**4. Therapeutic lifestyle changes (TLCs)**

Therapeutic lifestyle changes are the foundation for non-drug management of HTN and/or CVD. These include smoking cessation, reduced intake of sodium diet, the Dietary Approach to Stop Hypertension (DASH), body weight management, moderation of alcohol consumption and physical activity. The American Diabetes Association (ADA) 2020 standards of medical care recommend that for patients with blood pressure > 120/80 mmHg, lifestyle intervention consists of weight loss if overweight or obese, DASH-style eating pattern including reducing sodium and increasing potassium intake, moderation of alcohol intake, and increased physical activity [14].

#### **4.1 Smoking cessation**

Smoking increases the risk of developing serious health problems and death. It is estimated that there are 1.1 billion people who smoke and 80% of them come from the low-to-middle income countries (LMICs). Further estimates reveal that smokers are likely to develop heart disease and stroke 2–4 times higher compared to nonsmokers. The **Table 1** below is a summary of the health benefits of quitting smoking from 20 minutes to 15 years adapted from the forefront UChicago Medicine [15].

#### **4.2 Reduced intake of sodium diet**

High sodium intake, estimated at >2 grams per day which is equivalent to 5 grams of table salt per day, contributes to high blood pressure and increases risk of heart disease and stroke. If global salt intake could be reduced to recommended levels, an estimated 2.5 million deaths could be prevented [16]. In a systematic review and meta regression done on salt intake in sub-Saharan Africa, the results of the study revealed high sodium intake in many adult population (and some populations of children) above the 2 g intake recommended as the upper limit established by WHO [17].

#### *Lifestyle and Epidemiology - The Double Burden of Poverty and Cardiovascular Diseases...*


#### **Table 1.**

*Time of quitting smoking and extent of body recovery.*

There is a strong content-dependent relationship between raised blood pressure and consumption of high amounts of sodium. Dietary guidelines recommend a daily intake of sodium at less than 2.3 grams in the general population and less than 1.5 grams in people with high blood pressure, diabetes, kidney disease and those aged 50 years old or more. Salt reduction initiates a decline in average blood pressure in a week time. It also improves the body response blood pressure medicines. Lowering blood pressure reduces risk of heart disease, stroke and death due to salt related CVDs.

#### **4.3 The DASH eating plan**

The pioneer trial that examined the role of diet in the management of hypertension was the DASH trial in 1997. The results of the trial revealed that after approximately 3 g sodium intake per day on both control and interventional group; within 2 weeks of the intervention, blood pressures reduced and the results sustained for another 6 weeks. Systolic blood pressure (SBP) reduced by 5.5 mm Hg and diastolic blood pressure (DBP) by 3.0 mm Hg more than the control diet [18].

The DASH eating plan entails a diet rich in fruits and vegetables (8–10 servings/ day); and low-fat dairy foods (2–3 servings/day), coupled with reduced saturated and total fat [19]. DASH is a flexible and balanced eating plan that helps create a heart-healthy eating style for life. The DASH eating plan requires no special foods and instead provides daily and weekly nutritional goals. DASH eating plan recommends that the choice of foods should also be based on food that are:


Globally, calories obtained from Proteins, Sugars and Fats have been increasing and those from roughage-rich foods have been declining. Consumption of processed foods continues to rise rapidly in low- and middle-income settings. This nutrition transition affects dietary patterns and nutrient intake, which influence the risk of developing NCDs.

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*Exploring Cardiovascular Diseases Treatment in Africa DOI: http://dx.doi.org/10.5772/intechopen.95871*

drinks containing sugar.

**4.4 Body weight management**

larger weight losses had greater benefits [21].

increasing BP and weakening heart muscles [24].

**4.6 Physical activity**

**4.5 Moderation of alcohol consumption**

DASH diet is one among such healthy dietary patterns, which emphasizes on;

• Whole grains, poultry, fish, and small quantities of red meat, sweets and

• The increased risk of cardiovascular diseases associated with higher sodium intake (>5 g/day) is most prominent in those with high blood pressure.

Overweight and obesity are major risk factors for a number of chronic diseases, including CVDs such as heart disease and stroke, which are the leading causes of death worldwide. Globally, obesity is one side of the double burden of malnutrition, and today more people are obese than underweight in most regions of the world. A body mass index (BMI) over 25 kg/m−2 is considered overweight, and over 30 kg/ m−2 is obese. The issue has grown to epidemic proportions, with over 4 million people dying each year as a result of being overweight or obese in 2017 according to the global burden of disease [20]. Nevertheless, modest weight losses of 5 to <10% were associated with significant improvements in CVD risk factors at one year, but

The Centers for Disease Control and Prevention (CDC) define alcohol moderation as having up to one drink per day for women and up to two drinks per day for men. The definition refers to the amount consumed on any single day and is not intended as an average over several days [22]. However, it is not recommended that that people who do not drink alcohol start drinking for any reason. Excessive alcohol intake includes binge drinking, heavy drinking and any alcohol use during pregnancy. Binge drinking corresponds to five or more drinks in men and four or more drinks in women on a single occasion, generally within two hours; while heavy drinking is defined as consuming 15 drinks or more per week for men and eight drinks or more per week in women. In 2019, top nine African countries with high alcohol consumption in liters per capita were in the order of Nigeria, Eswatini, South Africa, Lesotho, Zimbabwe, Zambia, Malawi, Ghana and Morocco [23]. Excessive alcohol consumption increases the risk of developing heart disease by

Globally, lack of sufficient physical activity is the fourth risk factor to development of NCDs. While physical inactivity is attributed to prevalence of diabetes at 27%, heart diseases caused by heart vessels blockage at 30% and breast and colon cancer at 21–25%; 3.2–5 million deaths globally are associated with physical inactivity [25]. The World Health Organization defines physical activity as a bodily movement produced by muscular and skeletal body systems which require energy expenditure. In other words, physical activity encompasses all activities undertaken while working, playing, carrying out household chores, traveling, recreation; in addition to exercise activities. Physical activity is further classified as moderateand vigorous-intensity physical activity. Also, physical activities are sub-classified as aerobic (those that engage large muscles of the hands and legs; making the

• Consumption of fruits, vegetables and low-fat dairy foods.

DASH diet is one among such healthy dietary patterns, which emphasizes on;

