Slide Source Hypertension Online In The Name of God.

Slide SourceHypertension Online

www.hypertensiononline.org

In The Name of God



Prevention and Prevention and Nondrug Nondrug

Management of HTNManagement of HTNMohammad Garak Yaraghi,MDCardiologistAssociate Professor of

Isfahan University of Medical Sciences



Blood Pressure ClassificationBlood Pressure Classification

BP Classification SBP mmHg* DBP mmHg Lifestyle Modification

Drug Therapy**

Normal <120 and <80 Encourage No

Prehypertension 120-139 or 80-89 Yes No

Stage 1 Hypertension 140-159 or 90-99 Yes

Single Agent

Stage 2 Hypertension ≥ 160 or ≥ 100 Yes Combo

JNC 7 Express. JAMA. 2003 Sep 10; 290(10):1314

*Treatment determined by highest BP category; **Consider treatment for compelling indications regardless of BP



Why Prehypertension?Why Prehypertension?

• Patients normotensive at age 55 have a 90% lifetime risk to develop HTN

• Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

• Prehypertensive: 120–139 / 80–89 mmHg– Require health-promoting lifestyle

modifications to prevent CVD• Public health goal: Prevent hypertension

and cardiovascular disease before it happens



Causal Factors for HypertensionCausal Factors for Hypertension

• Excess body weight– 122 million Americans are overweight or

obese• Excess dietary sodium

– Mean intake: Men 4100 mg; Women 2750 mg

– 75% from processed foods• Reduced physical activity• Inadequate fruit, vegetable and potassium

intake• Excess alcohol consumption

Hypertension 2003;289:2560-2572.



Recommended Lifestyle Modifications and Their Recommended Lifestyle Modifications and Their Individual Effects on Blood PressureIndividual Effects on Blood Pressure

Chobanian AV, et al. JAMA. 2003;289:2560-2572;Blumenthal JA, et al. Arch Intern Med. 2000;160:1947-1958.

Modifications* RecommendationApproximate SBP Reduction

Reduce weight Maintain normal body weight (BMI

of 18.524.9 kg/m2)320 mm Hg

Adopt DASH dietRich in fruit, vegetables, and low-fat dairy; reduced saturated and

total fat content814 mm Hg

Reduce dietary sodium <100 mmol (2.4 g)/day 28 mm Hg

Increase physical activity

Aerobic activity >30 min/day most days of the week

49 mm Hg

Moderate alcohol consumption

Men: ≤ 2 drinks/dayWomen: ≤ 1 drink/day

24 mm Hg

*Combining 2 or more of these modifications may or may not have an additive effect on blood pressure reduction.

SBP = systolic blood pressure; BMI = body mass index; DASH = Dietary Approaches to Stop Hypertension



Impact of a 5 mmHg ReductionImpact of a 5 mmHg Reduction

Overall Reduction

Stroke 14%

Coronary Heart Disease 9%

All Cause Mortality 7%

Hypertension 2003;289:2560-2572.



Effects of Lifestyle Modifications on Effects of Lifestyle Modifications on Blood PressureBlood Pressure

• Reduce systolic and diastolic blood pressures• Correct obesity or overweight• Decrease insulin resistance• Prevent or delay the onset of hypertension• Enhance antihypertensive drug efficacy• Decrease cardiovascular risk• Augment antihypertensive effect when two or

more lifestyle modifications are used concurrently*

Chobanian AV, et al. JAMA. 2003;289:2560-2572;Hyman DJ, et al. Arch Intern Med. 2007;167:1152-1158.

*Data from a randomized trial conducted by Hyman et al. (2007) provide some evidence favoring the simultaneous adoption of multiple lifestyle modifications.



