Exam 1: HTN Flashcards
1
Q
Def: blood pressure
A
Pressure of blood pushing against the walls of your arteries
2
Q
Def: systolic BP
A
Pressure of blood exerting against artery walls when heart is beating
3
Q
Def: Diastolic BP
A
Pressure of blood exerting against artery walls while heart is resting between beats
4
Q
Def: Systole
A
Ventricular contraction and blood ejection
5
Q
Def: Diastole
A
Ventricular relaxation and blood filling
6
Q
T/F: BP normally rises and falls throughout the day
A
True
7
Q
Def: HTN
A
When BP is consistently too high
8
Q
HTN: Uncontrollable Risk Factors: Genetics: 3 factors
A
- Race – African Americans develop HTN more often than caucasians (earlier and more severe)
- Family History – Predisposes pt developing HTN
- Age – BP increases with age >35 (men >45 and women >55)
9
Q
HTN: Controllable Risk Factors: 6 Factors
A
- Obesity: BMI of 30+ more likely to develop HTN
- Poor diet: high NA intake, salt sensitivity, low K intake
- EtOH: heavy and regular consumption can increase BP
- Sedentary lifestyle: Increased likelihood of becoming overweight and developing HTN
- Stress: Possible risk factor (difficult to measure)
- Smoking
10
Q
HTN: Drug Induced
A
- Oral contraceptives
- decongestants
- systemic NSAIDs
- systemic corticosteroids
- Cyclosporine
- herbals (Ma Huang, St. John’s Wort)
- Amphetamines
- MAOIs, SNRIs, TCAs
- Recreational drugs (“bath salts”, cocaine)
- High Na+ agents or solutions
11
Q
HTN: Etiology
A
- No clear, readily discernable cause of increased BP (primary or “essential HTN”)
- Secondary causes: renal artery stenosis, sleep apnea, endocrine disorder, cerebral damage, drug induced
12
Q
HTN: Normal BP levels + treatment/ f/u recommendations
A
SBP: <120
DBP: <80
Promote optimal lifestyle habits
Reassess in 1 year
13
Q
HTN: Elevated BP levels + treatment/ f/u recommendations
A
SBP: 120-129
DBP: <80
Non-pharmacologic therapy
Reassess in 3-6 months
14
Q
HTN: Stage 1 HTN levels + treatment/ f/u recommendations
A
SBP: 130-139
DBP: 80-89
ASCVD < 10% - non-pharmacologic therapy; reassess in 3-6 months
ASCVD > 10% - non-pharmacologic therapy AND BP med; reassess in 1 month
15
Q
Measuring BP: Cuff length
A
~2/3 of the pt’s arm length
16
Q
Measuring BP: bladder width
A
~40% of arm circumference
17
Q
Measuring BP: Bladder length
A
Encircle 80% of arm circumference
18
Q
Measuring BP: If arm is HIGHER than heart level ____estmiation of BP
A
Under
19
Q
Measuring BP: If arm if LOWER than heart level __estimation of BP
A
Over
20
Q
Measuring BP: If cuff is too SMALL, ___estimation of BP
A
over
21
Q
Measuring BP: If cuff is too LARGE, ___estimation of BP
A
UNDER
22
Q
HBPM Counseling Points
A
- Check and record x2/day (AM before meds, PM before dinner)
- Do NOT check BP 30 min after exercise, smoking, or intaking caffeine
- Pt should be seated with arm at heart level and resting for at least 5 min
- Avoid clothing with tight sleeves
- Midline of cuff should be over arterial pulse, lower end of cuff should be above bend of elbow
23
Q
HTN: ACEI: MOA
A
Inhibits the conversion of Angiotensin I to II
24
Q
