The integral role of lifestyle in the prevention and management of hypertension and associated cardiometabolic and cognitive disorders: a review

Hypertension represents a paramount global health challenge, intricately linked to cardiovascular, metabolic, and cognitive morbidity. This narrative review provides a critical synthesis of current evidence, anchored by a systematic literature search, to delineate the integral role of comprehensive lifestyle interventions in the prevention and management of hypertension and its complications. Our analysis demonstrates that evidence-based, multidimensional strategies—including dietary modifications (e.g., DASH and Mediterranean diets), regular physical activity, structured weight management, and stress reduction—effectively lower blood pressure, improve metabolic parameters, and attenuate target organ damage. These non-pharmacological approaches act synergistically with antihypertensive drug therapy and can be personalized through digital health technologies. The findings underscore that embedding structured lifestyle medicine into clinical practice and public health policy is an indispensable, cost-effective strategy for alleviating the global burden of hypertension.

1 Introduction

Hypertension, or high blood pressure, is a significant global health issue, closely associated with cardiovascular, metabolic, and cognitive disorders. High blood pressure remains one of the most prevalent and impactful non-communicable diseases (NCDs) globally, significantly contributing to morbidity and mortality worldwide. Its insidious nature often leads to delayed diagnosis and treatment, silently predisposing individuals to a myriad of severe health complications (1, 2). The rising global prevalence of hypertension poses an immense burden on healthcare systems and public health initiatives, necessitating robust and sustainable strategies for prevention and management. Central to these strategies is the recognition of lifestyle as a powerful, modifiable determinant of health, capable of significantly influencing the trajectory of hypertension and its associated comorbidities.

The intricate interplay between hypertension and other chronic conditions, notably cardiovascular diseases (CVDs), metabolic syndrome, chronic kidney disease (CKD), and cognitive decline, underscores the imperative for a holistic approach to patient care. There is consistent evidence of a causal association between cardiovascular risk factors and the development of hypertension, establishing a vicious cycle of deteriorating health (3). Moreover, conditions such as obesity (4), diabetes, and dyslipidemia frequently co-exist with hypertension, forming the complex constellation known as cardiometabolic syndrome (5, 6). Beyond its well-established cardiovascular ramifications, hypertension is increasingly recognized as a critical risk factor for cognitive impairment and dementia, with lifestyle factors playing a substantial role in either mitigating or exacerbating this risk (7–9).

This review aims to provide a broad and insightful overview of the current scientific literature concerning the integral role of lifestyle interventions in addressing hypertension and its associated cardiometabolic and cognitive disorders. First, we will meticulously detail the burden of hypertension and its interconnectedness with various health conditions. We will then explore the diverse range of evidence-based lifestyle strategies constitutes the foundation of both primary prevention and effective therapeutic management. We will also explore the evolution of these interventions, incorporating modern, integrated approaches and technological advancements that enhance their reach and efficacy. Through this critical analysis, the review aims to consolidate the understanding of the vital role of lifestyle in a holistic health paradigm.

2 Methods

To ensure a comprehensive and structured synthesis of the current evidence, a systematic literature search strategy was designed and executed. The primary objective was to identify high-quality, recent publications relevant to the role of lifestyle interventions in hypertension and its associated disorders.

2.1 Search strategy

A focused electronic literature search was performed using the PubMed database. The search was restricted to articles published from January 1, 2020, to June 30, 2025, to ensure the inclusion of the most recent and relevant evidence. The search strategy combined key Medical Subject Headings (MeSH) terms and free-text keywords related to the core themes of the review.

The main search blocks included:

Block 1: (“Hypertension”[Mesh] OR “High Blood Pressure”)

Block 2: (“Life Style”[Mesh] OR “Diet”[Mesh] OR “Exercise”[Mesh] OR “Physical Activity” OR “Weight Management”)

Block 3: (“Cardiovascular Diseases”[Mesh] OR “Cognitive Dysfunction”[Mesh] OR “Dementia”[Mesh] OR “Renal Insufficiency, Chronic”[Mesh] OR “Metabolic Syndrome”[Mesh])

Block 4: (“Prevention and Control”[Subheading] OR “Therapeutics”[Mesh] OR “Management”)

Block 5 (Study Design Filter): (“randomized controlled trial”[pt] OR “controlled clinical trial”[pt] OR “systematic review”[pt] OR “meta-analysis”[pt] OR “prospective studies”[MeSH] OR (prospective[tiab] AND cohort[tiab]))

Blocks 1–4 were combined using ‘AND’, and the resulting set was then combined with Block 5 using ‘AND’ to focus on specific study designs.

2.2 Selection and eligibility criteria

The identified records were screened for relevance based on titles and abstracts, followed by a full-text assessment of potentially eligible articles.

Inclusion Criteria: We included randomized controlled trials (RCTs), prospective cohort studies, systematic reviews, and meta-analyses that investigated at least one lifestyle intervention (diet, exercise, weight loss, etc.) for the prevention or management of hypertension and its cardiometabolic or cognitive complications.

Exclusion Criteria: We excluded studies published in languages other than English, preclinical studies, editorials, letters, commentaries, and studies without original data.

2.3 Data synthesis

Given the broad, multi-domain scope of this review, a formal meta-analysis was not feasible. Instead, a narrative synthesis approach was adopted. The selected evidence was organized into thematic sections to provide a coherent and critical overview of the current scientific landscape.

3 The burden of hypertension and its interconnectedness with cardiometabolic and cognitive health

Hypertension poses a heterogeneous and substantial burden on global public health, with its prevalence and control rates demonstrating significant disparities across geographic, socioeconomic, and demographic lines. While trends have improved in some high-income countries, a pronounced rise is observed across East and South Asia, Oceania, and sub-Saharan Africa. These regions, along with many low- and middle-income countries, are further challenged by low rates of treatment and effective control. Beyond geography, the burden of hypertension is not uniformly distributed by gender or residence. Men generally exhibit higher blood pressure levels than women in younger populations, a gap that narrows with age, though this pattern exhibits regional variation. Furthermore, complex disparities exist between rural and urban areas, often mediated by factors such as socioeconomic status and educational attainment. Access to healthcare resources is crucial (10). Hypertension is often referred to as a “silent killer” due to its asymptomatic nature in the early stages, leading to delayed diagnosis and an increased risk of end-organ damage (1). It has been identified as the most significant modifiable risk factor for cardiovascular disease (CVD) events, including coronary heart disease, heart failure, and stroke, as well as mortality. The relationship between cardiovascular risk factors and hypertension is not just correlational; it is fundamentally causal, with specific risk factors directly contributing to the development and progression of elevated blood pressure (3). This establishes hypertension as a central component within a broader network of cardiometabolic dysregulations. For example, the COVID-19 pandemic has been associated with an increased prevalence of metabolic syndrome, highlighting how systemic inflammation and lifestyle disruptions can exacerbate cardiometabolic risks (5). Individuals with hypertension often present with multiple cardiometabolic comorbidities, a phenomenon known as cardiometabolic multimorbidity. Encouragingly, adopting healthy lifestyle habits has been shown to significantly lower the risk of developing this multimorbidity in hypertensive patients, emphasizing the protective role of lifestyle (6). Ideal cardiovascular health, which includes optimal blood pressure, lipid profiles, glucose metabolism, and lifestyle factors, is profoundly associated with a reduced risk of various diseases, further emphasizing the interconnectedness of these health domains (11).

Beyond its direct impact on the cardiovascular system, hypertension is a critical determinant of cognitive health and a significant risk factor for cognitive impairment, including vascular dementia and Alzheimer’s disease. Hypertension has been identified as a significant risk factor for cognitive decline, particularly in middle age, with notable correlations observed between. Hypertension and cognitive impairment, as well as brain morphological changes in later life, are of concern. Blood pressure variability (BPV) has been identified as an independent risk factor for cognitive decline. Hypertension is a condition that has the potential to cause a series of detrimental effects on bodily functions. These effects include vascular damage, inflammation, neurovascular dysfunction, and disruption of the blood-brain barrier (BBB). Collectively, these factors can significantly impact brain health, resulting in neuronal damage and subsequent cognitive decline. Furthermore, hypertension has been demonstrated to exacerbate cognitive decline through mechanisms such as affecting cerebral blood flow, cerebrospinal fluid mobility, and cerebral small vessel disease (CSVD). It is important to note that, in contrast to the prevailing traditional view, which considers Alzheimer’s disease (AD) to be purely a neurodegenerative disorder, contemporary perspectives emphasize the significant role of vascular brain lesions in AD, with the majority of patients exhibiting a combination of pathological features. Additionally, hypertension has been shown to exacerbate the progression of Alzheimer’s disease (AD) pathology through the promotion of the accumulation of β-amyloid (Aβ) and phosphorylated tau protein (p-tau) (12). A substantial proportion of dementia cases, potentially up to one-third, are considered preventable through the modification of lifestyle and vascular risk factors (8). Indeed, modifiable risk factors account for approximately 50% of dementia cases in populations like Canada, underscoring the immense potential for prevention through targeted interventions (7). Some studies have shown that blood pressure treatment may help reduce the risk of cognitive decline, particularly in individuals who start treatment in middle age. Intensive blood pressure lowering, for instance, has been demonstrated to reduce the risk of cognitive impairment, indicating a direct link between effective hypertension management and cognitive health. Tension management and brain health (9). Effective blood pressure control can slow the progression of cerebral small vessel disease (13). Furthermore, lifestyle interventions have been shown to improve cerebrovascular function, thereby potentially mitigating cognitive decline (14). Tools like the LIBRA score, which incorporates lifestyle factors and medical history, can predict cognitive function, highlighting the cumulative impact of various health determinants on brain health (15). The bidirectional association between hypertension and cognitive function underscores the importance of early and sustained intervention.

The pervasive impact of hypertension extends to a spectrum of other severe health outcomes. Stroke: Hypertension is the leading risk factor for stroke. A common dietary pattern of low vegetable intake significantly increases the risk of stroke in hypertensive patients (16). Both primary and secondary stroke prevention strategies heavily rely on blood pressure control and lifestyle modifications (17, 18). Digital platforms are increasingly utilized to support stroke prevention efforts, enhancing patient engagement and adherence (19). Atrial Fibrillation (AFib): Lifestyle interventions have shown promise in reducing the risk of atrial fibrillation, a common cardiac arrhythmia that significantly increases stroke risk (20). Even with optimal medical therapy, approximately 30% of residual stroke risk in AFib patients is attributable to modifiable factors, emphasizing the continued relevance of lifestyle interventions (21). Heart Failure (HF): Elevated blood pressure is a primary driver of heart failure development. Maintaining a healthy lifestyle has been shown to significantly reduce the risk of heart failure (22). Furthermore, conditions such as high serum sodium levels have been linked to an increased risk of heart failure (23). In South Asian populations, the rising burden of heart failure is strongly associated with diabetes, which is another cardiometabolic condition closely linked to hypertension (24).For individuals who have received a heart transplant, tailored prevention and rehabilitation programs that incorporate lifestyle elements are crucial for long-term health (25). Chronic Kidney Disease (CKD): Hypertension and CKD share a strong bidirectional relationship, where each condition can cause or exacerbate the other (26). Dietary interventions, such as plant-based diets, can help to manage kidney disease (27), and the Dietary Approaches to Stop Hypertension (DASH) diet has been shown to reduce the risk of CKD (28). The co-exposure to organic pollutants and diabetes further exacerbates the risk of kidney disease (29). Cancer: Although the primary focus of hypertension research is cardiovascular health, there are also links to cancer. Blood pressure-lowering treatment generally does not significantly increase the risk of cancer, which is reassuring for those undergoing long-term antihypertensive therapy (30). However, Western lifestyle patterns have been linked to an increased burden of gastrointestinal cancers (31), and specific lifestyle factors such as smoking and obesity increase the risk of renal cancer (32). Air pollution has also been positively correlated with an increased risk of colorectal cancer (33), highlighting the importance of broader environmental determinants of health. Lifestyle interventions can also modulate cancer metabolism (34). Pregnancy-Related Conditions: Hypertension during pregnancy, including gestational hypertension and pre-eclampsia, significantly increases the long-term cardiovascular risk for the mother (34). Comprehensive interventions are critical for managing hypertension and diabetes during pregnancy (35). Lifestyle interventions are also effective in reducing the risk of gestational diabetes (36). International guidelines for the management of hypertension management show both similarities and differences, emphasizing the need for adaptable approaches (37). Pre-pregnancy health optimization is vital for reducing adverse pregnancy outcomes (38), and long-term management strategies are essential for women with pregnancy-induced hypertension (39). Other Conditions: The interconnectedness extends to conditions like Polycystic Ovary Syndrome (PCOS), which increases the risk of cardiovascular disease (40). Post-Traumatic Stress Disorder (PTSD) has been shown to increase the incidence risk of hypertension (41), highlighting the role of mental health in cardiovascular well-being. Gout, traditionally managed through diet, also necessitates an approach that considers metabolic health, as obesity is a major preventable gout risk factor (42, 43). Childhood obesity and specific childhood cancers can also predispose individuals to health challenges in adulthood, underscoring the importance of early lifestyle interventions (44, 45).

The intricate and bidirectional relationships between hypertension and its associated complications are complex and multifaceted. To visually summarize these interconnections and provide a conceptual framework for understanding the systemic nature of hypertension, Figure 1 illustrates the interconnected web linking hypertension with cardiometabolic and cognitive comorbidities.

Figure 1

Figure 1. The interconnected web of hypertension and its cardiometabolic and cognitive comorbidities. This schematic illustrates thecomplex bidirectional relationships between hypertension (center) and its major endorgan complications. Solid arrows indicate direct pathological effects, while the dashed arrow represents a behavioral consequence. Key pathophysiological pathways, such as endothelial dysfunction, oxidative stress,and inflammation,underpin these connections (see Section 3 for details). Aß, ß-amyloid; p-tau, phosphorylated tau; CVD, cardiovascular disease; HF, heart failure; AFib, atrial fibrillation;MI, myocardial infarction; RAAS, renin-angiotensin-aldosterone system.