OBESITY

Osteoarthritis

Mental Health

T2 Diabetes

Disability

Cancer Heart Disease



Dietary Approaches to Stop Hypertension

• Lowers systolic BP – in normotensive

patients by an average of 3.5 mm Hg

– In hypertensive patients by 11.4 mm Hg

• Copies available from NHLBI website

http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/



The DASH eating planThe DASH eating plan

"DASH" stands for "Dietary Approaches to Stop Hypertension"

• Study results indicated that elevated blood pressures were reduced by an eating plan that emphasizes fruits, vegetables, and low fat dairy foods and is low in saturated fat, total fat, and cholesterol

• The DASH eating plan includes whole grains, poultry, fish, and nuts and has reduced amounts of fats, red meats, sweets, and sugared beverages



The DASH Eating PlanHigh in:Fruits and vegetables (four or five servings each per day)Fiber (seven or eight servings per day)Low-fat dairy products (two or three servings per day)Lean meat (two servings per day)CalciumMagnesiumPotassiumLow in:Saturated fatCholesterolSalt*DASH = dietary approaches to stop hypertension.*—Low sodium intake was a later addition to the plan.



Sample MenuSample Menu

• Breakfast– 1 whole-wheat bagel– 2 tablespoons peanut butter– 1 medium orange– 1 cup fat-free milk– Decaffeinated coffee

• Lunch– Spinach salad made with 4 cups of fresh spinach leaves, 1

sliced pear, 1/2 cup mandarin orange sections, 1/3 cup unsalted peanuts and 2 tablespoons reduced-fat red wine vinaigrette

– 12 reduced-sodium wheat crackers– 1 cup fat-free milk

• Dinner – Herb crusted baked cod– 1 cup bulgur– 1/2 cup fresh green beans, steamed– 1 sourdough roll with 1 teaspoon trans-free margarine– 1 cup fresh berries with chopped mint– Herbal iced tea



Adopting the DASH eating planAdopting the DASH eating plan

Change gradually

• If you now eat one or two vegetables a day, add a serving at lunch and another at dinner.

• If you don't eat fruit now or have only juice at breakfast, add a serving to your meals or have it as a snack.

• Use only half the butter, margarine, or salad dressing you do now.

• Try lowfat or fat free condiments, such as fat free salad dressings.

• Gradually increase dairy products to three servings per day. For example, drink milk with lunch or dinner, instead of soda, alcohol, or sugar-sweetened tea. Choose lowfat (1 percent) or fat free (skim) dairy products to reduce total fat intake.



What’s In A Teaspoon?What’s In A Teaspoon?• A teaspoon of salt contains about 2,300 mg of

sodium

Wow! That’s a lotof sodium!

One teaspoon of salt has about a day’s supply of sodium for most people



•Sea salt is “chunkier” than table salt; so a teaspoon of it will contain more air (between the chunks) and less salt.

•One level teaspoon (6 grams) of table salt = 2,300 mg sodium.

•One teaspoon of sea salt (5 grams) =1960 mg of sodium

•Sea salt may a have a nutritionally insignificant amount of additional minerals, which may add a subtle flavor difference.

What Is the Difference Between What Is the Difference Between Table Salt and Sea Salt?Table Salt and Sea Salt?



Current Sodium Consumption is Current Sodium Consumption is Too HighToo High

• Institute of Medicine’s Upper Limit for Sodium = 2300 mg

• This is the maximum level that is likely to pose no risk of adverse effects for healthy individuals. – May be too high for individuals who

already have hypertension or who are under the care of a health care professional.



DASH Study ResultsDASH Study Results(Dietary Approach to Stop Hypertension)(Dietary Approach to Stop Hypertension)

DASH-Sodium • Three different sodium levels• Usual (Control) diet and DASH diet (rich in produce, low fat dairy, whole grains and nuts)• The 3 sodium levels were:

– a “higher” intake of 3,300 mg per day– an “intermediate” intake of 2,400 mg per day– a “lower” intake of 1,500 mg per day.


www.hypertensiononline.orgResults: blood pressure lowered with lower sodium diet.

DASH Study ResultsDASH Study Results(Dietary Approach to Stop Hypertension)(Dietary Approach to Stop Hypertension)

DASH-Sodium

• At every sodium level, Blood Pressure was lower for the DASH diet compared with the “regular” control diet.

• Lower sodium lower BP– for both the usual and DASH diets.



