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Lifestyle modifications in Hypertension


Lifestyle modifications in Hypertension Side Effects Unintended effects of a medication Many medications cause minor side effects All antihypertensive medications can ... – PowerPoint PPT presentation

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Title: Lifestyle modifications in Hypertension

Lifestyle modifications in Hypertension
Blood Pressure
  • The pressure in the arterial blood vessels
    results from
  • flow of blood from the heart
  • resistance of the arterial blood vessel walls
  • The higher the blood pressure, the harder the
    heart has to pump in order to supply the body
    with blood

Blood Pressure
Blood Pressure
  • The first (top) number is the systolic blood
    pressure (SBP) and indicates the pressure in the
    artery when the heart is actively pumping blood
  • The second (bottom) number is the diastolic blood
    pressure (DBP) and indicates the pressure in the
    artery when the heart is resting between beats

Measuring Blood Pressure
Measuring Blood Pressure
  • Blood pressure is measured in the sitting
    position after at least 5 minutes of rest
  • The blood pressure cuff should be the correct
    size and should not be placed over clothing
  • At least two blood pressure measurements should
    be made and blood pressure categorized based on
    the average

Blood Pressure Categories
Category Systolic BP Diastolic BP
Normal blood pressure Less than 120 Less than 80
Pre-hypertension 120 to 139 80 to 89
Stage 1 hypertension 140 to 159 90 to 99
Stage 2 hypertension 160 or higher 100 or higher
Blood Pressure Aging
  • There is an age-related increase in blood
    pressure due to
  • Increased arterial wall tension
  • Increased peripheral resistance
  • Increased arterial stiffness
  • This is not benign The blood pressure categories
    are not adjusted upwards to compensate for aging

Why Do We Worry About High Blood Pressure?
Framingham Heart Study
  • Objective
  • identify the common factors or characteristics
    that contribute to cardiovascular disease by
    following its development over a long period of
    time in a large group of participants who had not
    yet developed overt symptoms of cardiovascular
    disease or suffered a heart attack or stroke.

Framingham Heart Study Risks of Hypertension
  • Cardiac disease
  • Heart attack and heart failure
  • Cerebrovascular disease
  • Stroke
  • Peripheral vascular disease
  • Circulation in the extremities
  • Microvascular disease
  • Kidney and eye disease

Benefits of Blood Pressure Control
  • Blood pressure control can reduce the risk of
    heart attack by 20 to 25
  • Blood pressure control can reduce the risk of
    heart failure by more than 50
  • Blood pressure control can reduce the risk of
    stroke by 35 to 40
  • A 10mmHg drop in SBP lowers the risk of death
    from stroke by 50-60 and the risk of death from
    heart attack by 40-50

Blood Pressure Control
Lowering Blood Pressure
  • Lifestyle modification
  • Smoking cessation
  • Increased physical activity
  • Limitation of alcohol intake
  • Maintenance of a healthy body weight
  • Diet comprised of healthy foods
  • Pharmacotherapy (medications)

Lifestyle Modification
Modification Recommendation Approximate drop in SBP
Weight reduction Maintain normal body weight 5-10 mmHg/ 10kg weight loss
DASH eating plan Rich in fruits, vegetables, low fat dairy reduced saturated total fat 8-14 mmHg
Less dietary sodium No more than 2.4 g sodium/day 2-8 mmHg
Physical activity Aerobic activity for 30 minutes at least 5 days/week 4-9 mmHg
Alcohol in moderation No more than 2/day for men No more than 1/day for women 2-4 mmHg
Diet Blood Pressure
  • Salt
  • Excess can increase blood pressure
  • Potassium
  • Insufficient can increase blood pressure
  • Weight
  • Excess can increase blood pressure
  • Alcohol
  • Excess can increase blood pressure

Diet Blood Pressure
  • Several research studies have shown beneficial
    effects of diets rich in magnesium, potassium,
    calcium, fiber, and protein
  • Studies looking at supplementation of individual
    nutrients have not shown much improvement in
    blood pressure

DASH Clinical Trial
  • Looked at the effect of dietary patterns rather
    than individual nutrients for blood pressure
  • Studied three different diet patterns
  • Control (typical) diet
  • Fruits and vegetables diet
  • Combination (DASH) diet

Control Diet
  • Potassium, magnesium, and calcium levels were
    close to 25th percentile of U.S. consumption
  • Macronutrients (carbohydrate, fat, protein) and
    fiber were similar to average U.S. consumption
  • Typical American diet