As depicted in Figure 1, hypertension rarely occurs in isolation but rather functions as a central node within a complex network of interrelated conditions. This interconnectedness underscores the imperative for holistic management strategies that address not only blood pressure control but also the broader spectrum of cardiometabolic and cognitive health.

4 Lifestyle interventions: foundations of prevention and management

Lifestyle interventions form the cornerstone of both primary prevention and therapeutic management for hypertension, often serving as the first line of defense and a vital adjunct to pharmacotherapy. Their efficacy stems from addressing fundamental physiological processes influenced by daily habits. Non-pharmacological interventions are widely recommended in hypertension guidelines, emphasizing their foundational role (46, 47). Lifestyle interventions have been demonstrated to be effective in addressing a range of medical concerns, with their efficacy being sustained over time. In contrast, the benefits of pharmaceutical treatment have been shown to be limited in duration and scope. The cumulative benefits of a healthy lifestyle alongside antihypertensive medication have been shown to significantly reduce mortality rates (48).

Given the multifactorial pathophysiology of hypertension, effective management requires a comprehensive approach that targets multiple physiological pathways simultaneously. Figure 2 presents a multimodal framework for lifestyle intervention, highlighting the five core domains and their synergistic interactions in achieving blood pressure control and cardiovascular risk reduction.

Figure 2

Figure 2. A multimodal and synergistic framework for lifestyle intervention in hypertension. The achievement of optimal blood pressure control and cardiovascular risk reduction (center) is best accomplished through the concurrent and synergistic application of five core lifestyle domains. Each domain contributes through distinct yet overlapping physiological mechanisms. The bidirectional arrows between domains emphasize that interventions in one area (e.g., exercise) can positively influence adherence and outcomes in others (e.g., weight management and stressreduction), creating a whole that is greater than the sum of its parts (see Sections 4 & 6).

The integrative framework shown in Figure 2 emphasizes that optimal hypertension management extends beyond isolated recommendations to encompass coordinated interventions across multiple lifestyle domains. The following sections will critically examine the evidence base supporting each of these core components, beginning with dietary strategies.

4.1 Dietary strategies

Dietary patterns play a pivotal role in modulating blood pressure and overall cardiometabolic health. A well-structured diet can prevent the onset of hypertension, aid in its management, and mitigate associated complications. DASH Diet: The Dietary Approaches to Stop Hypertension (DASH) diet is perhaps the most widely recognized and evidence-based dietary intervention for hypertension. Rich in fruits, vegetables, whole grains, and low-fat dairy, while being low in saturated fat, cholesterol, and total fat, the DASH diet is highly effective in lowering blood pressure (49). A meta-analysis evaluating the impact of DASH diet adherence on hypertension risk found that high adherence to the DASH diet was associated with lower hypertension risk compared to low adherence. This suggests that lifestyle changes should be initiated early, even in individuals with normal blood pressure (50). Beyond blood pressure control, the DASH diet has been specifically linked to a reduced risk of chronic kidney disease (CKD) (28). While generally highly effective, its blood pressure-lowering effect may be limited in patients with diabetes, suggesting the need for individualized approaches in comorbid conditions (51). Plant-Based and Mediterranean Diets: Plant-based dietary patterns are increasingly recognized for their health benefits. They are particularly beneficial for kidney disease patients, offering advantages in managing metabolic parameters and reducing disease progression (27). Similarly, legumes, a key component of plant-based diets, contain bioactive compounds that improve cardiovascular health (52). The Mediterranean diet, characterized by high intake of fruits, vegetables, whole grains, nuts, legumes, and olive oil, along with moderate consumption of fish and poultry, and low intake of red meat, is another well-established pattern. When combined with energy restriction, the Mediterranean diet can significantly reduce cardiovascular disease risk, including hypertension (53). Sodium and Potassium Balance: The balance between dietary sodium and potassium is a critical determinant of blood pressure. High sodium and low potassium intake are major contributors to hypertension (54). A systematic analysis found that higher baseline blood pressure was associated with greater blood pressure reduction from sodium restriction. However, it remains unclear whether baseline potassium intake levels alter the magnitude of blood pressure reduction from sodium restriction (55). When sodium intake was high, potassium supplementation exerted a greater blood pressure-lowering effect. One study found a negative correlation between higher potassium intake and higher blood pressure thresholds, and that the sodium-to-potassium ratio was a stronger predictor of blood pressure levels than sodium or potassium alone (56).Genetic factors also play a role in an individual’s blood pressure sensitivity to sodium and potassium intake, suggesting that personalized dietary recommendations might be beneficial (57). Reducing sodium intake is a fundamental recommendation in hypertension management (47). Specific Food Components and Supplements: Dietary Nitrates: Found in vegetables like leafy greens and beetroot, dietary nitrates can be converted to nitric oxide in the body, leading to vasodilation and blood pressure reduction. Research supports their role in lowering hypertension risk (58). Bioactive Peptides: These are specific protein fragments that can exert various physiological effects, including regulation of metabolic diseases, which encompass hypertension. Their role in influencing blood pressure and metabolic health is an active area of research (59). Antioxidant Vitamins: Vitamins such as A, C, and E, possessing antioxidant properties, have been hypothesized to lower blood pressure. While promising, the evidence base for direct blood pressure reduction through antioxidant vitamin supplementation alone is still evolving (60). Functional Foods: Beyond specific nutrients, certain functional foods and food waste extracts have shown promise. For instance, sweet cherry and beet waste extracts have been found to protect endothelial function, which is crucial for blood pressure regulation (61). Meta-analyses support the role of various functional foods in assisting blood pressure reduction (62). Impact on Other Conditions: Dietary considerations are also crucial for other conditions. A Western lifestyle, often high in processed foods and red meat, is associated with an increased burden of gastrointestinal cancers (32). For gout patients, dietary recommendations must holistically consider metabolic health, emphasizing foods that reduce uric acid while supporting cardiovascular well-being (42). Dietary patterns also significantly influence the progression of metabolic-associated steatotic liver disease (MASLD, formerly NAFLD), a condition often co-occurring with hypertension and insulin resistance (63). Furthermore, healthy eating habits contribute to improved glucose metabolism, which is essential for preventing and managing type 2 diabetes and its cardiovascular complications (64).

4.2 Physical activity and exercise

Regular physical activity is an indispensable component of a healthy lifestyle, providing profound benefits for cardiovascular health and blood pressure regulation. Blood Pressure Control: Exercise is a primary non-pharmacological intervention recommended for preventing and treating hypertension (49). Consistent engagement in physical activity improves cardiorespiratory fitness, which in turn reduces the risk of hypertension incidence (65). Personalized Exercise Prescriptions: Individualized exercise prescriptions, tailored to an individual’s health status, preferences, and goals, are more effective in lowering blood pressure. This personalized approach enhances adherence and optimizes outcomes (66). Broader Cardiovascular Benefits: Beyond direct blood pressure effects, exercise training improves cardiac conduction, reducing the risk of certain heart rhythm disorders (67) Regular physical activity also contributes to kidney protection, with exercise frequency correlated with improved renal outcomes (68). Furthermore, physical activity, alongside diet, can modulate cancer metabolism, influencing tumor growth and response to therapy (69) A healthy lifestyle, including regular exercise, significantly reduces the risk of sudden cardiac arrest (70).

Physical activity is a key lifestyle modification for the management of hypertension. Aerobic Exercise: Aerobic exercise is a form of moderate to high-intensity exercise designed to increase heart rate and metabolic rate, including brisk walking, running, swimming, cycling, and high-intensity interval training (HIIT). A meta-analysis revealed that 30 minutes of weekly aerobic exercise reduces systolic blood pressure by 1.78 mmHg and diastolic blood pressure by 1.23 mmHg. The analysis showed that the exercise has a dose-dependent effect, with the most significant reduction occurring at 150 minutes per week (71). Resistance Training: Resistance training is a form of exercise that enhances muscle strength, endurance, and muscle size by using external resistance. It not only helps increase muscle mass and bone density but also improves cardiovascular health and overall body composition (72). A meta-analysis indicates that resistance training reduces both systolic and diastolic blood pressure in elderly individuals aged 60 and over, by 6.88 mmHg and 3.37 mmHg respectively. Studies using traditional resistance equipment (free weights and machines) showed a decrease of 7.04 mmHg in systolic blood pressure and a reduction of 2.60 mmHg in diastolic blood pressure. By contrast, resistance band interventions resulted in a decrease of 2.79 mmHg in systolic blood pressure and a drop of 1.68 mmHg in diastolic blood pressure. Moderate-intensity resistance training was associated with a decrease of 6.98 mmHg in systolic blood pressure and 3.64 mmHg in diastolic blood pressure (73). Isometric resistance training (IRT): This involves sustained muscle contractions against fixed resistance, with minimal or negligible changes in muscle length. The most common form of IRT is unilateral grip squeeze exercises. Research indicates that IRT has a limited impact on 24-hour or daytime blood pressure, but significantly reduces night-time blood pressure — a finding that could help to reduce the risk of target organ damage in patients with hypertension. However, due to its lack of additional health benefits, such as controlling blood sugar and cholesterol, and the paradoxical pattern of reduced night-time blood pressure without a corresponding reduction during the day, IRT remains underutilized as an anti-hypertensive therapy (74). Isometric Exercise Training (IET): IET, which involves sustained muscle contraction without movement, has emerged as a particularly potent non-pharmacological strategy for blood pressure reduction, demonstrating significant hypotensive effects. Data from multiple systematic reviews and randomized controlled trials (RCTs) suggest that IET is more effective at reducing blood pressure than exercise regimens recommended in traditional guidelines, and is potentially as effective as standard antihypertensive drug therapy. For example, IET can reduce mean systolic blood pressure by 5–9 mmHg and diastolic blood pressure by 1–4 mmHg. IET improves blood pressure through various mechanisms, including enhanced vascular endothelial function, autonomic neurovascular regulation, and vascular remodeling. It also improves cardiac function, increasing cardiac output and reducing heart rate (HR), and enhances endothelium-dependent vasodilation in local and systemic vessels. This reduces oxidative stress and inflammatory responses (75). While IET is generally safe for most people, its effectiveness and reactions vary individually. Caution should be exercised when administering it to specific groups (e.g. patients with hypertension or cardiovascular disease), as individual health conditions and potential risks must be carefully considered. While existing studies support the blood pressure-lowering effects of IET, the small sample sizes in these studies mean that long-term efficacy and population-specific variations require further investigation. Furthermore, the long-term safety of IET, optimal training protocols and personalized prescriptions require further research.

For individuals who are beginners or those with complex health conditions, exercise should be supervised by a healthcare professional. Digital health tools, such as wearable devices and mobile applications, can support exercise monitoring and behavior change. Governments and communities should promote safe exercise environments and infrastructure to encourage public participation in physical activity. Education and policy support are essential for promoting healthy lifestyles (76).

4.3 Weight management

Obesity is a major modifiable risk factor for hypertension and cardiometabolic diseases, with visceral adiposity conferring greater risk than subcutaneous fat (4, 77). The pathophysiological mechanisms involve neurohormonal activation, increased renal sodium reabsorption, chronic inflammation, and physical compression of the kidneys by adipose tissue (4, 76). In children and adolescents, obesity significantly increases hypertension risk (2-fold increase in obese children, over 4-fold increase in severely obese children) (78, 79).

Therefore, effective weight management is crucial for both hypertension prevention and treatment. Weight reduction has consistently been emphasized as a key strategy for lowering blood pressure in overweight or obese individuals (80). Even moderate weight loss yields clinically significant blood pressure reductions, often diminishing or eliminating the need for antihypertensive medications. Studies indicate that maintaining a body mass index within the recommended Asian range (18.5–22.9 kg/m²) substantially lowers hypertension risk (81). Each kilogram of weight loss is associated with an average reduction of approximately 1.05 mmHg in systolic blood pressure, with particularly pronounced effects in insulin-resistant individuals (82). Controlling waist circumference (men <90 cm, women <85 cm) is a stronger predictor of blood pressure improvement than BMI alone, as visceral fat reduction directly enhances inflammation control and endothelial function (76).

4.3.1 Clinical efficacy and stepwise management strategy

Given the strong association between obesity and hypertension, a structured, stepwise weight management strategy is central to achieving effective blood pressure control.

4.3.1.1 Step 1: Comprehensive lifestyle intervention—first-line foundational strategy

This strategy integrates dietary modification, physical activity, and behavioral therapy. It is applicable to all overweight or obese hypertensive patients and serves as the cornerstone of treatment (83).

4.3.1.1.1 Core dietary adjustments

Adhere to evidence-supported dietary patterns: Recommendation of heart-healthy diets such as DASH or Mediterranean (84).

Limit sodium intake: Restricting daily sodium to <2.3 grams (equivalent to approximately 5.8 grams of salt) reduces systolic blood pressure by 5–6 mmHg (76).

Adopt the DASH diet: This pattern emphasizes whole grains, fruits, vegetables, and low-fat dairy while reducing saturated fats, lowering systolic blood pressure by 8–14 mmHg (84). Multiple 2023 studies confirmed that adding plant-based proteins (e.g., legumes, nuts) and reducing processed meats to the traditional DASH diet further lowers systolic blood pressure by 2.4 mmHg (85).

Controlling Energy Intake: Reducing daily energy intake by 500–750 kcal with a goal of 5%-10% weight loss significantly improves blood pressure (average systolic reduction of approximately 5 mmHg) (76).

4.3.1.1.2 Exercise prescription

Aerobic Exercise: ≥150 minutes of moderate-intensity aerobic activity (e.g., brisk walking, swimming) weekly can lower systolic blood pressure by 4–5 mmHg (76).

Resistance Training: Strength training twice weekly enhances cardiovascular adaptability (83). In elderly hypertensive patients, resistance training combined with respiratory regulation simultaneously reduces sympathetic activity and enhances blood pressure reduction (86).

