Non-pharmacological Treatment of Hypertension

  • Dénes Páll
  • Miklós Zrínyi
Part of the Updates in Hypertension and Cardiovascular Protection book series (UHCP)


Lowering elevated blood pressure in children and adolescents has significant impact. In these ages, non-pharmacological treatment, that is, comprehensive lifestyle changes, is preferred. Most hypertensive youth are often overweight or obese. Loss of body weight therefore not only lowers blood pressure but also has favorable effects for other cardiovascular risk factors. Changes in eating habits, mainly restricted calorie intake and the addition of DASH diet, should hold great potential in decreasing elevated blood pressure. Increased physical activity has a strong and positive effect on lowering blood pressure as well, but the focus should be on regularity of exercise and not its intensity. Decline of daily salt intake should also contribute to achieving target blood pressure levels. Other factors, such as motivational interviewing and stress management, hold promise for reaching regulated blood pressure outcomes in adolescents. Best results may be achieved by combining these lifestyle-modifying methods for long-term success.


Blood pressure Hypertension Lifestyle changes Low-calorie diet DASH diet Physical activity Salt intake Motivational interview Stress reduction Obesity Children and adolescent 


  1. 1.
    Lurbe E, Cifkova R, Cruickshank JK, et al. European Society of Hypertension. Management of high blood pressure in children and adolescents: recommendations of the European Society of Hypertension. J Hypertens. 2009;27:1719–42.CrossRefGoogle Scholar
  2. 2.
    Lurbe E, Agabiti-Rosei E, Cruickshank JK, et al. 2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J Hypertens. 2016;34:1887–920.CrossRefGoogle Scholar
  3. 3.
    Kotsis V, Nilsson P, Grassi G, et al. Obesity, diabetes, the high risk patient, European Society of Hypertension. New developments in the pathogenesis of obesity-induced hypertension. J Hypertens. 2015;33:1499–508.CrossRefGoogle Scholar
  4. 4.
    Torrance B, McGuire KA, Lewanczuk R, McGavock J. Overweight, physical activity and high blood pressure in children: a review of the literature. Vasc Health Risk Manag. 2007;3:139–49.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Lurbe E. Childhood blood pressure: a window to adult hypertension. J Hypertens. 2003;21:201–13.CrossRefGoogle Scholar
  6. 6.
    Lauer RM, Connor WE, Leaverton PE, et al. Coronary heart disease risk factors in school children: the Muscatine study. J Pediatr. 1975;86:697–708.CrossRefGoogle Scholar
  7. 7.
    Trost SG, Kerr LM, Ward DS, Pate RR. Physical activity and determinants of physical activity in obese and non-obese children. Int J Obes Relat Metab Disord. 2001;25:822–9.CrossRefGoogle Scholar
  8. 8.
    Reinehr T, Andler W. Changes in the atherogenic risk factor profile according to degree of weight loss. Arch Dis Child. 2004;89:419e22.CrossRefGoogle Scholar
  9. 9.
    Rocchini AP, Katch V, Anderson J, et al. Blood pressure in obese adolescents: effect of weight loss. Pediatrics. 1988;82:16–23.PubMedGoogle Scholar
  10. 10.
    Monzavi R, Dreimane D, Geffner ME, et al. Improvement in risk factors for metabolic syndrome and insulin resistance in overweight youth who are treated with lifestyle intervention. Pediatrics. 2006;117(6):e1111–8. Scholar
  11. 11.
    Puri M, Flynn JT. Management of hypertension in children and adolescents with the metabolic syndrome. J Cardiometab Syndr. 2006;1:259e68.CrossRefGoogle Scholar
  12. 12.
    Ho M, Garnett SP, Baur L, et al. Effectiveness of lifestyle interventions in child obesity: systematic review with meta-analysis. Pediatrics. 2012;130:e1647–71.CrossRefGoogle Scholar
  13. 13.
    Holm JC, Gamborg M, Neland M, et al. Longitudinal changes in blood pressure during weight loss and regain of weight in obese boys and girls. J Hypertens. 2012;30:368–74.CrossRefGoogle Scholar
  14. 14.
    Hvidt KN, Olsen MH, Ibsen H, Holm JC. Effect of changes in BMI and waist circumference on ambulatory blood pressure in obese children and adolescents. J Hypertens. 2014;32:1470–7.CrossRefGoogle Scholar
  15. 15.
    Sorof JM, Poffenbarger T, Franco K, et al. Isolated systolic hypertension, obesity, and hyperkinetic hemodynamic states in children. J Pediatr. 2002;140:660–6.CrossRefGoogle Scholar
  16. 16.
