Lifestyle advice should be offered to all patients on an ongoing basis because a healthy diet and regular exercise may reduce or remove the need for antihypertensive therapy. However, for most patients, it is adherence to medication that is required. Advice can be provided on diet, nutrition, alcohol intake, smoking, physical activity and weight management.

Diet and nutrition advice:

• Starchy foods should form one-third of the diet
• 15 per cent of daily calories should come from protein
• Eat two portions of fish a week
• Reduce sugar and saturated fat intake
• Eat five portions of fruit/ vegetables a day (canned and frozen fruit and vegetables count)
• Reduce salt intake – salt is implicated in hypertension (no more than 6g a day)
• Ensure adequate fluid intake (approximately six to eight glasses of water a day)
• Discourage excessive consumption of coffee and other caffeine-rich products.

Physical activity advice:

• Aim to be active daily
• Aim for at least 150 minutes of moderate intensity activity (i.e. activity that makes the person feel out of breath) a week in bouts of at least 10 minutes
• Twice weekly do activities to increase muscle strength
• For patients over the age of 65, any physical activity will be beneficial; it should be built up gradually.

Alcohol consumption:

• One unit of alcohol equals 10ml or 8mg of pure alcohol (e.g. 25ml whisky, a third of a pint of beer or half a glass of wine – approximately 85ml, although this depends on the percentage of alcohol)
• Men should consume no more than three to four units a day and women no more than two to three units a day
• Alcohol should be avoided in pregnancy (especially in the first trimester)
• If a patient drinks excessively, encourage a reduction as this can reduce blood pressure.

Smoking status:

• Offer smokers advice and help to stop smoking because it will reduce their CVD risk
• Signpost smokers to the NHS Stop Smoking Service if you do not offer a smoking cessation service in the pharmacy.

Stress reduction:

• Relaxation therapies (e.g. yoga, meditation, mindfulness) can reduce blood pressure and people may wish to pursue these as part of their treatment
• Signpost to NHS Choices for 10 ‘stress busters’

Weight management:

• More than 60 per cent of adults are overweight or obese, and patients can have increased BP as a result of their weight
• Normal BMI is 20-25
• A BMI of 25-29.9 is overweight
• A BMI of over 30 is obese (subject to ethnic variations).

In all cases, pharmacists should offer appropriate guidance and written or audiovisual materials to promote lifestyle changes and signpost to appropriate healthcare professionals and services if necessary.

Reflection exercise 

Look at the list of approved blood pressure meters on the British Hypertension Society website. Which would be most suitable:

• To use in your pharmacy?
• To recommend to patients for home blood pressure monitoring?