High-Intensity Interval Training (HIIT): As a time-efficient alternative, HIIT demonstrates advantages in reducing 24-hour ambulatory blood pressure while effectively improving vascular endothelial function and reducing arterial stiffness (86, 87). For patients aged 65 and older, HIIT exhibits good safety under medical supervision (88).

4.3.1.1.3 Behavioral support

Enhance adherence through health education and self-monitoring (e.g., dietary and weight logging).

Apply cognitive behavioral techniques (e.g., appetite awareness training) to promote healthy behaviors.

Leverage digital health tools (e.g., mobile health apps) to provide continuous feedback and support, reinforcing intervention outcomes (84).

4.3.1.2 Step Two: Pharmacotherapy—adjunct to lifestyle interventions

When lifestyle interventions alone prove insufficient (typically for BMI ≥27 kg/m² with comorbidities like hypertension), pharmacologic weight loss support may be employed. Glucagon-like peptide-1 (GLP-1) receptor agonists represent the most evidence-based class of medications (89, 90).

4.3.1.2.1 GLP-1 receptor agonists

Efficacy: Subcutaneous injection of semaglutide (2.4 mg/week) or tirzepatide (5–15 mg/week) achieves 9–12 kg weight loss and 5–7 mmHg systolic blood pressure reduction over 12 months (90). A 2025 Bayesian network meta-analysis involving 29,506 patients confirmed that GLP-1 receptor agonists reduce weight by an average of 9.0 kg and lower systolic blood pressure by 5.3 mmHg (91). Dual receptor agonists demonstrated superior weight loss effects, reducing weight by an average of 11.0 kg and lowering systolic blood pressure by 6.8 mmHg (91).

Multiple Mechanisms of Benefit: Beyond weight loss, GLP-1 drugs independently improve endothelial function and suppress renin-angiotensin system activity, with effects positively correlated with baseline BMI (92).

Indications and Precautions: Suitable for obese patients with hypertension, type 2 diabetes, or high cardiovascular risk. Liver and kidney function must be assessed, and contraindications evaluated (90). A 2024 meta-analysis revealed that GLP-1 receptor agonists can help patients with post-bariatric surgery weight regain by achieving an additional 7.83 kg loss and improving blood pressure control (93).Oral formulations show similar efficacy but with higher incidence of gastrointestinal adverse events (94).

4.3.1.2.2 Other medications

Orlistat (lipase inhibitor): Aids weight loss but has weak antihypertensive effects (84).

Sympathomimetic weight loss drugs (such as phentermine): Not recommended for hypertensive patients due to potential blood pressure elevation (76).

4.3.1.3 Step Three: Metabolic surgery—advanced option for severe obesity

For severely obese patients with poorly controlled hypertension, metabolic surgery offers significant and sustained blood pressure reduction (95, 96).

4.3.1.3.1 Procedures and efficacy

Roux-en-Y Gastric Bypass (RYGB): Maintains sustained systolic blood pressure reduction of 5–6 mmHg at 5-year follow-up, with hypertension remission rates reaching 35%-51% (96).

Sleeve Gastrectomy: Yields slightly less blood pressure reduction than RYGB but still achieves 4–5 mmHg systolic lowering and medication reduction (96).

Endoscopic Balloon Therapy: As a less invasive option, short-term studies indicate that a 6-month gastric balloon placement reduces body weight by 12% and significantly lowers systolic blood pressure, with particularly pronounced effects in individuals with higher baseline blood pressure (97).

4.3.1.3.2 Long-term benefits and mechanisms

Metabolic surgery sustainably prevents new-onset hypertension. An 8-year prospective study revealed a 71% lower risk of new hypertension in the surgical group compared to controls, with consistent effects across age, gender, and socioeconomic status (95).

The procedure achieves blood pressure reduction through multiple pathways, including weight loss, decreased sympathetic nervous system activity, renin-angiotensin system modulation, and reduced inflammatory markers (98).

4.3.1.3.3 Postoperative management and multidisciplinary collaboration

Long-term monitoring of nutritional status and blood pressure changes is required postoperatively, necessitating coordinated management by a multidisciplinary team encompassing endocrinology, cardiovascular surgery, and nutritional science (99, 100).

4.3.2 Summary and Considerations for Special Populations

Weight management for hypertension should follow a stepwise approach: personalized lifestyle interventions are the first choice; if insufficient, medications such as GLP-1 receptor agonists (GLP-1RAs) may be added to aid weight loss; for severe obesity and resistant hypertension, metabolic surgery may be considered as an effective option. All strategies require multidisciplinary collaboration and long-term follow-up to achieve blood pressure control and reduce cardiovascular risk.

For children and adolescents, weight management should be integrated into routine health examinations, including BMI calculation. Non-hypertensive individuals should aim for healthy weight to prevent hypertension, while hypertensive children should reduce blood pressure through weight loss (79).

Additionally, maintaining a healthy weight significantly reduces the risk of metabolic-associated fatty liver disease, which is closely linked to insulin resistance and cardiovascular risk (101). Obesity has also been identified as a major preventable factor for gout, highlighting its broad metabolic impact (43). Stratifying obesity levels can further optimize cardiovascular prevention strategies and enable more precise interventions (102).

4.4 Stress management and mental health

Psychological stress and mental health disorders can contribute to the development and exacerbation of hypertension. PTSD and Hypertension: Post-Traumatic Stress Disorder (PTSD) has been associated with an increased incidence of hypertension, highlighting the physiological impact of chronic psychological distress on the cardiovascular system (41). This connection underscores the importance of integrating mental health support into hypertension prevention and management programs. Depression and Cognitive Decline: Depression is a known risk factor for Alzheimer’s disease (103), and while multidomain interventions may have limited impact on depression, addressing mental health remains crucial for overall well-being and potentially for mitigating cognitive decline (104). Strategies that promote mental well-being, such as mindfulness, relaxation techniques, and adequate sleep, indirectly support blood pressure regulation by reducing sympathetic nervous system activity and inflammatory responses.

Psychological interventions, including but not limited to mindfulness, meditation, proper sleep habits, social support, and digital tools, have been demonstrated to reduce blood pressure and enhance overall health. A growing body of research has demonstrated the efficacy of mindfulness as a psychological intervention, with studies indicating its potential to reduce blood pressure and enhance mental health outcomes. A growing body of research suggests that practices such as mindfulness exercises, meditation, yoga, and deep breathing techniques can effectively alleviate stress, thereby aiding blood pressure control. Maintaining optimal sleep habits is imperative for effective blood pressure management. Sleep disorders, including insomnia and sleep apnea, have been demonstrated to exhibit a notable correlation with hypertension. Maintaining healthy sleep patterns, ensuring adequate sleep duration (7–9 hours), and avoiding prolonged late-night activities are recommended. Digital health interventions, encompassing wearable devices, mobile applications, and online support systems, have emerged as ancillary instruments to assist patients in blood pressure monitoring, behavioral change tracking, and the provision of psychological support (76).

4.5 Tobacco and alcohol avoidance

Tobacco cessation and alcohol moderation are cornerstone interventions for cardiovascular health. Smoking and certain metabolic factors significantly increase the risk of early-onset myocardial infarction (105). These habits directly contribute to endothelial damage, arterial stiffening, and increased blood pressure, making their avoidance fundamental to hypertension prevention and control. It is noteworthy that e-cigarettes have increasingly become a subject of interest among smokers as a potential alternative to traditional cigarettes. The effects of e-cigarettes on the cardiovascular system represent a complex and ongoing area of research. Existing evidence suggests that e-cigarette use is associated with short-term changes in heart rate and blood pressure. For instance, a systematic review and meta-analysis indicated that acute e-cigarette exposure is linked to elevated heart rate and blood pressure, though its impact on systolic and diastolic blood pressure is less pronounced compared to traditional cigarettes (106). Another study also indicated that e-cigarette users consume nicotine more frequently, and nicotine intake is significantly associated with increased blood pressure and heart rate (107). Current research does not provide sufficient evidence to support a direct link between e-cigarette use and cardiovascular disease, cardiac dysfunction, or remodeling. However, e-cigarettes may indirectly affect cardiovascular health by influencing endothelial function and hemodynamics (108). Current research has several limitations, including small sample sizes, inconsistent study designs, and a lack of long-term follow-up data. Therefore, future studies should expand sample sizes, control for confounding factors, and conduct long-term follow-ups to better assess the long-term effects of e-cigarettes on the cardiovascular system. In summary, no tobacco product has been proven to be safe and risk-free.

Tobacco and alcohol use recommendations include limiting or avoiding alcohol and strongly advising smoking cessation. Alcohol intake patterns vary by region, encompassing frequency, types, and associated behaviors. Intake levels exhibit substantial regional disparities. In order to achieve optimal cardiovascular health, it is recommended that individuals abstain from alcohol consumption. The recommended daily upper limit for alcohol consumption is two standard drinks for men and one standard drink for women (10 grams of alcohol per standard drink). It is strongly recommended that individuals attempt to cease smoking. It is imperative to implement measures aimed at averting weight gain subsequent to smoking cessation (76).

Lifestyle interventions have been demonstrated to be efficacious in reducing blood pressure, thereby enhancing hypertension control. Of particular significance is the observation that lifestyle modifications have the capacity to engender marked enhancements in cardiovascular health and general well-being. Regardless of genetic predisposition, adopting a healthy lifestyle—including managing body mass index (BMI), improving dietary habits, quitting smoking, moderating alcohol consumption, and reducing sodium intake—can lower systolic blood pressure by 3.5 mmHg and reduce the risk of cardiovascular disease (CVD) by around 30%. Health education interventions can effectively address these factors by reducing salt and fat intake, adjusting dietary habits to prioritize fruit and vegetables, encouraging smoking cessation, limiting alcohol consumption, promoting regular exercise, maintaining a healthy weight and managing stress. These behaviors have a positive effect on blood pressure by regulating visceral fat accumulation, insulin resistance, the renin-angiotensin-aldosterone system, vascular endothelial function, oxidative stress, inflammation and autonomic nervous system activity (84). Lifestyle interventions have been demonstrated to enhance the efficacy of pharmaceutical therapy. In circumstances where drug therapy is necessary, it is recommended that lifestyle adjustments be implemented concurrently. However, the effectiveness of lifestyle support can be hindered by insufficient implementation, impacting overall cardiovascular risk reduction (109).The International Society of Hypertension (ISH) expert committee convened an international team of specialists to develop a policy statement providing practical guidance for healthcare providers and public health programs worldwide. This document has been developed based on the latest evidence and existing guidelines, and has been subject to a joint review and endorsement by the World Hypertension Alliance and the European Society of Hypertension. The text emphasizes that lifestyle interventions are fundamental to the management of hypertension. For individuals with normal blood pressure, these interventions are crucial in preventing the development of hypertension. For individuals diagnosed with hypertension, lifestyle modifications represent the primary therapeutic intervention. In instances where lifestyle modifications prove ineffective in managing blood pressure, the implementation of combined pharmacological therapy is recommended to enhance efficacy. It is imperative to recognize that even in circumstances where the initiation of medication is indicated, the implementation of sustained lifestyle interventions remains of the essence. It is imperative that healthcare professionals receive specialized training in order to engage in lifestyle interventions with patients.

5 Novel insights into molecular and physiological mechanisms

Although the benefits of lifestyle interventions for hypertension and its associated complications are well-established, the underlying molecular and physiological mechanisms continue to be an area of active exploration. Recent research has unveiled a range of novel mechanisms that extend beyond traditional pathophysiological models, providing fresh perspectives on how diet and exercise fundamentally regulate blood pressure and organ health.

5.1 Novel signaling molecules and regulatory pathways

Moving beyond the classical catecholamine system, emerging research has identified novel endogenous signaling molecules with significant cardiovascular effects. A notable example is 6-nitrodopamine (6-ND), a recently identified endogenous catecholamine that exhibits a potent, nitric oxide (NO)-dependent positive chronotropic effect. The discovery that 6-ND’s activity is abolished in models of NO-deficient hypertension (88) highlights its role within a crucial vasodilatory pathway. This underscores a potential mechanistic link to lifestyle interventions, such as consumption of nitrate-rich vegetables (e.g., beetroot, leafy greens), which are known to enhance NO bioavailability and improve endothelial function (58).

5.2 Endothelial dysfunction, oxidative stress, and inflammation: core pathways in diverse forms of hypertension

This triad of pathological processes represents a common final pathway in various forms of hypertension, from drug-induced to salt-sensitive models. Vascular endothelial integrity is the cornerstone of blood pressure homeostasis. Endothelial dysfunction, characterized by diminished nitric oxide (NO) bioavailability and increased oxidative stress, is not only a core mechanism in primary hypertension but also a pivotal driver in other forms of elevated blood pressure. For instance, the hypertension induced by Bruton’s tyrosine kinase inhibitors (BTKis) in hematologic treatments serves as a compelling model. BTKis induce hypertension primarily by inhibiting the PI3K/Akt/eNOS pathway, reducing NO production, and concurrently increasing oxidative stress, leading to eNOS uncoupling and activation of vasoconstrictive pathways like RhoA/ROCK (89). Similarly, a paradigm shift is observed in our understanding of salt-sensitive hypertension (SSHTN), moving from a “renal-centric” to a “vascular-centric” model. In SSHTN, high salt intake directly induces endothelial inflammation and activation, blunting vasodilation and causing a failure to appropriately reduce peripheral vascular resistance post-salt load. This endothelial dysfunction, mediated by reduced NO and increased oxidative stress, is a primary driver of the increased peripheral resistance, independent of volume overload. Furthermore, research highlights significant sex differences, with females being more susceptible to SSHTN, partly due to the protective effects of estrogen on endothelial function and its interplay with the immune system (90).

