Editing Hypertension (section)

==Prevention==
Much of the disease burden of high blood pressure is experienced by people who are not labeled as hypertensive.<ref name=BHSIV>{{cite journal | vauthors = Williams B, Poulter NR, Brown MJ, Davis M, McInnes GT, Potter JF, Sever PS, McG Thom S | title = Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society, 2004-BHS IV | journal = Journal of Human Hypertension | volume = 18 | issue = 3 | pages = 139–185 | date = March 2004 | pmid = 14973512 | doi = 10.1038/sj.jhh.1001683 | doi-access = free }}</ref> Consequently, [[public health|population strategies]] are required to reduce the consequences of high blood pressure and reduce the need for antihypertensive medications. Lifestyle changes are recommended to lower blood pressure.

Recommended lifestyle changes for the prevention of hypertension include:
* maintain normal body weight for adults (e.g. [[body mass index]] below 25 kg/m<sup>2</sup>)<ref name=ESH2023/>
* [[Salt and cardiovascular disease|reduce dietary sodium intake]] to <100 mmol/day (<6 g of salt (sodium chloride) or <2.4 g of sodium per day)<ref name=ESH2023/>
* engage in regular aerobic physical activity with moderate intensity (minimum 150 minutes per week)<ref name=ESH2023/>
* limit alcohol consumption,<ref name=ESH2023/> max 1 drink for women and 2 for men per day<ref name="WHO2023"/>
* consume a diet rich in whole grains, fruits, and vegetables,<ref name=ESH2023/> such as the [[DASH diet]]<ref name=ESH2023/>
* [[smoking cessation|not smoking]]<ref name=ESH2023/>
* stress reduction and management,<ref name=ESH2023/> e.g. by meditation and [[yoga]]<ref name=ESH2023/>

Effective lifestyle modification may lower blood pressure as much as an individual antihypertensive medication. Combinations of two or more lifestyle modifications can achieve even better results.<ref name="BHSIV"/> There is considerable evidence that [[Salt and cardiovascular disease|reducing dietary salt intake lowers blood pressure]], but whether this translates into a reduction in mortality and cardiovascular disease remains uncertain.<ref name="Salt2016">{{cite journal | vauthors = <!-- No authors listed --> | title = Evidence-based policy for salt reduction is needed | journal = Lancet | volume = 388 | issue = 10043 | pages = 438 | date = July 2016 | pmid = 27507743 | doi = 10.1016/S0140-6736(16)31205-3 | s2cid = 205982690 }}</ref> Estimated sodium intake ≥6 g/day and <3 g/day are both associated with high risk of death or major cardiovascular disease, but the association between high sodium intake and adverse outcomes is only observed in people with hypertension.<ref>{{cite journal | vauthors = Mente A, O'Donnell M, Rangarajan S, Dagenais G, Lear S, McQueen M, Diaz R, Avezum A, Lopez-Jaramillo P, Lanas F, Li W, Lu Y, Yi S, Rensheng L, Iqbal R, Mony P, Yusuf R, Yusoff K, Szuba A, Oguz A, Rosengren A, Bahonar A, Yusufali A, Schutte AE, Chifamba J, Mann JF, Anand SS, Teo K, Yusuf S | title = Associations of urinary sodium excretion with cardiovascular events in individuals with and without hypertension: a pooled analysis of data from four studies | journal = Lancet | volume = 388 | issue = 10043 | pages = 464–475 | date = July 2016 | pmid = 27216139 | doi = 10.1016/S0140-6736(16)30467-6 | s2cid = 44581906 | url = https://ecommons.aku.edu/pakistan_fhs_mc_chs_chs/331|quote=The results showed that cardiovascular disease and death are increased with low sodium intake (compared with moderate intake) irrespective of hypertension status, whereas there is a higher risk of cardiovascular disease and death only in individuals with hypertension consuming more than 6 g of sodium per day (representing only 10% of the population studied)| hdl = 10379/16625 | hdl-access = free }}</ref> Consequently, in the absence of results from randomized controlled trials, the wisdom of reducing levels of dietary sodium intake below 3 g/day has been questioned.<ref name="Salt2016"/> ESC guidelines mention [[periodontitis]] is associated with poor cardiovascular health status.<ref>{{cite journal | vauthors = Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, Albus C, Benlian P, Boysen G, Cifkova R, Deaton C, Ebrahim S, Fisher M, Germano G, Hobbs R, Hoes A, Karadeniz S, Mezzani A, Prescott E, Ryden L, Scherer M, Syvänne M, Scholte op Reimer WJ, Vrints C, Wood D, Zamorano JL, Zannad F | title = European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts) | journal = European Heart Journal | volume = 33 | issue = 13 | pages = 1635–1701 | date = July 2012 | pmid = 22555213 | doi = 10.1093/eurheartj/ehs092 | doi-access = free }}</ref>

