1. Risk of hypertension (HTN) and non-drug management Aliakbar Tavassoli

2. Prevalence: 1,000,000,000 in world HTN is usually silent and symptoms are often due to target organ damage The most common cause of HTN is essential and secondary HTN is about 5%.

3. Secondary cause of HTN Renal Endocrine Coarctation of aorta Pregnancy Drugs (NSAIDS, estrogen, elicit drugs, cocaine,, ergot, nervous system stimulants, etc) Sleep apnea syndrome

4. Factors that increase risk of complication in hypertensive patients Age/ elderly Duration of HTN BP level Target organ damage (Brain, eye, heart, kidney, vessels) Socioeconomic status Ethnicity (Higher in blacks) Non-dipper Salt sensitive patients Macroabuminuria LVH

5. Non-drug therapies The aims of life style changes Lower BP Minimize drug use Reduce overall cardiovascular diseases Improve outcome Maintain or improve quality of life

6. Weight control BMI>30 kg/m 2 ----Two folds increase of HTN prevalence Obesity is more potent risk factor in male than female and in younger patients than older patients In overweight (BMI>25 kg/m 2 )or obese (BMI>30 kg/m 2 ), the initial goal is loss of 10% body weight over 6 months at the rate of 0.5-1 kg/wk Consider of anorectic drugs and weight loss surgery

7. Weight control Benefits of weight control Lower BP Lower drug requirement Improved glucose tolerance Lower LV load and stain Lower risk of arterial thrombosis

8. Exercise and physical activity Physical activity is associated with lower cardiovascular morbidity and mortality BP-lowering effects of exercise are greater in hypertensives Regular exercise also benefits other cardiovascular risk factors by: ---decreasing insulin resistance ---decrease in coagulation ---increase HDL Moderate intensity exercise for at least three times a wk is recommended to achieve health benefits

9. Diet DASH diet (the dietary approach to stop HTN) and Mediterranean diet High fruit and high vegetable High fiber/ whole-grain cereals Low fat dairy products Nuts Smaller amounts of meat and poultry Low fat and high fish consumption Low salt (2.4 g sodium of 6 g NaCl) High K, Mg and Ca intake (Diet not supplement)

10. Some effects of dietary omega-3 fatty acid Reduce platelet aggregation Lower TG Increased HDLs Improved endothelial function Lower BP Anti-arrythmic effect (in animals) Anti-inflammatory effect

11. Alcohol consumption and HTN Alcohol is a pressor agent Consumption > 6 drinks/d----2-folds increase in HTN Consumption ≤2-3 drinks/d may have protective effect on cardiovascular disease Binge and abrupt withdrawal Risk in older patients is more than youngers

12. Alcohol Alcohol is an important and reversible cause of HTN Regular alcohol consumption can increase anti- hypertensive drug requirements Lower levels of alcohol consumption may protect against coronary heart events Alcohol increases the risk of hemorrhagic stroke Binge-drinking patterns increase the risk of all stroke types Hypertensive drinkers should be advised to restrict intake to one or two standard drinks a day

13. Caffeine containing beverage Caffeine is a pressor agent Caffeine increase BP acutely in the ‘caffeine naïve’ state Long-term pressor effect of caffeine are more obvious in elderly hypertensives Hypertensives should be advised to limit their intake of caffeine. The combination of smoking and caffeine intake should be avoided.

14. Smoking and BP Risk in females is more than male Risk in younger is more than older Acute smoking causes acute mild rise of BP lasting 15 min Dept of inhalation, duration of smoking and number of cigarette are more important

15. Smoking Quitting smoking should be a high priority in lowering risk for cardiovascular diseases Prognosis is worse and BP more difficult to control in hypertensive smokers Risk is reduced within two years of quitting smoking Advice about alcohol, weight control, diet and exercise should be combined with efforts to stop smoking