5.3 The crosstalk between metabolism and inflammation

Hypertension is not an isolated hemodynamic disorder but is intricately intertwined with metabolic dysregulation, and this relationship is now established as causal. Large-scale Mendelian randomization studies provide robust genetic evidence for this link, demonstrating that total triglycerides (TG) are the foremost causal risk factor for elevated systolic and diastolic blood pressure. Furthermore, atherogenic lipoprotein particles (such as those in VLDL, IDL, and LDL subfractions) are causally associated with increased pulse pressure. These findings underscore that lipid abnormalities are not merely comorbid conditions but play a direct causal role in elevating blood pressure, highlighting the imperative for integrated management of both blood pressure and metabolism. Lifestyle intervention remains the cornerstone strategy that simultaneously targets both systems, addressing these shared pathological pathways at their root (92).

5.4 Vascular remodeling and extracellular matrix regulation

The dynamic equilibrium of the extracellular matrix (ECM) is critical for maintaining vascular elasticity and compliance. The overactivation of the matrix metalloproteinase (MMP) family, particularly MMP-2 and MMP-9, is a direct cause of hypertensive vascular remodeling and stiffening. These enzymes degrade key ECM components like collagen and elastin, disrupt the balance with their tissue inhibitors (TIMPs), and promote vascular inflammation. They interact bidirectionally with the Renin-Angiotensin-Aldosterone System (RAAS), creating a vicious cycle that drives pathological vascular changes and end-organ damage. Notably, many dietary nutrients found in natural foods have been identified as effective MMP inhibitors. Curcumin, quercetin (found in apples and onions), and epigallocatechin gallate (EGCG) from green tea can suppress MMP activity, revealing a molecular mechanism through which a healthy diet and specific nutritional interventions can directly protect vascular structure and function, thereby mitigating hypertension-induced remodeling (91).

5.5 Mechanistic links to end-organ damage and therapeutic implications

Sustained hypertension inflicts damage on terminal organs like the heart, brain, and kidneys through the multifaceted mechanisms described above (endothelial dysfunction, oxidative stress, inflammation, RAAS/MMP activation). The choice of antihypertensive therapy can significantly influence this risk based on its mechanism of action. Large-scale real-world evidence indicates that the neuroprotective effect of antihypertensive drugs is closely linked to their ability to penetrate the blood-brain barrier (BBB). Angiotensin II Receptor Blockers (ARBs) that can cross the BBB are associated with a significantly greater reduction in the risk of Alzheimer’s disease and related dementias (ADRD) compared to those that cannot or compared to ACE inhibitors. This underscores the direct impact of central RAAS inhibition and the cerebral microenvironment on cognitive health (93).

Concurrently, the importance of early and aggressive blood pressure management is paramount in high-risk populations, such as children with chronic kidney disease (CKD), to prevent irreversible cardiac remodeling. Clinical trials are actively exploring whether intensive blood pressure control can improve diastolic function and prevent adverse cardiac changes in this vulnerable group, emphasizing that the timing and intensity of intervention are critical for long-term organ protection (94).

In summary, the value of lifestyle interventions extends far beyond the improvement of clinical endpoints. It is deeply rooted in their multi-faceted, network-like beneficial regulation of endothelial function, oxidative stress, inflammation, metabolism, vascular remodeling, and novel signaling pathways. A profound understanding of these effects at the molecular mechanism level will lay a solid foundation for developing more precise and efficient prevention and treatment strategies.

The multifaceted molecular mechanisms through which various lifestyle interventions exert their antihypertensive effects are summarized in Table 1.

Table 1

Table 1. Impact of lifestyle interventions on key molecular pathways in hypertension.

6 Integrated and modern approaches to lifestyle intervention

The increasing complexity of chronic disease management, coupled with rapid technological advancements, has propelled the evolution of lifestyle interventions beyond isolated recommendations to integrated, multi-modal, and technologically enhanced approaches. These modern strategies aim to maximize efficacy, improve adherence, and broaden accessibility.

6.1 Multidomain interventions

Recognizing the multifactorial nature of many chronic conditions, especially cognitive decline, researchers and clinicians have increasingly advocated for multidomain interventions that concurrently target several modifiable risk factors. Preventing Cognitive Decline: Multi-domain interventions, which typically combine dietary modifications, physical activity, cognitive training, and vascular risk factor management, have demonstrated efficacy in preventing cognitive decline and reducing dementia risk (110–112). These interventions capitalize on the synergistic effects of addressing multiple pathways simultaneously, such as improving cerebrovascular health, reducing inflammation, and enhancing brain plasticity. Such comprehensive approaches are designed to improve overall brain vascular function, thereby supporting cognitive integrity (15). Holistic Brain Health: A digital, multi-modal lifestyle intervention has been specifically shown to promote brain health, indicating the powerful combination of diverse lifestyle elements delivered through modern platforms (113). While some multi-domain interventions have shown limited impact on depression directly (104), their overall benefits for cognitive and physical health are substantial. Brain health clinics are also emerging as specialized centers for managing cognitive impairment, offering integrated care that often incorporates lifestyle counseling (114). Comprehensive Disease Management: For conditions like hypertension and diabetes during pregnancy, comprehensive, multi-faceted interventions are required, often integrating lifestyle components with close medical monitoring (35, 39). Similarly, for individuals after a heart transplant, tailored and comprehensive prevention and rehabilitation guidelines underscore the importance of integrating medical and lifestyle support (25).

6.2 Technological advancements and digital health

The digital revolution has profoundly transformed healthcare delivery, offering innovative avenues for implementing and supporting lifestyle interventions. Digital Platforms for Disease Prevention and Management: Digital platforms and mobile health (mHealth) applications are increasingly utilized to facilitate lifestyle modifications. For stroke prevention, digital tools can enhance patient education, monitoring, and adherence to preventive strategies (19). In cardiac rehabilitation programs, digital health interventions have proven effective in promoting weight loss, a key component of cardiovascular recovery (115). For hypertension management, network-based digital interventions have shown significant positive effects, improving blood pressure control through remote monitoring, personalized feedback, and educational content (116). Digital screening also assists in community-based hypertension management, allowing for wider reach and earlier detection (117). These approaches are being validated by real-world applications. For instance, AI-powered personalized recommendations—such as those from the “MyHeart” platform, which correlates real-time dietary records with blood pressure data—have been shown to increase the 6-month blood pressure control rate by 31% (118). Similarly, the integration of remote monitoring, where home blood pressure monitor data is automatically synchronized with community health systems and combined with biweekly nurse follow-up calls, has raised intervention adherence rates to 82% (81). Artificial Intelligence and Machine Learning: The advent of Artificial Intelligence (AI) and Machine Learning (ML) brings unprecedented capabilities to risk prediction and personalized health interventions. AI models are being developed and refined to predict hypertension risk, utilizing vast datasets of clinical, demographic, and lifestyle information (119). Similarly, machine learning techniques are employed to predict hypertension risk in specific populations, such as residents of desert areas in China, allowing for targeted public health interventions (120). These technologies hold immense promise for more precise risk stratification and the delivery of highly individualized lifestyle recommendations. Big Data and Predictive Analytics: The analysis of large-scale datasets, including genetic information, lifestyle patterns, and clinical markers, is leading to new insights. For example, machine learning models can predict hypertension risk based on various factors (120). While lifestyle factors are crucial, some serum biomarkers have shown superior predictive power for lifespan compared to lifestyle scores alone (121), suggesting a future where combined approaches using both lifestyle and advanced biological markers could optimize risk assessment. Furthermore, models like the Singaporean model predict cognitive impairment risk in the elderly (122), highlighting the role of predictive analytics in targeted preventive efforts. Lifestyle factors integrated with cardiovascular metabolic multimorbidity risk prediction provide a more comprehensive assessment (123).

6.3 Public health and policy initiatives

Broad-scale public health policies and initiatives are crucial for fostering environments conducive to healthy lifestyles and supporting widespread adoption of beneficial behaviors. Workplace Interventions: The workplace represents a significant setting for health promotion. Comprehensive workplace interventions have demonstrated substantial improvements in blood pressure control among employees (124). Similarly, specific workplace interventions have been shown to reduce the incidence of hypertension, contributing to a healthier workforce (125). Food Industry Reform: Mandatory sodium substitution technologies at the front end (such as replacing 50% of sodium salts with potassium salts) implemented in Canada and Australia resulted in a median reduction of 1.7 mmHg in systolic blood pressure among the population (76). National Programs: Initiatives like the American Target: BP program have played a vital role in improving blood pressure control rates across the United States, demonstrating the effectiveness of coordinated national efforts (126). Evolving Public Health Landscape: The COVID-19 pandemic significantly altered the landscape of public health policy for healthy living, prompting adaptations in how health information and interventions are disseminated and consumed (127). Early Childhood Intervention: School-based curriculum-integrated healthy eating education combined with family involvement reduces adolescent hypertension risk by 34% (10-year follow-up data) (82). This shift has underscored the importance of resilience and adaptability in public health strategies. Lifestyle Medicine Frameworks: The integration of lifestyle medicine principles, which systematically apply evidence-based lifestyle therapeutic interventions as a primary modality to prevent, treat, and often reverse chronic diseases, is gaining traction. This holistic framework is particularly relevant for older adults, aiming to integrate lifestyle factors into comprehensive care plans (128). Addressing Disparities and Underdiagnosis: Despite advancements, challenges persist in diagnosing and managing hypertension in certain populations, such as rural communities (1). Similarly, issues like low education levels being a primary risk factor for mortality (129) highlight the importance of addressing social determinants of health to achieve equitable health outcomes.

6.4 Synergy with pharmacotherapy

While lifestyle interventions are powerful on their own, their integration with pharmacological treatments often yields superior outcomes, particularly in managing established hypertension and complex comorbidities. Combined Benefits for Mortality: A combination of healthy lifestyle adherence and the use of antihypertensive medication has been shown to reduce mortality rates more effectively than either approach alone (48). This synergistic effect underscores that lifestyle is not merely an alternative to medication but a complementary and essential component of comprehensive care. Intensified Blood Pressure Lowering: Intensive blood pressure lowering, often achieved through a combination of lifestyle and pharmacological interventions, has been shown to reduce the risk of cognitive impairment, highlighting the neuroprotective benefits of aggressive hypertension management (9). Antihypertensive Treatment and Cancer Risk: Reassuringly, anti-hypertensive treatment has not been found to have a significant association with cancer risk, allowing clinicians to confidently prescribe these medications without undue concern about oncogenic effects (30). Novel Drug Classes: Newer pharmacological agents, such as SGLT-2 inhibitors, initially developed for diabetes, have demonstrated significant cardiovascular and renal protective effects, including in diabetic cardiomyopathy, showcasing how advancements in drug therapy can complement lifestyle efforts in managing complex cardiometabolic conditions (130) While combined hypertension and diabetes intervention may not always significantly reduce CVD events, emphasizing comprehensive risk reduction remains paramount (131). Targeting Residual Risk: Even with medication, residual risks remain. For example, in patients with atrial fibrillation, approximately 30% of residual stroke risk is modifiable through lifestyle interventions (21). This underscores that even when medications are prescribed, ongoing adherence to lifestyle recommendations remains critical for optimal outcomes. Physicians’ advice for secondary prevention becomes more frequent, highlighting the perceived importance of ongoing intervention (132). However, in China, there is an underutilization of secondary prevention medications for cardiovascular diseases, indicating gaps in care delivery (133).

6.5 Key considerations and challenges

Although lifestyle interventions offer a novel approach to the prevention, treatment and reversal of hypertension, multidisciplinary collaboration is required between cardiologists, nutritionists, exercise specialists and psychologists. Clinicians must master systematic lifestyle intervention techniques and follow actionable pathways to provide long-term, sustained guidance and support patients in making behavioral changes. Adherence and Support: Behavioral change is influenced by patients’ values, their social environment, and psychological factors. Without the necessary internal motivation, it is difficult for patients to maintain a lifestyle change in the long term, even if they initially commit to it. Insufficient lifestyle support is a major factor impacting cardiovascular risk reduction (109). Effective strategies require continuous support, education, and patient engagement. As key agents in lifestyle change, physicians face a ‘double whammy’ when their own poor habits undermine both their credibility and their ability to provide support. Most clinicians lack the necessary skills for lifestyle interventions, particularly motivational interviewing (encouraging patients to explore their motivations, resolve conflicts and increase their self-efficacy) and cognitive behavioral therapy (changing unhealthy thought patterns to encourage long-term behavior change). This gap can significantly reduce the effectiveness of lifestyle interventions. Individualization: A one-size-fits-all approach is often insufficient. When developing personalized plans, planners and implementers must communicate thoroughly to clarify desired outcomes. Planners should motivate patients to commit to change while fully considering individual patient characteristics and preferences. This not only enhances patient adherence but also maximizes the effectiveness of lifestyle interventions. Personalized exercise prescriptions, for instance, are more effective in lowering blood pressure (66). Similarly, managing conditions like pregnancy-induced hypertension requires long-term, individualized strategies (39), and post-cardiac transplant patients need customized prevention and rehabilitation plans (25). Social Determinants of Health: The limited availability of regular outpatient clinics makes it difficult to conduct in-depth lifestyle assessments and counselling. The current medical insurance system offers limited reimbursement for lifestyle interventions, which makes it challenging to sustain such programs. Socioeconomic factors, such as low education, significantly impact health outcomes (129). Access to healthy foods, safe environments for physical activity, and healthcare resources varies, creating health disparities. Community-based and digital screening initiatives for hypertension can help bridge some of these gaps, particularly in underserved areas. Implementation will encounter multiple interrelated challenges, including insufficient digital literacy, technological limitations, resource scarcity, and low stakeholder engagement. Addressing these challenges requires a multi-pronged strategy encompassing enhanced digital literacy training, improved technical support systems, robust data management frameworks, and deepened collaboration between healthcare systems and digital health initiatives—undoubtedly demanding increased human and material resources (117). Emerging Environmental and Occupational Risk Factors: Environmental factors are increasingly recognized as contributors to chronic diseases. Air pollution, for example, is positively associated with colorectal cancer risk (33). Exposure to lead also correlates with an increased risk of hypertension (134). Per- and polyfluoroalkyl substances (PFAS), while showing a weak association with blood pressure (134), can impact kidney function (135), underscoring the need to consider environmental toxicants in a comprehensive health assessment. Occupation itself can be a risk factor for type 2 diabetes (136).

