Blood Pressure ControlWilliam Abide, M.D.

Normal: < 120/<80 Pre-Hypertension: 120-139/80-89 Stage I Hypertension: 140-159/90-99 Stage II Hypertension: >160/>100

Genetics If parents have it, 2x more likely

Increase sodium intake Obesity Physical inactivity Race High cholesterol

Secondary Causes: Kidney disease Drug induced (NSAIDS) Renovascular Disease Endocrine disorders (hypo/hyperthyroidism) Sleep Apnea

High Blood Pressure increases risk of: Kidney disease Stroke Heart failure

Mortality benefit with decreased BP starting at 115 mm Hg

< 140/<90 ? With diabetes ? With CAD ? With CKD ACCORD Trial-5 years of follow up

BP in treatment group 119 mmHg vs 134 mm Hg

No difference in outcomes (MI, non-fatal stroke, death)

More adverse events (3.3% vs 1.3%) Hypotension, syncope, bradycardia, angioedema,

renal failure

Persistently above 140/90 medications

> 160/100 medications

Weight Loss 0.5-2 mmHg for every 1 Kg weight loss Very effective with low sodium diet

Aerobic Exercise Can lower BP as much as 5-15 mmHg Usually SBP decrease of 4-6 mmHg and

diastolic decrease of 3 mmHg Resistance Training

BP decrease of 4/4 Recommendations:

30 min of activity most days of the week

Moderate salt restriction

Diet of fruits, vegetables, low fat dairy products

DASH Trial: One of 3 diets:

Control diet: LOW in fruits, vegetables, and legumes and HIGH in snacks, sweets, meats and saturated fat

Trial diet: HIGH in fruits, vegetables, and legumes and LOW in snacks and sweets

Combination diet: HIGH in fruits, vegetables, legumes, and low fat dairy products and LOW in snacks, sweets, meats, and saturated fat

Trial diet: Decrease in BP by 2.8/1.1 mmHg

Combination diet: Decrease in BP by 5.5/3 mmHg

If dx of HTN, even more benefit 11.4/5.5 mmHg

BP decrease was max at end of week 2 and continued until end of trial (week 8)

Regardless of sodium, DASH diet lowered BP

Low sodium in either diet lowered BP Biggest benefit between high sodium

control diet and low sodium dash diet

11.5 mmHg

Alcohol use Women with 2 or more drinks daily and men

with 3 or more drinks daily have higher chance of HTN

Dose related effect Is some alcohol good for me??

LOW to MODERATE amount may be 1 drink/day for women 1-2 drinks/day in men