LIFESTYLE MODIFICATION for controlling. STAGE 1 HYPERTENSION & STAGE 11 HYPERTENSION.

The current criteria of blood pressure status.

Normal - <120 />80

Stage 1 – 130 -140 /80-90

Stage 11- >140 / >90.

BP of > 180 / 120 is considered hypertensive crisis.

Clinical trials &meta- analysis Have shown that even Stage 1 hypertension is associated with high cardiovascular mortality and should be treated. 80% stroke patients are found to have hypertension at the time of diagnosis and hypertension is the 2nd most common cause of heart failure.

I have always been telling my unit medical officers that lower the blood pressure without symptoms longer you live but they never believed me or took it serious. But it has now proved beyond doubt. ( annex trial data- some screenshots).

To start with there are many non-pharmacological measures that alone may be sufficient in BP reduction in early stages – called lifestyle modifications. Many medications can be avoided for a long or BP can be controlled with a few doses if practiced adequately or aggressively!

1. Weight reduction to at least 5-10% of initial weight in overweight or obese patients would reduce blood pressure considerably. 80% of weight reduction is achieved by dietary measures and 20% by exercise. When both combined there would be an additive effect. Please note that an attempt at crash reduction may have adverse consequences. It has to be gradual. The first 2-3 kg reduction is due to water loss, so don’t get elated with the initial loss.

1mm BP reduction is seen with a loss of 1kg of weight.

2. High salt intake is a definite contributing factor. Still, about 20% of Sri Lankan families add salt to rice. This should be immediately stopped. Salt-rich food like dry fish, pickles, etc should be avoided, and adding salt at the dining table should be stopped ( no separate cooking or adding salt after taking curries for the patient should strictly be avoided. All should learn a less salt diet).

3. Consumption of alcohol and smoking to be stopped completely.

4. Should begin to do some brisk exercises, the minimum being 20mts at least 3 times per week. How brisk is a question many people ask? It should be to a level of maintaining your heart rate to 120 to 130 beats/ Mt. Higher for young. Many people have many excuses for not doing it. Always there are alternative forms of exercise.

5. Improving potassium potassium-rich diet helps to reduce BP. Eat plenty of fresh vegetables & fruits.

6. Magnesium supplements have been shown to help reduce BP. Magnesium-rich diet is advised. Magnesium tablets are now available & you can take a 400mg tab once daily for a few months.

7. Stress is an important contributing factor. Dry to minimize by many ways available.

8. Meditation & yoga may help in relaxation & reduction of BP.

9. A good night's sleep, a joyful evening with family and/or friends, a relaxed walk, etc help reduce stress.

10. All lifestyle modifications together can reduce the BP by 14.2 /7.4 according to the Premier trial. This may avoid treatment in some but certainly reduces the number & doses of medications required to control the BP.