Table 9.

Lifestyle and dietary recommendations to reduce high blood pressure values

Goals
•	BMI in the normal weight range: maintain BMI to prevent overweight
•	BMI in the overweight range: weight maintenance in younger children or gradual weight loss in older children and adolescents to return to the normal weight range
•	BMI in the obesity range: gradual weight loss (1–2 kg/month) to achieve normal weight
General recommendations
•	Moderate to vigorous physical aerobic activity for 40 min, 3–5 days/week and avoid more than 2 h of daily sedentary activities (besides school hours)
•	Participation in (competitive) sports activities limited only in the presence of uncontrolled stage 2 hypertension
•	Avoid severe dietary restrictions, reduce portion size, stimulate the habit of having breakfast
•	Limit salt intake
•	Avoid intake of excess sugar, excess soft drinks, saturated and trans fat, animal protein
•	Drink water
•	Stimulate the intake of healthy food (fruit, vegetables, legumes, whole grain products, fish)
•	Implement the behavioral changes (physical activity and diet) suitable for individual and family characteristics
•	Establish realistic goals
•	Involve the family, caregivers, teachers and other educators in the process of dietary and life-style changes
•	Provide educational support and materials
•	Develop reward systems (non-food) to achieve healthy behavior

Lurbe et al. “Management of High Blood Pressure in Children and Adolescents: recommendations of the ESH”. Journal of Hypertension 2009 [2] (modified).