1. Treatment Thresholds and Non-Pharmacologic Therapy
By :- Hasanain Ghaleb Khudhair
3th stage medical student
College of Medicine/karbala university-Iraq -
19/3/2015

2. 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

3. 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.

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

5. 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.

6. 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.

7. 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,
1000
419.23
mg/100ml

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

9. Alcohol
High intake of alcohol can be related to hypertension

10. 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

11. Other benefit???
Prevent heart diseases
D.M
Even some cancer such as breast and colon cancer
Decrease risks of stroke and depression

12. Healthy diet Reduce the fat intake
saturated fats should be limited to one third of the total intake of fats; --replaced by monounsaturated fats--
Olive oil/ Almonds

13. Increases in dietary intake of potassium
increased consumption of fruits and vegetables
banana / melon / tomato

15. 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.

16. 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.

17. For a patient

18. 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

19. 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?