomatic research in hypertension: the lack of impact of decades of research and new directions to consider. J. Clin. Hypertens. 14, 657–664 (2012).
Nagele, E. et al. Clinical effectiveness of stress-reduction techniques in patients with hypertension: systematic review and meta-analysis. J. Hypertens. 32, 1936–1944 (2014).
Dickinson, H. O. et al. Relaxation therapies for the management of primary hypertension in adults: a Cochrane review. J. Hum. Hypertens. 22, 809–820 (2008).
Schneider, R. H., Fields, J. Z. & Brook, R. D. The 2017 ACC/AHA hypertension guidelines: should they have included proven nonpharmacological blood pressure-lowering strategies such as transcendental meditation? J. Clin. Hypertens. 21, 434 (2019).
Gathright, E. C. et al. The impact of transcendental meditation on depressive symptoms and blood pressure in adults with cardiovascular disease: a systematic review and meta-analysis. Complement. Ther. Med. 46, 172–179 (2019).
Ponte Márquez, P. H. et al. Benefits of mindfulness meditation in reducing blood pressure and stress in patients with arterial hypertension. J. Hum. Hypertens. 33, 237–247 (2019).
Wu, Y. et al. Yoga as antihypertensive lifestyle therapy: a systematic review and meta-analysis. Mayo Clin. Proc. 94, 432–446 (2019).
Geiker, N. R. W. et al. Does stress influence sleep patterns, food intake, weight gain, abdominal obesity and weight loss interventions and vice versa? Obes. Rev. 19, 81–97 (2018).
Wardle, J., Chida, Y., Gibson, E. L., Whitaker, K. L. & Steptoe, A. Stress and adiposity: a meta-analysis of longitudinal studies. Obesity 19, 771–778 (2011).
Tomiyama, A. Stress and obesity. Annu. Rev. Psychol. 70, 703–718 (2019).
Pechtel, P. & Pizzagalli, D. A. Effects of early life stress on cognitive and affective function: an integrated review of human literature. Psychopharmacology 214, 55–70 (2011).
Lowe, C. J., Reichelt, A. C. & Hall, P. A. The prefrontal cortex and obesity: a health neuroscience perspective. Trends Cogn. Sci. 23, 349–361 (2019).
Torres, S. J. & Nowson, C. A. Relationship between stress, eating behavior, and obesity. Nutrition 23, 887–894 (2007).
O’Connor, D. B., Jones, F., Conner, M., McMillan, B. & Ferguson, E. Effects of daily hassles and eating style on eating behavior. Heal. Psychol. 27, S20–S31 (2008).
Pecoraro, N., Reyes, F., Gomez, F., Bhargava, A. & Dallman, M. F. Chronic stress promotes palatable feeding, which reduces signs of stress: feedforward and feedback effects of chronic stress. Endocrinology 145, 3754–3762 (2004).
Stults-Kolehmainen, M. A. & Sinha, R. The effects of stress on physical activity and exercise. Sport. Med. 44, 81–121 (2014).
Åkerstedt, T., Kecklund, G. & Axelsson, J. Impaired sleep after bedtime stress and worries. Biol. Psychol. 76, 170–173 (2007).
Fatima, Y., Doi, S. A. R. & Mamun, A. A. Sleep quality and obesity in young subjects: a meta-analysis. Obes. Rev. 17, 1154–1166 (2016).
Christaki, E. et al. Stress management can facilitate weight loss in Greek overweight and obese women: a pilot study. J. Hum. Nutr. Diet. 26, 132–139 (2013).
Cox, T. L. et al. Stress management-augmented behavioral weight loss intervention for African American women: a pilot, randomized controlled trial. Heal. Educ. Behav. 40, 78–87 (2013).
Yi, C. X. et al. Glucocorticoid signaling in the arcuate nucleus modulates hepatic insulin sensitivity. Diabetes 61, 339–345 (2012).
Kuo, L. E. et al. Neuropeptide Y acts directly in the periphery on fat tissue and mediates stress-induced obesity and metabolic syndrome. Nat. Med. 13, 803–811 (2007).