7 Clinical implications and future directions

7.1 The evidence synthesized in this review has direct implications for clinical practice

To facilitate the translation of this evidence into actionable clinical strategies, a framework for personalized lifestyle prescription is provided in Table 2.

Table 2

Table 2. Evidence-based personalized prescription for lifestyle medicine in hypertension.

Structured Patient Assessment: Clinicians should routinely and systematically assess lifestyle factors during every encounter with hypertensive patients or those at risk. Simple tools like the American Heart Association’s Life’s Essential 8 or taking a “lifestyle history” can be integrated into electronic health records to facilitate this. Personalized Prescription for Lifestyle Medicine: Just as with pharmacology, lifestyle interventions should be personalized. This involves: Exercise Prescription: Specifying type (aerobic, resistance, HIIT), frequency, intensity, and time, tailored to the patient’s fitness, comorbidities, and preferences. Dietary Counseling: Moving beyond generic “eat healthy” advice to recommending specific evidence-based patterns like DASH or Mediterranean diet, with practical guidance and, if possible, referral to a dietitian. Shared Decision-Making: Discussing the robust evidence for lifestyle interventions with patients, including their synergistic effects with medication and potential to reduce pill burden, can enhance motivation and adherence. Utilization of Digital Health Tools: Clinicians should advocate for and utilize digital health platforms (e.g., apps for BP monitoring, diet tracking, tele-rehabilitation) to extend support beyond the clinical setting and improve long-term engagement. Multidisciplinary Care Model: Effective hypertension management requires a team-based approach. Cardiologists and general practitioners should work closely with nurses, dietitians, physiotherapists, and psychologists to deliver comprehensive lifestyle counseling and support. Policy Advocacy: Healthcare providers should advocate for broader public health policies that support lifestyle medicine, such as sodium reduction in processed foods, creation of safe spaces for physical activity, and insurance reimbursement for structured lifestyle intervention programs. While implementing the current evidence into practice is paramount, the field of hypertension management continues to evolve. The next frontier lies in moving beyond standardized approaches to embrace precision prevention and to solve the challenge of long-term maintenance of healthy lifestyles.

7.2 Future directions: precision prevention and long-term maintenance

The future of hypertension management lies in moving beyond one-size-fits-all approaches to precision prevention and developing effective strategies for long-term maintenance of healthy behaviors.

7.2.1 Early identification of high-risk populations

Polygenic Risk Score (PRS): Initiating intensive lifestyle interventions a decade in advance for individuals identified as having high genetic risk (top 10% PRS) can reduce the conversion rate to hypertension by 47% (76). Application of Metabolic Biomarkers: For individuals with serum uric acid >380 μmol/L or abnormal cystatin C levels, weight loss interventions are recommended even in the presence of normal blood pressure, facilitating preemptive management (82).

7.2.2 Evidence updates for maintenance strategies

Periodic Booster Interventions: Centralized lifestyle courses conducted every 4 months (including group exercise and dietitian counseling) can address behavioral fatigue and reduce the 5-year weight rebound rate to 22% (118). Preventive Use of GLP-1 Receptor Agonists: For prediabetes populations with a BMI ≥27 kg/m², low-dose semaglutide (0.5 mg/week) combined with lifestyle intervention can reduce the risk of developing hypertension by 62% (76).

8 Conclusion

Hypertension stands as a formidable global health challenge, intricately linked to a myriad of cardiometabolic and cognitive disorders. The complex interplay between hypertension and these conditions underscores the importance of comprehensive, personalized interventions for prevention and management. Lifestyle interventions—including dietary modifications, physical exercise, weight management, and stress reduction—form the foundation for effectively preventing and controlling hypertension and its complications. Substantial evidence demonstrates that such interventions significantly lower blood pressure, improve cardiovascular health, and reduce the risk of complications such as cardiovascular disease, chronic kidney disease, and cognitive decline. Notably, the effectiveness of these interventions increases substantially when tailored to individual patient characteristics, preferences, and needs. Personalized approaches—such as customized exercise prescriptions and dietary recommendations—further ensure long-term adherence and enhance treatment outcomes. Beyond individual interventions, comprehensive risk assessment tools such as the American Heart Association’s Life’s Essential 8 and the Brain Care Score have been developed to provide a holistic framework for cardiovascular and cognitive health promotion (137, 138). These tools underscore the importance of integrating multiple lifestyle and health metrics in clinical practice to optimize patient outcomes. Clinicians should routinely assess patients’ lifestyle habits using simple tools and provide structured, patient-centered counseling, leveraging digital health platforms for long-term support. Policymakers should prioritize national hypertension control programs, implement policies for reducing sodium in processed foods, and create environments that promote physical activity. Future research should focus on long-term effectiveness of digital interventions, cost-effectiveness analyses, and implementation strategies in low-resource settings. In summary, managing hypertension through integrated approaches combining lifestyle interventions, clinical care, and public health policies represents a critical pathway to reducing the global burden of hypertension and its complications.

In conclusion, a robust and sustained commitment to lifestyle modifications represents the most potent and accessible strategy for individuals and public health systems alike in the ongoing battle against hypertension and its pervasive consequences. Embracing lifestyle as a primary therapeutic modality is not just about managing a single condition; it is about cultivating a paradigm of health that promotes longevity, enhances quality of life, and mitigates the intertwined burdens of cardiometabolic and cognitive decline.

Author contributions

QW: Writing – review & editing, Writing – original draft. DW: Writing – review & editing, Writing – original draft. YH: Funding acquisition, Writing – review & editing.

Funding

The author(s) declare financial support was received for the research and/or publication of this article. This research was funded by Sichuan Provincial Cadre Health Research Project (2024-109). This research was funded by Science and Technology Achievement Transformation Fund of West China Hospital, Sichuan University(CGZH21006). This work was supported by the National Key Research and Development Program of China (Grant No.2023ZD0506103): Molecular Subtyping and Precision Therapy for Chronic Obstructive Pulmonary Disease, a subproject of Precision Classification and Advanced Diagnostic/Therapeutic Technologies for Chronic Respiratory Diseases with Regional and Multi-Ethnic Characteristics. This research was supported by Noncommunicable Chronic Diseases-National Science and Technology Major Project (2023ZD0501803). This work was supported by Sichuan Science and Technology Program (No. 2024NSFSC1603). This work was supported by Science and Technology Achievement Transformation Fund of West China Hospital, Sichuan University (HX-H2406199).

Acknowledgments

This article is supported by the National Clinical Key Specialty Construction Project.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Generative AI statement

The author(s) declare that no Generative AI was used in the creation of this manuscript.

Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

References

1. Rai P, Sahadevan P, Mensegere AL, Issac TG, Muniz-Terrera G, and Sundarakumar JS. Rural-urban disparities in the diagnosis and treatment of hypertension and diabetes among aging Indians. Alzheimers Dement. (2024) 20:2943–51. doi: 10.1002/alz.13771

PubMed Abstract | Crossref Full Text | Google Scholar

2. Banegas JR, Sánchez-Martínez M, Gijón-Conde T, López-García E, Graciani A, Guallar-Castillón P, et al. Numerical values and impact of hypertension in Spain. Rev Esp Cardiol (Engl Ed). (2024) 77:767–78. doi: 10.1016/j.recesp.2024.03.002

PubMed Abstract | Crossref Full Text | Google Scholar

3. van Oort S, Beulens JWJ, van Ballegooijen AJ, Grobbee DE, and Larsson SC. Association of cardiovascular risk factors and lifestyle behaviors with hypertension: A mendelian randomization study. Hypertension. (2020) 76:1971–9. doi: 10.1161/HYPERTENSIONAHA.120.15761

PubMed Abstract | Crossref Full Text | Google Scholar

4. Valenzuela PL, Santos-Lozano A, Saco-Ledo G, Castillo-García A, and Lucia A. Obesity, cardiovascular risk, and lifestyle: cross-sectional and prospective analyses in a nationwide Spanish cohort. Eur J Prev Cardiol. (2023) 30:1493–501. doi: 10.1093/eurjpc/zwad204

PubMed Abstract | Crossref Full Text | Google Scholar

5. Mechanick JI, Rosenson RS, Pinney SP, Mancini DM, Narula J, and Fuster V. Coronavirus and cardiometabolic syndrome: JACC focus seminar. J Am Coll Cardiol. (2020) 76:2024–35. doi: 10.1016/j.jacc.2020.07.069

PubMed Abstract | Crossref Full Text | Google Scholar

6. Xie H, Li J, Zhu X, Li J, Yin J, Ma T, et al. Association between healthy lifestyle and the occurrence of cardiometabolic multimorbidity in hypertensive patients: a prospective cohort study of UK Biobank. Cardiovasc Diabetol. (2022) 21:199. doi: 10.1186/s12933-022-01632-3

PubMed Abstract | Crossref Full Text | Google Scholar

7. Son S, Speechley M, Zou GY, Kivipelto M, Mangialasche F, Feldman HH, et al. Potentially modifiable dementia risk factors in Canada: an analysis of canadian longitudinal study on aging with a multi-country comparison. J Prev Alzheimers Dis. (2024) 11:1490–9. doi: 10.14283/jpad.2024.105

PubMed Abstract | Crossref Full Text | Google Scholar

8. Montero-Odasso M, Ismail Z, and Livingston G. One third of dementia cases can be prevented within the next 25 years by tackling risk factors. The case "for" and "against. Alzheimers Res Ther. (2020) 12:81. doi: 10.1186/s13195-020-00646-x

PubMed Abstract | Crossref Full Text | Google Scholar

9. Elahi FM, Alladi S, Black SE, Claassen J, DeCarli C, Hughes TM, et al. Clinical trials in vascular cognitive impairment following SPRINT-MIND: An international perspective. Cell Rep Med. (2023) 4:101089. doi: 10.1016/j.xcrm.2023.101089

PubMed Abstract | Crossref Full Text | Google Scholar

10. Zhou B, Perel P, Mensah GA, and Ezzati M. Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension. Nat Rev Cardiol. (2021) 18:785–802. doi: 10.1038/s41569-021-00559-8

PubMed Abstract | Crossref Full Text | Google Scholar

11. Te Hoonte F, Spronk M, Sun Q, Wu K, Fan S, Wang Z, et al. Ideal cardiovascular health and cardiovascular-related events: a systematic review and meta-analysis. Eur J Prev Cardiol. (2024) 31:966–85. doi: 10.1093/eurjpc/zwad405

PubMed Abstract | Crossref Full Text | Google Scholar

12. Pacholko A and Iadecola C. Hypertension, neurodegeneration, and cognitive decline. Hypertension. (2024) 81:991–1007. doi: 10.1161/HYPERTENSIONAHA.123.21356

PubMed Abstract | Crossref Full Text | Google Scholar

13. Wardlaw JM, Debette S, Jokinen H, De Leeuw FE, Pantoni L, Chabriat H, et al. ESO Guideline on covert cerebral small vessel disease. Eur Stroke J. (2021) 6:Iv. doi: 10.1177/23969873211027002

PubMed Abstract | Crossref Full Text | Google Scholar

14. Brinkley TE, Garcia KR, Mitchell GF, Tegeler CH, Sarwal A, Bennett J, et al. POINTER neurovascular ancillary study: Study design and methods. Alzheimers Dement. (2025) 21:e14574. doi: 10.1002/alz.14574

PubMed Abstract | Crossref Full Text | Google Scholar

15. Wesenhagen K, Deckers K, Picavet H, Rietman ML, Kok A, Köhler S, et al. Lifestyle and cognition: Separating the effects of average lifestyle and lifestyle changes based on the LIBRA score. J Prev Alzheimers Dis. (2025) 12:100159. doi: 10.1016/j.tjpad.2025.100159

PubMed Abstract | Crossref Full Text | Google Scholar

16. Asowata OJ, Bodunde I, Okekunle AP, Akpa OM, Danladi DK, Fakunle AG, et al. Low vegetable consumption doubles the odds of stroke among people with hypertension: Findings from the SIREN Study in West Africa. Int J Stroke. (2025) 20:17474930251349474. doi: 10.1177/17474930251349474

PubMed Abstract | Crossref Full Text | Google Scholar

17. Diener HC and Hankey GJ. Primary and secondary prevention of ischemic stroke and cerebral hemorrhage: JACC focus seminar. J Am Coll Cardiol. (2020) 75:1804–18. doi: 10.1016/j.jacc.2019.12.072

PubMed Abstract | Crossref Full Text | Google Scholar

18. Sagris D, Ntaios G, and Milionis H. Beyond antithrombotics: recent advances in pharmacological risk factor management for secondary stroke prevention. J Neurol Neurosurg Psychiatry. (2024) 95:264–72. doi: 10.1136/jnnp-2022-329149

PubMed Abstract | Crossref Full Text | Google Scholar

19. Feigin VL, Krishnamurthi R, Medvedev O, Merkin A, Nair B, Kravchenko M, et al. Usability and feasibility of PreventS-MD web app for stroke prevention. Int J Stroke. (2024) 19:94–104. doi: 10.1177/17474930231190745

PubMed Abstract | Crossref Full Text | Google Scholar

20. Chung MK, Eckhardt LL, Chen LY, Ahmed HM, Gopinathannair R, Joglar JA, et al. Lifestyle and risk factor modification for reduction of atrial fibrillation: A scientific statement from the american heart association. Circulation. (2020) 141:e750–72. doi: 10.1161/CIR.0000000000000748

PubMed Abstract | Crossref Full Text | Google Scholar

21. Maeda T, Nishi T, Funakoshi S, Tada K, Tsuji M, Satoh A, et al. Residual risks of ischaemic stroke and systemic embolism among atrial fibrillation patients with anticoagulation: large-scale real-world data (F-CREATE project). Heart. (2021) 107:217–22. doi: 10.1136/heartjnl-2020-317299