HTN: ACEI: 3 Agents and dosing
A
- Lisinopril 10-40mg
- Captopril 12.5-150mg (BID/TID)
- Enalapril 5-40mg (QD/BID)
25
HTN: ACEI + ARBs: ADEs
ACEI-induced cough (increased bradykinin)
Angioedema (more common in AA pt)
Hyperkalemia
Benign increase in SCr (<30% from baseline)
26
HTN: ARBs: MOA
Antagonizes the angiotensin II type 1 receptor
27
HTN: ARBs: 3 Agents and Dosing
1. Losartan 25-100mg QD
2. Valsartan 80-320mg QD
3. Irbesartan 150-200mg QD
28
HTN: ACEI and ARBs Clinical considerations
First line therapy
2nd line in AA pts due to low renin predisposition
Losartan's uricosuric properties may be useful in pts with gout
Contraindicated with pregnancy
DO NOT USE ACEI with ARBs
29
HTN: More than ___ adults in the US have HTN
78 million
30
HTN: Primary Etiology
Unknown (~90% of all HTN cases)
31
HTN: Secondary Etiology
Renal artery stenosis, sleep apnea, endocrine disorders, cerebral disorder, drug-induced
32
HTN: BP = CO x TPR
| Most pts with essential HTN have normal ___ but increased ____
Normal CO but increased TPR
33
HTN: ACEI + ARB: Monitor
BP, K+, SCr, BUN
34
HTN: CCBs: 2 Types and MOA
1. DHP CCB - block slow Ca channels in vascular smooth muscle, dilates peripheral arterioles
2. Non-DHP CCB - block slow Ca channels in myocardium, relaxing coronary vascular sm. muscle, decrease HR and AV node conduction
35
HTN: CCBs: Agents and dosing
1. DHP CCBs: Amlodipine 5-10mg daily
| 2. Non-DHP CCBs: diltiazem 120-540mg daily, verapamil
36
HTN: CCBs: Clinical considerations
Alcohol increases effect of CCB
DHP CCB is 1st line therapy
Preferred agent in AA pts and elderly pts with isolated systolic HTN
37
HTN: CCBs: DHP ADEs
```
Pedal edema
Gingival hyperplasia
Headache
Reflex tachycardia
Orthostatic hypotension
```
38
HTN: CCBs: Non-DHP ADEs
Bradycardia
| Constipation (verapamil)
39
HTN: CCBs: Non-DHP Contraindications
Heart block and HF
40
HTN: CCBs: DHP: DDIs
Simvastatin doses >20mg (contraindicated)
41
HTN: CCBs: Non-DHP: DDIs
```
P450 substrates
Simvastatin doses >10mg (contraindicated)
Beta blockers (avoid use)
```
42
HTN: CCBs: Monitor
BP
HR
Edema
43
HTN: Thiazides: MOA
Inhibit sodium reabsorption in DCT (increases Na and H2O excretion)
44
HTN: Thiazides: 2 Agents and dosing
HCTZ 12.5-25mg daily
| Chlorthalidone 12.5-50mg daily
45
HTN: Thiazides: Clinical considerations
Relative contraindication in sulfa allergy
Use with caution in gout and renal insufficiency
First line therapy
Little efficacy in CrCl <30ml/min
Little benefit from HCTZ doses >25mg
Avoid in pts with active gout flares
46
HTN: Thiazides: Agent equivalents
25mg HCTZ = 12.5mg Chlorthalidone
47
HTN: Loops: MOA
Selectively inhibits NaCl reabsorption in the thick ascending limb of loop of Henle
48
HTN: Loops: Agent and Dose
Furosemide 20-80mg (1-2x/day)
49
HTN: Loops: Clinical considerations
Relative contraindication in sulfa allergy
Use with caution in gout and renal insufficiency
Ethacrynic acid does not contain a sulfa moiety
Preferred in symptomatic HF and later stage CKD (eGFR <30)
Use with caution in tinnitus
Most potent diuretic class
50
Which diuretic class is MOST potent?
