بنام آرامش دهنده قلب ها

1. بنام آرامش دهنده قلب ها

2. Nonpharmacological Treatment:Lifestyle Modification درمان های غیر دارویی (اصلاح شیوه زندگی) دکتر میترا مرادی نیا

3. درمان های غیر دارویی • درمان های غیر دارویی برای تمام بیماران مبتلا به فشارخون بالا صرفنظر از درمانهای دارویی لازم است. • درمان های غیر دارویی ممکن است : • 1- فشار را پایین بیاورد. • 2- یا دوز داروی مورد نیاز را کمتر کند. • 3- یا حتی فرم های خفیف فشار خون را کاملا درمان کند ونیاز به دارو را از بین ببرد.

4. عوارض ناشی از فشارخون بالا

5. counseling • Nutrition 35% • Exercise 26% • patients 75 years of age are least likely to receive such counseling

6. Lifestyle modifications • Smoking cessation • Reduction in excess body weight • Modification of sodium and alcohol intake • Increased physical activity • Reduction mental stress • LSM may also reduce antihypertensive drug doses needed for BP control.

7. مداخلات آموزشی براي اصلاح شیوه زندگی سالمند مبتلا و یا در معرض ابتلا به فشارخون بالا • ·دخانیات را ترک نماید. • ·غذاي کم نمک مصرف نماید. • ·از مصرف فراورده هاي غذایی نمک سود مثل چیپس، پفک، سوسیس، کالباس و.... خودداري نماید. • · مصرف میوه و سبزی را افزایش داده و مصرف چربی به خصوص چربی های اشباع را کم نماید. • · فعالیت بدنی منظم روزانه حداقل 30 دقیقه، سه روز در هفته داشته باشد. • · استفاده از رژیم غذاییDASH * که غنی از میوه و سبزی و لبنیات کم چرب و غلات سبوس دار می باشد. مصرف گوشت قرمز محدود شده و مصرف ماهی و ماکیان افزایش می یابد ( اگر سالمندی به علت مشکلات دندانی نتواند از این رژیم استفاده کند توصیه به مصرف سبزی و میوه پخته، آش و سوپ می گردد. در این رژیم سدیم محدود و پتاسیم افزایش می یابد.

10. Smoking cessation • Smoking cessation may not directly • reduce BP, but markedly reduces overall cardiovascular risk. The risk of myocardial infarction is 2–6 times higher and the risk of stroke is 3 times higher in people who smoke than in non-smokers

11. Smoking cessation • Smokers 65 years of age benefit greatly from abstinence • Older smokers who quit reduce their risk of • Death from CAD • Chronic obstructive pulmonary disease Lung cancer Osteoporosis. Age does not appear to diminish the desire to quit or the benefits of quitting. However, smokers 65 years of age are less likely to be prescribed smoking cessation medications.

12. Smoking cessation • Pharmacotherapy (nicotine replacement therapy, bupropion, varenicline) is effective. • The risk of adverse effects is small and is generally outweighed by the significant risk of continuing to smoke.

13. Smoking cessation • Consider pharmacotherapy for those who smoke more than 10 cigarettes per day and have no contraindications.

14. Weight reduction • Weight reduction lowers BP in overweight individuals: loss of 3% to 9% of body weight reduces systolic and DBP about 3 mm Hg each • In the TONE study, a diet that reduced weight by a • 3.5 kg lowered BP by 4.0/1.1 mm Hg among 60- to • 80-year-old patients with hypertension. • Every 1% reduction in body weight lowers systolic BP by an average of 1 mmHg

15. Dietary sodium restriction • Dietary sodium restriction is perhaps the best-studied • lifestyle intervention for BP reduction. • Mean BP reduction of 3.7/0.9 mm Hg for a 100 mmol/day decrease in sodium excretion BP declines were generally larger in older adults.

16. Dietary sodium restriction • In patients 60 to 80 years of age • BP 145/85 mm Hg • taking 1 antihypertensive drug • mean BP reduction of 4.3/2.0 mm Hg occurred after • 3 months of sodium restriction to 80 mmol/d • medication withdrawal • 30 to m45 minutes brisk walking most days. • However, BP and adverse outcome reductions did not achieve statistical significance in 70 to 80 year olds. • Other studies have confirmed benefits of lifestyle modification in older subjects for BP Control.

17. Increased potassium intake • Increased potassium intake, either by fruits and vegetables or pills, reduces BP. (In a meta-analysis of 33 RCTs) • Potassium supplements significantly lowered BP by 3.1/2.0 mm Hg, and this effect was enhanced in persons with higher sodium intake. • Two trials confirmed significant BP reductions (4.3/1.7 mm Hg and 10.0/ • 6.0 mm Hg, respectively) among elderly patients with hypertension.