Morgan, S. A. et al. 11Β-hydroxysteroid dehydrogenase type 1 regulates glucocorticoid-induced insulin resistance in skeletal muscle. Diabetes 58, 2506–2515 (2009).
Gathercole, L. L., Bujalska, I. J., Stewart, P. M. & Tomlinson, J. W. Glucocorticoid modulation of insulin signaling in human subcutaneous adipose tissue. J. Clin. Endocrinol. Metab. 92, 4332–4339 (2007).
Paul-Labrador, M. et al. Effects of a randomized controlled trial of transcendental meditation on components of the metabolic syndrome in subjects with coronary heart disease. Arch. Intern. Med. 166, 1218–1224 (2006).
Terock, J. et al. Living alone and activation of the renin-angiotensin-aldosterone-system: differential effects depending on alexithymic personality features. J. Psychosom. Res. 96, 42–48 (2017).
Aguilera, G., Kiss, A. & Sunar-Akbasak, B. Hyperreninemic hypoaldosteronism after chronic stress in the rat. J. Clin. Invest. 96, 1512–1519 (1995).
Custodis, F. et al. Heart rate contributes to the vascular effects of chronic mental stress: effects on endothelial function and ischemic brain injury in mice. Stroke 42, 1742–1749 (2011).
Greaney, J. L., Koffer, R. E., Saunders, E. F. H., Almeida, D. M. & Alexander, L. M. Self-reported everyday psychosocial stressors are associated with greater impairments in endothelial function in young adults with major depressive disorder. J. Am. Heart Assoc. 8, e010825 (2019).
Marsland, A. L., Walsh, C., Lockwood, K. & John-Henderson, N. A. The effects of acute psychological stress on circulating and stimulated inflammatory markers: a systematic review and meta-analysis. Brain Behav. Immun. 64, 208–219 (2017).
Xu, W. et al. High-sensitivity CRP: possible link between job stress and atherosclerosis. Am. J. Ind. Med. 58, 773–779 (2015).
Nazmi, A. & Victora, C. G. Socioeconomic and racial/ethnic differentials of C-reactive protein levels: a systematic review of population-based studies. BMC Public Health 7, 212 (2007).
Sanada, K. et al. Effects of mindfulness-based interventions on biomarkers and low-grade inflammation in patients with psychiatric disorders: a meta-analytic review. Int. J. Mol. Sci. 21, 2484 (2020).
Park, J., Lyles, R. H. & Bauer-Wu, S. Mindfulness meditation lowers muscle sympathetic nerve activity and blood pressure in African-American males with chronic kidney disease. Am. J. Physiol. Regul. Integr. Comp. Physiol. 307, 93–101 (2014).
Barnes, V. A., Pendergrast, R. A., Harshfield, G. A. & Treiber, F. A. Impact of breathing awareness meditation on ambulatory blood pressure and sodium handling in prehypertensive African American adolescents. Ethn. Dis. 18, 1–5 (2008).
Manikonda, J. P. et al. Contemplative meditation reduces ambulatory blood pressure and stress-induced hypertension: a randomized pilot trial. J. Hum. Hypertens. 22, 138–140 (2008).
Schneider, R. H. et al. Long-term effects of stress reduction on mortality in persons ≥55 years of age with systemic hypertension. Am. J. Cardiol. 95, 1060–1064 (2005).
Parohan, M. et al. Dietary acid load and risk of hypertension: a systematic review and dose-response meta-analysis of observational studies. Nutr. Metab. Cardiovasc. Dis. 29, 665–675 (2019).
Dehghan, P. & Abbasalizad-Farhangi, M. Dietary acid load, blood pressure, fasting blood sugar and biomarkers of insulin resistance among adults: findings from an updated systematic review and meta-analysis. Int. J. Clin. Pract. 74, e13471 (2019).
Khan, K. et al. The effect of viscous soluble fiber on blood pressure: a systematic review and meta-analysis of randomized controlled trials. Nutr. Metab. Cardiovasc. Dis. 28, 3–13 (2018).
Godos, J. et al. Dietary polyphenol intake, blood pressure, and hypertension: a systematic review and meta-analysis of observational studies. Antioxidants 8, 152 (2019).
