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Home Books CURRENT Practice Guidelines in Primary Care 2019

Chapter 14: Cardiovascular Disorders

HYPERTENSION (HTN)

Population

  • –Persons at risk for developing HTN.a

Recommendations

CHEPb 2015, JNC 8, 2014, ICSI 15th Ed 2014, ESC 2013

  • –Recommend weight loss, reduced sodium intake, moderate alcohol consumption, increased physical activity, potassium supplementation, and modification of eating patterns.

  • –Above the normal replacement levels, supplementation of K, Ca, and Mg is not recommended for the prevention or treatment of HTN.

Sources

  • –Hypertension Canada.

  • –JAMA. 2014;311(5):507-520.

  • –Kenning I, Kerandi H, Luehr D, et al. Institute for Clinical Systems Improvement. Hypertension Diagnosis and Treatment. 2014.

  • –Eur Heart J. 2013;34:2159-2219.

Population

  • –Patients age >65 y.

Recommendation

ACCF/AHA 2011

  • –Lifestyle management is effective in all ages.

Source

  • –J Am Coll Cardiol. 2011;57(20):2037-2114.

Comments

  1. A 5 mm Hg reduction in systolic blood pressure in the population would result in a 14% overall reduction in mortality from stroke, a 9% reduction in mortality from CHD, and a 7% decrease in all-cause mortality.

  2. Weight loss of as little as 10 lb (4.5 kg) reduces blood pressure and/or prevents HTN in a large proportion of overweight patients.

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LIFESTYLE MODIFICATIONS FOR PREVENTION OF HYPERTENSION

  • Maintain a healthy body weight for adults (BMI, 18.5–24.9 kg/m2; waist circumference <102 cm for men and <88 cm for women).

  • Reduce dietary sodium intake to no more than 100 mmol/d (approximately 6 g of sodium chloride or 2.4 g of sodium/d). Per CHEP 2015: adequate intake 2000 mg daily (all >19-y-old) (80% in processed foods; 10% at the table or in cooking); 2000 mg sodium (Na) = 87 mmol sodium (Na)= 5 g of salt (NaCl) ~1 teaspoon of table salt.

  • Engage in regular aerobic physical activity, such as brisk walking, jogging, cycling, or swimming (30–60 min per session, 4–7 d/wk), in addition to the routine activities of daily living. Higher intensities of exercise are not more effective. Weight training exercise does not adversely influence BP.

  • Limit alcohol consumption to no more than 2 drinks (eg, 24 oz [720 mL] of beer, 10 oz [300 mL] of wine, or 3 oz [90 mL] of 100-proof whiskey) per day in most men and to no more than one drink per day in women and lighter-weight persons.

  • Maintain adequate intake of dietary potassium (>90 mmol [3500 mg]/d). Above the normal replacement levels, supplementation of potassium, calcium, and magnesium is not recommended for prevention or treatment of hypertension.

  • Daily K dietary intake >80 mmol.

  • Consume a diet that is rich in fruits and vegetables and in low-fat dairy products with a reduced content of saturated and total fat (Dietary Approaches ...

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