PubMed Abstract | Crossref Full Text | Google Scholar

22. Zhu Z, Li FR, Jia Y, Li Y, Guo D, Chen J, et al. Association of lifestyle with incidence of heart failure according to metabolic and genetic risk status: A population-based prospective study. Circ Heart Fail. (2022) 15:e009592. doi: 10.1161/CIRCHEARTFAILURE.122.009592

PubMed Abstract | Crossref Full Text | Google Scholar

23. Rabinowitz J, Darawshi M, Burak N, Boehm M, and Dmitrieva NI. Risk of hypertension and heart failure linked to high-normal serum sodium and tonicity in general healthcare electronic medical records. Eur J Prev Cardiol. (2025) 32:1371–81. doi: 10.1093/eurjpc/zwaf232

PubMed Abstract | Crossref Full Text | Google Scholar

24. Martinez-Amezcua P, Haque W, Khera R, Kanaya AM, Sattar N, Lam CSP, et al. The upcoming epidemic of heart failure in south asia. Circ Heart Fail. (2020) 13:e007218. doi: 10.1161/CIRCHEARTFAILURE.120.007218

PubMed Abstract | Crossref Full Text | Google Scholar

25. Simonenko M, Hansen D, Niebauer J, Volterrani M, Adamopoulos S, Amarelli C, et al. Prevention and rehabilitation after heart transplantation: A clinical consensus statement of the European Association of Preventive Cardiology, Heart Failure Association of the ESC, and the European Cardio Thoracic Transplant Association, a section of ESOT. Eur J Heart Fail. (2024) 26:1876–92. doi: 10.1002/ejhf.3185

PubMed Abstract | Crossref Full Text | Google Scholar

26. Burnier M and Damianaki A. Hypertension as cardiovascular risk factor in chronic kidney disease. Circ Res. (2023) 132:1050–63. doi: 10.1161/CIRCRESAHA.122.321762

PubMed Abstract | Crossref Full Text | Google Scholar

27. Joshi S, McMacken M, and Kalantar-Zadeh K. Plant-based diets for kidney disease: A guide for clinicians. Am J Kidney Dis. (2021) 77:287–96. doi: 10.1053/j.ajkd.2020.10.003

PubMed Abstract | Crossref Full Text | Google Scholar

28. Maroto-Rodriguez J, Ortolá R, Cabanas-Sanchez V, Martinez-Gomez D, Rodriguez-Artalejo F, and Sotos-Prieto M. Diet quality patterns and chronic kidney disease incidence: a UK Biobank cohort study. Am J Clin Nutr. (2025) 121:445–53. doi: 10.1016/j.ajcnut.2024.12.005

PubMed Abstract | Crossref Full Text | Google Scholar

29. Wei D, Shi J, Xu H, Guo Y, Wu X, Chen Z, et al. Prospective study on the joint effect of persistent organic pollutants and glucose metabolism on chronic kidney disease: Modifying effects of lifestyle interventions. Sci Total Environ. (2024) 951:175694. doi: 10.1016/j.scitotenv.2024.175694

PubMed Abstract | Crossref Full Text | Google Scholar

30. Nazarzadeh M, Copland E, Smith Byrne K, Canoy D, Bidel Z, Woodward M, et al. Blood pressure lowering and risk of cancer: individual participant-level data meta-analysis and mendelian randomization studies. JACC CardioOncol. (2025) 7:609–23. doi: 10.1016/j.jaccao.2025.03.005

PubMed Abstract | Crossref Full Text | Google Scholar

31. Lu L, Mullins CS, Schafmayer C, Zeißig S, and Linnebacher M. A global assessment of recent trends in gastrointestinal cancer and lifestyle-associated risk factors. Cancer Commun (Lond). (2021) 41:1137–51. doi: 10.1002/cac2.12220

PubMed Abstract | Crossref Full Text | Google Scholar

32. Campi R, Rebez G, Klatte T, Roussel E, Ouizad I, Ingels A, et al. Effect of smoking, hypertension and lifestyle factors on kidney cancer - perspectives for prevention and screening programmes. Nat Rev Urol. (2023) 20:669–81. doi: 10.1038/s41585-023-00781-8

PubMed Abstract | Crossref Full Text | Google Scholar

33. Zhao D and Zhu M. Invisible foes: how air pollution and lifestyle conspire in the rise of colorectal cancer. Qjm. (2025) 118:501–13. doi: 10.1093/qjmed/hcaf074

PubMed Abstract | Crossref Full Text | Google Scholar

34. Lewey J, Sheehan M, Bello NA, and Levine LD. Cardiovascular risk factor management after hypertensive disorders of pregnancy. Obstet Gynecol. (2024) 144:346–57. doi: 10.1097/AOG.0000000000005672

PubMed Abstract | Crossref Full Text | Google Scholar

35. Stephansson O and Sandström A. Can short- and long-term maternal and infant risks linked to hypertension and diabetes during pregnancy be reduced by therapy? J Intern Med. (2024) 296:216–33. doi: 10.1111/joim.13823

PubMed Abstract | Crossref Full Text | Google Scholar

36. Xu J, Lin X, Fang Y, Cui J, Li Z, Yu F, et al. Lifestyle interventions to prevent adverse pregnancy outcomes in women at high risk for gestational diabetes mellitus: a randomized controlled trial. Front Immunol. (2023) 14:1191184. doi: 10.3389/fimmu.2023.1191184

PubMed Abstract | Crossref Full Text | Google Scholar

37. Scott G, Gillon TE, Pels A, von Dadelszen P, and Magee LA. Guidelines-similarities and dissimilarities: a systematic review of international clinical practice guidelines for pregnancy hypertension. Am J Obstet Gynecol. (2022) 226:S1222–s1236. doi: 10.1016/j.ajog.2020.08.018

PubMed Abstract | Crossref Full Text | Google Scholar

38. Wang S, Mitsunami M, Ortiz-Panozo E, Leung CW, Manson JE, Rich-Edwards JW, et al. Prepregnancy healthy lifestyle and adverse pregnancy outcomes. Obstet Gynecol. (2023) 142:1278–90. doi: 10.1097/AOG.0000000000005346

PubMed Abstract | Crossref Full Text | Google Scholar

39. Countouris M, Mahmoud Z, Cohen JB, Crousillat D, Hameed AB, Harrington CM, et al. Hypertension in pregnancy and postpartum: current standards and opportunities to improve care. Circulation. (2025) 151:490–507. doi: 10.1161/CIRCULATIONAHA.124.073302

PubMed Abstract | Crossref Full Text | Google Scholar

40. Osibogun O, Ogunmoroti O, and Michos ED. Polycystic ovary syndrome and cardiometabolic risk: Opportunities for cardiovascular disease prevention. Trends Cardiovasc Med. (2020) 30:399–404. doi: 10.1016/j.tcm.2019.08.010

PubMed Abstract | Crossref Full Text | Google Scholar

41. Mendlowicz V, Garcia-Rosa ML, Gekker M, Wermelinger L, Berger W, Luz MP, et al. Post-traumatic stress disorder as a predictor for incident hypertension: a 3-year retrospective cohort study. Psychol Med. (2023) 53:132–9. doi: 10.1017/S0033291721001227

PubMed Abstract | Crossref Full Text | Google Scholar

42. Yokose C, McCormick N, and Choi HK. Dietary and lifestyle-centered approach in gout care and prevention. Curr Rheumatol Rep. (2021) 23:51. doi: 10.1007/s11926-021-01020-y

PubMed Abstract | Crossref Full Text | Google Scholar

43. McCormick N, Rai SK, Lu N, Yokose C, Curhan GC, and Choi HK. Estimation of primary prevention of gout in men through modification of obesity and other key lifestyle factors. JAMA Netw Open. (2020) 3:e2027421. doi: 10.1001/jamanetworkopen.2020.27421

PubMed Abstract | Crossref Full Text | Google Scholar

44. Dixon SB, Liu Q, Chow EJ, Oeffinger KC, Nathan PC, Howell RM, et al. Specific causes of excess late mortality and association with modifiable risk factors among survivors of childhood cancer: a report from the Childhood Cancer Survivor Study cohort. Lancet. (2023) 401:1447–57. doi: 10.1016/S0140-6736(22)02471-0

PubMed Abstract | Crossref Full Text | Google Scholar

45. Wang KW, Ladhani S, Empringham B, Portwine C, Fleming A, Banfield L, et al. Bariatric interventions in obesity treatment and prevention in pediatric acute lymphoblastic leukemia: a systematic review and meta-analysis. Cancer Metastasis Rev. (2020) 39:79–90. doi: 10.1007/s10555-020-09849-y

PubMed Abstract | Crossref Full Text | Google Scholar

46. Maniero C, Lopuszko A, Papalois KB, Gupta A, Kapil V, and Khanji MY. Non-pharmacological factors for hypertension management: a systematic review of international guidelines. Eur J Prev Cardiol. (2023) 30:17–33. doi: 10.1093/eurjpc/zwac163

PubMed Abstract | Crossref Full Text | Google Scholar

47. Carey RM, Wright JT Jr., Taler SJ, and Whelton PK. Guideline-driven management of hypertension: an evidence-based update. Circ Res. (2021) 128:827–46. doi: 10.1161/CIRCRESAHA.121.318083

PubMed Abstract | Crossref Full Text | Google Scholar

48. Lu Q, Zhang Y, Geng T, Yang K, Guo K, Min X, et al. Association of lifestyle factors and antihypertensive medication use with risk of all-cause and cause-specific mortality among adults with hypertension in China. JAMA Netw Open. (2022) 5:e2146118. doi: 10.1001/jamanetworkopen.2021.46118

PubMed Abstract | Crossref Full Text | Google Scholar

49. Valenzuela PL, Carrera-Bastos P, Gálvez BG, Ruiz-Hurtado G, Ordovas JM, Ruilope LM, et al. Lifestyle interventions for the prevention and treatment of hypertension. Nat Rev Cardiol. (2021) 18:251–75. doi: 10.1038/s41569-020-00437-9

PubMed Abstract | Crossref Full Text | Google Scholar

50. Theodoridis X, Chourdakis M, Chrysoula L, Chroni V, Tirodimos I, Dipla K, et al. Adherence to the DASH diet and risk of hypertension: A systematic review and meta-analysis. Nutrients. (2023) 15:3261. doi: 10.3390/nu15143261

PubMed Abstract | Crossref Full Text | Google Scholar

51. Tseng E, Appel LJ, Yeh HC, Pilla SJ, Miller ER, Juraschek SP, et al. Effects of the dietary approaches to stop hypertension diet and sodium reduction on blood pressure in persons with diabetes. Hypertension. (2021) 77:265–74. doi: 10.1161/HYPERTENSIONAHA.120.14584

PubMed Abstract | Crossref Full Text | Google Scholar

52. Chen M, Li Y, and Liu X. A review of the role of bioactive components in legumes in the prevention and treatment of cardiovascular diseases. Food Funct. (2025) 16:797–814. doi: 10.1039/D4FO04969A

PubMed Abstract | Crossref Full Text | Google Scholar

53. Greenwood H, Barnes K, Ball L, and Glasziou P. Comparing dietary strategies to manage cardiovascular risk in primary care: a narrative review of systematic reviews. Br J Gen Pract. (2024) 74:e199–207. doi: 10.3399/BJGP.2022.0564

PubMed Abstract | Crossref Full Text | Google Scholar

54. Hamaya R, Sun Q, Li J, Yun H, Wang F, Curhan GC, et al. 24-h urinary sodium and potassium excretions, plasma metabolomic profiles, and cardiometabolic biomarkers in the United States adults: a cross-sectional study. Am J Clin Nutr. (2024) 120:153–61. doi: 10.1016/j.ajcnut.2024.05.010

PubMed Abstract | Crossref Full Text | Google Scholar

55. Huang L, Neal B, Wu JHY, Huang Y, Marklund M, Campbell NRC, et al. The impact of baseline potassium intake on the dose-response relation between sodium reduction and blood pressure change: systematic review and meta-analysis of randomized trials. J Hum Hypertens. (2021) 35:946–57. doi: 10.1038/s41371-021-00510-x

PubMed Abstract | Crossref Full Text | Google Scholar

56. Bhagavathula AS, Refaat SA, Bentley BL, and Rahmani J. Association between intake of sodium, potassium, sodium-to-potassium ratio, and blood pressure among US adults. Int J Vitam Nutr Res. (2023) 93:392–400. doi: 10.1024/0300-9831/a000740

PubMed Abstract | Crossref Full Text | Google Scholar

57. Razavi MA, Bazzano LA, Nierenberg J, Huang Z, Fernandez C, Razavi AC, et al. Advances in genomics research of blood pressure responses to dietary sodium and potassium intakes. Hypertension. (2021) 78:4–15. doi: 10.1161/HYPERTENSIONAHA.121.16509

PubMed Abstract | Crossref Full Text | Google Scholar

58. Li X, Zhang W, Laden F, Curhan GC, Rimm EB, Guo X, et al. Dietary nitrate intake and vegetable consumption, ambient particulate matter, and risk of hypertension in the Nurses' Health study. Environ Int. (2022) 161:107100. doi: 10.1016/j.envint.2022.107100

PubMed Abstract | Crossref Full Text | Google Scholar

59. Singh BP, Aluko RE, Hati S, and Solanki D. Bioactive peptides in the management of lifestyle-related diseases: Current trends and future perspectives. Crit Rev Food Sci Nutr. (2022) 62:4593–606. doi: 10.1080/10408398.2021.1877109

PubMed Abstract | Crossref Full Text | Google Scholar

60. Młynarska E, Biskup L, Możdżan M, Grygorcewicz O, Możdżan Z, Semeradt J, et al. The role of oxidative stress in hypertension: the insight into antihypertensive properties of vitamins A, C and E. Antioxidants (Basel). (2024) 13:848. doi: 10.3390/antiox13070848

PubMed Abstract | Crossref Full Text | Google Scholar

61. Caliceti C, Malaguti M, Marracino L, Barbalace MC, Rizzo P, and Hrelia S. Agri-food waste from apple, pear, and sugar beet as a source of protective bioactive molecules for endothelial dysfunction and its major complications. Antioxidants (Basel). (2022) 11:1786. doi: 10.3390/antiox11091786

