Introduction: The World Health Organization has estimated that hypertension causes one in every eight deaths, making it as the third leading killer in the world. In Egypt, 2004, hypertension reached about 26.3% of whole population. Lifestyle modifications have an important role in the management of patients with hypertension; when used effectively. Objective: to assess efficacy of lifestyle modifications on hypertensive patients, and also assessing their compliance towards lifestyle modifications advice. Subjects and Methods: An intervention study was carried out on 448 hypertensive patients recruited among those attending 5 accredited health centers in greater Cairo from May 2007 to March 2008. Patients were divided into 2 groups: case group (240 patient) & control one (248 patient). Both groups were examined for baseline data: blood pressure, obesity parameters & lipid profile & fulfilled a pre-coded questionnaire containing the relevant variables. Then only intervention group was submitted for 3 months to an educational program about lifestyle modifications, while control group received routine outpatient services & asked to maintain their usual lifestyle including dietary & exercise habits. After 3 months both groups were re-examined for the same baseline data done before 3 months.  Administrative and ethical issues were followed in all stages of the study, and appropriate statistical design and tests of significance were performed. Results: The results of this study showed the following findings: Applying of a Comprehensive lifestyle modifications program including regular physical activity, reducing salt intake, weight reduction …etc. had a direct beneficial effect on lowering both systolic and diastolic blood pressure, weight & lipid profile of the studied cases.  Low rate of regular physical exercises practicing by the studied cases was detected before the intervention .There was   a good compliance of the studied cases towards practicing regular physical activities, consuming little  salty & starchy foods,  excess vegetables, fruits, fish & using plant oil in cooking, while they were un-compliant as regards drinking coffee or tea, consuming eggs ,sweets & quitting smoking. Conclusion & Recommendations: the study concluded that modifying life style lowers level of blood pressure, lipid profile and minimizes the use of Anti-hypertensive, and recommended:  increasing the awareness of hypertensive patients about lifestyle modifications program and its importance to control their high blood pressure through health providers or health educators. Ensure more focusing on lifestyle modifications as preventive and curative measures for hypertension in medical curricula. Further research based on evidence based guidelines to improve health related quality of life of hypertensive patients should be encouraged.