Serban, M. C. et al. Effects of quercetin on blood pressure: a systematic review and meta-analysis of randomized controlled trials. J. Am. Heart Assoc. 5, e002713 (2016).
Driscoll, K. S., Appathurai, A., Jois, M. & Radcliffe, J. E. Effects of herbs and spices on blood pressure. J. Hypertens. 37, 671–679 (2019).
Hasani, H. et al. Does ginger supplementation lower blood pressure? A systematic review and meta-analysis of clinical trials. Phyther. Res. 33, 1639–1647 (2019).
Bahadoran, Z., Mirmiran, P., Kabir, A., Azizi, F. & Ghasemi, A. The nitrate-independent blood pressure-lowering effect of beetroot juice: a systematic review and meta-analysis. Adv. Nutr. 8, 830–838 (2017).
Schroeter, H. et al. (−)-Epicatechin mediates beneficial effects of flavanol-rich cocoa on vascular function in humans. Proc. Natl Acad. Sci. USA 103, 1024–1029 (2006).
Hollenberg, N. K., Fisher, N. D. L. & McCullough, M. L. Flavanols, the Kuna, cocoa consumption, and nitric oxide. J. Am. Soc. Hypertens. 3, 105–112 (2009).
Ried, K., Fakler, P. & Stocks, N. P. Effect of cocoa on blood pressure. Cochrane. Database Syst. Rev. 4, CD008893 (2017).
Ursoniu, S., Sahebkar, A., Andrica, F., Serban, C. & Banach, M. Effects of flaxseed supplements on blood pressure: a systematic review and meta-analysis of controlled clinical trial. Clin. Nutr. 35, 615–625 (2016).
D’Elia, L., La Fata, E., Galletti, F., Scalfi, L. & Strazzullo, P. Coffee consumption and risk of hypertension: a dose–response meta-analysis of prospective studies. Eur. J. Nutr. 58, 271–280 (2019).
Yarmolinsky, J., Gon, G. & Edwards, P. Effect of tea on blood pressure for secondary prevention of cardiovascular disease: a systematic review and meta-analysis of randomized controlled trials. Nutr. Rev. 73, 236–246 (2015).
Li, G. et al. Effect of green tea supplementation on blood pressure among overweight and obese adults: a systematic review and meta-analysis. J. Hypertens. 33, 243–254 (2015).
Myint, P. K., Luben, R. N., Wareham, N. J. & Khaw, K. T. Association between plasma vitamin C concentrations and blood pressure in the European prospective investigation into cancer–Norfolk population-based study. Hypertension 58, 372–379 (2011).
d’Uscio, L. V., Milstien, S., Richardson, D., Smith, L. & Katusic, Z. S. Long-term vitamin C treatment increases vascular tetrahydrobiopterin levels and nitric oxide synthase activity. Circ. Res. 92, 88–95 (2003).
Vimaleswaran, K. S. et al. Association of vitamin D status with arterial blood pressure and hypertension risk: a mendelian randomisation study. Lancet Diabetes Endocrinol. 2, 719–729 (2014).
Li, K. et al. Effects of multivitamin and multimineral supplementation on blood pressure: a meta-analysis of 12 randomized controlled trials. Nutrients 10, 1018 (2018).
Rautiainen, S. et al. Multivitamin use and the risk of hypertension in a prospective cohort study of women. J. Hypertens. 34, 1513–1519 (2016).
Juraschek, S. P., Guallar, E., Appel, L. J. & Miller, E. III Effects of vitamin C supplementation on blood pressure: a meta-analysis of randomized controlled trials. Am. J. Clin. Nutr. 95, 1079–1088 (2012).
Zhang, D. et al. Effect of vitamin D on blood pressure and hypertension in the general population: an update meta-analysis of cohort studies and randomized controlled trials. Prev. Chronic Dis. 17, 190307 (2020).
Shu, L. & Huang, K. Effect of vitamin D supplementation on blood pressure parameters in patients with vitamin D deficiency: a systematic review and meta-analysis. J. Am. Soc. Hypertens. 12, 488–496 (2018).
