Treatment Thresholds and Non-Pharmacologic Therapy

By :- Hasanain Ghaleb Khudhair3th stage medical studentCollege of Medicine/karbala university-Iraq

19/3/2015

Treatment Thresholds• Recommended Initial Threshold for Starting Antihypertensive

Medication • 20131. Age > 60 without D.M or CKD 2. Age<60 without D.M or CKD 3. Any age with D.M or CKD

joint national committee (JNC) US

Non pharmacological treatment• reduce blood pressure in patients with or without hypertension.• These approaches 1. may reduce the need for drug treatment2. complement the effect of antihypertensive drugs 3. occasionally allow antihypertensive drugs to be stopped.effictivnace• as much as a single antihypertensive drug. • Combinations produce even better results.

Non pharmacological treatment1. Obesity and weight reduction2. Salt intake and salt restriction3. Alcohol4. Exercise and physical activity5. Healthy diet6. Obstructive sleep apnea7. other

Obesity and weight reduction• the mechanisms are complex1. Firstly, there is a tendency to over read blood pressure with

an upper arm cuff.2. higher salt intake associate with obesity3. increased sympathetic tone؟ 4. obstructive sleep apnoea (OSA)

Salt intake and salt restriction • On average, one-third of such patients who reduce their

intake of salt will achieve a reduction in blood pressure of 5/5 mm Hg.

• Modest salt restriction can be achieved by not adding salt at table or when cooking. However, this ‘decreasing’ salt intake only accounts for 10–20% of total salt intake.

• A greater reduction of salt intake can be achieved by reducing intake of salty foods,

419.231006.466 1000

mg/100ml

• Unfortunately, in many countries, food labelling is inadequate, so it is difficult for patients to judge whether some processed foods are salty.!!!

Alcohol• High intake of alcohol can be related to hypertension

Exercise and physical activity• regular and aerobic (such as fast walking)

regular aerobic exercise for at least 30 min, at least three, days of the week

• Other benefit???1. Prevent heart diseases2. D.M3. Even some cancer such as breast and colon cancer4. Decrease risks of stroke and depression

Healthy diet• Reduce the fat intake• saturated fats should be limited to one third of the total intake

of fats; --replaced by monounsaturated fats--

• Increases in dietary intake of potassium

• increased consumption of fruits and vegetables

Obstructive sleep apnoea• Overweight

• nasal positive airway pressure (nCPAP) improves symptoms and also reduces blood pressure.

Other lifestyle interventions• Stress managementshort-term reductions in office blood pressure, but they have little effect on ambulatory blood pressure over 24 h

• Cigarette smokingstop smoking.Nicotine replacements can help smoking cessation.

For a patient

Case study• Johor 25 year old man ,come to hypertension clinic complained from

hypertension . when taking history ;-• The diagnosis of HTN from his friend measure the BP after football match

which equal to 150/100 , and fellow by headache which confirmed the diagnosis. He was so fear and tolled he will never take medication because its cases dependence and cardiac problem

• On examination the • BP is 116/80 • HR 78 • Temperature 37.3 c• BR 15• Oxygen saturation 98

• What is you diagnosis?• Who to deal with the patient?• What is the complication of HTN?• What is the guidelines to treatment HTN?• What is the new treatment available?