Loop
51
HTN: Loops: Agent equivalents
Bumetanide 1mg = torsemide 20mg = furosemide 40mg
52
HTN: Thiazides and Loop: ADE
HYPER: uricemia, glycemia
HYPO: kalemia, natremia, volemia, tension
53
HTN: Thiazides and Loop: Relative ADEs: Hyperuricemia
Thiazides > Loops
54
HTN: Thiazides and Loop: Relative ADEs: Hyperglycemia
Thiazides = Loops
55
HTN: Thiazides and Loop: Relative ADEs: Hypokalemia
Thiazides < Loops
56
HTN: Thiazides and Loop: Relative ADEs: Hyponatremia
Thiazides < loops
57
HTN: Thiazides and Loop: Relative ADEs: Hypovolemia
Thiazides < loops
58
HTN: Thiazides and Loop: Relative ADEs: Hypotension
Thiazides < loops
59
HTN: Diuretics: Monitor
Obtain a complete metabolic panel to assess electrolyte levels and renal fxn 2 to 4 weeks after initiating therapy
K+, Glu, Na+, SCr, CrCl, Lipids, SUA
60
HTN: BB: MOA
Competitively inhibit catecholamine NT at B1 (cardiac) and B2 (SM/lungs) receptors
61
HTN: BB: Nonselective agents (B1 and B2 activity) and dosing
Propranolol 160-480mg BID
Propranolol LA 80-320mg daily
Nadalol 40-120mg daily
62
HTN: BB: 4 B1 selective (cardioselective) agents and dosing
Atenolol 25-100mg daily
Metoprolol succinate 50-400mg (daily, BID)
Metoprolol tartrate 50200mg (BID)
Bisoprolol 2.5-10mg daily
63
HTN: BB: 2 Agents with B2 Agonist properties and dosing
Acebutolol 200-800mg BID
| Pindolol 5-10mg BID
64
HTN: BB: Mixed a1/BB Agents and dosing
Carvedilol (Coreg CR) 20-80mg daily
Carvedilol (Coreg) 6.25-50mg BID
Labetolol 200-800mg BID
65
HTN: BB: Mixed BB/NO Agent and dosing
Nebivolol (Bystolic) 6-10mg daily
66
HTN: BB: Nonselective clinical considerations
Avoid in pts with reactive airway disease
67
HTN: BB: Cardioselective B1: Clinical Considerations
Preferred in pts with bronchospastic airway disease (that require BB) due to limited effect on pulmonary fxn
Selectivity is lost at higher doses
68
HTN: BB: Agents with B2 agonist properties (ISA): Clinical considerations
Rarely used
Useful in pts who develop severe bradycardia with other non-ISA BB
Does NOT decrease mortality post MI
69
HTN: BB: Mixed a1/BB: Clinical Considerations
Less effect on HR and CO > pure BB
Carvedilol: mortality benefit HF
Labetolol: preferred in pregnancy, hypertensive emergency (IV), has beta agonist effects
70
HTN: BB: Mixed BB/NO: Clinical considerations
```
B1 selective (3.5x more selective > bisoprolol)
Role in HF questionable
```
71
HTN: BB: General considerations
Not first line for uncomplicated HTN
Reserve for pts with co-existing condition (useful in HF, SIHD, post MI, afib, migraine, essential tremor)
Abrupt d/c cause rebound HTN (taper over 1-2 weeks)
Fatigue (2-6 weeks)
Caution in asthma/COPD
72
HTN: BB: General Considerations: C/I
Sinoatrial or AV node dysfunction, decompensated HF, severe bronchospastic disease
73
HTN: BB: ADEs
```
Bronchospasm
Bradyardia
Fatigue, exercise intolerance
Insomnia/sleep disturbances
Sexual dysfunction
Masked s/sx of hypoglycemia (except sweating)
```
74
HTN: BB: DDI with
Non-DHP CCBs
75
HTN: Which HTN drug classes should not be used together?
1. BB and Non-DHP
2. ACEI and ARBs
3. Direct Renin Inhibitors and ACEI/ARBs
4. Aldosterone antagonists and K+ sparing diuretics
76
HTN: BB: Monitor
BP, HR, Glu if you have DM, Symptoms of asthma/COPD
77
HTN: A1 blockers: MOA
Selectively blocks a1 receptors on sm muscle cells of peripheral vasculature
78
HTN: A1 blockers: 3 agents and dosing
1. Doxazosin 1-8mg daily
2. Prazosin 2-20mg (BID/TID)
3. Terazosin 1-20mg daily
79
HTN: A1 blockers: Clinical considerations
2nd line agent in men with BPH
| NO benefit in preventing MI/CHD
80