    Karatzi K, Protogerou A, Rarra V, Stergiou GS. Home and office blood pressure in children and adolescents: the role of obesity. The Arsakeion school study. J Hum Hypertens. 2009;23:512–20.CrossRefGoogle Scholar
  17. 17.
    Marti B, Vartiainene E. Relation between leisure time exercise and cardiovascular risk factors among 15-year-olds in Eastern Finland. J Epidemiol Community Health. 1989;43:228–33.CrossRefGoogle Scholar
  18. 18.
    Macintyre S, Watt G, West P, Ecob R. Correlates of blood pressure in 15 year olds in the west of Scotland. J Epidemiol Community Health. 1991;45:143–7.CrossRefGoogle Scholar
  19. 19.
    Brage S, Wedderkopp N, Ekelund U, et al. Features of the metabolic syndrome are associated with objectively measured physical activity and fitness in Danish children: the European youth heart study. Diabetes Care. 2004;27:2141–8.CrossRefGoogle Scholar
  20. 20.
    Andersen LB, Harro M, Sardinha LB, et al. Physical activity and clustered cardiovascular risk in children: a cross-sectional study (the European youth heart study). Lancet. 2006;368:299–304.CrossRefGoogle Scholar
  21. 21.
    Kelley GA, Kelley KS, Tran ZV. The effects of exercise on resting blood pressure in children and adolescents: a meta-analysis of randomized controlled trials. Prev Cardiol. 2003;6:8–16.CrossRefGoogle Scholar
  22. 22.
    Alpert BS, Wilmore JH. Physical activity and blood pressure in adolescents. Pediatr Exerc Sci. 1984;8:361–80.Google Scholar
  23. 23.
    Leary SD, Ness AR, Smith GD, et al. Physical activity and blood pressure in childhood: findings from a population-based study. Hypertension. 2008;51:92–8.CrossRefGoogle Scholar
  24. 24.
    Farpour-Lambert NJ, Aggoun Y, Marchand LM, et al. Physical activity reduces systemic blood pressure and improves early markers of atherosclerosis in prepubertal obese children. J Am Coll Cardiol. 2009;54:2396–406.CrossRefGoogle Scholar
  25. 25.
    Gutin B, Basch C, Shea S, et al. Blood pressure, fitness, and fatness in 5- and 6-year-old children. JAMA. 1990;264:1123–7.CrossRefGoogle Scholar
  26. 26.
    Shea S, Basch CE, Gutin B, et al. The rate of increase in blood pressure in children 5 years of age is related to changes in aerobic fitness and body mass index. Pediatrics. 1994;94:465–70.PubMedGoogle Scholar
  27. 27.
    Carnethon MR, Gulati M, Greenland P. Prevalence and cardiovascular disease correlates of low cardiorespiratory fitness in adolescents and adults. JAMA. 2005;294:2981–8.CrossRefGoogle Scholar
  28. 28.
    Hagberg JM, Goldring D, Ehsani AA, et al. Effect of exercise training on the blood pressure and hemodynamic features of hypertensive adolescents. Am J Cardiol. 1983;52:763–8.CrossRefGoogle Scholar
  29. 29.
    Hagberg JM, Ehsani AA, Goldring D. Effect of weight training on blood pressure and hemodynamics in hypertensive adolescents. J Pediatr. 1984;104:147–51.CrossRefGoogle Scholar
  30. 30.
    Gutin B, Barbeau P, Litaker MS, et al. Heart rate variability in obese children: relations to total body and visceral adiposity, and changes with physical training and detraining. Obes Res. 2000;8:12–9.CrossRefGoogle Scholar
  31. 31.
    Becque MD, Katch VL, Rocchini AP, et al. Coronary risk incidence of obese adolescents: reduction by exercise plus diet intervention. Pediatrics. 1988;81:605–12.PubMedGoogle Scholar
  32. 32.
    Watts K, Beye P, Siafarikas A, et al. Exercise training normalizes vascular dysfunction and improves central adiposity in obese adolescents. J Am Coll Cardiol. 2004;43:1823–7.CrossRefGoogle Scholar
  33. 33.
    Ribeiro MM, Silva AG, Santos NS, et al. Diet and exercise training restore blood pressure and vasodilatory responses during physiological maneuvers in obese children. Circulation. 2005;111:1915–23.CrossRefGoogle Scholar
  34. 34.