Conklin, D. J. et al. Cardiovascular injury induced by tobacco products: assessment of risk factors and biomarkers of harm. a Tobacco Centers of Regulatory Science compilation. Am. J. Physiol. Hear. Circ. Physiol. 316, H801–H827 (2019).
Virdis, A., Giannarelli, C., Fritsch Neves, M., Taddei, S. & Ghiadoni, L. Cigarette smoking and hypertension. Curr. Pharm. Des. 16, 2518–2525 (2010).
Linneberg, A. et al. Effect of smoking on blood pressure and resting heart rate: a mendelian randomization meta-analysis in the CARTA consortium. Circ. Cardiovasc. Genet. 8, 832–841 (2015).
Hackshaw, A., Morris, J. K., Boniface, S., Tang, J. L. & Milenkovi, D. Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports. BMJ 360, j5855 (2018).
Lindeberg, S., Nilsson-Ehle, P. & Vessby, B. Lipoprotein composition and serum cholesterol ester fatty acids in nonwesternized Melanesians. Lipids 31, 153–158 (1996).
Lindeberg, S., Eliasson, M. & Lindahl Ahrén, B. Low serum insulin in traditional Pacific islanders – the Kitava study. Metabolism 48, 1216–1219 (1999).
Mancilha-Carvalho, Jairo de Jesus & Silva, Nelson Albuquerque de Souzae The Yanomami indians in the INTERSALT study. Arq. Bras. Cardiol. 80, 295–300 (2003).
Pontzer, H. et al. Hunter-gatherer energetics and human obesity. PLoS ONE 7, e40503 (2012).
Pontzer, H., Wood, B. M. & Raichlen, D. A. Hunter-gatherers as models in public health. Obes. Rev. 19, 24–35 (2018).
Gurven, M., Jaeggi, A. V., Kaplan, H. & Cummings, D. Physical activity and modernization among Bolivian Amerindians. PLoS ONE 8, e55679 (2013).
Liebert, M. A. et al. Implications of market integration for cardiovascular and metabolic health among an indigenous Amazonian Ecuadorian population. Ann. Hum. Biol. 40, 228–242 (2013).
Mcdade, T. W. et al. Analysis of variability of high sensitivity C-reactive protein in lowland Ecuador reveals no evidence of chronic low-grade inflammation. Am. J. Hum. Biol. 24, 675–681 (2012).
Madimenos, F. C., Snodgrass, J. J., Blackwell, A. D., Liebert, M. A. & Sugiyama, L. S. Physical activity in an indigenous Ecuadorian forager-horticulturalist population as measured using accelerometry. Am. J. Hum. Biol. 23, 488–497 (2011).
Zhou, B. et al. Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants. Lancet 389, 37–55 (2017).
Seals, D. R. & Reiling, M. J. Effect of regular exercise on 24-hour arterial pressure in older hypertensive humans. Hypertension 18, 583–592 (1991).
Mobasseri, M., Yavari, A., Najafipoor, A., Aliasgarzadeh, A. & Niafar, M. Effect of a long-term regular physical activity on hypertension and body mass index in type 2 diabetes patients. J. Sports Med. Phys. Fit. 55, 84–90 (2015).
Cox, K. L. et al. Long-term effects of exercise on blood pressure and lipids in healthy women aged 40–65 years: the Sedentary Women Exercise Adherence Trial (SWEAT). J. Hypertens. 19, 1733–1743 (2001).
Williamson, W. et al. Will exercise advice be sufficient for treatment of young adults with prehypertension and hypertension? A systematic review and meta-analysis. Hypertension 68, 78–87 (2016).
Dengel, D. R., Galecki, A. T., Hagberg, J. M. & Pratley, R. E. The independent and combined effects of weight loss and aerobic exercise on blood pressure and oral glucose tolerance in older men. Am. J. Hypertens. 11, 1405–1412 (1998).
Blumenthal, J. A. et al. Exercise and weight loss reduce blood pressure in men and women with mild hypertension: effects on cardiovascular, metabolic, and hemodynamic functioning. Arch. Intern. Med. 160, 1947–1958 (2000).
Whelton, S. P., Chin, A., Xin, X. & He, J. Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Arch. Intern. Med. 136, 493–503 (2002).