HTN: A1 blockers: ADEs
```
Orthostatic hypotension
First dose syncope (1-3 after first dose)
Dizziness
Sexual dysfunction
Reflex tachycardia
Peripheral edema
```
81
HTN: A1 blockers: Monitor
BP
| Monitor pt after 1st dose and with each dose increase
82
HTN: A2 agonist: MOA
stimulate A2 presynaptic receptors in the brain to increase inhibitory neuron activity and decrease sympathetic outflow
83
HTN: A2 agonists: 3 Agents and dosing
1. Clonidine 0.1-0.8mg BID
2. Clonidine path 0.1-0.3mg weekly
3. Methyldopa 250-1000mg BID
84
HTN: A2 agonists: Clinical considerations
NOT a first line therapy
Avoid in HF pts
Possibly indicated in resistant HTN (clonidine) or pregnancy (methyldopa)
85
HTN: A2 agonists: ADEs
CNS effects (impaired concentration, nightmares, sedation, drowsiness, fatigue, vertigo (methyldopa)
Orthostatic hypotension
Dry mouth
Depression (clonidine)
Abrupt d/c can cause rebound HTN (use clonidine patches to decrease rebound HTN)
86
HTN: A2 Agonists: Monitor
BP
Mental state
HR
Methyldopa only: LFTs, CBC
87
HTN: Direct Vasodilators: MOA
Act directly on vascular sm muscle to dilate arterioles (not veins)
88
HTN: Direct vasodilators: 2 agents and dosing
1. Minoxidil 10-40mg (QD or BID)
| 2. Hydralazine 20-200mg (BID/TID/QID)
89
HTN: Direct vasodilators: clinical considerations
Little/no place as first-line agents
May consider 3rd or 4th line
For use in resistant HTN
90
HTN: Direct vasodilators: ADEs
```
Reflex tachycardia, palpitations
Headache, dizziness
Na+/H2O retention
Hirsutism (minoxidil)
Lupus-like syndrome (higher doses of hydralazine)
```
91
HTN: Direct vasodilators: Monitor
BP, HR, SCr, hypotension, edema
92
HTN: Direct Renin inhibitors: MOA
Blocks RAAS at its initial point of activation, prevents formation of ATI and ATII
93
HTN: Direct Renin Inhibitors: Agent and dosing
Aliskiren 150-300mg daily
94
HTN: Direct Renin Inhibitors: Clinical considerations
Do not use with ACEI or ARBs
| Similar cautions as ACEI/ARBs
95
HTN: Direct Renin Inhibitors: ADEs
```
Slight rise in BUN, SCr at initiation of therapy
Hyperkalemia
GI upset (dose-related)
Cough (less than w/ ACEI)
Only 2 cases of angioedema reported
High fat meals decrease absorption
```
96
HTN: Direct Renin Inhibitors: Monitor
K+, BUN, Scr
97
HTN: Aldosterone Antagonists: MOA
Inhibitor aldosterone receptor in DCT, increase NaCl/H2O excretion while conserving K+
Block effect of aldosterone on arteriolar smooth muscle
98
HTN: Aldosterone Antagonist: 2 Agents and dosing
1. Eplerenone 50-100mg daily/BID
| 2. Spironolactone 25-100mg daily/BID
99
HTN: Aldosterone antagonists: Clinical considerations
Avoid aldosterone receptors blockers if: Anuria, K+ > 5mEq/L or on K+ supps or K+ sparking diuretics, acute renal insufficiency (eGFR <30ml/min)
100
HTN: Aldosterone antagonists: Special population
Used in HF in pts with reduced LVEF, primary aldosteronism, resistant HTN
101
HTN: Aldosterone antagonists: ADEs
```
Hyperkalemia
Hyponatremia
Gynecomastia (male breast)
Impotence
Hypotension
```
102
HTN: Aldosterone antagonist: Monitor
K+, CrCl
103
HTN: K-Sparing Agents: MOA
Reduce Na+ absorption into collecting duct and tubules
104
HTN: K-sparing agents: Agents and Dosing
Amiloride 5-10mg daily/BID
Triamterene 50-100mg daily/BID
Triamterene/HCTZ TABS 37.5/25 - 75/50mg daily
Triamterene HCTZ CAPS 27.5/75 = 25/50mg daily
105
HTN: K-sparing agents: Clinical Considerations
NOT recommended for initial tx of HTN per ACC/AHA and JNC8
weak diuretics, primarily used to prevent hypokalemia caused by other agents (i.e. thiazide or loop diuretics)
Avoid in pts with significant CKD (GFR <45)