    Chen HH, Chen YL, Huang CY, et al. Effects of one-year swimming training on blood pressure and insulin sensitivity in mild hypertensive young patients. Chin J Physiol. 2010;53(3):185–9.CrossRefGoogle Scholar
  35. 35.
    Rebholz CM, Gu D, Chen J, et al. GenSalt collaborative research group. Physical activity reduces salt sensitivity of blood pressure: the genetic epidemiology network of salt sensitivity study. Am J Epidemiol. 2012;176:S106–13.CrossRefGoogle Scholar
  36. 36.
    World Health Organization. Physical activity and young people. Recommended levels of physical activity for children aged 5–17 years. 2010. Accessed 13 Apr 2016.
  37. 37.
    Yang Q, Zhang Z, Kuklina EV, et al. Sodium intake and blood pressure among US children and adolescents. Pediatrics. 2012;130:611–9.CrossRefGoogle Scholar
  38. 38.
    Mattes RD, Donnelly D. Relative contributions of dietary sodium sources. J Am Coll Nutr. 1991;10:383–93.CrossRefGoogle Scholar
  39. 39.
    Geleijnse JM, Hofman A, Witteman JC, et al. Long-term effects of neonatal sodium restriction on blood pressure. Hypertension. 1997;29:913–7.CrossRefGoogle Scholar
  40. 40.
    He FJ, MacGregor GA. Importance of salt in determining blood pressure in children: meta-analysis of controlled trials. Hypertension. 2006;48:861–9.CrossRefGoogle Scholar
  41. 41.
    Boegehold MA. The effect of high salt intake on endothelial function: reduced vascular nitric oxide in the absence of hypertension. J Vasc Res. 2013;50:458–67.CrossRefGoogle Scholar
  42. 42.
    Shi L, Krupp D, Remer T. Salt, fruit and vegetable consumption and blood pressure development: a longitudinal investigation in healthy children. Br J Nutr. 2014;111:662–71.CrossRefGoogle Scholar
  43. 43.
    Barnes TL, Crandell JL, Bell RA, et al. Change in DASH diet score and cardiovascular risk factors in youth with type 1 and type 2 diabetes mellitus: the SEARCH for diabetes in youth study. Nutr Diabetes. 2013;3:e91.CrossRefGoogle Scholar
  44. 44.
    Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical practice guideline for screening and Management of High Blood Pressure in children and adolescents. Pediatrics. 2017;140(3):e201719042017.CrossRefGoogle Scholar
  45. 45.
    Couch SC, Saelens BE, Levin L, et al. The efficacy of a clinic-based behavioral nutrition intervention emphasizing a DASH-type diet for adolescents with elevated blood pressure. J Pediatr. 2008;152:494–501.CrossRefGoogle Scholar
  46. 46.
    Moore LL, Bradlee ML, Singer MR, et al. Dietary approaches to stop hypertension (DASH) eating pattern and risk of elevated blood pressure in adolescent girls. Br J Nutr. 2012;108:1678–85.CrossRefGoogle Scholar
  47. 47.
    Gunther AL, Liese AD, Bell RA, et al. Association between the dietary approaches to hypertension diet and hypertension in youth with diabetes mellitus. Hypertension. 2009;53(1):6–12.CrossRefGoogle Scholar
  48. 48.
    Saneei P, Hashemipour M, Kelishadi R, et al. Effects of recommendations to follow the dietary approaches to stop hypertension (DASH) diet v. usual dietary advice on childhood metabolic syndrome: a randomised cross-over clinical trial. Br J Nutr. 2013;110:2250–9.CrossRefGoogle Scholar
  49. 49.
    Asghari G, Yuzbashian E, Mirmiran P, et al. Dietary approaches to stop hypertension (DASH) dietary pattern is associated with reduced incidence of metabolic syndrome in children and adolescents. J Pediatr. 2016;174:178–184.e1.CrossRefGoogle Scholar
  50. 50.
    Yuan WL, Kakinami L, Gray-Donald K, et al. Influence of dairy product consumption on children’s blood pressure: results from the QUALITY cohort. J Acad Nutr Diet. 2013;113(7):936–41.CrossRefGoogle Scholar
  51. 51.
    Damasceno MM, de Araújo MF, de Freitas RW, et al. The association between blood pressure in adolescents and the consumption of fruits, vegetables and fruit juice--an exploratory study. J Clin Nurs. 2011;20:1553–60.CrossRefGoogle Scholar
  52. 52.
