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Chapter 14: Cardiovascular Disorders

HYPERTENSION (HTN)

Population

  • – Persons at risk for developing HTN.a

Recommendations

ACC/AHA 2017, ESC/ESH 2018, Hypertension Canada 2018, JNC 8, ICSI 2018

  • – Lose weight toward or maintain normal BMI <25, restrict sodium intake <2 g/d, moderate alcohol consumption <14 drinks/wk for men, <8–9 drinks/wk for women, increase physical exercise 30 min/d 5–7 days/wk, emphasize smoking cessation.

  • – Consume diet rich in vegetables, fruit, fish, nuts, whole grains, low-fat dairy products, and unsaturated fats.

  • – Do not supplement calcium or magnesium for the prevention or treatment of HTN.

Hypertension Canada 2018

  • – For patients not at risk of hyperkalemia, increase dietary potassium intake to reduce BP.

  • – Recommend stress management including relaxation techniques for patients whose stress might be contributing to high BP.

Sources

  • – ACC/AHA. J Am Coll Cardiol. 2018;71:e127-e248.

  • – USPSTF. Ann Int Med. 2015;163(10):778-787.

  • – ESC/ESH. Eur Heart J. 2018;39:3021-3104.

  • – Can J Cardiol. 2018;34:506-525.

  • – JAMA. 2014;311(5):507-520.

  • – ICSI Hypertension Work Group: 2018 Commentary.

Population

  • – Patients age ≥65 y.

Comments

  1. A 10-mmHg reduction in SBP or 5-mmHg reduction in DBP would decrease all major cardiovascular events by 20%, all-cause mortality by 10–15%, stroke by 35%, coronary events by 20%, heart failure by 40%. (ESC/ESH. Eur Heart J. 2018;39:3021-3104)

  2. For overweight patients, expect 1-mmHg reduction in SBP for every 1-kg reduction in body weight. (ACC/AHA. J Am Coll Cardiol. 2018;71:e127-e248)

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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 2000 mg sodium/d (approximately 5 g of sodium chloride). 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 or 90–150 min/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. Isometric exercise, eg, hand grip 4×2 min, 1 min rest between exercises, 3 sessions/wk shown to reduce 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 ...

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