PubMed Abstract | Crossref Full Text | Google Scholar

62. Venkatakrishnan K, Chiu HF, and Wang CK. Impact of functional foods and nutraceuticals on high blood pressure with a special focus on meta-analysis: review from a public health perspective. Food Funct. (2020) 11:2792–804. doi: 10.1039/D0FO00357C

PubMed Abstract | Crossref Full Text | Google Scholar

63. Mao T, Sun Y, Xu X, and He K. Overview and prospect of NAFLD: Significant roles of nutrients and dietary patterns in its progression or prevention. Hepatol Commun. (2023) 7:e0234. doi: 10.1097/HC9.0000000000000234

PubMed Abstract | Crossref Full Text | Google Scholar

64. Gradinariu V, Ard J, and van Dam RM. Effects of dietary quality, physical activity and weight loss on glucose homeostasis in persons with and without prediabetes in the PREMIER trial. Diabetes Obes Metab. (2023) 25:2714–22. doi: 10.1111/dom.15160

PubMed Abstract | Crossref Full Text | Google Scholar

65. Holmlund T, Ekblom B, Börjesson M, Andersson G, Wallin P, and Ekblom-Bak E. Association between change in cardiorespiratory fitness and incident hypertension in Swedish adults. Eur J Prev Cardiol. (2021) 28:1515–22. doi: 10.1177/2047487320942997

PubMed Abstract | Crossref Full Text | Google Scholar

66. Hanssen H, Boardman H, Deiseroth A, Moholdt T, Simonenko M, Kränkel N, et al. Personalized exercise prescription in the prevention and treatment of arterial hypertension: a Consensus Document from the European Association of Preventive Cardiology (EAPC) and the ESC Council on Hypertension. Eur J Prev Cardiol. (2022) 29:205–15. doi: 10.1093/eurjpc/zwaa141

PubMed Abstract | Crossref Full Text | Google Scholar

67. Frimodt-Møller EK, Soliman EZ, Kizer JR, Vittinghoff E, Psaty BM, Biering-Sørensen T, et al. Lifestyle habits associated with cardiac conduction disease. Eur Heart J. (2023) 44:1058–66. doi: 10.1093/eurheartj/ehac799

PubMed Abstract | Crossref Full Text | Google Scholar

68. Böhm M, Schumacher H, Werner C, Teo KK, Lonn EM, Mahfoud F, et al. Association between exercise frequency with renal and cardiovascular outcomes in diabetic and non-diabetic individuals at high cardiovascular risk. Cardiovasc Diabetol. (2022) 21:12. doi: 10.1186/s12933-021-01429-w

PubMed Abstract | Crossref Full Text | Google Scholar

69. Locasale JW. Diet and exercise in cancer metabolism. Cancer Discov. (2022) 12:2249–57. doi: 10.1158/2159-8290.CD-22-0096

PubMed Abstract | Crossref Full Text | Google Scholar

70. Park JH, Cha KC, Ro YS, Song KJ, Shin SD, Jung WJ, et al. Healthy lifestyle factors, cardiovascular comorbidities, and the risk of sudden cardiac arrest: A case-control study in Korea. Resuscitation. (2022) 175:142–9. doi: 10.1016/j.resuscitation.2022.03.030

PubMed Abstract | Crossref Full Text | Google Scholar

71. Jabbarzadeh Ganjeh B, Zeraattalab-Motlagh S, Jayedi A, Daneshvar M, Gohari Z, Norouziasl R, et al. Effects of aerobic exercise on blood pressure in patients with hypertension: a systematic review and dose-response meta-analysis of randomized trials. Hypertens Res. (2024) 47:385–98. doi: 10.1038/s41440-023-01467-9

PubMed Abstract | Crossref Full Text | Google Scholar

72. Anekwe CV, Cano A, Mulligan J, Ang SB, Johnson CN, Panay N, et al. The role of lifestyle medicine in menopausal health: a review of non-pharmacologic interventions. Climacteric. (2025) 28:478–96. doi: 10.1080/13697137.2025.2548806

PubMed Abstract | Crossref Full Text | Google Scholar

73. Henkin JS, Pinto RS, MaChado CLF, and Wilhelm EN. Chronic effect of resistance training on blood pressure in older adults with prehypertension and hypertension: A systematic review and meta-analysis. Exp Gerontol. (2023) 177:112193. doi: 10.1016/j.exger.2023.112193

PubMed Abstract | Crossref Full Text | Google Scholar

74. Baffour-Awuah B, Pearson MJ, Dieberg G, and Smart NA. Isometric resistance training to manage hypertension: systematic review and meta-analysis. Curr Hypertens Rep. (2023) 25:35–49. doi: 10.1007/s11906-023-01232-w

PubMed Abstract | Crossref Full Text | Google Scholar

75. Edwards JJ, Coleman DA, Ritti-Dias RM, Farah BQ, Stensel DJ, Lucas SJE, et al. Isometric exercise training and arterial hypertension: an updated review. Sports Med. (2024) 54:1459–97. doi: 10.1007/s40279-024-02036-x

PubMed Abstract | Crossref Full Text | Google Scholar

76. Charchar FJ, Prestes PR, Mills C, Ching SM, Neupane D, Marques FZ, et al. Lifestyle management of hypertension: International Society of Hypertension position paper endorsed by the World Hypertension League and European Society of Hypertension. J Hypertens. (2024) 42:23–49. doi: 10.1097/HJH.0000000000003563

PubMed Abstract | Crossref Full Text | Google Scholar

77. Hamaya R, Wang M, Hertzmark E, Cook NR, Manson JE, Sun Q, et al. Modifiable lifestyle factors in the primordial prevention of hypertension in three US cohorts. Eur J Intern Med. (2025) 132:55–66. doi: 10.1016/j.ejim.2024.10.028

PubMed Abstract | Crossref Full Text | Google Scholar

78. Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, et al. 2020 International Society of Hypertension global hypertension practice guidelines. J Hypertens. (2020) 38:982–1004. doi: 10.1097/HJH.0000000000002453

PubMed Abstract | Crossref Full Text | Google Scholar

79. Rabi DM, McBrien KA, Sapir-Pichhadze R, Nakhla M, Ahmed SB, Dumanski SM, et al. Hypertension Canada's 2020 comprehensive guidelines for the prevention, diagnosis, risk assessment, and treatment of hypertension in adults and children. Can J Cardiol. (2020) 36:596–624. doi: 10.1016/j.cjca.2020.02.086

PubMed Abstract | Crossref Full Text | Google Scholar

80. Hall ME, Cohen JB, Ard JD, Egan BM, Hall JE, Lavie CJ, et al. Weight-loss strategies for prevention and treatment of hypertension: A scientific statement from the american heart association. Hypertension. (2021) 78:e38–50. doi: 10.1161/HYP.0000000000000202

PubMed Abstract | Crossref Full Text | Google Scholar

81. Bulto LN, Roseleur J, Noonan S, Pinero de Plaza MA, Champion S, Dafny HA, et al. Effectiveness of nurse-led interventions versus usual care to manage hypertension and lifestyle behaviour: a systematic review and meta-analysis. Eur J Cardiovasc Nurs. (2024) 23:21–32. doi: 10.1093/eurjcn/zvad040

PubMed Abstract | Crossref Full Text | Google Scholar

82. Slater K, Colyvas K, Taylor R, Collins CE, and Hutchesson M. Primary and secondary cardiovascular disease prevention interventions targeting lifestyle risk factors in women: A systematic review and meta-analysis. Front Cardiovasc Med. (2022) 9:1010528. doi: 10.3389/fcvm.2022.1010528

PubMed Abstract | Crossref Full Text | Google Scholar

83. Wani RT, Khader K, and Udawat P. Behavioral interventions in hypertension: A lifestyle medicine approach. Indian J Public Health. (2023) 67:S35–s40. doi: 10.4103/ijph.ijph_672_23

PubMed Abstract | Crossref Full Text | Google Scholar

84. Ojangba T, Boamah S, Miao Y, Guo X, Fen Y, Agboyibor C, et al. Comprehensive effects of lifestyle reform, adherence, and related factors on hypertension control: A review. J Clin Hypertens (Greenwich). (2023) 25:509–20. doi: 10.1111/jch.14653

PubMed Abstract | Crossref Full Text | Google Scholar

85. Zhang Z, Zhou X, Mei Y, Bu X, Tang J, Gong T, et al. Novel low-sodium salt formulations combined with Chinese modified DASH diet for reducing blood pressure in patients with hypertension and type 2 diabetes: a clinical trial. Front Nutr. (2023) 10:1219381. doi: 10.3389/fnut.2023.1219381

PubMed Abstract | Crossref Full Text | Google Scholar

86. Liang W, Liu C, Yan X, Hou Y, Yang G, Dai J, et al. The impact of sprint interval training versus moderate intensity continuous training on blood pressure and cardiorespiratory health in adults: a systematic review and meta-analysis. PeerJ. (2024) 12:e17064. doi: 10.7717/peerj.17064

PubMed Abstract | Crossref Full Text | Google Scholar

87. Li L, Liu X, Shen F, Xu N, Li Y, Xu K, et al. Effects of high-intensity interval training versus moderate-intensity continuous training on blood pressure in patients with hypertension: A meta-analysis. Med (Baltimore). (2022) 101:e32246. doi: 10.1097/MD.0000000000032246

PubMed Abstract | Crossref Full Text | Google Scholar

88. de Souza Mesquita FO, Gambassi BB, de Oliveira Silva M, Moreira SR, Neves VR, Gomes-Neto M, et al. Effect of high-intensity interval training on exercise capacity, blood pressure, and autonomic responses in patients with hypertension: A systematic review and meta-analysis. Sports Health. (2023) 15:571–8. doi: 10.1177/19417381221139343

PubMed Abstract | Crossref Full Text | Google Scholar

89. Nunns M, Febrey S, Buckland J, Abbott R, Whear R, Bethel A, et al. The quantity, quality and findings of network meta-analyses evaluating the effectiveness of GLP-1 RAs for weight loss: a scoping review. Health Technol Assess. (2025) 28:1–73. doi: 10.3310/SKHT8119

PubMed Abstract | Crossref Full Text | Google Scholar

90. Wong HJ, Sim B, Teo YH, Teo YN, Chan MY, Yeo LLL, et al. Efficacy of GLP-1 receptor agonists on weight loss, BMI, and waist circumference for patients with obesity or overweight: A systematic review, meta-analysis, and meta-regression of 47 randomized controlled trials. Diabetes Care. (2025) 48:292–300. doi: 10.2337/dc24-1678

PubMed Abstract | Crossref Full Text | Google Scholar

91. Sinha B and Ghosal S. Efficacy and safety of GLP-1 receptor agonists, dual agonists, and retatrutide for weight loss in adults with overweight or obesity: A bayesian NMA. Obes (Silver Spring). (2025) 33:2046–54. doi: 10.1002/oby.24360

PubMed Abstract | Crossref Full Text | Google Scholar

92. Katout M, Zhu H, Rutsky J, Shah P, Brook RD, Zhong J, et al. Effect of GLP-1 mimetics on blood pressure and relationship to weight loss and glycemia lowering: results of a systematic meta-analysis and meta-regression. Am J Hypertens. (2014) 27:130–9. doi: 10.1093/ajh/hpt196

PubMed Abstract | Crossref Full Text | Google Scholar

93. Kramer CK, Retnakaran M, and Viana LV. Effect of glucagon-like peptide-1 receptor agonists (GLP-1RA) on weight loss following bariatric treatment. J Clin Endocrinol Metab. (2024) 109:e1634–41. doi: 10.1210/clinem/dgae176

PubMed Abstract | Crossref Full Text | Google Scholar

94. Wharton S, Blevins T, Connery L, Rosenstock J, Raha S, Liu R, et al. Daily oral GLP-1 receptor agonist orforglipron for adults with obesity. N Engl J Med. (2023) 389:877–88. doi: 10.1056/NEJMoa2302392

PubMed Abstract | Crossref Full Text | Google Scholar

95. Vahtera V, Pajarinen JS, Kivimäki M, Ervasti J, Pentti J, Stenholm S, et al. Incidence of new onset arterial hypertension after metabolic bariatric surgery: an 8-year prospective follow-up with matched controls. J Hypertens. (2025) 43:871–9. doi: 10.1097/HJH.0000000000003993

PubMed Abstract | Crossref Full Text | Google Scholar

96. Alghamdi S, Mirghani H, Alhazmi K, Alatawi AM, Brnawi H, Alrasheed T, et al. Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy effects on obesity comorbidities: A systematic review and meta-analysis. Front Surg. (2022) 9:953804. doi: 10.3389/fsurg.2022.953804

PubMed Abstract | Crossref Full Text | Google Scholar

97. Samuel GO, Lambert K, Asagbra E, Harvin G, and Ibegbu E. Impact of intragastric balloon on blood pressure reduction: A retrospective study in Eastern North Carolina. World J Gastrointest Endosc. (2021) 13:115–24. doi: 10.4253/wjge.v13.i5.115

PubMed Abstract | Crossref Full Text | Google Scholar

98. Seksaria S, Dutta BJ, Kaur M, Gupta GD, Bodakhe SH, and Singh A. Role of GLP-1 receptor agonist in diabetic cardio-renal disorder: recent updates of clinical and pre-clinical evidence. Curr Diabetes Rev. (2024) 20:e090823219597. doi: 10.2174/1573399820666230809152148

PubMed Abstract | Crossref Full Text | Google Scholar

99. Schiavon CA, Bhatt DL, Ikeoka D, Santucci EV, Santos RN, Damiani LP, et al. Three-year outcomes of bariatric surgery in patients with obesity and hypertension: A randomized clinical trial. Ann Intern Med. (2020) 173:685–93. doi: 10.7326/M19-3781