Kim, D. & Ha, J.-W. Hypertensive response to exercise: mechanisms and clinical implication. Clin. Hypertens. 22, 16–19 (2016).
Schultz, M. G. et al. Lifestyle change diminishes a hypertensive response to exercise in type 2 diabetes. Med. Sci. Sports Exerc. 43, 764–769 (2011).
Kraschnewski, J. L. et al. Long-term weight loss maintenance in the United States. Int. J. Obes. 34, 1644–1654 (2010).
Johns, D. J., Hartmann-Boyce, J., Jebb, S. A. & Aveyard, P. Diet or exercise interventions vs combined behavioral weight management programs: a systematic review and meta-analysis of direct comparisons. J. Acad. Nutr. Diet. 114, 1557–1568 (2014).
Dombrowski, S. U., Knittle, K., Avenell, A., Araújo-Soares, V. & Sniehotta, F. F. Long term maintenance of weight loss with non-surgical interventions in obese adults: systematic review and meta-analyses of randomised controlled trials. BMJ 348, g2646 (2014).
Kanbay, M. et al. Acute effects of salt on blood pressure are mediated by serum osmolality. J. Clin. Hypertens. 20, 1447–1454 (2018).
Toney, G. M. & Stocker, S. D. Hyperosmotic activation of CNS sympathetic drive: implications for cardiovascular disease. J. Physiol. 588, 3375–3384 (2010).
Rodriguez-Iturbe, B., Pons, H. & Johnson, R. J. Role of the immune system in hypertension. Physiol. Rev. 97, 1127–1164 (2017).
Bankir, L., Bichet, D. G. & Bouby, N. Vasopressin V2 receptors, ENaC, and sodium reabsorption: a risk factor for hypertension? Am. J. Physiol. Ren. Physiol. 299, F917–F928 (2010).
Fedorova, O. V., Shapiro, J. I. & Bagrov, A. Y. Endogenous cardiotonic steroids and salt-sensitive hypertension. Biochim. Biophys. Acta 1802, 1230–1236 (2010).
Song, Z. et al. Role of fructose and fructokinase in acute dehydration-induced vasopressin gene expression and secretion in mice. J. Neurophysiol. 117, 646–654 (2017).
Work by P.L.V. is supported by University of Alcalá (FPI2016). Research by G.R.-H., L.M.R. and A.L. is funded by the Spanish Ministry of Economy and Competitiveness and Fondos FEDER (PI18/00139, PI17/01093 and PI17/01193). G.R.-H. holds a Miguel Servet research contract (CP15/00129). The authors thank K. McCreath (Madrid, Spain) for editorial assistance and A. Castillo-García (Fissac-Physiology, Health and Physical Activity, Madrid, Spain) for assistance with generating the figures for submission.
The authors declare no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
- Clinic (or office) blood pressure
Blood pressure (BP) measured in the clinical setting (for example, an outpatient clinic). In this Review, ‘BP’ refers to ‘clinic BP’ unless otherwise stated.
- Resistant hypertension
Clinic (or office) systolic blood pressure/diastolic blood pressure ≥140/90 mmHg (or ≥130/80 mmHg according to the 2017 ACC/AHA guidelines) in patients receiving at least three antihypertensive drugs (including one diuretic) at maximally tolerated doses.
- Physical exercise
Also termed ‘exercise training’ or simply ‘exercise’. A subset of physical activity that is planned, structured and repetitive and has a final or an intermediate objective of improving or maintaining physical fitness. In this Review, physical activity and exercise are sometimes used interchangeably to ease readability.
- Non-westernized populations
Hunter–gatherers, traditional horticulturalists, pastoralists and farmers, and other populations minimally affected by western habits.
- Non-westernized dietary patterns
Composed mainly of universal fresh food sources very low in refined oils, margarine, refined cereal grains, added sugars and ultra-processed foods.
- Physical activity
Any bodily movement produced by skeletal muscles that requires energy expenditure.
