by Marmee Cosico

Created on: October 25, 2009

Early detection of Hypertension and their Management

Hypertension is not a heredofamilial disease anymore. It can now be acquired by someone in their early twenties depending on their lifestyle. Hypertension affects approximately > 50 million Americans or one in 4 adults. Recent surveys showed 70% are aware of the diagnosis,with 59% on treatment. Unfortunately the remaining 30% are unaware of their problem. the National Health and Nutritional Examination Surveys (NHANES) data suggest that hypertension is responsible for approximately one third of heart attacks, one half of heart failure and one fourth of premature deaths. And Framingham heart study estimates the lifetime risk of developing hypertension is close to 90%.

Common diagnostic criteria:

Assessment of one's lifestyle reveals a history of cigarette smoking, obesity (BMI >30) especially truncal obesity, physical inactivity,excess dietary sodium, inadequate intake of fruits, vegetables and potassium, excessive alcohol intake, drug interactions such as use of non-steroidal anti-inflammatory drugs, illicit drugs, oral contraceptives, herbal supplements and use of OTC medications (both prescription and non-prescription). Symptoms like chest pain, headache, dizziness, blurry and double vision are reported on the review of systems. Based on age factor, there is high risk among men older than 45 years old and women older than 65 years old.

Goals of Therapy:

The pharmacologic treatment for Stage 1 are Thiazide Diuretics. Stage 2 requires combination therapy with two medications given either as separate prescription or as a fixed dose combination of medications.The non-pharmacologic management is lifestyle modification. An evaluation of one's diet and activity levels is noted. Overweight people should have a regular aerobic exercise of moderate-intensity or a daily half an hour (30 minutes) brisk walking in order to lose excess pounds. Recreational activities like moderate biking or swimming and even household chores(scrubbing and vacuuming the floors) can help lose weight. However, consult your doctor first what is the best physical activity that suits you. In order to maintain your weight,avoid a high caloric intake of carbohydrates. Focus on eating proteins (eggs,lean meat,poultry,fish,nuts,etc.) and whole grains. Dietary sodium reduction is highly advised when dining out. Any smoker should immediately quit. Moderation of alcohol consumption is required. Men should consume no more than two alcoholic beverages a day which is 1 oz .or 30 ml. ethanol( eg.24 oz.whiskey).On the other and, women and lighter-weight persons should have an intake of no more than one drink per day.A dietary plan known as DASH (Dietary Approaches to Stop Hypertension) reduces blood pressure in an amount comparable to single agent drug therapy. DASH eating plan includes consumption of the following food products: (a) rich in fruits, vegetables and low fat dairy products; (b) low in cholesterol along with a reduced content of saturated and total fat; (c) rich in potassium and calcium; (d) less than 2.4 g (preferably 1.6 g) of sodium per day. Finally, an informational brochure detailing the DASH diet is available from the National Heart, Lung and Blood Institute at www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_d ash.pdf.

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