PubMed Abstract | Crossref Full Text | Google Scholar

100. O'Leary S, Price A, Camarillo-Rodriguez L, Costa M, Karas P, Young CC, et al. Impact of GLP-1 receptor agonists on idiopathic intracranial hypertension clinical and neurosurgical outcomes: a propensity-matched multi-institutional cohort study. J Neurosurg. (2025) 143:1037–47. doi: 10.3171/2025.1.JNS242357

PubMed Abstract | Crossref Full Text | Google Scholar

101. Xi JY, Wang YJ, Li XH, Sun NM, Ming RQ, Yan HL, et al. Impact of healthy lifestyles on the risk of metabolic dysfunction-associated steatotic liver disease among adults with comorbid hypertension and diabetes: Novel insight from a largely middle-aged and elderly cohort in South China. Diabetes Obes Metab. (2025) 27:2800–9. doi: 10.1111/dom.16289

PubMed Abstract | Crossref Full Text | Google Scholar

102. Ostrominski JW and Powell-Wiley TM. Risk stratification and treatment of obesity for primary and secondary prevention of cardiovascular disease. Curr Atheroscler Rep. (2024) 26:11–23. doi: 10.1007/s11883-023-01182-3

PubMed Abstract | Crossref Full Text | Google Scholar

103. Dafsari FS and Jessen F. Depression-an underrecognized target for prevention of dementia in Alzheimer's disease. Transl Psychiatry. (2020) 10:160. doi: 10.1038/s41398-020-0839-1

PubMed Abstract | Crossref Full Text | Google Scholar

104. den Brok M, Hoevenaar-Blom MP, Coley N, Andrieu S, van Dalen J, Meiller Y, et al. The effect of multidomain interventions on global cognition, symptoms of depression and apathy - A pooled analysis of two randomized controlled trials. J Prev Alzheimers Dis. (2022) 9:96–103. doi: 10.14283/jpad.2021.53

PubMed Abstract | Crossref Full Text | Google Scholar

105. Wienbergen H, Boakye D, Günther K, Schmucker J, Mata Marín LA, Kerniss H, et al. Lifestyle and metabolic risk factors in patients with early-onset myocardial infarction: a case-control study. Eur J Prev Cardiol. (2022) 29:2076–87. doi: 10.1093/eurjpc/zwac132

PubMed Abstract | Crossref Full Text | Google Scholar

106. Martinez-Morata I, Sanchez TR, Shimbo D, and Navas-Acien A. Electronic cigarette use and blood pressure endpoints: a systematic review. Curr Hypertens Rep. (2020) 23:2. doi: 10.1007/s11906-020-01119-0

PubMed Abstract | Crossref Full Text | Google Scholar

107. Mueller SD, Britton GR, James GD, and Stewart Fahs P. Vaping behaviour patterns and daily blood pressure and heart rate variation: a brief report. Ann Hum Biol. (2021) 48:535–9. doi: 10.1080/03014460.2021.2010803

PubMed Abstract | Crossref Full Text | Google Scholar

108. Kundu A, Feore A, Sanchez S, Abu-Zarour N, Sutton M, Sachdeva K, et al. Cardiovascular health effects of vaping e-cigarettes: a systematic review and meta-analysis. Heart. (2025) 111:599–608. doi: 10.1136/heartjnl-2024-325030

PubMed Abstract | Crossref Full Text | Google Scholar

109. Lemp JM, Nuthanapati MP, Bärnighausen TW, Vollmer S, Geldsetzer P, and Jani A. Use of lifestyle interventions in primary care for individuals with newly diagnosed hypertension, hyperlipidaemia or obesity: a retrospective cohort study. J R Soc Med. (2022) 115:289–99. doi: 10.1177/01410768221077381

PubMed Abstract | Crossref Full Text | Google Scholar

110. Zülke AE, Pabst A, Luppa M, Oey A, Weise S, Fankhänel T, et al. Effects of a multidomain intervention against cognitive decline on dementia risk profiles - Results from the AgeWell.de trial. Alzheimers Dement. (2024) 20:5684–94. doi: 10.1002/alz.14097

PubMed Abstract | Crossref Full Text | Google Scholar

111. Lisko I, Kulmala J, Annetorp M, Ngandu T, Mangialasche F, and Kivipelto M. How can dementia and disability be prevented in older adults: where are we today and where are we going? J Intern Med. (2021) 289:807–30. doi: 10.1111/joim.13227

PubMed Abstract | Crossref Full Text | Google Scholar

112. Deckers K, Zwan MD, Soons LM, Waterink L, Beers S, van Houdt S, et al. A multidomain lifestyle intervention to maintain optimal cognitive functioning in Dutch older adults-study design and baseline characteristics of the FINGER-NL randomized controlled trial. Alzheimers Res Ther. (2024) 16:126. doi: 10.1186/s13195-024-01495-8

PubMed Abstract | Crossref Full Text | Google Scholar

113. Rosenberg A, Untersteiner H, Guazzarini AG, Bödenler M, Bruinsma J, Buchgraber-Schnalzer B, et al. A digitally supported multimodal lifestyle program to promote brain health among older adults (the LETHE randomized controlled feasibility trial): study design, progress, and first results. Alzheimers Res Ther. (2024) 16:252. doi: 10.1186/s13195-024-01615-4

PubMed Abstract | Crossref Full Text | Google Scholar

114. Butters AF, Blackman J, Farouk H, Meky S, M AN, Lemke T, et al. Brain health clinics - An evolving clinical pathway? J Prev Alzheimers Dis. (2025) 12:100051. doi: 10.1016/j.jpad.2024.100051

PubMed Abstract | Crossref Full Text | Google Scholar

115. Widmer RJ, Senecal C, Allison TG, Lopez-Jimenez F, Lerman LO, and Lerman A. Dose-response effect of a digital health intervention during cardiac rehabilitation: subanalysis of randomized controlled trial. J Med Internet Res. (2020) 22:e13055. doi: 10.2196/13055

PubMed Abstract | Crossref Full Text | Google Scholar

116. Baderol Allam FN, Ab Hamid MR, Buhari SS, and Md Noor H. Web-based dietary and physical activity intervention programs for patients with hypertension: scoping review. J Med Internet Res. (2021) 23:e22465. doi: 10.2196/22465

PubMed Abstract | Crossref Full Text | Google Scholar

117. Nong TTT, Nguyen GH, Lepe A, Tran TB, Nguyen LTP, and Koot JAR. Challenges and opportunities in digital screening for hypertension and diabetes among community groups of older adults in Vietnam: mixed methods study. J Med Internet Res. (2024) 26:e54127. doi: 10.2196/54127

PubMed Abstract | Crossref Full Text | Google Scholar

118. de Jong M, Jansen N, and van Middelkoop M. A systematic review of patient barriers and facilitators for implementing lifestyle interventions targeting weight loss in primary care. Obes Rev. (2023) 24:e13571. doi: 10.1111/obr.13571

PubMed Abstract | Crossref Full Text | Google Scholar

119. Naik A, Nalepa J, Wijata AM, Mahon J, Mistry D, Knowles AT, et al. Artificial intelligence and digital twins for the personalised prediction of hypertension risk. Comput Biol Med. (2025) 196:110718. doi: 10.1016/j.compbiomed.2025.110718

PubMed Abstract | Crossref Full Text | Google Scholar

120. Cheng Y, Gu K, Ji W, Hu Z, Yang Y, and Zhou Y. Two-year hypertension incidence risk prediction in populations in the desert regions of northwest China: prospective cohort study. J Med Internet Res. (2025) 27:e68442. doi: 10.2196/68442

PubMed Abstract | Crossref Full Text | Google Scholar

121. Srour B, Hynes LC, Johnson T, Kühn T, Katzke VA, and Kaaks R. Serum markers of biological ageing provide long-term prediction of life expectancy-a longitudinal analysis in middle-aged and older German adults. Age Ageing. (2022) 51:afab271. doi: 10.1093/ageing/afab271

PubMed Abstract | Crossref Full Text | Google Scholar

122. Ng TP, Lee TS, Lim WS, Chong MS, Yap P, Cheong CY, et al. Development, validation and field evaluation of the Singapore longitudinal ageing study (SLAS) risk index for prediction of mild cognitive impairment and dementia. J Prev Alzheimers Dis. (2021) 8:335–44. doi: 10.14283/jpad.2021.19

PubMed Abstract | Crossref Full Text | Google Scholar

123. Han W, Chen S, Kong L, Li Q, Zhang J, Shan G, et al. Lifestyle and clinical factors as predictive indicators of cardiometabolic multimorbidity in Chinese adults: Baseline findings of the Beijing Health Management Cohort (BHMC) study. Comput Biol Med. (2024) 168:107792. doi: 10.1016/j.compbiomed.2023.107792

PubMed Abstract | Crossref Full Text | Google Scholar

124. Wang Z, Wang X, Shen Y, Li S, Chen Z, Zheng C, et al. Effect of a workplace-based multicomponent intervention on hypertension control: A randomized clinical trial. JAMA Cardiol. (2020) 5:567–75. doi: 10.1001/jamacardio.2019.6161

PubMed Abstract | Crossref Full Text | Google Scholar

125. Hu Z, Wang X, Hong C, Zheng C, Zhang L, Chen Z, et al. Workplace-based primary prevention intervention reduces incidence of hypertension: a post hoc analysis of cluster randomized controlled study. BMC Med. (2023) 21:214. doi: 10.1186/s12916-023-02915-6

PubMed Abstract | Crossref Full Text | Google Scholar

126. Smith AP, Overton K, Rakotz M, Wozniak G, and Sanchez E. Target: BP™: A national initiative to improve blood pressure control. Hypertension. (2023) 80:2523–32. doi: 10.1161/HYPERTENSIONAHA.123.20389

PubMed Abstract | Crossref Full Text | Google Scholar

127. Whitsel LP, Ajenikoko F, Chase PJ, Johnson J, McSwain B, Phelps M, et al. Public policy for healthy living: How COVID-19 has changed the landscape. Prog Cardiovasc Dis. (2023) 76:49–56. doi: 10.1016/j.pcad.2023.01.002

PubMed Abstract | Crossref Full Text | Google Scholar

128. Lassell RKF, Pritchard K, Baehr LA, Ceïde ME, Chatterjee SA, Colón-Semenza C, et al. New horizons in advancing lifestyle medicine for older adults utilizing a transdisciplinary approach: gaps and opportunities. Age Ageing. (2025) 54:afaf159. doi: 10.1093/ageing/afaf159

PubMed Abstract | Crossref Full Text | Google Scholar

129. Lu J, Li M, He J, Xu Y, Zheng R, Zheng J, et al. Association of social determinants, lifestyle, and metabolic factors with mortality in Chinese adults: A nationwide 10-year prospective cohort study. Cell Rep Med. (2024) 5:101656. doi: 10.1016/j.xcrm.2024.101656

PubMed Abstract | Crossref Full Text | Google Scholar

130. Kowalska K, Wilczopolski P, Buławska D, Młynarska E, Rysz J, and Franczyk B. The importance of SGLT-2 inhibitors as both the prevention and the treatment of diabetic cardiomyopathy. Antioxidants (Basel). (2022) 11:2500. doi: 10.3390/antiox11122500

PubMed Abstract | Crossref Full Text | Google Scholar

131. Wei X, Zhang Z, Chong MKC, Hicks JP, Gong W, Zou G, et al. Evaluation of a package of risk-based pharmaceutical and lifestyle interventions in patients with hypertension and/or diabetes in rural China: A pragmatic cluster randomised controlled trial. PloS Med. (2021) 18:e1003694. doi: 10.1371/journal.pmed.1003694

PubMed Abstract | Crossref Full Text | Google Scholar

132. Tiffe T, Morbach C, Malsch C, Gelbrich G, Wahl V, Wagner M, et al. Physicians' lifestyle advice on primary and secondary cardiovascular disease prevention in Germany: A comparison between the STAAB cohort study and the German subset of EUROASPIRE IV. Eur J Prev Cardiol. (2021) 28:1175–83. doi: 10.1177/2047487319838218

PubMed Abstract | Crossref Full Text | Google Scholar

133. Lu J, Zhang L, Lu Y, Su M, Li X, Liu J, et al. Secondary prevention of cardiovascular disease in China. Heart. (2020) 106:1349–56. doi: 10.1136/heartjnl-2019-315884

PubMed Abstract | Crossref Full Text | Google Scholar

134. Qu Y, Lv Y, Ji S, Ding L, Zhao F, Zhu Y, et al. Effect of exposures to mixtures of lead and various metals on hypertension, pre-hypertension, and blood pressure: A cross-sectional study from the China National Human Biomonitoring. Environ pollut. (2022) 299:118864. doi: 10.1016/j.envpol.2022.118864

PubMed Abstract | Crossref Full Text | Google Scholar

135. Lin PD, Cardenas A, Hauser R, Gold DR, Kleinman KP, Hivert MF, et al. Per- and polyfluoroalkyl substances and kidney function: Follow-up results from the Diabetes Prevention Program trial. Environ Int. (2021) 148:106375. doi: 10.1016/j.envint.2020.106375

PubMed Abstract | Crossref Full Text | Google Scholar

136. Carlsson S, Andersson T, Talbäck M, and Feychting M. Incidence and prevalence of type 2 diabetes by occupation: results from all Swedish employees. Diabetologia. (2020) 63:95–103. doi: 10.1007/s00125-019-04997-5

PubMed Abstract | Crossref Full Text | Google Scholar

137. Lloyd-Jones DM, Allen NB, Anderson CAM, Black T, Brewer LC, Foraker RE, et al. Life's essential 8: updating and enhancing the american heart association's construct of cardiovascular health: A presidential advisory from the american heart association. Circulation. (2022) 146:e18–43. doi: 10.1161/CIR.0000000000001078

PubMed Abstract | Crossref Full Text | Google Scholar

138. Rivier CA, Singh S, Senff J, Tack RW, Marini S, Clocchiatti-Tuozzo S, et al. Brain care score and neuroimaging markers of brain health in asymptomatic middle-age persons. Neurology. (2024) 103:e209687. doi: 10.1212/WNL.0000000000209687

PubMed Abstract | Crossref Full Text | Google Scholar