Relaxation and good sleep key to managing high blood pressure

Mindfulness practices such as meditation and yoga should be recommended to people with high blood pressure, according to a comprehensive review of lifestyle changes that can help prevent and manage the condition, co-authored by UCL's Professor Bryan Williams.

People should also be advised to get quality sleep and reduce their exposure to air pollution, according to the wide-ranging position paper from the International Society of Hypertension (ISH).

For the paper, published in the Journal of Hypertension, an international panel of experts from 18 countries made recommendations on effective lifestyle changes for blood pressure control, based on the latest clinical and scientific evidence.

The paper highlights perhaps less obvious strategies such as stress management and sleep quality alongside long-standing recommendations to:

• maintain a healthy weight
• exercise regularly
• eat a healthy diet
• reduce consumption of salt
• stop smoking
• limit (ideally stop) alcohol consumption.

Hypertension affects around 4 in 10 people worldwide. There are effective medications for high blood pressure, but the best approach is often to start with lifestyle interventions, before introducing drug treatment if needed.

The authors of the paper said health care professionals should consider stress reduction and mindfulness-based therapies for people with high blood pressure, pointing to evidence that practices such as meditation, muscle relaxation, yoga and deep breathing techniques can all lower blood pressure.

They also said health care professionals should explore all aspects of a patient's sleep, including duration, quality and timing, and they recommend population-based awareness campaigns advocating for better sleep quality.

Evidence shows a strong, dose-response, relationship between exposure to air pollution and blood pressure. The authors of the paper said that, where possible, people should aim to reduce their exposure to outdoor air pollution, for instance by exercising in gardens and parks away from busy roadways.

But the authors said that, in this area, the greatest benefits would be seen by governmental action to improve air quality.

For physical activity, the authors make recommendations around aerobic activity (brisk walking, running), strength training, and isometric training (static exercises such as squeezing a hand grip).

They emphasize salt and sugar intake should be limited, with alcohol consumption ideally zero.

Speaking to BBC News, Professor Bryan Williams (UCL Institute of Cardiovascular Science), UCLH Director of Research and Director of the NIHR BRC at UCLH, said, "It all sounds like it is a bit soft and fluffy and not as dynamic, for example, as taking drugs but these things make such an important contribution to reducing the effects of stress on the cardiovascular system and the evidence is accumulating.

"There's so much people can do for themselves. All of us need to take a step back and say, actually, I should be able to find half an hour in my day to have a little bit of time to myself and decompress and just relax—whether it's listening to music, going for a walk or going to the gym and doing some exercise."

Lead author of the paper, Professor Fadi Charchar, of Federation University, Australia, said, "Our aim was to provide a holistic set of recommendations for changes to lifestyle, which focus on all areas of health, including movement and bodyweight, food and drink, the body and mind, as well as other factors such as exposure to air pollution."