High
Blood Pressure: What Can Be Done?
Pharmacotherapy
In clinical trials,
antihypertensive
drug therapy reduces stroke by 34-40%, myocardial infarction by
20-25%, and heart failure by more than 50%.
Unfortunately,
only about 30% of hypertensives are adequately controlled [MMWR
2005; Hajjar
2006].
Lifestyle
Based upon JCN
Express, Table 5, page 8:
|
Modification
|
Recommendation
|
Systolic
BP Reduction
|
|
Weight reduction
|
Maintain
normal body weight (BMI
18.5-24.9).
|
5-20 mmHg
per 10kg weight loss
|
|
Adopt DASH
eating plan
|
Consume
a diet rich in fruits, vegetables, and lowfat dairy products
with a reduced content of saturated and total fat.
|
8-14 mmHg
|
|
Dietary
sodium reduction
|
Reduce dietary
sodium intake to no more than 2400 mg sodium.
|
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
|
Limit consumption
to no more than 2 drinks per day in most men and no more than
1 drink per day in women and lighter weight persons.
|
2-4 mmHg
|
These changes
in individual behavior are not likely to occur without public health
interventions that change the environment in which lifestyle choices
are made.
Public Health Approaches
Salt.
A 5 mmHg decrease in the mean population systolic blood pressure would
result in 14% fewer deaths from stroke and 9% fewer deaths from coronary
heart disease. About 75% of our daily sodium intake comes from salt
added by food manufacturers and restaurants [Havas
2004]. A recent review in the journal Cardiology [Altun
2006] demonstrated the importance of salt as a determinant of
non-optimal blood pressures. The 7th Report of the Joint National
Committee on the Prevention, Detection, Evaluation, and Treatment
of High Blood Pressure endorses the American Public Health Association's
call for food manufacturers and restaurants to reduce sodium in the
food supply by 50% over the next decade [JCN
Express].
Physical
Activity. Pedestrian safety programs can increase the practice
of walking as a regular form of physical activity.
Farmers
Markets increase access to fresh fruits and vegetables [SF
Farmers Markets].
A recent (February
2010) Institute
of Medicine Report calls for a population-based approach.
According to a
report in the New York Times, the food industry is attempting
to re-cast the problem of highly salted foods.
According to estimates
from the Global Burden of Disease Study [Murray
2003], a combination of person and non-personal health interventions
to lower blood pressure could decrease the incidence of carviovascular
events by 50%.
