Page 35 - GUIAS ESC ESH 2018

ESC/ESH Guidelines 35

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Globally, usual sodium intake is between 3.5–5.5 g per day (which . . . accompanied by other lifestyle changes such as physical exercise and
corresponds to 9 - 12 g of salt per day), with marked differences . . . weight loss. 35
between countries and even between regions within countries. We . . . With regard to coffee consumption, caffeine has been shown to
recommend sodium intake to be limited to approximately 2.0 g per . . . have an acute pressor effect. 267 Nevertheless, coffee consumption is
day (equivalent to approximately 5.0 g salt per day) in the general . . . associated with CV benefits, as highlighted by a recent systematic
population and to try to achieve this goal in all hypertensive . . . review of prospective cohort studies including more than 1 million
patients. Effective salt reduction is not easy and there is often poor . . . participants and 36 352 CV events. 267 Moreover, green or black tea
appreciation of which foods contain high salt levels. Advice should . . . consumption may also have a small but significant BP-lowering
be given to avoid added salt and high-salt foods. A reduction in pop- . . . effect. 268,269
ulation salt intake remains a public health priority but requires a . . . Regular consumption of sugar-sweetened soft drinks has been
combined effort between the food industry, governments, and the . . . associated with overweight, metabolic syndrome, type 2 diabetes,
public in general, as 80% of salt consumption involves hidden salt in . . . and higher CV risk. The consumption of these drinks should be
processed foods. . . . . . discouraged. 35
Thus, adopting a healthy and balanced diet may assist in BP reduc-
7.4.3 Moderation of alcohol consumption . . . . . tion and also reduce CV risk.
There is a long-established positive linear association between alco- . . .
hol consumption, BP, the prevalence of hypertension, and CVD risk. . . . .
17
Binge drinking can have a strong pressor effect. The Prevention and . . . 7.4.5 Weight reduction
Treatment of Hypertension Study (PATHS) investigated the effects . . . Excessive weight gain is associated with hypertension, and reducing
of alcohol reduction on BP; the intervention group had a modest 1.2/ . . . weight towards an ideal body weight decreases BP. 270 In a meta-
0.7 mmHg lower BP than the control group at the end of the 6 month . . . analysis, the mean SBP and DBP reductions associated with an aver-
period. 260 A Mendelian randomization meta-analysis of 56 epidemio- . . . age weight loss of 5.1 kg were 4.4 and 3.6 mmHg, respectively. 271
logical studies suggested that reduction of alcohol consumption, even . . . Both overweight and obesity are associated with an increased risk of
for light–moderate drinkers, might be beneficial for CV health. 261 . . . CV death and all-cause mortality. Weight reduction is recommended
Hypertensive men who drink alcohol should be advised to limit their . . . in overweight and obese hypertensive patients for control of meta-
consumption to 14 units per week and women to 8 units per week . . . bolic risk factors, but weight stabilization may be a reasonable goal
(1 unit is equal to 125 mL of wine or 250 mL of beer). Alcohol-free . . . for many. The Prospective Studies Collaboration 272 concluded that
days during the week and avoidance of binge drinking 35 are also . . . mortality was lowest at a body mass index (BMI) of approximately
advised. . . . . . 22.5 - 25 kg/m , whereas a more recent meta-analysis concluded that
2
273,274
optimal BMI is unclear, maintenance of a healthy body weight (BMI of
7.4.4 Other dietary changes . . . . . mortality was lowest in subjects with overweight. Although the
2
Hypertensive patients should be advised to eat a healthy balanced . . . approximately 20- 25 kg/m in people <60 years of age; higher in
diet containing vegetables, legumes, fresh fruits, low-fat dairy prod- . . . older patients) and waist circumference (<94 cm for men and <80
ucts, wholegrains, fish, and unsaturated fatty acids (especially olive . . . cm for women) is recommended for non-hypertensive individuals to
oil), and to have a low consumption of red meat and saturated fatty . . . prevent hypertension, and for hypertensive patients to reduce BP. 35
acids. 262–264 The Mediterranean diet includes many of these nutrients . . . Weight loss can also improve the efficacy of antihypertensive medica-
and foods, with a moderate consumption of alcohol (mostly wine . . . tions and the CV risk profile. Weight loss should employ a multidisci-
with meals). A number of studies and meta-analyses 262–265 have . . . plinary approach that includes dietary advice, regular exercise, and
shown that the Mediterranean diet is associated with a reduction in . . . . motivational counselling. 35,275 Furthermore, short-term results are
CV events and all-cause mortality. An RCT in high-risk individuals on . . . often not maintained over the long-term. Weight loss can also be
the Mediterranean diet over 5 years showed a 29% CV risk reduction . . . promoted by anti-obesity drugs and, to a greater degree, bariatric
compared with a low-fat control diet, and a 39% reduction in . . . surgery, which appears to decrease CV risk in severely obese
stroke. 265 The Mediterranean diet also significantly reduced ambula- . . . patients. Further details are available in a recent document of the
tory BP, blood glucose, and lipid levels. 266 The diet should be . ESH and the European Association for the Study of Obesity. 276

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