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Lifestyle Interventions are Effective Treatments of Hypertensive Patients

Con. Lifestyle Interventions are Effective Treatments of Hypertensive Patients. Thomas Pickering MD, DPhil Behavioral Cardiovascular Health and Hypertension Program Columbia Presbyterian Medical Center New York. JNC 7: Treatment Overview. Goals of therapy Lifestyle modification

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Lifestyle Interventions are Effective Treatments of Hypertensive Patients

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  1. Con Lifestyle Interventions are Effective Treatments of Hypertensive Patients Thomas Pickering MD, DPhil Behavioral Cardiovascular Health and Hypertension Program Columbia Presbyterian Medical Center New York

  2. JNC 7: Treatment Overview • Goals of therapy • Lifestyle modification • Pharmacologic treatment • Algorithm for treatment of hypertension • Classification and management of BP for adults • Followup and monitoring

  3. JNC 7: Lifestyle Modification

  4. DASH Fact Sheet

  5. Effects of DASH diet on BP Study Group BP change Administered DASH HT 11.4/5.5 Provided BHT 5.5/3.0 Provided DASH/Na BHT 8.9/4.5 Provided DEW-IT HT 7.4/5.7 Provided PREMIER HT 1.7/1.6Patient ALLHAT Diuretic 12.3/8.1

  6. Effects of DASH diet on BP Study Group BP change Administered DASH HT 11.4/5.5 Provided BHT 5.5/3.0 Provided DASH/Na BHT 8.9/4.5 Provided DEW-IT HT 7.4/5.7 Provided PREMIER HT 1.7/1.6 Patient ALLHAT Diuretic 12.3/8.1

  7. Lifestyle Modification: PREMIER(JAMA 2003: 289; 2083) Baseline 3 mo 6 mo

  8. Issues in the Treatment of Hypertension Drugs DASH If I do it, will it work? Yes Yes Will I do it? Maybe No Will I continue to do it? Maybe No Will it lower risk ? Yes ?Yes Is it cost-effective? Very No

  9. Issues in the Treatment of Hypertension DrugsDASH If I do it, will it work? YesYes Will I do it? MaybeNo Will I continue to do it? MaybeNo Will it lower risk ? Yes ?Yes Is it cost-effective? Very No

  10. Issues in the Treatment of Hypertension DrugsDASH If I do it, will it work? YesYes Will I do it? MaybeNo Will I continue to do it? MaybeNo Will it lower risk ? Yes ?Yes Is it cost-effective? Very No

  11. Issues in the Treatment of Hypertension DrugsDASH If I do it, will it work? YesYes Will I do it? MaybeNo Will I continue to do it? MaybeNo Will it lower risk ? Yes ?Yes Is it cost-effective? Very No

  12. Failure to Maintain Behavioral Changes over the Long Term (data of TOHP II) Months 0 -10 -20 Weight -30 Na intake -40 -50 -60 Weight (Kg) Na intake (mmol/d)

  13. Issues in the Treatment of Hypertension DrugsDASH If I do it, will it work? YesYes Will I do it? MaybeNo Will I continue to do it? MaybeNo Will it lower risk ? Yes ?Yes Is it cost-effective? Very No

  14. Issues in the Treatment of Hypertension DrugsDASH If I do it, will it work? YesYes Will I do it? MaybeNo Will I continue to do it? MaybeNo Will it lower risk ? Yes ?Yes Is it cost-effective? Very No

  15. DASH - How was it done? “Each weekday, subjects ate lunch or dinner on site. After the on-site meal, the subjects received coolers containing the food to be consumed off –site. On Fridays, they also received weekend meals, all consumed off-site.”

  16. PREMIER- How was it done? Advice only- a single 30 minute session

  17. PREMIER- How was it done? Advice only- a single 30 minute session SBP Change -7.8 mmHg

  18. PREMIER- How was it done? Established - Goals: Weight loss of 15 lbs Exercise 3 hours/week Restrict Na intake to 100mEq Restrict alcohol to<2 drinks/day Procedure: Over 6 months of study 14 group training sessions 4 individual training sessions Recorded food and exercise diaries

  19. PREMIER- How was it done? SBP Change -12.5 mmHg Incremental change - 4.7 mmHg Established - Goals: Weight loss of 15 lbs Exercise 3 hours/week Restrict Na intake to 100mEq Restrict alcohol to<2 drinks/day Procedure: Over 6 months of study 14 group training sessions 4 individual training sessions Recorded food and exercise diaries

  20. PREMIER- How was it done? Established + DASH- Goals: As for Established PLUS Increased fruit & veg intake Decrease total & saturated fat Increase low-fat dairy Procedure: Over 6 months of study 14 group training sessions 4 individual training sessions Recorded food and exercise diaries

  21. PREMIER- How was it done? SBP Change -14.2 mmHg Incremental change - 1.7mmHg Established + DASH- Goals: As for Established PLUS Increased fruit & veg intake Decrease total & saturated fat Increase low-fat dairy Procedure: Over 6 months of study 14 group training sessions 4 individual training sessions Recorded food and exercise diaries

  22. Comparison of Fruit/Vegetable Intake in DASH & PREMIER Servings per Day DASH PREMIER

  23. Issues in the Treatment of Hypertension DrugsDASH If I do it, will it work? YesYes Will I do it? MaybeNo Will I continue to do it? MaybeNo Will it lower risk ? Yes ?Yes Is it cost-effective? Very No

  24. Lifestyle Interventions are Effective Treatments of Hypertensive PatientsConclusions • Lifestyle interventions such as the DASH diet CAN produce substantial reductions of BP, and probably of risk • In reality, most patients will NOT achieve sufficient changes to have a major impact on BP

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