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Population strategies to treat hypertension

Opinion statement

The risks of cardiovascular disease, cerebrovascular disease, peripheral artery disease, and end-stage renal disease are linearly related to systolic blood pressure. As the population ages and the prevalence of high blood pressure increases, the implementation of population-based strategies will be essential to reduce the burden of hypertension-related diseases. Reduction and control of elevated blood pressure can effectively slow the progression of end-stage renal disease, cerebrovascular disease, peripheral vascular disease, and cardiovascular disease. The strategies for population-based hypertension control are implemented through an increased awareness of the newest guidelines. In the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, the strategies include lifestyle modification and antihypertensive medication. Although specific blood pressure levels determine antihypertensive medications, lifestyle modifications are advised for all segments of the population and for all blood pressure levels. In particular, lifestyle modification is the recommended intervention for the “prehypertension” category and is encouraged for individuals with normal blood pressure. Also, strategies for lifestyle modifications are part of the treatment strategies for stage 1 and stage 2 hypertension categories in conjunction with antihypertensive medications. The major lifestyle modifications to reduce and manage blood pressure include weight management, incorporation of specific diet plans, dietary sodium reduction, physical activity, and moderation of alcoholic consumption. The implementation and commitment to these strategies can effectively and significantly reduce blood pressure levels, and subsequent hypertension-related disease risks in the population.

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References and Recommended Reading

  1. 1.

    Chobanian AV, Bakris GL, Black HR, et al.: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure: the JNC 7 Report. JAMA 2003, 289:2560–2572. This is the summary of the JNC 7 reports and represents an excellent review of the guidelines. The document is an important clinical reference.

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Sacks FM, Svetkey LP, Vollmer WM, et al.: Effects on blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (DASH) diet. DASH-Sodium Collaboration Research Group. N Engl J Med 2001, 344:3–10.

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Effects of weight loss and sodium reduction on blood pressure and hypertension incidence in overweight people with high-normal blood pressure. The Trials of Hypertension Prevention, phase II. The Trials of Hypertension Prevention Collaborative Research Group [no authors listed]. Arch Intern Med 1997, 157:657–667.

  4. 4.

    Ho J, Whelton PK, Appel LJ, et al.: Long-term effects of weight loss and dietary sodium reduction on incidence of hypertension. Hypertension 2004, 35:444–449.

    Google Scholar 

  5. 5.

    Wolk R, Shamsuzzaman AS, Somers VK: Obesity, sleep apnea, and hypertension. Hypertension 2003, 42:1067–1074.

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Reaven GM: Importance of identifying the overweight patient who will benefit the most by losing weight. Ann Intern Med 2003, 138:1420–1423.

    Google Scholar 

  7. 7.

    Sacks FM, Svetkey LP, Vollmer WM, et al.: Effects on blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med 2001, 135:1019–1028.

    Google Scholar 

  8. 8.

    Bray GA Vollmer VM, Sacks FM, et al.: A further sub-group analysis of the effects of the DASH diet and three sodium levels on blood pressure: results of the DASH-Sodium Trial. Am J Cardiol 2004, 94:222–227.

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Svetkey LP, Simons-Morton DG, Proschan MA, et al.: Effect of the dietary approaches to stop hypertension diet and reduced sodium intake on blood pressure control. J Clin Hypertens 2004, 6:373–381.

    Article  Google Scholar 

  10. 10.

    Appel LJ, Champagne CM, Harsha DW, et al.: Effects of comprehensive lifestyle modification on blood pressure control in main results of the PREMIER clinical trial. JAMA 2003, 289:2083–2093.

    PubMed  Article  Google Scholar 

  11. 11.

    Stamler J: The INTERSALT Study: background, methods, findings, and implications. Am J Clin Nutr 1997, 65:626S-642S.

    PubMed  CAS  Google Scholar 

  12. 12.

    Forrester T: Historic and early life origins of hypertension in Africans. J Nutr 2004, 134:211–216.

    PubMed  CAS  Google Scholar 

  13. 13.

    Ergul A: Hypertension in black patients: an emerging role of the endothelium system in salt sensitive hypertension. Hypertension 2000, 36:62–67.

    PubMed  CAS  Google Scholar 

  14. 14.

    Tobian L: Dietary sodium chloride and potassium have effects on the pathophysiology of hypertension in humans and animals. Am J Clin Nutr 1997, 65:606S-611S.

    PubMed  CAS  Google Scholar 

  15. 15.

