Hypertension and lifestyle modification: how useful are the guidelines?

Hypertension is a significant risk factor for coronary artery disease and stroke, a leading cause of death and disability worldwide, and a major risk for dementia, chronic kidney disease, coronary heart disease, and heart failure. The prevalence of hypertension-related events is increasing, with the majority occurring among pre-hypertensives (120–139 mmHg systolic; 80–89 mmHg diastolic) and stage-1 hypertensives (140–159 mmHg systolic; 90–99 mmHg diastolic). In the UK it was estimated that there are 62 000 needless deaths per year due to uncontrolled blood pressure,1 with the condition presenting a particular problem among Asian immigrant communities. There has been some discussion in this Journal of the helpfulness of guidelines for a number of conditions. One editorial has highlighted the possible mismatch between guidelines and internationally-agreed quality criteria, the lack of a concise set of concrete recommendations, and a risk of bias in that, notwithstanding the availability of scientific evidence, the guidelines may in fact largely reflect local culture or personal viewpoints.2 It is with this in mind that we intend to examine the guidelines for control of hypertension with respect to diet/behavioural modification. The hypertension clinical guideline from the National Institute for Health and Clinical Excellence (NICE) usefully recommends regular aerobic exercise and reduction of salt, alcohol, and smoking, and advocates ‘healthy, low-calorie diets' for ‘overweight individuals with raised blood pressure’, but gives a rather negative comment about its ‘modest effect’ …