Behavioral (life-style) modification in the prevention and treatment of hypertension

The importance of behavioral (life-style) factors in hypertension and cardiovascular disease risk is now widely recognized. The 1993 Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure recommended adoption of life-style changes as definitive and adjunctive treatment for hypertension. This paper reviews the major behavioral intervention areas, including relaxation and biofeedback, weight reduction, low sodium diets, aerobic exercise, and alcohol intake moderation. Findings from major or representative clinical trials illustrate the effects of each of these types of interventions on blood pressure in individuals with elevated blood pressure and their preventive effects in individuals with high normal pressure. Results from trials evaluating treatment packages that combine several types of behavioral interventions are also discussed. The epidemiology of hypertension and issues of diagnosis, including the phenomenon of “white coat” hypertension, are also briefly reviewed. Challenges for behavioral researchers and clinicians to further improve effectiveness of behavioral interventions are presented as questions for future research.