Treatment Thresholds and Non-Pharmacologic Therapy By :- Hasanain Ghaleb Khudhair 3th stage medical student College of Medicine/karbala university-Iraq E-mail:- hasanain.ghaleb@gmail.com 19/3/2015

Treatment Thresholds Recommended Initial Threshold for Starting Antihypertensive Medication 2013 Age > 60 without D.M or CKD Age<60 without D.M or CKD 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 may reduce the need for drug treatment complement the effect of antihypertensive drugs occasionally allow antihypertensive drugs to be stopped. effictivnace as much as a single antihypertensive drug. Combinations produce even better results.

Non pharmacological treatment Obesity and weight reduction Salt intake and salt restriction Alcohol Exercise and physical activity Healthy diet Obstructive sleep apnea other

Obesity and weight reduction the mechanisms are complex Firstly, there is a tendency to over read blood pressure with an upper arm cuff. higher salt intake associate with obesity increased sympathetic tone؟ obstructive sleep apnoea (OSA) 3-The mechanisms by which central obesity drive an increase in sympathetic activity are not entirely clear but may initially reflect a homoeostatic response to feeding such that excess energy is dissipated as heat rather than stored as fat. http://www.medscape.com/viewarticle/775055_4

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, http://www.endmemo.com/health/food/Crackers,%20cheese,%20regular.php 1000 1006.466 419.23 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??? Prevent heart diseases D.M Even some cancer such as breast and colon cancer 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-- http://imgkid.com/monounsaturated-fatty-acid-foods.shtml http://www.everydayhealth.com/health-report/high-cholesterol-pictures/the-best-healthy-fat-foods.aspx Olive oil/ Almonds

Increases in dietary intake of potassium increased consumption of fruits and vegetables http://healthyeating.sfgate.com/potassium-salt-7959.html http://firstdaydiet.altervista.org/tag/potassium/ banana / melon / tomato

Obstructive sleep apnoea Overweight nasal positive airway pressure (nCPAP) improves symptoms and also reduces blood pressure. Mechanism:- hypoxia – sympathtic - HTN CPAP stands for "continuous positive airway pressure." CPAP pumps air under pressure into the airway, keeping the windpipe open during sleep. The forced air delivered by CPAP prevents episodes of airway collapse that block the breathing in persons with obstructive sleep apnoea and other breathing problems. http://www.nlm.nih.gov/medlineplus/ency/article/001916.htm

Other lifestyle interventions Stress management short-term reductions in office blood pressure, but they have little effect on ambulatory blood pressure over 24 h Cigarette smoking stop 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?