Dr Tariq Jagnarine
Fam Med, Endocrinology/Diabetes
Effective management and treatment of hypertension requires clinicians and patients to work together to balance pharmacologic and non-pharmacologic interventions and prevent target organ damage. Healthy lifestyle choices can prevent or delay the onset of high BP, and can reduce cardiovascular risk. Lifestyle modification is also the first line of antihypertensive treatment. Modifications in lifestyle can also enhance the effects of antihypertensive treatment. Lifestyle modifications should include the following.
• REGULAR PHYSICAL EXERCISE
Current guidelines recommend that all people, including those with hypertension, engage in at least 150 minutes of moderate intensity, aerobic exercise every week, or 75 minutes a week of high intensity exercise.
People should exercise on at least 5 days of the week.
Examples of suitable activities are walking, jogging, cycling, or swimming.
• STRESS REDUCTION
Avoiding or learning to manage stress can help a person control blood pressure. Meditation, warm baths, yoga, and simply going on long walks are relaxation techniques that can help relieve stress. People should avoid consuming alcohol, recreational drugs, tobacco, and junk food to cope with stress, as these can contribute to elevated blood pressure and the complications of hypertension.
Smoking can increase blood pressure. Avoiding or quitting smoking reduces the risk of hypertension, serious heart conditions, and other health issues.
• DIET: DASH DIET
People can prevent high blood pressure by following a heart-healthy diet. The U.S. National Heart, Lung, and Blood Institute (NHLBI) recommend the DASH diet for people with high blood pressure. DASH stands for “Dietary Approaches to Stop Hypertension.”
DASH is a flexible and balanced eating plan with a firm grounding in research by the NHLBI, who advise that the diet:
• Lowers high blood pressure
• Improves levels of fats in the bloodstream
• Reduces the risk of cardiovascular disease
Research from 2014 suggests that using probiotic supplements for 8 weeks or more may benefit people with hypertension.
• REDUCING SALT INTAKE
People’s average salt intake is between 9 grams and 12 grams per day in most countries around the world. The World Health Organization (WHO) recommend reducing intake to under 5 grams a day, to help decrease the risk of hypertension and related health problems. Lowering salt intake can benefit people both with and without hypertension.
• MODERATING ALCOHOL CONSUMPTION
Moderate to excessive alcohol consumption can increase blood pressure. The American Heart Association (AHA) recommend a maximum of two alcoholic drinks a day for men, and one for women.
The following would count as one drink:
• a 12-ounce (oz) bottle of beer
• 4 oz of wine
• 1.5 oz of 80-proof spirits
• 1 oz of 100-proof spirits
A healthcare provider can help people reduce consumption if they find it difficult to moderate their alcohol intake.
• EATING MORE FRUIT AND VEGETABLES AND LESS FAT
People who have high blood pressure or people at high risk of developing high blood pressure should eat as little saturated and total fat as possible. Instead, experts recommend:
• Whole grain, high fibre foods
• A variety of fruits and vegetables
• Beans, pulses, and nuts
• Fish rich in omega-3 twice a week
• No tropical vegetable oils; for example, olive oil
• Skinless poultry and fish
• Low fat dairy products
It is important to avoid trans fats, hydrogenated vegetable oils, and animal fats, as well as large portion sizes.
Some fats, such as those in oily fish and olive oil, have protective effects on the heart. However, these are still fats. While they are typically healthful, people with a risk of hypertension should still consider how they include them in their total fat intake.
• MANAGING BODY WEIGHT
Excess body weight can contribute to hypertension. A fall in blood pressure usually follows weight loss, as the heart does not have to work so hard to pump blood around the body.
A balanced diet with a calorie intake that matches the individual’s size, sex, and activity level will help.
• MEDICATION
People can use specific medications to treat hypertension. A low dose is recommended initially, but this may need to be increased based on how a person responds to treatment. Antihypertensive medications would usually have only minor side effects.
Eventually, people with hypertension would need to combine two or more drugs to manage their blood pressure. Medications for hypertension include:
• Diuretics, including thiazides, chlorthalidone, and indapamide
• Beta-blockers and alpha-blockers
• Calcium-channel blockers
• Central agonists
• Peripheral adrenergic inhibitors
• Vasodilators
• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin receptor blockers
The choice of medication depends on the individual and any underlying medical conditions they may experience. Anyone on antihypertensive medications should carefully read the labels of any over-the-counter (OTC) drugs they may also take, such as decongestants. These OTC drugs may interact with the medications they are taking to lower their blood pressure.
HYPERTENSION COMPLICATIONS
Long-term hypertension can cause complications through atherosclerosis, where plaque develops on the walls of blood vessels, causing them to narrow. This narrowing makes hypertension worse, as the heart must pump harder to circulate the blood. Hypertension-related atherosclerosis can lead to:
• Heart failure and heart attacks
• Aneurysm, or abnormal bulge in the wall of an artery, that can burst
• Kidney failure
• Stroke
• Amputation
• Hypertensive retinopathies in the eye, which can lead to blindness
Regular blood pressure monitoring can help people avoid these more severe complications.
• PREVENTION
A comprehensive strategy for reduction of mortality and morbidity associated with hypertension must include prevention strategies, earlier detection, and adequate treatment. More intensive efforts are required to lower blood pressure in high-risk population groups, which include individuals with a family history of hypertension, African ancestry, obesity, excessive sodium consumption, physical inactivity, and/or alcohol consumption. Even a small reduction in BP confers significant health benefits. A reduction of 2 mm Hg in diastolic BP is estimated to decrease the risk of stroke by 15% and the risk of coronary heart disease by 6%.
Most individuals diagnosed with hypertension would have increasing blood pressure (BP) as they age. Untreated hypertension is notorious for increasing the risk of mortality, and is often described as a silent killer. Mild to moderate hypertension, if left untreated, may be associated with a risk of atherosclerotic disease in 30% of people, and organ damage in 50% of people within 8-10 years after onset. Patients with resistant hypertension are also at higher risk for poor outcomes, particularly those with certain comorbidities (eg, chronic kidney disease, ischemic heart disease). Patients with resistant hypertension who have lower BP appear to have a reduced risk for some cardiovascular events (eg, incident stroke, coronary heart disease, or heart failure).
A world without high blood pressure is always a better place!!