Contraindicated if K>5.5, receiving K supps, or on meds that can increase K
106
HTN: Which 2 med classes are recommended to AVOID if K+ > 5 (5.5), on K+ supps, or meds that can increase K
Aldosterone antagonists and K-sparing agents
107
HTN: K-sparing agents: Monitor
K+, GFR
108
HTN: Goals of therapy
<130/80 per ACC/AHA 2017
109
HTN: Goals of Therapy: Lowest risk of CVD mortality at SBP of ____
120-124 mmHg
110
HTN: All guidelines support use of ________ as first line therapy
Thiazides, CCBs, ACEI/ARBs
111
HTN Classifications: Normal BP
120/80mmHg
112
HTN Classification: Elevated BP
120-129/<80 mmHg
113
HTN Classification: Stage 1 HTN
130-139/80-90 mmHg
114
HTN Classification: Stage 2 HTN
>140/90
115
HTN Classification: Normal BP: Treatment and F/U
Continue healthy lifestyle habits
| F/U in 1 year
116
HTN Classification: Elevated BP: Treatment and F/U
Encourage therapeutic lifestyle modifications
| F/U in 3-6 months
117
HTN Classification: Stage 1 HTN: Treatment and F/U
ASCVD< 10%: Lifestyle changes
F/U 3-6 months
Clinical ASCVD, DM, CKD or ASCVD > 10%: pharmacotherapy + lifestyle changes
F/U in 1 month
118
HTN Classification: Stage 2 HTN: Treatment and F/U
Start pharmacotherapy + lifestyle changes (consider 2 drugs)
BP >20/10mmHg above goal, start 2 diff meds (use caution for elderly)
BP >160/100 should be promptly treated, carefully monitored, and subject to upward med dose adjustment
F/U in 1 month
119
HTN: which drug classes are shown to prevent CVD and are 1st line of therapy
Thiazide, CCB, ACE/ARB
120
HTN: Which drug class is superior for HF prevention?
Thiazide superior compared to amlodipine (CCB) and lisinopril (ACEI)
121
HTN: Which drug class is LESS effective for lowering BP and preventing stroke?
ACEI less effective than CCB and thiazide
122
HTN: Which drug class is equally effective in reducing CVD events other than HF?
CCBs = diuretics
123
HTN: Which drug classes are contraindicated for sulfa allergy?
Thiazides and loops
124
What is white coat HTN?
Pts get nervous when they get BP measured at a clinic so BP is more elevated than normal
125
Why should pts not use ACEI and ARBs together for HTN?
Increased risk of CV and renal risk
126
T/F: BB are recommended as 1st line therapy
False -- BB are NOT recommended as 1st line in absence of CV co-morbidities such as CAD and CHF
127
HTN: Which drug classes are NOT considered first line?
Alpha/beta blockers, alpha agonists, direct vasodilators, aldosterone antagonists, loop diuretics
128
T/F: If pt is not at goal on 2-3 meds, adding fourth med can fix their HTN
False -- additional treatment above 3 meds tends to be ineffective or poorly tolerated
!!!: consider referral to HTN specialist
129
HTN: Special Populations and Therapy: Black patients
Higher prevalence of HTN, lower control rates, higher rates to M/M attributed to HTN
Therapy: Thiazide or CCB (most pts will need 2+ meds to reach goal)
130
HTN: Compare: ACEI and CCB for HF and stroke
ACEI LESS effective than CCB in preventing HF and stroke
131
HTN: Compare: Thiazide and ACeI for CVD
Thiazide MORE effective in improving cerebrovascular, HF, and combined CV outcomes than ACEI
132
HTN: Compare: CCB and Thiazide for HF
CCB LESS effective than thiazide in preventing HF but same for other CV
133
HTN: Compare: ACEI and CCB for reducing BP
ACEI is less effective in reducing BP compared to CCB (possibly due to low renin production)
134
HTN: Special Populations and Therapy: Elderly
Goal BP <130/80 (use clinical judgement)
Complicated in elderly due to high risks, ADEs, poly-pharmacy, etc.