Excess Sodium Intake May Play Excess Sodium Intake May Play A Role In Other Diseases Such A Role In Other Diseases Such

As…As…

•Osteoporosis•Stomach cancer•Kidney stones



Where Does Salt Intake Come From?Where Does Salt Intake Come From?

77%

12%

6% 5%

Processed food

Naturally Occurring

At the Table

During Cooking

Salt intake comes mostly from processed foods and meals that are eaten away from home.



Read the Label

•If a food contains 140 mg or less of sodium, then it is low in sodium.



Scientifically established benefits Scientifically established benefits of physical activity (PA)of physical activity (PA)

• ↓ risk of dying prematurely • ↓ risk of dying from heart disease • ↓ risk of developing diabetes • ↓ risk of developing high blood pressure • Helps ↓ blood pressure in people who already have high blood

pressure • ↓ risk of developing colon cancer • ↓ feelings of depression and anxiety • Helps control weight • Helps build and maintain healthy bones, muscles, and joints • Promotes psychological well-being



Absolute Intensity

• Activities are classified into light-, moderate-, or vigorous-intensity based on amount of energy expended/minute (METs)– Moderate = 3.0 to 5.9 METs– Vigorous = 6.0+ METs

• One needs to look up the intensity of an activity (see tables in guidelines)– Brisk walk = moderate; Jog/run = vigorous– Activities can be either light, moderate, or vigorous

based on (usually) speed of doing them• Leisurely walk = light intensity• Brisk walk = moderate intensity• Race-walking = vigorous intensity



Relative Intensity

• Effort required relative to person’s fitness level• Guidelines use 0-10 scale to communicate relative intensity, where:

– Sitting is 0– Highest level of effort possible is 10– Moderate-intensity activity = a 5 or 6– Vigorous-intensity activity = a 7 or 8.

• To help communication, the PA guidelines endorsed the “talk test” and advises people to pay attention to heart rate and breathing– Moderate-intensity = can talk without pausing, but cannot sing– Vigorous-intensity = cannot say more than a few words without pausing

for breath• Relative intensity of a brisk walk depends on fitness and can be:

– light-intensity for elite athletes– moderate-intensity for recreational walkers– high intensity for inactive middle-aged adults– Impossible for near-frail older adults



The Benefits of ExerciseThe Benefits of ExercisePrimary PreventionPrimary Prevention

• Brisk walking, 30mins/day, 5 times/week– 30% ↓vascular events in 3.5 years follow-up1

• 3 hours of brisk walking/week = 1.5 hours of vigorous exercise per week2

• Resistance exercise and weight training were also beneficial3

1. Manson JE, Greenland P, LaCroix AZ, et al: Walking compared with vigorous exercise for the prevention of cardiovascular events in women N Eng J. Med 347;716, 2002

2. Manson JE, Hu FB, Rich Edward JW , et al: a prospective study of walking as compared with vigouous exercise in the prevention of coronary artery disease in women. N Eng J. Med 341:650, 1999

3. Tanasescu M, Leitzmann MF, Rimm EB, et al: Exercise type and intensity in relation to coronary heart disease in men. JAMA 288:1994, 2002



The Benefits of ExerciseThe Benefits of ExerciseSecondary PreventionSecondary Prevention

Physical activity with 1000kcal/wk – 20-30% ↓ all cause mortality1

For patients without revascularization– Exercise training improves SBP, angina

symptoms and exercise tolerance2

For patients with revascularization– Improvement in QoL, exercise tolerance– ↓29% cardiac events – ↓re-admissions (18.6 vs 46%)3

1. Lee I-M, Skerett PJ: Physical activity and all-cause mortality—What is the dose response relation? Med. Sci Sports exerc33(6Suppl):S459,2001

2. Hambrecht R. Wolf A, Gielen S, et al: Effects of exercise on coronary endoothelial function in patients wwith coronary artery disease. Am J Cadriol 90:124, 2002

3. Belardinelli R, Paolini I, Cianci G, et al: Exercise training intervention after coronary angioplasty: The ETICA trial. J Am Coll Cardiol 37:1891, 2001



