Cardiovascular Medicine Book

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Hypertension General Measures

Aka: Hypertension General Measures, Lifestyle Modification in Hypertension, Nonpharmacologic Management of Hypertension
  1. See Also
    1. Hypertension
    2. Hypertension Management
    3. Nonpharmacologic Management of Hypertension
    4. DASH Diet
  2. Prevention: Habit Changes
    1. Weight Reduction
      1. BP may normalize with 10 pound weight loss alone
      2. Weight loss of 10 kg (22 lb) may reduce SBP up to 5-20 mmHg
    2. Alcohol consumption moderated (limit to <1 ounce/day)
      1. Beer (<24 ounces/day)
      2. Wine (<8 ounces/day)
      3. Whiskey 100-Proof (<2 ounces/day)
    3. Dynamic Aerobic Exercise
      1. Exercise at least 150 minutes per week
      2. Three times per week
      3. Thirty minutes per time
      4. Exercise to 70% of maximum Heart Rate
    4. Smoking Cessation
    5. Stress Reduction
      1. Yoga or meditation
      2. Muscle relaxation
      3. Biofeedback
    6. Home Blood Pressure Monitor
      1. Effective in short-term (lowers SBP 2-8 mmHg at 12 months)
      2. Long-term Blood Pressure effects are unclear
      3. Uhlig (2013) Ann Intern Med 159(3): 185-94 [PubMed]
  3. Prevention: General Diet
    1. DASH Diet encompasses key nutritional approaches
      1. See Hypertension Resources for education materials
      2. High fiber, Potassium, calcium, Magnesium
      3. Low salt, Cholesterol and saturated fat
    2. Reduce Saturated fat intake
    3. Decrease Sodium intake (see below)
    4. Increase fruits and vegetables (see below)
    5. Supplements do not offer consistent or substantial Blood Pressure reduction
      1. Insufficient evidence for Garlic or cocoa
      2. Also insufficient evidence for Vitamin C, coenzyme Q10, Omega-3 Fatty Acids, Magnesium
  4. Prevention: Increase fruits, vegetables (high Potassium)
    1. Study: Fruit and Vegetable with Low Fat Diet (n=459)
    2. Overall (compared with standard "American diet")
      1. Reduced Systolic Blood Pressure 5.5 mmHg
      2. Reduced Diastolic Blood Pressure 3.0 mmHg
    3. Hypertensives (Baseline Blood Pressure >140/90)
      1. Reduced Systolic Blood Pressure 11.4 mmHg
      2. Reduced Diastolic Blood Pressure 5.5
    4. Reference
      1. Appel (1997) N Engl J Med 336: 1117-24 [PubMed]
      2. Sacks (2001) N Engl J Med 344: 3-10 [PubMed]
  5. Prevention: Sodium Restriction
    1. Sodium Limits
      1. No added salt diet (<3000-4000 mg, 135-180 meq/day)
        1. Hypertension
        2. Cardiovascular disease
        3. Congestive Heart Failure
        4. Acute and Chronic Renal Failure
      2. Restrictive diet (<2000 mg or 90 meq/day)
        1. Liver Cirrhosis or other liver failure
        2. Pulmonary edema
        3. Moderate to severe Congestive Heart Failure
    2. Salt sensitive (Accounts for 50% of hypertensives)
      1. Black Ethnicity
      2. Advanced Age
      3. Older
      4. Obese
      5. Low renin
    3. Intersalt Study reanalyzed (n=10000, 32 countries)
      1. Each 100 mml increase in 24 hour Sodium excretion
        1. Systolic Blood Pressure rises 3-6 mmHg
        2. SBP rises 10-11 mmHg if age over 55 years
      2. Reference
        1. Elliott (1996) BMJ 312:1249-53 [PubMed]
  6. References
    1. Chobanian (2003) Hypertension 42:1206-52 [PubMed]
    2. Oza (2015) Am Fam Physician 91(11): 772-6 [PubMed]
    3. Wexler (2006) Am Fam Physician 73:1953-8 [PubMed]

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