liftsiron
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Alcohol intake
Alcohol is probably the most important pressor agent in daily practice. Most of our hypertensive patients, especially the ones who are difficult to treat, often report an excessive alcohol intake. There is no single mechanism by which alcohol increases blood pressure. There seems to be a dose dependency - low to moderate (up to 2 drinks/day) alcohol intakes are not associated with increased blood pressure. Because of alcohol-induced liver pathology, antihypertensive drugs are differently metabolized, so that they are less effective, requiring larger dosages that are more likely to produce side effects.
There is a strong relationship between the frequency of alcohol intake and the absolute amount of alcohol consumed. Accordingly we try not to forbid alcohol completely, which would be an unrealistic strategy; however, we try to convince our patients not to drink daily.
Women have a lower so-called first pass metabolism of alcohol in the gastric mucosa. It is conceivable that the alcohol-blood pressure relationship for a certain dose may be stronger in women. This would be of importance at low to moderate levels of intake; however, in heavier consumers the gender difference in alcohol metabolism is not seen.
Caffeine intake
In a person who never consumes caffeine, blood pressure increases upon the ingestion of a cup of coffee or a cup of espresso. However, in regular coffee drinkers, you don't see a blood pressure increasing effect of coffee consumption. So, in daily practice, it is not necessary to advise coffee-drinking hypertensive patients to cut down their coffee consumption.
Weight and exercise
Losing weight is a difficult issue for most people. If you have a really obese patient, it probably makes the most sense to control blood pressure pharmacologically (and thus avoid any potential complications of the high blood pressure), while at the same time trying to reduce body weight by individually tailored strategies. If somebody loses only 10% of their initial body weight, this loss can have a considerable and positive impact on blood pressure and the other cardiovascular risk factors. However, as with other strategies, there are responders and non-responders.
One central component in any weight loss and weight maintenance life strategy is physical activity. In the setting of the obese hypertensive patient, increased levels of physical activity in daily life at work and at home lead to an increased energy expenditure and thus weight loss, or at least weight stabilization. In addition, physical activity is associated with many favorable effects on most cardiovascular risk factors (e.g. insulin resistance, dyslipidemia) including hypertension. Every person - independent of their age, body weight and blood pressure status - should pursue at least 30 minutes of daily physical activity - aerobic and endurance activity - that raises the pulse rate. In hypertensive patients, isometric exercise training, such as weight lifting or rowing, is not a recommended physical activity, because irregular repetitive bouts of heavy physical activity are associated with increases in blood pressure.
The DASH diet
The DASH ("Dietary Approaches to Stop Hypertension") diet is a type of global summary of the important dietary strategies to control hypertension. During the last few years two DASH studies have been published. In DASH I, a combination diet rich in fruits and vegetables and low-fat dairy products demonstrated significant reduction of blood pressure, especially in hypertensive subjects. 1 Salt restriction was studied in DASH II. The greatest effect of the DASH diet was seen at the lowest level of sodium intake. 2 For daily practice, we recommend starting with the DASH-I diet and, then, if there is still insufficient blood pressure control and the presence of salt sensitivity is suspected, adding an additional salt restriction.
Source
Robert M. Russell, MD and Paolo M. Suter, MD. Nutrition and Blood Pressure http://www.cyberounds.com
Alcohol is probably the most important pressor agent in daily practice. Most of our hypertensive patients, especially the ones who are difficult to treat, often report an excessive alcohol intake. There is no single mechanism by which alcohol increases blood pressure. There seems to be a dose dependency - low to moderate (up to 2 drinks/day) alcohol intakes are not associated with increased blood pressure. Because of alcohol-induced liver pathology, antihypertensive drugs are differently metabolized, so that they are less effective, requiring larger dosages that are more likely to produce side effects.
There is a strong relationship between the frequency of alcohol intake and the absolute amount of alcohol consumed. Accordingly we try not to forbid alcohol completely, which would be an unrealistic strategy; however, we try to convince our patients not to drink daily.
Women have a lower so-called first pass metabolism of alcohol in the gastric mucosa. It is conceivable that the alcohol-blood pressure relationship for a certain dose may be stronger in women. This would be of importance at low to moderate levels of intake; however, in heavier consumers the gender difference in alcohol metabolism is not seen.
Caffeine intake
In a person who never consumes caffeine, blood pressure increases upon the ingestion of a cup of coffee or a cup of espresso. However, in regular coffee drinkers, you don't see a blood pressure increasing effect of coffee consumption. So, in daily practice, it is not necessary to advise coffee-drinking hypertensive patients to cut down their coffee consumption.
Weight and exercise
Losing weight is a difficult issue for most people. If you have a really obese patient, it probably makes the most sense to control blood pressure pharmacologically (and thus avoid any potential complications of the high blood pressure), while at the same time trying to reduce body weight by individually tailored strategies. If somebody loses only 10% of their initial body weight, this loss can have a considerable and positive impact on blood pressure and the other cardiovascular risk factors. However, as with other strategies, there are responders and non-responders.
One central component in any weight loss and weight maintenance life strategy is physical activity. In the setting of the obese hypertensive patient, increased levels of physical activity in daily life at work and at home lead to an increased energy expenditure and thus weight loss, or at least weight stabilization. In addition, physical activity is associated with many favorable effects on most cardiovascular risk factors (e.g. insulin resistance, dyslipidemia) including hypertension. Every person - independent of their age, body weight and blood pressure status - should pursue at least 30 minutes of daily physical activity - aerobic and endurance activity - that raises the pulse rate. In hypertensive patients, isometric exercise training, such as weight lifting or rowing, is not a recommended physical activity, because irregular repetitive bouts of heavy physical activity are associated with increases in blood pressure.
The DASH diet
The DASH ("Dietary Approaches to Stop Hypertension") diet is a type of global summary of the important dietary strategies to control hypertension. During the last few years two DASH studies have been published. In DASH I, a combination diet rich in fruits and vegetables and low-fat dairy products demonstrated significant reduction of blood pressure, especially in hypertensive subjects. 1 Salt restriction was studied in DASH II. The greatest effect of the DASH diet was seen at the lowest level of sodium intake. 2 For daily practice, we recommend starting with the DASH-I diet and, then, if there is still insufficient blood pressure control and the presence of salt sensitivity is suspected, adding an additional salt restriction.
Source
Robert M. Russell, MD and Paolo M. Suter, MD. Nutrition and Blood Pressure http://www.cyberounds.com