Safety of Exercise Safety of Exercise

Exercise without medical advice:– Sudden Cardiac Arrest: 1 per 60,000 pt. hours1

Supervised Programs:– Cardiac events: 8.9 per 1,000,000 pt. hours– Myocardial Infarction: 3.4 per 1,000,000 pt. hours– Mortality: 1.3 per 1,000,000 pt. hours2

1. Fletcher GF, Balady GJ, Amsterdam EA, et al: Exercise standards for testing and training: A statement for healthcarecare professionals from the American eart Association. Circulation 104:1694, 2001

2. Ades PA: Cardiac rehabilitation and secondary prevention of coronary heart disease. N Eng J Med 345:892, 2001



Principles of ExercisePrinciples of Exercise

Avoid:• Unstable angina• SBP ≥ 180mmHg or DBP ≥ 100mmHg• Symptomatic orthostatic BP drop > 20mmHg• Critical aortic stenosis• Acute systemic illness or fever• Uncontrolled arrhythmia• Uncompensated CHF• 3rd degree AV Block (complete heart block)• Acute pericarditis & myocarditis• Recent embolism• Thrombophlebitis• Resting ST displacement ≥ 2mm• Uncontrolled DM• Electrolyte disturbance• hypovolemia



Pre- exercise treadmill Stress Pre- exercise treadmill Stress test was indicated:test was indicated:

1. Age > 402. Age > 30 with

– DM > 10 yrs– HT– Smoking– Hyperlipidemia– Retinopathy– Nephropathy (microalbuminuria)

3. Coronary Artery Disease4. CVA5. Peripheral vascular disease6. Autonomic neuropathy7. Renal Failure



Current Recommendations for Physical Activity Current Recommendations for Physical Activity Among United States AdultsAmong United States Adults

American College of Sports MedicineAmerican College of Sports Medicineand the American Heart Associationand the American Heart Association

• Moderate-intensity* aerobic physical activity for a minimum of 30 minutes on 5 days each week,or

• Vigorous-intensity† aerobic physical activity for a minimum of 20 minutes on 3 days each week,or

• Combinations thereof for adults between the ages of 18 and 65 years,and

• Muscle-strengthening activities for a minimum of 2 nonconsecutive days each week.

Haskell WL, et al, for the American College of Sports Medicine andthe American Heart Association. Circulation. 2007;116:1081-1093.

*Exemplified by a brisk walk; noticeably accelerates heart rate.†Exemplified by jogging; causes rapid breathing and a substantial increase in heart rate.



37

PA Guidelines – Children and Adolescents (ages 6–17)

• 1 hour (60 minutes) or more of daily physical activity that is mixture of moderate and vigorous– It is important to encourage young people to

participate in physical activities that are age appropriate, enjoyable, and offer variety.



PA Guidelines – Adults (ages 18–64)

• Minimum levels a week– 2 hours and 30 minutes moderate-intensity aerobic

activity; or– 1 hour and 15 minutes vigorous-intensity aerobic

activity; or– OR an equivalent combination of the two

• Muscle-strengthening activities 2 or more days/wk



PA Guidelines – Older Adults (ages 65 years and older)

• Follow adult guidelines • If at risk for falls, perform balance exercises• If cannot follow the guidelines for ‘adults,’be as physically active as

abilities and conditions allow• No need for medical clearance



KEEP IT UP!KEEP IT UP!

•It takes about one to three months for regular exercise to have a stabilizing effect on blood pressure. The benefits last only as long as you continue to exercise.



Key Messages

• Any activity is better than none• Accumulate activity in small or large

bouts• Walking is a universally accepted

mode of activity• Gain benefits at any body weight• Pregnant and postpartum women

have a lot to gain by being active• Choose enjoyable activities



SummarySummary• Modification of unhealthy lifestyle practices can

lower blood pressure among hypertensive patients, regardless of age, ethnicity, or gender. These practices include:– Restriction of dietary sodium intake– Reduction of weight if overweight or obese– Initiation or maintenance of a regular aerobic

exercise program.• Lifestyle modifications can augment blood

pressure reduction caused by antihypertensive drugs.



