Lifestyle management of hypertension: International Society of Hypertension position paper endorsed by the World Hypertension League and European Society of Hypertension

Hypertension, defined as persistently elevated systolic blood pressure (SBP) >140 mmHg and/or diastolic blood pressure (DBP) at least 90 mmHg (International Society of Hypertension guidelines), affects over 1.5 billion people worldwide. Hypertension is associated with increased risk of cardiovascular disease (CVD) events (e.g. coronary heart disease, heart failure and stroke) and death. An international panel of experts convened by the International Society of Hypertension College of Experts compiled lifestyle management recommendations as first-line strategy to prevent and control hypertension in adulthood. We also recommend that lifestyle changes be continued even when blood pressure-lowering medications are prescribed. Specific recommendations based on literature evidence are summarized with advice to start these measures early in life, including maintaining a healthy body weight, increased levels of different types of physical activity, healthy eating and drinking, avoidance and cessation of smoking and alcohol use, management of stress and sleep levels. We also discuss the relevance of specific approaches including consumption of sodium, potassium, sugar, fibre, coffee, tea, intermittent fasting as well as integrated strategies to implement these recommendations using, for example, behaviour change-related technologies and digital tools

Reliable quantification of the potential for equations based on spot urine samples to estimate population salt intake: protocol for a systematic review and meta-analysis

Background: Methods based on spot urine samples (a single sample at one time-point) have been identified as a possiblealternative approach to 24-hour urine samples for determining mean population salt intake.Objective: The aim of this study is to identify a reliable method for estimating mean population salt intake from spot urinesamples. This will be done by comparing the performance of existing equations against one other and against estimates derivedfrom 24-hour urine samples. The effects of factors such as ethnicity, sex, age, body mass index, antihypertensive drug use, healthstatus, and timing of spot urine collection will be explored. The capacity of spot urine samples to measure change in salt intakeover time will also be determined. Finally, we aim to develop a novel equation (or equations) that performs better than existingequations to estimate mean population salt intake.Methods: A systematic review and meta-analysis of individual participant data will be conducted. A search has been conductedto identify human studies that report salt (or sodium) excretion based upon 24-hour urine samples and spot urine samples. Therewere no restrictions on language, study sample size, or characteristics of the study population. MEDLINE via OvidSP (1946-present),Premedline via OvidSP, EMBASE, Global Health via OvidSP (1910-present), and the Cochrane Library were searched, and tworeviewers identified eligible studies. The authors of these studies will be invited to contribute data according to a standard format.Individual participant records will be compiled and a series of analyses will be completed to: (1) compare existing equations forestimating 24-hour salt intake from spot urine samples with 24-hour urine samples, and assess the degree of bias according tokey demographic and clinical characteristics; (2) assess the reliability of using spot urine samples to measure population changesin salt intake overtime; and (3) develop a novel equation that performs better than existing equations to estimate mean populationsalt intake.Results: The search strategy identified 538 records; 100 records were obtained for review in full text and 73 have been confirmedas eligible. In addition, 68 abstracts were identified, some of which may contain data eligible for inclusion. Individual participantdata will be requested from the authors of eligible studies.Conclusions: Many equations for estimating salt intake from spot urine samples have been developed and validated, althoughmost have been studied in very specific settings. This meta-analysis of individual participant data will enable a much broaderunderstanding of the capacity for spot urine samples to estimate population salt intake

Los países de las Américas se movilizan para disminuir la hipertensión y las ECV mediante la reducción del consumo de sal en la población

La sal añadida a los alimentos constituye un factor fundamental en el aumento de la presión arterial en personas normo-tensas e hipertensas, sean adultos o niños. Asimismo, una dieta alta en sal aumenta el riesgo de hipertrofia ventricular izquierda y daño renal, es una causa probable de cáncer gástrico y posiblemente se asocia con la osteoporosis, los cálculos renales de calcio y el aumento en la severidad del asma. Como los alimentos salados provocan sed, es probable que contribuyan en forma importante con la obesidad infantil y de la adolescencia debido al mayor consumo de bebidas con contenido energético elevado. La reducción del consumo de sal, es una de las medidas más costo-efectivas para la salud pública. Puede reducir las tasas de una serie de enfermedades crónicas y condiciones relacionadas, a un costo estimado de $0,04-$0,32 por persona por año. La OPS respondió ante esta situación, por medio de la Iniciativa de “Prevención de las enfermedades cardiovasculares en las Américas mediante la reducción del consumo de sal alimentaría en toda la población”. Inició actividades en septiembre del 2009 y constituyó un Grupo de Expertos Regional, integrado por 19 expertos en nutrición y enfermedades crónicas no trasmisibles, provenientes de la academia, agencias de gobierno e instituciones de investigación del continente americano y Europa. Por su parte, los sistemas nacionales de vigilancia tendrán a cargo el monitoreo del progreso de las metas y compromisos acordados. Los programas nacionales de fortificación deben ser revisados para ajustar los contenidos de yodo y flúor en relación con las metas de disminución del consumo de sal/sodio

The Canadian Hypertension Education Program – a unique Canadian knowledge translation program

The Canadian Hypertension Education Program annually appraises data from hypertension research and updates clinical practice recommendation for the diagnosis and management of hypertension. Enormous effort is devoted to disseminating these recommendations to target groups throughout the country and, through the use of institutional databases, to evaluating their effectiveness in improving the health of Canadians by lowering blood pressure in people with hypertension. The mission of the Canadian Hypertension Education Program is to reduce the impact of hypertension on cardiovascular disease in Canada