    Juonala M, Viikari JS, Kähönen M, et al. Life-time risk factors and progression of carotid atherosclerosis in young adults: the cardiovascular risk in young Finns study. Eur Heart J. 2010;31:1745–51.CrossRefGoogle Scholar
  53. 53.
    Davis JN, Ventura EE, Cook LT, et al. LA sprouts: a gardening, nutrition, and cooking intervention for Latino youth improves diet and reduces obesity. J Am Diet Assoc. 2011;111:1224–30.CrossRefGoogle Scholar
  54. 54.
    Svetkey LP, Simons-Morton D, Vollmer WM, et al. Effects of dietary patterns on blood pressure: subgroup analysis of the dietary approaches to stop hypertension (DASH) randomized clinical trial. Arch Intern Med. 1999;159:285–93.CrossRefGoogle Scholar
  55. 55.
    Rasmussen BM, Vessby B, Uusitupa M, et al. The KANWU study group. Effects of dietary saturated, monounsaturated, and n-3 fatty acids on blood pressure in healthy subjects. Am J Clin Nutr. 2006;83:221–6.CrossRefGoogle Scholar
  56. 56.
    Moreno-Luna R, Muñoz-Hernandez R, Miranda ML, et al. Olive oil polyphenols decrease blood pressure and improve endothelial function in young women with mild hypertension. Am J Hypertens. 2012;25:1299–304.PubMedGoogle Scholar
  57. 57.
    Hertog MG, Kromhout D, Aravanis C, et al. Flavonoid intake and long-term risk of coronary heart disease and cancer in the seven countries study. Arch Intern Med. 1995;155:381–6.CrossRefGoogle Scholar
  58. 58.
    Nguyen S, Choi HK, Lustig RH, Hsu CY. Sugar-sweetened beverages, serum uric acid, and blood pressure in adolescents. J Pediatr. 2009;154:807–13.CrossRefGoogle Scholar
  59. 59.
    Simonetti GD, Schwertz R, Klett M, et al. Determinants of blood pressure in preschool children: the role of parental smoking. Circulation. 2011;123:292–8.CrossRefGoogle Scholar
  60. 60.
    Resnicow K, McMaster F, Bocian A, et al. Motivational interviewing and dietary counseling for obesity in primary care: an RCT. Pediatrics. 2015;135:649–57.CrossRefGoogle Scholar
  61. 61.
    Davoli AM, Broccoli S, Bonvicini L, et al. Pediatrician-led motivational interviewing to treat overweight children: an RCT. Pediatrics. 2013;132(5):e1236–46. Scholar
  62. 62.
    Broccoli S, Davoli AM, Bonvicini L, et al. Motivational interviewing to treat overweight children: 24-month follow-up of a randomized controlled trial. Pediatrics. 2016;137(1):e20151979.CrossRefGoogle Scholar
  63. 63.
    Döring N, Ghaderi A, Bohman B, et al. Motivational interviewing to prevent childhood obesity: a cluster RCT. Pediatrics. 2016;137:1–10.CrossRefGoogle Scholar
  64. 64.
    Gregoski MJ, Barnes VA, Tingen MS, et al. Breathing awareness meditation and LifeSkills training programs influence upon ambulatory blood pressure and sodium excretion among African American adolescents. J Adolesc Health. 2011;48:59–64.CrossRefGoogle Scholar
  65. 65.
    Sieverdes JC, Mueller M, Gregoski MJ, et al. Effects of Hatha yoga on blood pressure, salivary α-amylase, and cortisol function among normotensive and prehypertensive youth. J Altern Complement Med. 2014;20:241–50.CrossRefGoogle Scholar
  66. 66.
    van Dijk AE, van Eijsden M, Stronks K, et al. The association between prenatal psychosocial stress and blood pressure in the child at age 5-7 years. PLoS One. 2012;7(8):e43548.CrossRefGoogle Scholar
  67. 67.
    Stein DJ, Scott K, Haro Abad JM, et al. Early childhood adversity and later hypertension: data from the world mental health survey. Ann Clin Psychiatry. 2010;22(1):19–28.PubMedPubMedCentralGoogle Scholar
  68. 68.
    Katona E, Zrínyi M, Komonyi E, et al. Factors influencing adolescent blood pressure: the Debrecen hypertension study. Kidney Blood Press Res. 2011;34:188–95.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Dénes Páll
    • 1
    • 2
  • Miklós Zrínyi
    • 2
  1. 1.Department of MedicineUniversity of DebrecenDebrecenHungary
  2. 2.Coordination Center for Drug DevelopmentUniversity of DebrecenDebrecenHungary

Personalised recommendations