Hypertension Guide for Boomers

• High blood pressure levels: normal, less than 120/less than 80 mm Hg; prehypertension, 120-139/80-89 mm Hg; stage 1 hypertension, 140-159/90-99 mm Hg; stage 2 hypertension, at or greater than 160/at or greater than 100 mm Hg.
• Restrict dietary sodium to 1500 mg (65 mmol) per day in adults 50 years of age or younger.
• Perform 30 min to 60 min of moderate aerobic exercise four to seven days per week
• Maintain a healthy body weight (BMI 18.5 kg/m to 24.9 kg/m) and waist circumference (less than 102 cm for men and less than 88 cm for women)
• Limit alcohol consumption
• Emphasizes fruits, vegetables and low-fat dairy products.
• Eat foods rich in dietary and soluble fiber, whole grains and protein from plant sources, and that is low in saturated fat and cholesterol
• Blood pressure should be decreased to less than 140/90 mmHg in all patients, and to less than 130/80 mmHg in patients with diabetes mellitus or chronic kidney disease.
• Initial therapy should include thiazide diuretics, angiotensin- converting enzyme (ACE) inhibitors (in patients who are not black), long-acting calcium channel blockers (CCBs), angiotensin receptor blockers (ARBs) or beta-blockers (in those younger than 60 years of age).
• A combination of two first-line agents may also be considered as initial treatment of hypertension if systolic blood pressure is 20 mmHg above target or if diastolic blood pressure is 10 mmHg above target.
• The combination of ACE inhibitors and ARBs should not be used
• In patients with coronary artery disease, ACE inhibitors, ARBs or beta blockers are recommended as first-line therapy
• In patients with cerebrovascular disease, an ACE inhibitor/diuretic combination is preferred
• In patients with proteinuric nondiabetic chronic kidney disease, ACE inhibitors or ARBs (if intolerant to ACE inhibitors) are recommended
• In patients with diabetes mellitus, ACE inhibitors or ARBs (or, in patients without albuminuria, thiazides or dihydropyridine CCBs) are appropriate first-line therapies.
• In selected high-risk patients in whom combination therapy is being considered, an ACE inhibitor plus a long-acting dihydropyridine CCB is preferable to an ACE inhibitor plus a thiazide diuretic.
• All hypertensive patients with dyslipidemia should receive statin therapy. Once blood pressure is controlled, low-dose acetylsalicylic acid therapy should be considered.

 

References:

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)

Can J Cardiol.The 2010 Canadian Hypertension Education Program recommendations for the management of hypertension: part 2 - therapy.Hackam DG

Treating Diabetes and Hypertension

 

Diabetes and hypertension causes various micro- and macrovascular complications leading to changes in blood pressure (BP). A BP of < 130/80 mm Hg has been the recommendation for patients with both diabetes and hypertension.

However the  Action to Control Cardiovascular Risk in Diabetes (ACCORD) blood pressure-lowering trial and results from the International Verapamil SR-Trandolapril Study (INVEST) study have questioned this. The new recommendations suggest that different antihypertensive combinations may offer specific cardio-, vasculo-, and renoprotective advantages that not only treat the hypertension but also prevent complications of high BP.

Angiotensin converting enzyme (ACE) inhibitor plus diuretic combination therapy improves BP, counterbalances renin-angiotensin system activation due to diuretic therapy and reduces the risk of electrolyte alterations.

ACE inhibitor plus calcium channel blocker reduces proteinuria, the rate of decline in glomerular filtration rate (GUARD trial). Moreover, the ACCOMPLISH trial results led to the conclusion that ACE inhibitor/calcium channel blocker combo helps cardiovascular outcomes in high-risk patients.

 

References:

Curr Atheroscler Rep.Optimal Therapy in Hypertensive Subjects with Diabetes Mellitus.Reboldi G, Gentile G, Angeli F, Verdecchia P.

Vasc Health Risk Manag. Choice of ACE inhibitor combinations in hypertensive patients with type 2 diabetes: update after recent clinical trials. Reboldi G, Gentile G, Angeli F, Verdecchia P.