The Role of Lifestyle Interventions in the Primary Prevention of Hypertension

Abstract

Background: Hypertension, a leading cause of global cardiovascular mortality, affects over 1.28 billion adults and is closely linked to stroke and heart failure. As a preventable condition, its silent progression underscores the critical need for effective primary prevention strategies (1). Methods: Following PRISMA guidelines, we conducted a systematic review of peer-reviewed studies published in English from 2001 to August 25, 2025, sourced from PubMed, Medline, Google Scholar, BioMed Central, and WHO reports. Inclusion criteria targeted original research on lifestyle interventions for primary hypertension prevention, including randomized controlled trials (RCTs), systematic reviews, and meta-analyses reporting blood pressure outcomes. Of 87 identified studies, 64 were excluded (e.g., 20 non-English, 15 secondary prevention, 29 no BP outcomes), with 23 included for narrative synthesis. Risk of bias was assessed using Cochrane RoB 2 and ROBINS-I tools (2,3). Results: The 23 studies evaluated lifestyle interventions: dietary modification (4 studies), physical activity (5 studies), weight management (5 studies), smoking/alcohol moderation (3 studies), stress management (3 studies), and social determinants (3 studies). Dietary interventions, including sodium reduction and the DASH diet, reduced systolic blood pressure (SBP) by 5–11 mmHg (5,13,23). Physical activity (aerobic, resistance, HIIT) lowered SBP by 4–9 mmHg and hypertension incidence by up to 21% (3,8,15,24). Modest weight loss (5–10%) decreased SBP by 4–7 mmHg (6,7,9,12,21). Smoking cessation and alcohol moderation improved vascular health, reducing SBP by 3–5 mmHg (10,16,18). Stress reduction via mindfulness and CBT lowered SBP by 3–6 mmHg (19). Social determinants influenced efficacy, with disparities in underserved populations (4,17,22). Risk of bias was low to moderate in 15 studies and moderate to high in 8, due to blinding and reporting issues (2,3). Conclusion: Lifestyle interventions are effective, cost-efficient strategies for hypertension prevention, supporting their integration into public health policies and clinical practice. Heterogeneity and access disparities in underserved populations highlight the need for standardized, equitable interventions. No funding was received for this review.