Non-Pharmacological Management of Hypertension Flashcards
What are the factors affecting development of essential and secondary hypertension?
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Essential hypertension probably results from factors including:
- Effects of ageing on renal function, peripheral resistance.
- Genetic susceptibility.
- Environment e.g. smoking, stress, diet and lifestyle.
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Secondary hypertension results from:
- Renal disease
- Liver disease
- Cardiac failure
- Pre-eclampsia of pregnancy
What are the modifiable risk factors for hypertension?
- Excess dietary salt
- Poor diet and obesity
- Excess alcohol consumption
- Lack of physical activity
- Deprivation and socio-economic status
- Mental health and stress
What are the non-modifiable risk factors for hypertension?
- Age
- Ethnicity
- Genetics
- Gender
What are the most significant diet and lifestyle influences on hypertension?
- Overweight and obesity
- Lack of physical activity
- Excess alcohol intake
- Excess salt intake
Describe the ‘5As’ approach to behaviour change.
What is te impact of screening and brief interventions for obesity in primary care?
- n=1882 screened as obese.
- Randomised to receive one of two 30 second interventions:
- Advice only
- Support (offer to refer to weight management group)
- Both options found to be appropriate and helpful.
- At 12 months, weight loss = 2.43kg (support) vs 1.04kg (advice only).
What are the patient challenges when considering conservative management of hypertension?
- Readiness to change
- Motivation
- Self-esteem and confidence
- Appropriate time to attempt therapy?
- Acceptance of the need for a lifestyle change
- Any environmental, social and family factors (e.g. family Hx)
What is the effect of regular aerobic exercise on hypertension?
- Led to significant reductions in systolic and diostolic BP (-3.84mmHg and -2.58mmHg respectively) in analysis of 54 RCTs.
What is the effect of endurance training on hypertension?
- Led to reductions in BP in all study groups (hypertensive, prehypertensive and normotensive individuals), but significantly more pronounced in the hypertensive study groups in analysis of 72 trials.
How would you assess the dietary intake of a hypertensive patient?
- Food diary
- Food frequency questionnaire
- 24 hour recall
What are the UK physical activity recommendations for adults?
- To stay healthy, adults aged 19 to 64 should try to be active daily and should do:
- at least 150 minutes of moderate aerobic activity such as cycling or brisk walking every week and
- strength exercises on 2 or more days a week that work all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms)
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Or:
- 75 minutes of vigorous aerobic activity such as running or a game of singles tennis every week and
- strength exercises on 2 or more days a week that work all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms)
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Or:
- a mix of moderate and vigorous aerobic activity every week – for example, 2 x 30-minute runs plus 30 minutes of brisk walking equates to 150 minutes of moderate aerobic activity and
- strength exercises on 2 or more days a week that work all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms)
What is the effect of reduction in alcohol consumption of blood pressure?
What are SMART goals?
- Specific
- Measurable
- Acceptable
- Realistic
- Time - phased
Describe the DASH diet?
(Dietary approaches to stop hypertension)
- Diet rich in fruit and vegetables, low fat dairy products, wholegrains, fish, nuts and poultry.
- DASH diet reduced SBP and DBP significantly more than a control diet (reduction of 5.5mmHg more and of 3.0mmHg moe respectively).
- Similar to Mediterranean sytle diet and eatwell guide.
What are the key recommendations for reducing BP?
- Reduce salt intake to no more than 6g per day.
- Moderate alcohol intake to within UK recommendations - no more than 14 units per week.
- Reduce weight toward an ideal body weight.
- Increase physical activity levels toward UK recommendations.
- Increase fruit and vegetable intake to recommended levels.
- The 5As approach to behaviour change is an effective tool for use in primary care to support individuals to make appropriate diet and lifestyle changes.