Thank You for Your Attention



MeatMeatTreat meat as one part of the whole meal,

instead of the focus.

• Buy less meat. If it's not there, you won't eat it• Limit meat to 6 ounces a day (two servings)--all

that's needed. Three to four ounces is about the size of a deck of cards.

• If you now eat large portions of meat, cut them back gradually--by a half or a third at each meal.

• Include two or more vegetarian-style (meatless) meals each week.

• Increase servings of vegetables, rice, pasta, and dry beans in meals. Try casseroles and pasta, and stir-fry dishes, having less meat and more vegetables, grains, and dry beans.



Fruits and lowfat foodsFruits and lowfat foods

• Fruits and lowfat foods offer great taste and variety. Use fruits canned in their own juice. Fresh fruits require little or no preparation. Dried fruits are easy to carry with you.

• Try these snack ideas: unsalted pretzels or nuts mixed with raisins; graham crackers; lowfat and fat free yogurt and frozen yogurt; plain popcorn with no salt or butter added; and raw vegetables.



Blood Pressure Reductions ResultingBlood Pressure Reductions Resultingfrom Various Lifestyle Modificationsfrom Various Lifestyle ModificationsTrials of Hypertension Prevention Trials of Hypertension Prevention Phase I Phase I

Trials of Hypertension Prevention Collaborative Research Group. JAMA. 1992;267:1213-1220. Copyright © 1992, American Medical Association. All rights reserved.

-5

-4

-3

-2

-1

0

1

Net

Mean

Ch

an

ge in

B

lood

Pre

ssu

re (

mm

Hg

)

Weight Loss

ReducedSodium

AddedCalcium

AddedPotassium

Measures* 44.4 mmol/24 h1.22 mmol/24 h–58.45 mmol/24 h–5.67 kg

Systolic Blood Pressure

*All values are averages and are statistically significant at P < 0.01.

Diastolic Blood Pressure



Blood Pressure Reductions Resulting fromBlood Pressure Reductions Resulting from Lifestyle Modifications Can Persist Over Time Lifestyle Modifications Can Persist Over Time**

Trials of Hypertension Prevention Trials of Hypertension Prevention Phase II Phase II

Study Group(Baseline SBP

in mm Hg)

Change in SBP at

6 Months

Change in SBP at

18 Months

Change in SBP at

36 Months

Change in SBP at

48 Months

Weight Loss Only(127.6 ± 6.1)

–6.0 (8.1)† –3.6 (7.9)‡ 0.8 (8.7)§ –0.8 (9.0)¶

Sodium Reduction(127.7 ± 6.6)

–5.1 (9.6)† –3.8 (8.2)‡ –0.7 (9.0)§ –0.7 (9.2)¶

Combined(127.4 ±6.5)

–6.2 (8.6)† –3.9 (8.3)‡ –0.5 (9.0) –0.6 (9.3)

Usual Care(127.3 ± 6.4)

–2.2 (8.1) –1.8 (7.0) +0.6 (8.5) +0.3 (8.9)

*The values for the baseline systolic blood pressure (SBP) and the changes in SBPat the different time points are expressed as the mean ± the standard deviation.

Statistical significance found in comparisons with the usual care group: †P < 0.001;‡P < 0.003; §P < 0.03; ¶ P < 0.05.

The Trials of Hypertension Prevention CollaborativeResearch Group. Arch Intern Med. 1997;157:657-667.



Combining Lifestyle ModificationsCombining Lifestyle ModificationsCan Have Additive EffectsCan Have Additive Effectsto Reduce Blood Pressureto Reduce Blood Pressure

Study Group*Change in

Systolic BP†Change in

Diastolic BP†

Control(n=22)

–0.9 mm Hg –1.4 mm Hg

Exercise Only(n=44)

–4.4 mm Hg –4.3 mm Hg

Weight Lossand Exercise

(n=46)–7.4 mm Hg –5.6 mm Hg

*The differences in mean blood pressure (BP) values between the study groups at 6months were statistically significant (multivariate F4,258 = 6.76, P < 0.001).

