This lecture for 3rd year undergraduate student in college of medicine/University of karbala-Iraq. prepare and presented by me in 19/3/2015.

1. Treatment Thresholds
and Non-Pharmacologic
Therapy
By :- Hasanain Ghaleb Khudhair
3th stage medical student
College of Medicine/karbala university-Iraq
19/3/2015

2. Treatment Thresholds
• Recommended Initial Threshold for Starting Antihypertensive
Medication
• 2013
1. Age > 60 without D.M or CKD
2. Age<60 without D.M or CKD
3. Any age with D.M or CKD
joint national committee (JNC) US

3. Non pharmacological treatment
• reduce blood pressure in patients with or without hypertension.
• These approaches
1. may reduce the need for drug treatment
2. complement the effect of antihypertensive drugs
3. occasionally allow antihypertensive drugs to be stopped.
effictivnace
• as much as a single antihypertensive drug.
• Combinations produce even better results.

4. Non pharmacological treatment
1. Obesity and weight reduction
2. Salt intake and salt restriction
3. Alcohol
4. Exercise and physical activity
5. Healthy diet
6. Obstructive sleep apnea
7. other

5. Obesity and weight reduction
• the mechanisms are complex
1. Firstly, there is a tendency to over read blood pressure with an upper
arm cuff.
2. higher salt intake associate with obesity
3. increased sympathetic tone ‫؟‬
4. obstructive sleep apnoea (OSA)

6. Salt intake and salt restriction
• On average, one-third of such patients who reduce their intake of salt
will achieve a reduction in blood pressure of 5/5 mm Hg.

7. • Modest salt restriction can be achieved by not adding salt at table or
when cooking. However, this ‘decreasing’ salt intake only accounts for
10–20% of total salt intake.
• A greater reduction of salt intake can be achieved by reducing intake of
salty foods,
419.23
1006.466 1000
mg/100ml

8. • Unfortunately, in many countries, food labelling is inadequate, so it is
difficult for patients to judge whether some processed foods are
salty.!!!

9. Alcohol
• High intake of alcohol can be related to hypertension

10. Exercise and physical activity
• regular and aerobic (such as fast walking)
regular aerobic exercise for at least 30 min, at least three,
days of the week

11. • Other benefit???
1. Prevent heart diseases
2. D.M
3. Even some cancer such as breast and colon cancer
4. Decrease risks of stroke and depression

12. Healthy diet
• Reduce the fat intake
• saturated fats should be limited to one third of the total intake of fats;--
replaced by monounsaturated fats--

13. • Increases in dietary intake of potassium
• increased consumption of fruits and vegetables

15. Obstructive sleep apnoea
• Overweight
• nasal positive airway pressure (nCPAP) improves symptoms and also
reduces blood pressure.

16. Other lifestyle interventions
• Stress management
short-term reductions in office blood pressure, but they have little effect
on ambulatory blood pressure over 24 h
• Cigarette smoking
stop smoking.
Nicotine replacements can help smoking cessation.

17. For a patient

18. Case study
• Johor 25 year old man ,come to hypertension clinic complained from hypertension .
when taking history ;-
• The diagnosis of HTN from his friend measure the BP after football match which
equal to 150/100 , and fellow by headache which confirmed the diagnosis. He was
so fear and tolled he will never take medication because its cases dependence and
cardiac problem
• On examination the
• BP is 116/80
• HR 78
• Temperature 37.3 c
• BR 15
• Oxygen saturation 98

19. • What is you diagnosis?
• Who to deal with the patient?
• What is the complication of HTN?
• What is the guidelines to treatment HTN?
• What is the new treatment available?