1. Preventive Strategies for Hypertension
Dr Zia-Ul-Ain Sabiha

2. 2017 Hypertension Clinical Guidelines
Previous guidelines identified high blood pressure as ≥ 140/90 mm Hg. This guideline now defines high blood pressure to be anyone with a systolic blood pressure (SBP) ≥ 130 mm Hg or diastolic blood pressure (DBP) ≥ 80 mm Hg.
This guideline is an update of the National Heart, Lung, and Blood Institute publication, “The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure

3. “Ideal” blood pressure
115 mm Hg - systolic
75 mm Hg diastolic
115/75 mm Hg
according to the new standard set by the Seventh Joint National
Committee on Prevention, Detection, Evaluation, and Treatment of
High Blood Pressure (2003)

4. “prehypertension” Stage 1 hypertension. Stage 2 hypertension
STAGES OF HYPERTENSION
“prehypertension”
120 –139 mmHg systolic or mm Hg diastolic
Stage 1 hypertension.
140 – 159 mm Hg systolic or 90 –99 mm Hg diastolic
Stage 2 hypertension
>160 mm Hg systolic or > 100 mm Hg diastolic

5. ISOLATED SYSTOLIC HYPERTENSION--ISH ___________________________
High systolic blood pressure is very dangerous--
even when the diastolic pressure is low
140 mm/Hg Systolic = 2x’s the risk of CVD
than
120 mm Hg. Systolic pressure
An ISH of 150 mm Hg imparts three times the risk.

6. It’s estimated 25% of the population has BP.
At age 65 about 60% of folks have BP
Fifteen years later, about 90% will have BP.

7. The Risk Factors for High Blood Pressure:
Age
Race
Family history
Excess weight (>25 BMI or
>25 %Body Composition)
Inactivity
Tobacco use
Sodium intake
Low potassium, calcium, magnesium intake
Alcohol-even moderate intake for some
Stress

8. The Risk Factors for High Blood Pressure:
Other chronic conditions that contribute:
high cholesterol
diabetes
kidney disease
insufficient sleep and sleep apnea
overwork – working more than 40 hrs/wk.

9. Risk Factors for Hypertension
Non – Modifiable Risk Factors
Modifiable Risk Factors
Age
Sex
Genetic factors
Ethnicity
Obesity
Salt intake
Saturated fats
Dietary Fibers
Alcohol
Heart rate
Physical activity
Environmental Stress
Socio economic Status
Other factors (noise ,vibrations ,temperature and humidity )

10. Blocked or ruptured blood vessel in brain – resulting in stroke.
Complications:
Damage to the arteries
Heart Failure
Blocked or ruptured blood vessel in brain –
resulting in stroke.
Damage to blood vessels in the kidneys
and eyes.

11. The greatest long-term potential for avoiding hypertension is to apply prevention strategies early in life.

12. Approaches to Primary Prevention of Hypertension
Hypertension can be prevented by complementary application of strategies that target the general population and individuals and groups at higher risk for high blood pressure.
Lifestyle interventions are more likely to be successful and the absolute reductions in risk of hypertension are likely to be greater when targeted in persons who are older and those who have a higher risk of developing hypertension compared with their counterparts who are younger or have a lower risk.
However, prevention strategies applied early in life provide the greatest long-term potential for avoiding the precursors that lead to hypertension and elevated blood pressure levels and for reducing the overall burden of blood pressure related complications in the community.

13. Population Based Strategy
A population-based approach aimed at achieving a downward shift in the distribution of blood pressure in the general population is an important component for any comprehensive plan to prevent hypertension.
In an analysis based on Framingham Heart Study experience, Cook et al. concluded that a 2 mmHg reduction in the population average of diastolic blood pressure for white U.S. residents 35 to 64 years of age would result in
a 17 percent decrease in the prevalence of hypertension,
a 14 percent reduction in the risk of stroke and transient ischemic attacks, and
a 6 percent reduction in the risk of CHD.

14. Nutrition
Reduction of salt intake to an average of not more than 5 g /day
Moderate fat intake
The avoidance of high alcohol intake
Restriction of energy intake appropriate to body need

15. Public health approaches, such as lowering sodium content or caloric density in the food supply, and providing attractive, safe, and convenient opportunities for exercise are ideal population-based approaches for reduction of average blood pressure in the community.
Weight reduction, behavioral changes (reduction of stress and smoking),Health education, Self care are the life style modification to manage hypertension

16. INTENSIVE TARGETED STRATEGY(High Risk Strategy)
More intensive targeted approaches, aimed at achieving a greater reduction in blood pressure in those who are most likely to develop hypertension, complement the previously mentioned population based strategies for prevention of hypertension.

17. High Risk Strategy
Groups at high risk for hypertension include those with a high-normal blood pressure, a family history of hypertension, African American (black) ancestry.
Tracking of blood pressure from child hood may be used to identify individual at risk.

