Transcript Slide 1

Lifestyle Modification (LSM)
in hypertension
management
Dr. Hamid Sanei
Cardiologist
Interventionist
LSM are indicated for almost all
hypertensive individuals.
Lower BP. •
Reduce incidence and mortality of heart •
attacks
Reduce incidence and mortality of strokes. •
Success in LSM may be as difficult or even •
more difficult to achieve than having pt.
continue long term antihypertensive drug
therapy.
Even a small persistent
reduction in BP can have a
major protective effects on
C.V. system.
Avoidance of tobacco.
C/S is a major risk factor for C.V.D
Major presser effect easily missed.
Automatic monitoring is indicated
Tolerance does not develop to the pressor effect of
nicotine.
Sympathetic outflow increases with each cigarette.
Arterial stiffness↑
Insulin resistance↑
Visceral obesity
Progression of nephropathy
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Nicotine replacement are effective and have •
minimal pressor effects
Last parking puff. •
Weight reduction
Even small increases in weight have impressive effect on
BP. specially in the upper body
Women over 18 with BMI> 24 have 5 time more DM and
2 time more HTN than women ≤ 21
Obesity is major component of metabolic syndrome.
Maintain normal body weight (BMI = 18.5-24.9 kglm2)
5-20mmHg BP decrease per 10kg weight reduction.
Visceral obesity is a risk factor for HTN independent of
BMI.
Obesity → SAS
Wight loss is almost always fall in BP.
The type of diet used to lose weight is irrelevant.
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Physical activity
An increase in physical activity is almost always •
essential for weight reduction.
Even without weight loss physical activity can •
lower the incidence of HTN and DM.
Physical activity protect against cardiovascular •
dis.
Aerobic exercise (Regularly): 30 min/d •
Regular walking reduced overall mortality •
The longer the walk, the lower the mortality •
Higher intensity activity may be even better •
Dietary Approaches to Stop Hypertension
(DASH diet)
Diet rich in fruits. •
Vegetables –
Low fat dairy –
Low saturated fat –
Low total fat –
Increased K intake (1700 to 4100mg/d) –
Low Na. intake: 2300mg/d –
Increased Ca intake –
Increased fiber intake.
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Dietary changes
Increased Na. consumption → BP↑→ CVD
Reduced K, Ca intake → BP↑→ CVD
The required daily intake of sodium
20-40mmol 
2300mg for general population 
1500mg (25mmol) for black 
Current sodium consumption = 140-150 mmol (8-10gr/d)
Caloric intake and alcohol consumption → BP↑
Intake of Ca. and Mg. is associated with lower BP.
Caffeine causes only small transient rise in BP, but
modestly reduced risk of stroke.
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Dietary Sodium reduction
Typically high Na content of the diet in developed country
Urinary sodium excretion↑
Modest salt reduction help lower the BP
Average BP fall in hypertensive Pt> normotensive pt.
Component of metabolic syndrome increase BP sensitivity to
dietary Na.
Rigid degree of Na restriction is difficult and unsafe
Natural foods are Low in Na. and high in K.
Add no Na to food during cooking or at the table.
Use half Na half K preparation or pure K salt.
Avoid fast foods.
Antacids & other medication (NSIDS, Adrenergic-OCPcortisol)
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Potassium supplements
Increase body potassium content by •
A: Increasing dietary K intake
B: Decreasing K wastage (diuretic, …)
K supplements reduce BP. •
Too costly and potentially hazardous. •
The best source is fruits and vegetables •
Incidence of stroke↓ •
Calcium supplements
Additional Ca. either in the diet or from supplements •
may have small Anti hypertensive effect.
More CV events over 5 years •
Increased intake of Ca. will effect BP in those with •
low habitual intakes.
Magnesium supplements
Reduce BP only in pt. with low serum Mg •
levels.
Moderation of Alcohol
Alcohol is a two edged sword. •
Raises BP and have lethal effects •
Too little deny a number of C.V. benefits. •
Most experts don’t recommend hypertensive to drink •
Safe level of regular consumption: two drinks for •
men and one drink per day for women.
One drink is defined as (12 ml alcohol) (12 oz beer) •
(4 oz wine) or (1.5 oz liquor)
Breast Ca. ,DCM, hepatitis, … •
Others
Transient but non sustain BP lowering
Micro vascular decompression of brainstem
Statin
Omega3 fatty acid (Fish oil) (6-10 capsule a day)
Garlic supplement.
Fish
Bio feedback and relaxation techniques (yogahypnosis)
Reduced stress
Anti oxidant (Vit C – Vit E …)
UV
Animal keeper
Surgical manipulation
Reglis
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