18. Potassium supplementation • Potassium supplementation(90 mmol [3500 mg] daily) reduces BP in individuals with and without hypertension, • Effects are greater in individuals with higher dietary sodium levels. • In elderly patients with substantially impaired renal function, serum potassium should be monitored when supplementation is given.

19. DIETARY CHANGES • The DASH eating plan outlines a diet • Rich in fruits and vegetables • High in • Low-fat dairy products • Potassium, • Magnesium • Calcium • low in • Total saturated fats • Following this plan has been shown to produce mean reductions of 6 mm Hg in systolic blood pressure and 3 mm Hg in diastolic blood pressure, • combining the plan with a reduction in sodium intake produces additional blood pressure reduction. • 1

20. The DASH diet showed a mean BP decrease of 11.4/5.5 mm Hg in patients with hypertension (mean age 47 years) with a diet enriched with fruits and vegetables and low in saturated and total fat. • Similar BP reductions were seen in those 45 years of age • The DASH combination diet lowered SBP more in African Americans (6.8 mm Hg) than in whites (3.0 mm Hg) (P0.05) and in persons with hypertension (11.4 mm Hg) than in persons without hypertension • (3.4 mm Hg) (P0.05).

21. supplementation • Calcium and magnesium supplementation results in minimal • to no change in BP. • There is no evidence that vitamin, fiber, or herbal supplements influence BP in the elderly.

22. Alcohol • Consumption of 2 alcohol drinks per day is strongly associated with BP elevations in epidemiologic studies. • Evidence for meaningful BP reduction from lowering alcohol intake is limited in older adults

23. Regular physical activity • There is strong evidence that regular physical activity has an independent cardio protective effect. • Regular aerobic exercise can lower systolic BP by an average of 4 mmHg and diastolic BP by an average of 2.5 mmHg.25

24. Regular physical activity • Advise all patients to become physically active, as part of a comprehensive plan to control hypertension, regardless of drug treatment. • Aim for 30 minutes of moderate-intensity physical activity on most, if not all, days of the week

25. People with any the following should defer physicalactivity • 1- Sever hypertension (systolic BP ≥ 180 mmHg or diastolic BP ≥ 110 mmHg) • 2- Unstable angina • 3- Uncontrolled heart failure • 4- Severe aortic stenosis • 5- Resting tachycardia or arrhythmias • 6-symptoms (e.g. chest discomfort, shortness of breath) on low activity • 7- Diabetes with poor glycaemic control • Other acute illness.

26. Regular physical activity • The daily dose can be accumulated in shorter bouts (e.g. three 10-minute walks). • Moderate-intensity physical activity (e.g. brisk walking, lawn mowing, low-paced swimming, cycling, gentle aerobics) will cause a slight increase in breathing and heart rate, and may cause light sweating. • Advise against isometric exercise routines that may raise BP (e.g. weight lifting), except within professionally supervised programs

27. Regular physical activity • Exercise modality, frequency, intensity, and presence or absence of hypertension did not significantly affect the magnitude of BP decline.

28. Trials in older patients with hypertension • In 33 individuals 60 to 69 years of age • 9 months of training • 3 times weekly • 53% or 73% peak aerobic capacity • BP reductions averaging 7/3 mm Hg and 6/9 mm Hg,Respectively. • In 70 to 79 year old patients with hypertension • 6 months training • At 75% to 85% peak aerobic capacity. • BP reductions of 8/9 mm Hg occurred after

29. Regular physical activity • In sedentary men (mean age 59 years) with prehypertension • 9 months • aerobic training • 3 days per week • Elicited a BP reduction of 9/7 mm Hg; • men who combined exercise and a weight loss diet had a 11/9 mm Hg decline. • Thus, aerobic exercise alone or combined with a weight reduction diet reduces BP in older adults with hypertension.

30. Regular physical activity • The finding that exercise at moderate intensities elicits BP reductions similar to those of more intensive regimens is especially meaningful for the elderly.

31. Reducing mental stress MEDITATION Meditation includes a variety of techniques, such as repetition of a word or phrase (the mantra) and careful attention to the process of breathing, to achieve a state of inner calm, detachment, and focus. Meditation was shown To reduce blood pressure in one well-designed study that addressed baseline blood pressure measurements Adequately Although other studies have been inconsistent.

32. Meditation Long-term follow-up of 202 patients in two small studies indicated that transcendental meditation may even reduce mortality in patients with hypertension. Meditation may have other benefits and does not appear to be harmful except to patients with psychosis

33. Management of Associated Risk Factors • Classify all persons 70 or 75 years of age as high risk (ie, • 10% risk of CAD in next 10 years), thus deserving therapy. Older patients with hypertension may be classified at high or very high risk (eg, those with diabetes mellitus).

34. Patient preferences and values are also important in deciding on the advisability and mode of therapy • IN older individuals Quality of Life sometimes becomes more important than duration