Lifestyle modifications
- Weight reduction
- Weight loss of 22 lb (10 kg ) may decrease SBP by approx. 5 to 20 mm Hg
- Calorie restriction and physical activity
- DASH eating plan
- Fruits, vegetables, fat-free or low-fat milk, whole grains, fish, poultry, beans, seeds, and nuts
- Dietary sodium reduction
- < 2300 mg/day for healthy adults
- < 1500 mg/day for
- African Americans
- Middle-aged and older
- Those with hypertension, diabetes, or chronic kidney disease
- Moderation of alcohol intake
- Physical activity
- Moderate-intensity aerobic activity, at least 30 minutes, most days of the week
- Vigorous-intensity aerobic activity at least 20 minutes, 3 days a week
- Muscle-strengthening activities at least 2 times a week
- Flexibility and balance exercises 2 times a week
- Avoidance of tobacco products
- Nicotine causes vasoconstriction and elevated BP
- Smoking cessation reduces risk factors within 1 year
- Psychosocial risk factors
- Low socioeconomic status, social isolation and lack of support, stress, negative emotions
- Activate SNS and stress hormones
- Drug therapy and patient teaching
- Follow-up care
- Identify, report, and minimize side effects
- Orthostatic hypotension
- Sexual dysfunction
- Dry mouth
- Frequent urination
- Time of day to take drug
- Diuretics promote sodium and water excretion, reduce plasma volume, and reduce the vascular response to catecholamines.
- Adrenergic-inhibiting agents act by diminishing the SNS effects that increase BP. Adrenergic inhibitors include drugs that act centrally on the vasomotor center and peripherally to inhibit norepinephrine release or to block the adrenergic receptors on blood vessels.
- Direct vasodilators decrease the BP by relaxing vascular smooth muscle and reducing SVR.
- Calcium channel blockers increase sodium excretion and cause arteriolar vasodilation by preventing the movement of extracellular calcium into cells.
- Angiotensin-converting enzyme (ACE) inhibitors prevent the conversion of angiotensin I to angiotensin II and reduce angiotensin II (A-II)–mediated vasoconstriction and sodium and water retention.
- A-II receptor blockers (ARBs) prevent angiotensin II from binding to its receptors in the walls of the blood vessels.