Therapy: DHP CCBs effective in older pts with ISH
135
HTN: Special Populations and Therapy: Men
Antihypertensives have effect on erectile dysfunction
Neutral: ACEI/CCB
Worse: Thiazides/BB
Note: treat compelling indications first
136
HTN: Special Populations and Therapy: Pregnancy
Preferred therapies: Hydralazine or labetalol (severe elevations of BP), nifedipine, methyldopa
AVOID: sodium nitroprusside d/t risk of cyanide toxicity
C/I: ACEI/ARB, aliskiren, spironolactone
137
HTN: Special Populations and Therapy: Pregnancy: Preeclampsia
BP > 140/90mmHg occuring after 20weeks of gestation in women who were normotensive + one of the following: >300mg proteinuria in 24h, platelets <100,000, LFTs >2x ULN, development of renal dysfunction, pulmonary edema, cerebral/visual disturbances
Eclampsia: preeclampsia + new onset of seizures
Treatment: birth of baby
138
HTN: Special Populations and Therapy: HF
BP Goal <130/80 mmHg
1st line:
ACEI - cornerstone of HF therapy
ARB - valsartan and candesartan
BB - class 2-3 HF, metoprolol succinate, bisoprolol, carvedilol
Diuretic
Aldosterone antagonist 0 indicated in NYHA class 2 HF with LVEF <30 or class 3-4
AVOID: non-DHP CCB
139
HTN: Special Populations and Therapy: Post-MI
BP Goal: <130/80
1st Line:
ACEI/ARB
BB - choose one without ISA, start with metoprolol
140
HTN: Special Populations and Therapy: Stable Ischemic Heart Disease (SIHD)
BP Goal <130/80
1st line: BB, ACEI/ARB
BB: metoprolol, carvedilol, nadolol, bisoprolol, propranolol, timolol (AVOID atenolol)
Uncontrolled HTN:
- with angina: DHP CCB
- without angina: DHP CCB, thiazide, or aldosterone antagonist
141
HTN: Special Populations and Therapy: Diabetes
Goal <130/80
Therapy: ACEI/ARB (CCB or thiazide)
ACEI/ARB recommended in pt with UACR > 300mg/g or 30-299mg/g
CCB/Thiazide first line for AA pts
Loop diuretic considered if CrCl/eGFR <30
142
HTN: Special Populations and Therapy: CKD
BP Goal 130/80
1st line: ACEI/ARB
2nd line (add on) or 1st line with stage 1 or 2 CKD and UACR <300:
- Thiazide (less effective than loops in pts with decreased kidney fxn)
- CCB (non-DHP > DHP in terms of kidney protection, BUT DHPs preferred due to ADE profile)
143
HTN: CKD Definition
Kidney damage for > 3 months (GFR <60 for at least 3 months, with or without UACR > 300)
144
HTN: Special Populations and Therapy: Recurrent Stroke Prevention
BP Goal: <130/80 (lower BP to goal once stabilized)
1st line: ACEI/ARB, thiazide, combination of 2 (combo shown to decrease incidence of recurrent stroke)
2nd line: CCB, aldosterone antagonist
145
HTN: Resistant HTN
Office BP above goal AND >3 HTN meds
Office BP at goal with >4 HTN meds
Risk factors: older age, obesity, CKD, black race, DM
146
HTN: Hypertensive Urgency vs Emergency
Urgency: Severe elevation >180/120 without target organ damage (TOD), cause usually non-adherence
Emergency: BP >180/120 with TOD
Decrease BP by 25% within 1 hour, immediate treatment with IV agents to salvage viable organ tissue
147
HTN: Non-pharmacological treatment: Examples
Weight reduction, exercise, decrease Na intake, increase potassium intake, decrease alc intake, DASH diet
148
HTN: Non-pharmacological treatment: Weight reduction
5-10% of weight loss (ultimate goal IBW)
~1 mmHg for 1kg lost
Synergy from weight loss and HTN meds
~5mmHg SBP reduction
149
HTN: Non-pharmacological treatment: Exercise
30-45min or aerobic activity most days of the week OR 90-150 min per week
Regular and modest aerobic activity decreases BP in normotensive and HTN pts
~5-8 mmHg SBP reduction
150
HTN: Non-pharmacological treatment: Sodium intake
< 2.4g of Na+/day (~1 tsp of table salt)
Optimal goal <1.5g of Na+/day
Reduce daily Na+ intake by 1g from initial
Decreases salt and water retention
~5-6 mmHg SBP reduction
151
HTN: Non-pharmacological treatment: Potassium intake
3500-5000mg K+/day through diet
K+ can lower BP especially in pts (response can double)
~4-5 mmHg SBP reduction
152
HTN: Non-pharmacological treatment: Alcohol Consumption
Men: limit to 2 drinks/day
Women: limit to 1 drink/day
Most benefit in pts who drink more than 3 drinks/day
~4mmHg SBP reduction
153
HTN: Non-pharmacological treatment: DASH diet
Fresh foods, low fat dairy, reduced sat fats, avoid processed foods
Particularly effective for middle-aged and older pts, African-americans, and those who already had high BP
~11 mmHg SBP reduction
154
HTN: Non-pharmacological treatment: Other coniderations
Limit caffeine to 2 cups/day or 8 fl oz
Smoking cessation
Nutritionist referral?