19. 1993 Recommendations Weight loss, Reduced intake of dietary sodium,
Moderation in alcohol consumption,
Increased physical activity
Potassium supplementation and
Modification of eating patterns
as the best proven interventions for prevention of hypertension.

20. A sustained weight loss of 9. 7 lb (4
A sustained weight loss of 9.7 lb (4.4kg) or more can reduce systolic and diastolic blood pressure by 5.0 and 7.0 mmHg, respectively

21. The upper limit of dietary sodium intake is 2,400 mg per day
The upper limit of dietary sodium intake is 2,400 mg per day. Lower intake of dietary sodium reduces the risk of cardiovascular disease, especially in those who are also overweight.
In the NHANES I Epidemiologic Follow-up Study, He et al. reported that a 100 mmol higher level of sodium intake in overweight persons was associated with a 32 percent increase in stroke incidence, a 89 percent increase in stroke mortality, a 44 percent increase in CHD mortality, a 61 percent increase in CVD mortality, and a 39 percent increase in mortality from all causes

22. READ LABELS.
1 tsp salt = 6 grams and contains about 2400 mg. of sodium
(and 3600 mg. of chloride).
A flatware teaspoon is 2-3 x’s larger than a measuring
teaspoon!
Recommendation: everyone reduce daily sodium intake to
2400 mg.
Those with high blood pressure get only a modest decrease
@ 2400 mg
For significant results sodium to  1500 mg. a day.

24. POTASSIUM INTAKE IS CRITICAL.
A good balance between potassium & sodium is 3/1.
For 1500 mg. sodium you should aim for 4500 mg.
potassium.

25. POTASSIUM INTAKE IS CRITICAL.
2005 Dietary Guidelines 4.7 grams/day
= servings of fruits and vegetables

26. DASH diet (Dietary Approaches to Stop Hypertension).
Go to:
for a free copy and much more information.

27. DASH DIET (DIETARY APPROACHES TO STOP HYPERTENSION)
Follows heart healthy guidelines to limit saturated
fat and cholesterol.
Focuses on increasing intake of foods rich in nutrients
that are expected to lower blood pressure, mainly minerals
(like potassium, calcium, and magnesium), protein, and fiber.

28. DASH DIET (DIETARY APPROACHES TO STOP HYPERTENSION)
DASH diet formed the basis for the new USDA MyPyramid
Also adopted by:
The National Heart, Lung, and Blood Institute
The American Heart Association
The 2005 Dietary Guidelines for Americans
US guidelines for treatment of high blood pressure

29. DASH DIET (DIETARY APPROACHES TO STOP HYPERTENSION)
Type of food Servings on a 2000 Calorie diet
Grains and Grain
Products
(at least 3 wh. Grains) …………….7- 8
Fruits …………………………….4 - 5
Vegetables …..…………………….4 - 5
Low fat/fat free dairy………………2 - 3
Lean meats/poultry/fish……………< 2
Nuts, seeds, legumes………………4 - 5 / week
Sweets and fats…………………… 1-2/limited

30. Secondary Prevention
The goal of secondary prevention is to detect and control high blood pressure in affected individuals
Early Case Detection
Treatment
Patient Compliance

31. Early Detection Early detection is major problem
High blood pressure rarely causes symptoms until organic damage has occurred.
Our Aim is to control it before it happens
Screening populations is the only method for detection.
Screening – follow up sustained care

32. Treatment
If essential Hypertension- as in diabetes , we cannot treat the cause, because we do t know what it is.
The aim of treatment should be to obtain the blood pressure below 130/90, and ideally a blood pressure of 120/80.
Control of hypertension has been shown to reduce the incidence of stroke and other complications.
Care should be taken of other risk factors like smoking and elevated blood cholesterol level.

33. Patient Compliance
Treatment of high blood pressure is life long and this presents problems of patient compliance.
“the extent to which patient behavior (in terms of taking medicine, following diets , or executing other lifestyle changes) coincides with clinical prescription”.
Compliance rate can be improved through education directed to patient, families and community.

34. Modification
Recommendation
Approximate systolic BP reduction, Range
Weight Reduction
Maintain normal body weight(BMI , )
5-20 mmHg/10kg weight loss
Adopted DASH eating plan
Consume a diet rich in fruits , vegetables and low fat dietary products with a reduced content of saturated fat and total fat
8-14 mmHG
Dietary Sodium reduction
Reduce dietary sodium intake to no more than 100meq/d(2.4g sodium or 6 gram sodium chloride.
2-8 mmHg
Physical Activity
Engage in regular aerobic physical activity such as brisk walking(At least 30 minutes per day ,most days of the week)
4-9 mmHg
Moderation of Alcohol consumption
Limited consumption to no more than two drinks per day.
2-4 mm Hg