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Thursday, June 20, 2013

Managing High Blood Pressure

Lifestyle modifications are recommended for all patients with hypertension, including prehypertension. The Dietary Approaches to Stop Hypertension (DASH) study showed that 8 weeks of a diet of fruits, vegetables, low-fat dairy products, whole grains, poultry, fish, and nuts, along with a reduction in fats, red meat, and sweets, caused an 11.4-mm Hg decrease in systolic pressure and a 5.5-mm Hg decrease in diastolic pressure. In addition, patients using the DASH diet who consumed less than 100 mmol/d of sodium had a systolic pressure 3 mm Hg and a diastolic pressure 1.6 mm Hg less than those who consumed high amounts of sodium.


Weight reduction in a patient whose weight is 10% above ideal body weight lowers blood pressure by an average of 5 to 7 mm Hg. Alcohol consumption should be limited to two drinks daily for men and one for women, because excess amounts of alcohol may contribute to hypertension and resistance to antihypertensive medications. Regular aerobic exercise also modestly decreases blood pressure. In addition, patients should be counseled about smoking cessation.


The goal of treatment of hypertension is to reduce cardiovascular morbidity and mortality by lowering blood pressure. Lowering blood pressure has definitively been shown to reduce stroke, myocardial infarction, heart failure, and overall cardiovascular mortality. Evidence obtained from clinical trials suggests that the goal of antihypertensive treatment is to reduce blood pressure to below 140/90 mm Hg in the general population. The American Heart Association recommends a blood pressure target of 130/80 mm Hg for those with coronary artery disease, carotid artery disease, peripheral artery disease, abdominal aortic aneurysm, and a Framingham 10-year risk score of 10% or greater. However, data clearly demonstrate a linear, progressive increased risk of ischemic heart disease and stroke in patients with blood pressures higher than 115/75 mm Hg, which suggests that these targets may be too high. Clinical trials addressing lower blood pressure targets are currently being planned.


Ardavan Mashhadian D.O.
Nephrologist
1400 S Grand Ave Suite 615, Los Angeles, CA 90015
(213) 537-0328

1 comment:

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