Lifestyle Modification (LSM) in hypertension management

2. Lifestyle Modification (LSM) in hypertension management Dr. Hamid Sanei Cardiologist Interventionist

3. LSM are indicated for almost all hypertensive individuals. • Lower BP. • Reduce incidence and mortality of heart attacks • Reduce incidence and mortality of strokes.

4. Success in LSM may be as difficult or even more difficult to achieve than having pt. continue long term antihypertensive drug therapy.

5. Even a small persistent reduction in BP can have a major protective effects on C.V. system.

6. 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 • Nicotine replacement are effective and have minimal pressor effects • Last parking puff.

7. 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.

8. 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 • Pure isometric exercise

9. 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.

10. 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.

11. 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-OCP-cortisol) • The elderly are more Na sensitive.

12. 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↓

13. 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.

14. Magnesium supplements • Reduce BP only in pt. with low serum Mg levels.

15. 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, …

16. 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 (yoga-hypnosis) • Reduced stress • Anti oxidant (Vit C – Vit E …) • UV • Animal keeper • Surgical manipulation • Reglis