Transcript Hypertension - Dr. SP Yadav Hospital

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.”

Cardiac disease


Stroke
Peripheral vascular disease


Heart attack and heart failure
Cerebrovascular disease


Framingham Heart
Study: Risks of
Hypertension
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
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
lowering
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
similar
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 foods
Reduced amount of saturated fat, total fat, and
cholesterol
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
134
132
130
Control
Fruits/Veg
DASH
128
126
124
122
120
0
1
2
3
Weeks
4
5
6
7
DASH Meal Plan

Fruits: 4-5 servings/day


Vegetables: 4-5 servings/day


1 slice bread; ½ cup cereal, rice, pasta
Meat, Fish, Poultry: 2 or less servings/day


8 ounces milk/yogurt; 1.5 ounces cheese
Grains: 7-8 servings/day


1 cup raw leafy; ½ cup cooked
Low fat dairy products: 2-3 servings/day


1 medium fruit; 6 ounces fruit juice
3 ounces
Nuts, Seeds, Dried Beans: 4-5 servings/week

1/3 cup nuts; 2 tablespoons seeds, ½ cup cooked beans
Exercise
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 moderateand 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
Pharmacotherapy
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 don’t
cure it
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
Treatment
Recommendations
Area of
Concern
BP Target
Lifestyle
Modification
Specific Drug
Indications
General CAD
Prevention
<140/<90
Yes
Any effective BP drug
or combination
High CAD
Risk*
<130/<80
Yes
ACEI, ARB, CCB,
thiazide, or combination
Stable Angina
<130/<80
Yes
Β-blocker AND ACEI
or ARB
*Diabetes, chronic kidney disease, known CAD or CAD
equivalent, or 10y Framingham risk score >10%
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
Monitoring



Blood pressure should be rechecked within 2 to
4 weeks after starting a new blood pressure
medication
Blood pressure can be monitored at home or in
the clinic
Some antihypertensive medications also require
laboratory or heart rate monitoring (ACEI,
ARB, diuretic, BB, some CCBs)
Adherence to Therapy



Medications won’t work if you don’t take them
as prescribed
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
Summary



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