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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
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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
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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
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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
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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
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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