Transcript Slide 1
Risk of hypertension (HTN) and non-drug management Aliakbar Tavassoli • Prevalence: 1,000,000,000 in world • HTN is usually silent and symptoms are often due to target organ damage • The most common cause of HTN is essential and secondary HTN is about 5%. Secondary cause of HTN • • • • • Renal Endocrine Coarctation of aorta Pregnancy Drugs (NSAIDS, estrogen, elicit drugs, cocaine,, ergot, nervous system stimulants, etc) • Sleep apnea syndrome Factors that increase risk of complication in hypertensive patients • • • • • • • • • • Age/ elderly Duration of HTN BP level Target organ damage (Brain, eye, heart, kidney, vessels) Socioeconomic status Ethnicity (Higher in blacks) Non-dipper Salt sensitive patients Macroabuminuria LVH Non-drug therapies The aims of life style changes • • • • • Lower BP Minimize drug use Reduce overall cardiovascular diseases Improve outcome Maintain or improve quality of life Weight control • BMI>30 kg/m2 ----Two folds increase of HTN prevalence • Obesity is more potent risk factor in male than female and in younger patients than older patients • In overweight (BMI>25 kg/m2 )or obese (BMI>30 kg/m2 ), the initial goal is loss of 10% body weight over 6 months at the rate of 0.5-1 kg/wk • Consider of anorectic drugs and weight loss surgery Weight control Benefits of weight control • • • • • Lower BP Lower drug requirement Improved glucose tolerance Lower LV load and stain Lower risk of arterial thrombosis Exercise and physical activity • Physical activity is associated with lower cardiovascular morbidity and mortality • BP-lowering effects of exercise are greater in hypertensives • Regular exercise also benefits other cardiovascular risk factors by: ---decreasing insulin resistance ---decrease in coagulation ---increase HDL • Moderate intensity exercise for at least three times a wk is recommended to achieve health benefits Diet • DASH diet (the dietary approach to stop HTN) and Mediterranean diet • High fruit and high vegetable • High fiber/ whole-grain cereals • Low fat dairy products • Nuts • Smaller amounts of meat and poultry • Low fat and high fish consumption • Low salt (2.4 g sodium of 6 g NaCl) • High K , Mg and Ca intake (Diet not supplement) Some effects of dietary omega-3 fatty acid • • • • • • • Reduce platelet aggregation Lower TG Increased HDLs Improved endothelial function Lower BP Anti-arrythmic effect (in animals) Anti-inflammatory effect Alcohol consumption and HTN • Alcohol is a pressor agent • Consumption > 6 drinks/d----2-folds increase in HTN • Consumption ≤2-3 drinks/d may have protective effect on cardiovascular disease • Binge and abrupt withdrawal • Risk in older patients is more than youngers Alcohol • Alcohol is an important and reversible cause of HTN • Regular alcohol consumption can increase antihypertensive drug requirements • Lower levels of alcohol consumption may protect against coronary heart events • Alcohol increases the risk of hemorrhagic stroke • Binge-drinking patterns increase the risk of all stroke types • Hypertensive drinkers should be advised to restrict intake to one or two standard drinks a day Caffeine containing beverage • Caffeine is a pressor agent • Caffeine increase BP acutely in the ‘caffeine naïve’ state • Long-term pressor effect of caffeine are more obvious in elderly hypertensives • Hypertensives should be advised to limit their intake of caffeine. • The combination of smoking and caffeine intake should be avoided. Smoking and BP • Risk in females is more than male • Risk in younger is more than older • Acute smoking causes acute mild rise of BP lasting 15 min • Dept of inhalation, duration of smoking and number of cigarette are more important Smoking • Quitting smoking should be a high priority in lowering risk for cardiovascular diseases • Prognosis is worse and BP more difficult to control in hypertensive smokers • Risk is reduced within two years of quitting smoking • Advice about alcohol, weight control, diet and exercise should be combined with efforts to stop smoking