- Dietary Approaches to Stop Hypertension
(DASH). A lifelong approach to healthy eating that is designed to help treat or prevent hypertension without medication, sponsored by the NIH. This diet is rich in fruits, vegetables, whole grains and low-fat dairy products, includes poultry, fish and nuts, contains small amounts of red meat, sweets and sugar-containing beverages, and results in a sodium intake within normal limits.
- Minimum physical activity levels
WHO recommends that adults engage in ≥150 min per week of moderate-intensity physical activity (such as brisk walking) or ≥75 min per week of vigorous physical activity (such as very brisk walking or jogging), or a combination thereof, as well as in muscle-strengthening activities involving major muscle groups on ≥2 days per week.
- 24-h ambulatory BP
Also termed ‘24-h BP’. The mean result of blood pressure (BP) levels measured with a portable automated device at regular intervals during normal daily life over 24 h.
- Endurance exercise
Also termed ‘aerobic exercise’. A type of exercise that is performed for more than a few minutes and preferentially involves aerobic metabolism for energy production (for example, brisk walking, jogging, bicycling and swimming).
- Resistance exercise
Also termed ‘strength exercise’. A type of exercise that is performed against a load or resistance (for example, weight lifting and leg press).
- Isometric exercise
A type of exercise that usually involves small muscle groups and results in no displacement or joint movement (such as handgrip).
- Renal sympathetic nerve activity
An important nerve regulator of the function of the renal vasculature, tubules and juxtaglomerular granular cells and, therefore, of renal haemodynamics, tubular reabsorption and renin secretion rate.
- Renin–angiotensin–aldosterone system
(RAAS). A hormonal system that is a critical regulator of blood volume and systemic vascular resistance.
From the Greek adipo (fat), cytos (cell) and kinos (movement); also termed adipokines. Cytokines secreted by adipose tissue.
- Sympathetic nervous system
(SNS). One of the two main divisions of the autonomic nervous system, the other being the parasympathetic nervous system. Although its primary function is to stimulate the ‘fight, flight or freeze’ response, the SNS is constantly active at a basal level to maintain homeostasis in haemodynamics by inducing a vasoconstrictor effect in most vessels.
- Conduit arteries
Also known as conducting arteries or elastic arteries. Arteries with many collagen and elastin filaments in the tunica media, which provides the capacity to stretch in response to each pulse. Conduit arteries include the largest arteries in the body (pulmonary arteries, the aorta and its branches).
- Resistance arteries
Small-diameter blood vessels in the microcirculation with thick muscular walls and narrow lumen (usually arterioles and end point arteries) that contribute the most to the resistance to blood flow.
- Nitric oxide
(NO). A volatile gas produced by endothelial cells that acts to relax vascular tone.
- Oxidative stress
A process of cellular damage related to uncontrolled action of reactive oxygen species, a group of molecules, including oxygen and its derivatives, produced by the normal process of aerobic metabolism.
- Chronic systemic inflammation
Usually referred to as simply ‘inflammation’. A state of low-grade, non-infective (‘sterile’) inflammation at the systemic level that is characterized by activation of immune components that are often distinct from those engaged during an acute immune response and that can lead to major alterations in all cells, tissues and organs. This state is reflected by high baseline levels of specific biomarkers such as high-sensitive C-reactive protein.
From the Greek myo (muscle) and kinos (movement). Molecules (mostly, but not only, small peptides such as cytokines) released from muscles, usually during exercise.
Mechanical receptors that sense blood pressure changes in both carotid sinuses and the aortic arch.
- Arterial baroreflex
Also known as the baroreceptor reflex. A rapid negative feedback loop in which elevated blood pressure is sensed by baroreceptors, with their subsequent activation leading to rapid increases in parasympathetic outflow and decreases in sympathetic outflow and therefore to restoration of blood pressure levels.
- Peripheral chemoreceptors
Located in the carotid and aortic bodies. Sensory extensions of the peripheral nervous system into blood vessels that detect changes in chemical homeostasis (hypoxaemia, hypercapnia and acidosis), which increases their firing with a subsequent increase in ventilation and sympathetic nervous system outflow.
- Obstructive sleep apnoea
(OSA). A sleep-related breathing disorder characterized by repeated episodes of complete or partial upper-airway occlusion (and subsequent arterial hypoxaemia) during sleep.