Fruits Vegetables Diet
  • Potassium and magnesium close to the 75th
    percentile of U.S. consumption
  • High amount of fiber
  • More fruits and vegetables and fewer snacks and
    sweets than control diet, but was otherwise

Combination (DASH) Diet
  • Potassium, magnesium, and calcium close to the
    75th percentile of U.S. consumption
  • High amounts of fiber and protein
  • Rich in fruits, vegetables, and low fat dairy
  • Reduced amount of saturated fat, total fat, and

DASH Clinical Trial
  • Study subjects were provided with meals that were
    prepared in research kitchens
  • All diets contained approximately 3 grams sodium
    per day
  • Each subject was given the appropriate calories
    to maintain weight and diet was adjusted for
    weight loss or weight gain

Results (Change in SBP/Change in DBP)
Category DASH Control DASH Fruits/Veg Fruits/Veg Control
All subjects -5.5/-3.0 -2.7/-1.9 -2.8/-1.1
Men -4.9/-3.3 -1.6/-1.3 -3.3/-2.0
Women -6.2/-2.7 -3.9/-2.5 -2.3/-0.2
HTN -11.4/-5.5 -4.1/-2.6 -7.2/-2.8
No HTN -3.5/-2.1 -2.7/-1.8 -0.8/-0.3
DASH Results
Systolic Blood Pressure
DASH Meal Plan
  • Fruits 4-5 servings/day
  • 1 medium fruit 6 ounces fruit juice
  • Vegetables 4-5 servings/day
  • 1 cup raw leafy ½ cup cooked
  • Low fat dairy products 2-3 servings/day
  • 8 ounces milk/yogurt 1.5 ounces cheese
  • Grains 7-8 servings/day
  • 1 slice bread ½ cup cereal, rice, pasta
  • Meat, Fish, Poultry 2 or less servings/day
  • 3 ounces
  • Nuts, Seeds, Dried Beans 4-5 servings/week
  • 1/3 cup nuts 2 tablespoons seeds, ½ cup cooked

Aerobic Activity
To promote and maintain health, all healthy
adults age 18-65 years need moderate-intensity
physical activity for a minimum of 30 minutes on
five days each week OR vigorous-intensity for a
minimum of 20 minutes on three days each week.
Also, combinations of moderate- and
vigorous-intensity activity can be performed to
meet this recommendation.
American College of Sports Medicine American
Heart Association 2007 Recommendations
Muscle-Strengthening Activity
To promote and maintain good health and physical
independence, adults will benefit from performing
activities that maintain or increase muscular
strength and endurance for a minimum of two days
each week. It is recommended that 8-10 exercises
be performed on two or more nonconsecutive days
each week using the major muscle groups.
American College of Sports Medicine American
Heart Association 2007 Recommendations

Antihypertensive Medications
  • All antihypertensive medications are effective at
    lowering blood pressure
  • Some provide additional benefits
  • Newer medications are not necessarily better than
    older medications
  • Medications control hypertension, they dont cure
  • Medications only work if they are taken every day

Antihypertensive Medications
  • ACE Inhibitors (ACEI)
  • Angiotensin receptor blockers (ARB)
  • Diuretics
  • Beta blockers (BB)
  • Calcium channel blockers (CCB)
  • Alpha blockers
  • Nitrates

Area of Concern BP Target Lifestyle Modification Specific Drug Indications
General CAD Prevention lt140/lt90 Yes Any effective BP drug or combination
High CAD Risk lt130/lt80 Yes ACEI, ARB, CCB, thiazide, or combination
Stable Angina lt130/lt80 Yes ?-blocker AND ACEI or ARB
Diabetes, chronic kidney disease, known CAD or
CAD equivalent, or 10y Framingham risk score gt10
Side Effects
  • Unintended effects of a medication
  • Many medications cause minor side effects
  • All antihypertensive medications can cause you to
    feel dizzy if you stand up quickly, especially
    when you first start taking the medication

  • Blood pressure should be rechecked within 2 to 4
    weeks after starting a new blood pressure
  • Blood pressure can be monitored at home or in the
  • Some antihypertensive medications also require
    laboratory or heart rate monitoring (ACEI, ARB,
    diuretic, BB, some CCBs)

Adherence to Therapy
  • Medications wont work if you dont take them as
  • Medications must be taken daily to keep blood
    pressure under control
  • Talk to your provider about any problems that you
    have with taking your medication

  • High blood pressure increases risk of
    cardiovascular, kidney, and eye disease
  • Lifestyle modification is an effective means of
    lowering blood pressure
  • Medications are needed to achieve optimal blood
    pressure levels in many people
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