†All values are expressed as averages of the blood pressure reductions achieved by all

participants within a single study group.

Blumenthal JA, et al. Arch Intern Med. 2000;160:1947-1958.



Effect of Weight Loss on Blood Pressure in Effect of Weight Loss on Blood Pressure in Overweight or Obese Subjects by GenderOverweight or Obese Subjects by Gender

Trials of Hypertension Prevention Trials of Hypertension Prevention Phase I Phase I

Stevens VJ, et al. Arch Intern Med. 1993;153:849-858.

DiastolicDiastolicBlood PressureBlood Pressure

SystolicSystolicBlood PressureBlood Pressure

-4

-3

-2

-1

0

Mean

Ch

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ge (

mm

Hg

)

-4

-3

-2

-1

0

-2.8

-1.1

Men

Women

-2.0

-3.1



Decreasing Dietary Salt Intake Reduces Systolic Decreasing Dietary Salt Intake Reduces Systolic Blood PressureBlood Pressure

Dietary Approaches to Stop Hypertension TrialDietary Approaches to Stop Hypertension Trial

*Error bars represent standard deviation; †140 mmol/day; ‡62 mmol/day.

Reprinted from Obarzanek E, et al. Hypertension. 2003;42:459-467, with permission from Lippincott Williams & Wilkins.

High-Salt

Diet†

124

126

128

130

132

134

136

Systo

lic B

lood

Pre

ssu

re (

mm

Hg

)

1 2 3 4

Weeks on Low-Salt DietWeeks on Low-Salt Diet‡

*

**

**



Effects of Diet on Blood PressureEffects of Diet on Blood PressureDietary Approaches to Stop Hypertension Sodium TrialDietary Approaches to Stop Hypertension Sodium Trial

Appel LJ, et al. N Engl J Med. 1997;336:1117-1124. Copyright © 1997, Massachusetts Medical Society. All rights reserved.

Fruits-and- Vegetables Diet

CombinationDiet*

Systo

lic B

lood

Pre

ssu

re

(mm

Hg

)

Control Diet

122

124

126

128

130

132

Dia

sto

lic B

lood

Pre

ssu

re

(mm

Hg

)Week of Intervention

0 1 2 3 4 5 6 7 878

80

82

84

86

88

0 1 2 3 4 5 6 7 8

Week of Intervention

*Rich in fruits and vegetables, and rich in low-fat dairy products and low in saturated and total fat. 0 = baseline.



Greater Restriction of Sodium Intake Lowers Diet-Greater Restriction of Sodium Intake Lowers Diet-Reduced Blood PressureReduced Blood Pressure

Dietary Approaches to Stop Hypertension Sodium TrialDietary Approaches to Stop Hypertension Sodium Trial

Sacks FM, et al. N Engl J Med. 2001;344:3-10. Copyright © 2001, Massachusetts Medical Society. All rights reserved.

*P < 0.05; †P < 0.011; ‡P < 0.01; ( ) denote 95% confidence interval.DASH = Dietary Approaches to Stop Hypertension

50 mmol/day

Systo

lic B

lood

P

ressu

re (

mm

Hg

)

150 mmol/day 100 mmol/day

Daily Dietary Sodium Content

Control Diet

DASH Diet

–5.9(–8.0 to –3.7)† –5.0

(–7.6 to –2.5)†

–1.3(–2.6 to –0.0)†

–2.1(–3.4 to –0.8)*

–2.2(–4.4 to –0.1)†

–1.7(–3.0 to –0.4)‡

–4.6(–5.9 to –3.2)†

120

125

130

135



Dietary Sodium Reduction Results inDietary Sodium Reduction Results inGreater Blood Pressure ReductionGreater Blood Pressure Reductionin Older Than in Younger Adults*in Older Than in Younger Adults*

Dietary Approaches to Stop Hypertension Sodium TrialDietary Approaches to Stop Hypertension Sodium Trial

Patient Age Groups

Mean SBP Reduction with DASH Diet†

(mm Hg)

Mean SBP Reduction with American Diet†

(mm Hg)

23–41 years 1.0 4.8§

42–47 years 1.8‡ 5.9§

48–54 years 4.3§ 7.5§

55–76 years 6.0§ 8.1§

*Patients were fed a 2,100 kcal diet containing either 150, 100 or 50 mmol sodium daily for 30 days while consuming either the DASH diet or a typical American diet.

