BOX 1.

Lifestyle interventions for blood pressure reduction.

Dietary approach	Grade
•For adolescents with elevated BP a DASH (Dietary Approaches to Stop Hypertension) diet is recommended (9). •Combined intake of at least 2 servings/day of dairy products and at least 3 servings/day of fruits and vegetables throughout adolescence led to about a 35% lower risk of elevated BP by late adolescence (10). •Avoiding sugar-sweetened drinks and saturated fat is recommended •Quantity and quality of dietary fats also influence BP (11). A diet rich in monounsaturated fat resulted in reductions in systolic and diastolic BP (12). Olive oil polyphenols have been associated with several cardiovascular health benefits, especially a BP decreasing effect (13). •Higher sugar sweetened beverage consumption was associated with higher systolic BP (14).	C C C
Restrictions in salt intake are recommended (15). The World Health Organization (WHO) recommends a reduction in sodium intake for better control of BP in children aged 2–15 (16). • The European Food Safety Authority (EFSA) Panel on Nutrition considers safe and adequate sodium intake for children (17): ○ 1100 mg/day for children aged 1–3 years ○ 1300 mg/day for children aged 4–6 years ○ 1700mg/day for children aged 7–10 years ○ 2000 mg/day for children aged 11–17 years ○ For infants aged 7–11 months, an adequate intake (AI) of 200 mg/day is proposed based on upwards extrapolation of the estimated sodium intake in exclusively breast-fed infants aged 0–6 months. These recommendations need to be accompanied by a patient education due to difficulties to translate them into real life.	C
Physical activity
•Regular, daily physical activity is recommended •Regular physical activity (60 min session, 3 times/week) resulted in a significant reduction of BP (18).	C
Sedentary lifestyle
•For children and adolescents, the sedentary recreational screen time should be limited to 2 h a day, and they should be advised to engage in positive social interactions and experiences (1). There is evidence of a direct association between sedentary behavior and a high risk of HTN (19).	C
Sleep Disorders
•Short sleep duration is a risk factor for hypertension. •There is strong evidence that self-reported short sleep duration, defined by different cutoffs (≤5, ≤6, or ≤7 h), is a risk factor for HTN (20, 21). This has been reported also for several sleep disorders, including sleep apnea and insomnia (21).	C
Environmental factors
•Exposure to air pollution, environmental noise and outdoor temperature affect autonomic cardiovascular regulation, inflammatory pro-coagulative pathways and stress hormones. These mechanisms lead to vascular dysfunction and increases in blood pressure and cardiovascular (CV) events (22–25).	C