    Kotchen TA, Kotchen JM: Dietary sodium and blood pressure: interactions with other nutrients. Am J Clin Nutr 1997, 65:708S-711S.

    PubMed  CAS  Google Scholar 

  16. 16.

    Cutler JA: The effects of reducing sodium and increasing potassium intake for control of hypertension and improving health. Clin Exp Hypertens 1999, 21:769–783.

    PubMed  CAS  Article  Google Scholar 

  17. 17.

    Zoccali C, Mallamaci T: The salt epidemic: old and new concerns. Nutr Metab Cardiovasc Dis 2000, 10:168–171.

    PubMed  CAS  Google Scholar 

  18. 18.

    Kelley GA, Kelley KS: Progressive resistance exercise and resting blood pressure: a meta-analysis of randomized controlled trails. Hypertension 2000, 35:838–843.

    PubMed  CAS  Google Scholar 

  19. 19.

    Whelton SP, Chin A, Xin X, et al.: Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med 2002, 136:493–503.

    PubMed  Google Scholar 

  20. 20.

    Kokkinos PF, Papademetriou V: Exercise and hypertension. Coron Artery Dis 2000, 11:99–102.

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Reisin F: Nonpharmacologic approaches to hypertension. Weight, sodium, alcohol, exercise and tobacco considerations. Med Clin North Am 1997, 81:1289–1303.

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Xin X, He J, Frontini MG, et al.: Effects of alcohol reduction on blood pressure. A meta-analysis of randomized controlled trials. Ann Intern Med 2001, 38:1112–1117.

    CAS  Google Scholar 

  23. 23.

    Beilin L, Puddey IB, Burke V: Alcohol and hypertension—kill or cure? J Hum Hypertens 1996, 10(suppl 2):S1-S5.

    PubMed  Google Scholar 

  24. 24.

    Lip GY, Beevers DG: Alcohol and cardiovascular disease—more than one paradox to consider. Alcohol and hypertension-does it matter? (no!). J Cardiovasc Risk 2003, 10:11–14.

    PubMed  Article  Google Scholar 

  25. 25.

    Lewis EJ, Hunsucker LG, Bain RP et al.: The effect of angiotensin-converting enzyme inhibitor on diabetic nephropathy. The Collaborative Study Group. N Engl J Med 1993, 329:1456–1462.

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    Brenner BM, Cooper ME, de Zeeuw D, et al.: Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med 2001, 345:861–869.

    PubMed  Article  CAS  Google Scholar 

  27. 27.

    Lewis EJ, Hansucker LG, Clark WR, et al.: Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 2001, 345:851–860.

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Cushman WC, Ford CE, Cutler JA, et al.: Success and predictors of blood pressure control in diverse North American settings: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). J Clin Hypertens 2002, 4:393–404.

    Google Scholar 

  29. 29.

    Black HR, Elliott WJ, Neaton JD, et al.: Baseline characteristics and elderly blood pressure control in the CONVINCE trial. Hypertension 2001, 37:12–18.

    PubMed  CAS  Google Scholar 

  30. 30.

    Miller ER, Erlinger TR Young DR, et al.: Results of the Diet, Exercise, and Weight Loss Intervention Trial (DEW-IT). Hypertension 2002, 40:612–618.

    PubMed  Article  CAS  Google Scholar 

  31. 31.

    Conlin PR, Erlinger TR Bohannon A, et al.: The DASH diet enhances the blood pressure response to losartan in hypertensive patients. Am J Hypertens 2003, 16:337–342.

    PubMed  Article  CAS  Google Scholar 

  32. 32.

    Wald NJ, Law MR: A strategy to reduce cardiovascular disease by more than 50%. BMJ 2003, 326:1419–1423.

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    Franco OH, Bonneux L, de Laet C, et al.: The Polymeal: a more natural, safer, and probably tastier (than the Polypill) strategy to reduce cardiovascular disease by more than 75%. BMJ 2004, 329:1447–1450.

    PubMed  Article  Google Scholar 

  34. 34.

    Franklin BA, Kahn JK, Gordon NF, et al.: A cardioprotective “polypill”? Independent and additive benefits of lifestyle modification. Am J Cardiol 2004, 94:162–166.

    PubMed  Article  Google Scholar 

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Lackland, D.T. Population strategies to treat hypertension. Curr Treat Options Cardio Med 7, 253–258 (2005). https://doi.org/10.1007/s11936-005-0036-9

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Keywords

  • QBUJFOUT XJUI
  • Reduce Blood Pressure Level
  • Include Weight Management
  • BTTPDJBUFE XJUI
  • High Blood Pressure Increase