†These data reflect a reduction from the highest (150 mmol) to the lowest (50 mmol)level of sodium.

‡p < 0.10; §p < 0.01.DASH = Dietary Approaches to Stop Hypertension; SBP = systolic blood pressure

Bray GA, et al. Am J Cardiol. 2004;94:222-227.



Regular Aerobic Exercise LowersRegular Aerobic Exercise LowersBlood Pressure in Adults withBlood Pressure in Adults with

Mild to Moderate Hypertension* Mild to Moderate Hypertension*

Tsai JC, et al. Clin Exp Hypertens. 2004;26:255-265.

*Values are expressed as the mean ± standard deviation. †P < 0.05 vs. baseline; ‡P < 0.001 vs. baseline.

Control Group Exercise Group

110

120

130

140

150

160

170

141.2 144.4

Baseline Week 6 Week 10


mm

Hg

†‡

136.2 137.9 137.6 131.370

80

90

100

110

mm

Hg

Baseline Week 6 Week 10


† ‡

94.9 95.2 96.2 92.0 98.9 88.9



Even Modest Amounts of Aerobic ExerciseEven Modest Amounts of Aerobic ExerciseCan Lower Systolic Blood PressureCan Lower Systolic Blood Pressure

Reprinted from Ishikawa-Takata K, et al. Am J Hypertens.2003;16:629-633, with permission from Elsevier.

-25

-20

-15

-10

-5

0149±15 149±11 149±10 149±9 149±9

Ch

an

ges in

Systo

lic B

lood

Pre

ssu

re (

mm

Hg

)

None 30–40min/wk

61–90min/wk

91–120min/wk

>120min/wk

*

*†*† *†

*P < 0.01 vs. sedentary control group.†P < 0.01 vs. 30–60 min/wk exercise group.

SD = standard deviation

Baseline Value (mm Hg ± SD)

Exercise Duration



Physical Activity Reduces the Prevalence of Physical Activity Reduces the Prevalence of Hypertension Regardless of Ethnicity Hypertension Regardless of Ethnicity

National Health and Nutrition Examination Survey – Phase IIINational Health and Nutrition Examination Survey – Phase III

15

20

25

30

35

0 0.1-4.9 5+

Pre

vale

nce o

f H

yp

ert

en

sio

n*

(%)

Leisure-Time Physical Activity (Bouts/Week)

African-Americans

Anglo-Americans

Mexican-Americans

Reprinted from Bassett DR Jr, et al. Prev Med. 2002;34:179-186,with permission from Elsevier.

*Hypertension is defined as a systolic blood pressure >140 mm Hg, a diastolic bloodpressure >90 mm Hg, or being treated with antihypertensive medication.



Effect of Antihypertensive Monotherapy Is Effect of Antihypertensive Monotherapy Is Augmented by Lifestyle Modifications*Augmented by Lifestyle Modifications*

Diet-Exercise-Weight Loss Intervention TrialDiet-Exercise-Weight Loss Intervention Trial

Reprinted from Miller ER III, et al. Hypertension. 2002;40:612-618, with permission from Lippincott Williams & Wilkins.

110

120

130

140

150

Blo

od

Pre

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mm

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)

Blo

od

Pre

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re (

mm

Hg

)Time (hours) Time (hours)



60

70

80

90

100

6 10 12 14 16 188 20 22 0 2 4 6 10 12 14 16 188 20 22 0 2 4

Drug and lifestylemodificationsDrug and

lifestylemodifications

Drugtherapyalone†

Drugtherapyalone†

*Low-calorie, low-sodium diet and exercise.†A single antihypertensive drug.

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