The value of routine screening for hypertension is debated.<ref>{{cite journal | vauthors = Chiolero A, Bovet P, Paradis G | title = Screening for elevated blood pressure in children and adolescents: a critical appraisal | journal = JAMA Pediatrics | volume = 167 | issue = 3 | pages = 266–273 | date = March 2013 | pmid = 23303490 | doi = 10.1001/jamapediatrics.2013.438 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Daniels SR, Gidding SS | title = Blood pressure screening in children and adolescents: is the glass half empty or more than half full? | journal = JAMA Pediatrics | volume = 167 | issue = 3 | pages = 302–304 | date = March 2013 | pmid = 23303514 | doi = 10.1001/jamapediatrics.2013.439 }}</ref><ref name=":0">{{cite journal | vauthors = Schmidt BM, Durao S, Toews I, Bavuma CM, Hohlfeld A, Nury E, Meerpohl JJ, Kredo T | display-authors = 6 | title = Screening strategies for hypertension | journal = The Cochrane Database of Systematic Reviews | volume = 2020 | issue = 5 | pages = CD013212 | date = May 2020 | pmid = 32378196 | pmc = 7203601 | doi = 10.1002/14651858.CD013212.pub2 | collaboration = Cochrane Hypertension Group }}</ref> In 2004, the National High Blood Pressure Education Program recommended that children aged 3 years and older have blood pressure measurement at least once at every health care visit<ref name="fourth" /> and the [[National Heart, Lung, and Blood Institute]] and [[American Academy of Pediatrics]] made a similar recommendation.<ref>{{cite journal | vauthors =  | title = Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report | journal = Pediatrics | volume = 128 | issue = Suppl 5 | pages = S213–S256 | date = December 2011 | pmid = 22084329 | pmc = 4536582 | doi = 10.1542/peds.2009-2107C }}</ref> However, the [[American Academy of Family Physicians]]<ref>{{cite web |title=Hypertension – Clinical Preventive Service Recommendation |website=AAFP |url=http://www.aafp.org/patient-care/clinical-recommendations/all/hypertension.html |url-status=dead |archive-url=https://web.archive.org/web/20141101212302/http://www.aafp.org/patient-care/clinical-recommendations/all/hypertension.html |archive-date=1 November 2014 |access-date=2013-10-13}}</ref> supports the view of the [[United States Preventive Services Task Force|U.S. Preventive Services Task Force]] that the available evidence is insufficient to determine the balance of benefits and harms of screening for hypertension in children and adolescents who do not have symptoms.<ref name="Moyer2013">{{cite journal | vauthors = Moyer VA | title = Screening for primary hypertension in children and adolescents: U.S. Preventive Services Task Force recommendation statement | journal = Annals of Internal Medicine | volume = 159 | issue = 9 | pages = 613–619 | date = November 2013 | pmid = 24097285 | doi = 10.7326/0003-4819-159-9-201311050-00725 | s2cid = 20193715 |doi-access=free |s2cid-access=free }}</ref><ref>{{cite web |title=Document {{!}} United States Preventive Services Taskforce |url=https://www.uspreventiveservicestaskforce.org/uspstf/document?DOC=draft-recommendation-statement&TOPIC=high-blood-pressure-in-children-and-adolescents-screening-2020 |url-status=dead |archive-url=https://web.archive.org/web/20200522054932/https://www.uspreventiveservicestaskforce.org/uspstf/document?DOC=draft-recommendation-statement&TOPIC=high-blood-pressure-in-children-and-adolescents-screening-2020 |archive-date=22 May 2020 |access-date=22 April 2020 |website=uspreventiveservicestaskforce.org}}</ref> The US Preventive Services Task Force recommends screening adults 18 years or older for hypertension with office blood pressure measurement.<ref name=":0" /><ref>{{cite journal | vauthors = Krist AH, Davidson KW, Mangione CM, Cabana M, Caughey AB, Davis EM, Donahue KE, Doubeni CA, Kubik M, Li L, Ogedegbe G, Pbert L, Silverstein M, Stevermer J, Tseng CW, Wong JB | display-authors = 6 | title = Screening for Hypertension in Adults: US Preventive Services Task Force Reaffirmation Recommendation Statement | journal = JAMA | volume = 325 | issue = 16 | pages = 1650–1656 | date = April 2021 | pmid = 33904861 | doi = 10.1001/jama.2021.4987 | s2cid = 233409679 | doi-access = free }}</ref>