- Mediterranean diet
A diet abundant in fruits, vegetables, legumes, whole grains, olives, nuts and seeds, and containing extra-virgin olive oil associated with frequent consumption of fish, moderate consumption of dairy products and red wine, and low consumption of red meat and isolated sugars.
- Advanced glycation end-products
(AGEs). Proteins or lipids that become non-enzymatically glycated as a result of exposure to sugars.
A main class of plant secondary metabolite, existing in a wide variety of foods, typically divided into flavonoids and non-flavonoid polyphenols.
A type of flavonoid with antioxidant and colouring effects that give certain plants that are rich in these compounds (blueberry, raspberry, red and black grapes and black soybean, among many others) a red, blue, purple or black colour.
Sometimes referred to as ‘flavanols’, not to be confused with flavonols. Derivatives of flavans that include catechin, epicatechin gallate, epigallocatechin, epigallocatechin gallate, proanthocyanidins, theaflavins and thearubigins.
- Gut microbiota
The collective microorganisms (bacteria, archaea, fungi and viruses) that reside in the gastrointestinal tract.
Live microorganisms with purported health benefits when consumed, mainly as a result of improving or restoring the gut microbiota.
Chemical substances found within an organism that are not naturally produced or expected to be present within the organism.
- Bisphenol A
A ubiquitous plasticizing agent used in the manufacture of polycarbonate plastics and epoxy resins, found in food and beverage cans as well as in thermal receipt paper. Owing to a structural similarity to oestrogen, bisphenol affects various phenotypes that are regulated by the natural hormone oestrogen.
- Suprachiasmatic nucleus
(SCN). A small region of the brain in the hypothalamus, situated directly above the optic chiasm, that is responsible for controlling circadian rhythms.
- Sleep quality
The self-reported, retrospective appraisal of the sleep experience. A good sleep quality typically means falling asleep in ≤30 min and sleeping soundly through the night (one or no awakenings and drifting back to sleep within 20 min of waking up).
- Sleep-maintenance insomnia
A condition characterized by difficulty staying asleep, nocturnal awakenings and, in particular, waking too early and struggling to get back to sleep.
- Slow-wave sleep
The phase of sleep that is considered to be restorative and is associated with the highest arousal threshold.
- Low non-rapid eye movement sleep
The phase of sleep associated with better performance and learning as well as with decreased sympathetic nervous system activity and increased parasympathetic nervous system activity during the night.
- Psychosocial stress
Also frequently referred to as ‘mental stress’. The feeling of being overwhelmed or unable to cope as a result of pressures that are unmanageable.
- White-coat syndrome
Also known as ‘white-coat hypertension’. A phenomenon in which people exhibit a blood pressure above the normal range in a clinical setting but not in other settings (at home or with 24-h ambulatory assessments).
- Post-traumatic stress disorder
(PTSD). A mental health condition triggered by a terrifying event, either experiencing it or witnessing it, with symptoms including flashbacks, nightmares, severe anxiety or uncontrollable thoughts about the event.
- Dietary acid load
The balance of net acid-yielding food items (meats, fish, shellfish, eggs, cheese, cereal grains and salt) and net base-producing food items (fruits, tubers, roots and vegetables).
A type of polyphenol whose subclasses (for example, flavanols, flavonones and isoflavones) are present mostly in fruits, certain vegetables, seeds (such as flax), soy, whole grains, honey, tea, coffee, cocoa, some alcoholic beverages (such as wine) and a few spices.
The most abundant dietary flavonol, mainly found in onions, apples and berries.
A flowering plant whose rhizome is frequently used as a spice, containing several bioactive compounds (such as gingerols) with the potential to affect human health.
A seed from the flax plant with moderate-to-high contents of α-linolenic acid (an omega-3 fatty acid), lignans (a group of polyphenols), and soluble and insoluble fibre.
About this article
Cite this article
Valenzuela, P.L., Carrera-Bastos, P., Gálvez, B.G. et al. Lifestyle interventions for the prevention and treatment of hypertension. Nat Rev Cardiol 18, 251–275 (2021). https://doi.org/10.1038/s41569-020-00437-9