Feb 5, 2012

How far one can treat Hypertension without drugs: Life style modification for Hypertension

Hypertension is illness, which more often needs drug therapy throughout life. Most patients do not like to take drugs for hypertension. If blood pressure is not controlled then complication secondary to hypertension are very high.

There is place for life style modification in treatement for hypertension. Life style modification alone can be used treat hypertension in less severe hypertension i.e. stage one i.e. 140-159/ 90-99 without any Comorbid conditions. If blood pressure does not normalize, then need for drug is warranted. Undue delay or postponing drug therapy, may cause complication of hypertension
Below table gives general guidelines for imitation of drug therapy in cases of hypertension. I.e. blood pressure more then 140/90.
·          In general, all patients with blood pressure more then 160/90 will need drug therapy with life style modification. More so if patient is age more than 65 years.

·          For patient with blood pressure between 140/90 an d 160/100  without any Comorbid conditions initially patient can be given trial of life style modification for 1 to 3 months if blood pressure does not  fall below 140/90 then drug therapy is added along with lifestyle modification

·          Blood pressure between 140/90 to 160/100 with Comorbid conditions, (see table below for details) starting immediate drug therapy, with life style modification, is advised.

·          Whatever modality of treatment the patient is on, blood pressure check up is advised once in two to three months (Home monitoring best). If patient is on only life style modification and blood pressure rises above 140/90 then drug therapy is needed for him also.

When start drug therapy for hypertension patients
High risk  :-
·          If any one  three criteria if present, then it high risk patient
·          Patient needs put on drugs immediately and also life style modification started

  1. 1.        Blood pressure more then 140/90mmhg with evidence of  heart disease and /or diabetes  with without other risk factors
  2. 2.        Stage 2 hypertension i.e. Blood pressure more then 160/100
  3. 3.        Blood pressure more then 140/90 with any  three of these co morbid conditions.
o    Male age more then 55
o    Female age more then 65
o    Smoking
o    Increased cholesterol
o    Obesity
o    Target organ damage
Proteinuria (protein in urine)
Medium risk :-
·          Life style modification for 1 to 2 months if BP still more then 140/90 then add drugs continue life style modification
·          Blood pressure more then 140/90  to 160/100  (stage one) with any  one of these
o    Male age more then 55
o    Female age more then 65
o    Smoking
o    Increased cholesterol
o    Obesity
o    Target organ damage
§   Proteinuria (protein in urine)
Low risk :-
·          Life style modification for 1 to 3 months if BP still more then 140/90 then add drugs continue life style modification
·          Male age less than 55 years
·          Female age less than 65 years
·          Stage one hypertension i.e. Blood pressure between 140/90 to 160/100
·          No other risk factors
For patient with Blood pressure between 130/80 to 140/90 with diabetes or target organ damage heart disease, renal failure then patient requires drug therapy along with life style modification without Comorbid conditions, only life style modification is needed.
Life style modification for hypertension
1.        Weight reduction
a.        If BMI is more than 25 then weight reduction is needed.
b.        Android type of obesity is more dangerous then genocide type of obesity. Android obesity is obesity of upper segment of body i.e. i.e. abdomen. Gynoid obesity is obesity of lower segment of body i.e. thigh and buttocks
c.        Those patient who are not obese need not reduce weight
2.        DASH Diet
a.        Less sodium and saturated fat with high potassium and fiber rich diet

3.        Exercise
a.        Brisk walking for 4 to 5 time a week for 30 to 60 minutes is advised
4.        Salt restriction
a.        Reduce sodium intake increase potassium intake
b.        Processed food  and meet contain more sodium so avoid them
c.        Increase fresh vegetable, fruit which contain more potassium

5.        Stop smoking
a.        This is very important to reduce chances of heart attack. See Framingham risk score
6.        Alcohol moderation
a.        For purpose of hypertension, alcohol is better avoided. Most doctor do not permit alcohol; for hypertension but  some doctor may permit this. For men 2 drinks per day is allowed and for women one drink per days is permitted.
b.        One drink is defined as 12 ml of alcohol equivalent 12oz of beer or 4oz of wine, or 1.5oz of liquor.
7.        Coffee
a.        Reduce excess coffee i.e. 3 to 4 cups per day. Caffeine with soda is more dangerous avoid this.
8.        Acupuncture has questionable benefits for reduction of blood pressure. Relaxation exercise has shown only transient improvement in blood pressure control.  Some doctors have different opinion on this.