Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London EC1A 7BE, UK.
NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.
Eur J Prev Cardiol. 2023 Jan 11;30(1):17-33. doi: 10.1093/eurjpc/zwac163.
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.
生活方式的改变是高血压预防和治疗的基石之一。我们旨在系统地回顾高血压指南中关于非药物因素（包括生活方式干预）的建议，以突出证据强度、相似性和差异。本系统评价已在国际前瞻性系统评价登记处（CRD42021288815）注册。从 2010 年 1 月至 2020 年 6 月的 10 年期间，在 MEDLINE 和 EMBASE 数据库中检索出版物。我们还包括了负责指南制定的组织网站的搜索。两名评审员筛选标题和摘要以确定相关指南。两名评审员独立使用 AGREE II 工具评估指南制定的严谨性，一名评审员提取建议。在所确定的指南中，有 10 项显示出良好的发展严谨性（AGREE II≥60%），并纳入系统评价。这些指南在大多数建议上是一致的（减少盐摄入量、体重、饮食模式、增加身体活动和戒烟以及限制饮酒量）。在一些新的心理和环境因素（如压力或空气污染、饮酒阈值、肉类、咖啡和茶的消费以及精制糖）的建议方面，也确定了一些存在分歧的领域。目前的指南都同意生活方式在高血压治疗和预防中的重要性。关于戒烟、限制盐摄入量、增加身体活动的共识支持将其纳入高血压患者的管理以及在一般人群中的公共卫生措施中作为预防措施。对环境和心理因素作用的进一步研究可能有助于澄清未来的建议。
