Blood Pressure and Lifestyle

Steve - you might think that the following commentary would have come from us. Surprisingly, it came from the journal U.S. Pharmacist. The advice could not be any more straightforward. It makes one wonder: are any of the health professionals qualified to administer this advice following through?

Current Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure classification and treatment of BP for adults.

BP Classification	SBP (mmHg)	DBP (mmHg)	Lifestyle Modification	Initial Drug Therapy If No Compelling Indicationsa	Initial Drug Therapy If Compelling Indicationsa
Normal	<120	and <80	Encourage	None	Drug(s) for compelling indications
Prehypertension	120–139	or 80–89	Yes	None	See above
Stage 1 hypertension	140–159	or 90–99	Yes	Thiazide diuretics for most	See above
Stage 2 hypertension	≥160	or ≥100	Yes	Combination of 2 drugs for most	See above

Various lifestyle risk factors have been identified that elevate blood pressure and lead to HTN. Many of these risk factors have been well documented, and according to recent trials or new research awaiting publication, others have recently been postulated to affect BP

A healthy lifestyle is essential to preventing HTN and managing it successfully. Lifestyle modifications should be incorporated into every treatment regimen for prehypertension and HTN. Implementation of a healthy lifestyle decreases BP, reduces cardiovascular disease risk, and increases the efficacy of antihypertensive medications.

Lifestyle Risk Factors for the Development of Hypertension

-Cigarette smoking
-Obesity
-Lack of physical activity
-Increased sodium intake
-Excessive alcohol consumption
-Fructose-rich diet
-Vitamin D deficiency
-Sleep deprivation
-Residing near significant traffic noise
-Military combat exposure

Hypertension can also develop because of medication regimen, underlying health conditions, genetic history, or a combination of these factors.

Medications that may cause HTN include caffeine, chronic steroid therapy, oral contraceptives, nonsteroidal anti-inflammatory drugs (NSAIDs), cyclooxygenase-2 (COX-2) inhibitors, amphetamines and other stimulant drugs, cocaine, decongestants, weight loss drugs, cyclosporine and other immunosuppressants, erythropoietin, and OTC supplements (e.g., ephedra, licorice, ma huang).

Lifestyle Modifications for the Treatment of Hypertension

-Smoking cessation
-Weight loss
-Regular physical activity
-DASH eating plan (salt restriction)
-Limiting alcohol consumption
-Reduce fructose intake
-Adequate vitamin D levels
-Dark chocolate consumption
-Pet Ownership

A person's way of life can have substantial effects on his or her health, including the risk of developing HTN. Numerous lifestyle risk factors have been implicated in the development of HTN; likewise, several lifestyle modifications effectively lower BP. Alterations in lifestyle are essential to prevention and treatment of HTN and can decrease the need for one or more prescription medications.

Lifestyle changes to lower BP can additionally correct obesity, lower cardiovascular risk, decrease insulin resistance, improve drug efficacy, and enhance antihypertensive effect. Greater BP reductions are achieved if two or more lifestyle adjustments are made concurrently. Assisting and motivating patients to make lifestyle changes to lower their BP to goal levels is recommended yet is often underutilized by health care clinicians. It is imperative that pharmacists be knowledgeable in risk factors and treatments for HTN and express interest in having patients reach their BP goals.

U.S. Pharmacist, April 2010