Lifestyle modifications (reduced salt, physical activity, smoking cessation) were consistently recommended for hypertension management across 10 international guidelines with good development rigour.
Systematic Review (n=10)
What are the recommendations, similarities, and differences regarding non-pharmacological factors for hypertension management across international guidelines?
Current international guidelines consistently recommend lifestyle modifications like reduced salt intake, weight management, and physical activity for hypertension management, though consensus is lacking on novel environmental and psychological factors.
Lifestyle modifications are one of the cornerstones of hypertension prevention and treatment. We aimed to systematically review hypertension guidelines on their recommendations on non-pharmacological factors including lifestyle interventions, to highlight strength of evidence, similarities, and differences. This systematic review was registered with the international Prospective Register of Systematic Reviews (CRD42021288815). Publications in MEDLINE and EMBASE databases over 10 years since January 2010 to June 2020 were identified. We also included the search from websites of organizations responsible for guidelines development. Two reviewers screened the titles and abstracts to identify relevant guidelines. Two reviewers independently assessed rigour of guideline development using the AGREE II instrument, and one reviewer extracted recommendations. Of the identified guidelines, 10 showed good rigour of development (AGREE II ≥ 60%) and were included in the systematic review. The guidelines were consistent in most recommendations (reduced salt intake, weight, dietary patterns, increased physical activity and smoking cessation, and limiting alcohol intake). Some areas of disagreement were identified, regarding recommendations on novel psychological and environmental factors such as stress or air pollution, alcohol intake thresholds, meat, coffee and tea consumption and refined sugars. Current guidelines agree on the importance of lifestyle in the treatment and prevention of hypertension. Consensus on smoking cessation, limited salt intake, increased physical activity support their integration in management of hypertensive patients and in public health measurements in general population as preventative measurements. Further research into the role of environmental and psychological factors may help clarify future recommendations.
Maniero et al. (Wed,) conducted a systematic review in Hypertension (n=10). Lifestyle modifications was evaluated on Guideline recommendations on non-pharmacological factors. Lifestyle modifications (reduced salt, physical activity, smoking cessation) were consistently recommended for hypertension management across 10 international guidelines with good development rigour.