Preventing Hypertension Through Lifestyle Modification: An Evidence-Based Scoping Review of Behavioral Risk Factors and Intervention Targets

Abstract

Background: Hypertension remains the most prevalent non-communicable disease globally and a leading risk factor for cardiovascular morbidity and mortality. Despite strong evidence linking lifestyle behaviors to blood pressure regulation, adherence to lifestyle modification remains suboptimal, particularly in low- and middle-income countries (LMICs). This scoping review examines the role of modifiable behavioral risk factors and evaluates the effectiveness and implementation of lifestyle-based interventions for hypertension prevention. Methods: This study employed the Arksey and O’Malley framework for scoping reviews, with reporting guided by the PRISMA-ScR checklist. Five electronic databases (PubMed/MEDLINE, Scopus, Web of Science, CINAHL, and Google Scholar) were searched for relevant literature published between January 2000 and March 2025, with emphasis on recent evidence (2020 2025). Eligible studies included systematic reviews, randomized controlled trials, cohort studies, and clinical guidelines addressing lifestyle-related risk factors and interventions for hypertension. Data were extracted and synthesized narratively across key thematic domains. Results: A total of 47 studies met the inclusion criteria, comprising systematic reviews, randomized controlled trials, cohort studies, and international guidelines. Seven major modifiable risk factors were consistently identified: high dietary sodium intake, physical inactivity, overweight/obesity, tobacco use, harmful alcohol consumption, psychosocial stress, and poor sleep. Lifestyle interventions—including the DASH diet, sodium restriction, physical activity, weight management, smoking cessation, alcohol reduction, and stress management— demonstrated clinically significant reductions in blood pressure, with multi-component interventions showing the greatest effectiveness. However, global adherence to lifestyle modifications remains low (approximately 27.4%), with barriers including low health literacy, socioeconomic constraints, and weak health system support. Conclusion: Hypertension is largely preventable through evidence-based lifestyle modification. While effective interventions are well established, the primary challenge lies in implementation and sustained adherence, especially in LMIC settings. Strengthening primary healthcaresystems, integrating digital health solutions, and addressing structural and socioeconomic barriers are essential to achieving population-level impact in hypertension prevention.