To provide updated, evidence-based recommendations regarding the role of lifestyle modification in the treatment and prevention of hypertension.
Lifestyle modification interventions including exercise, weight reduction, alcohol consumption, dietary modification, intake of dietary cations and stress management are reviewed. Antioxidants and fish oil supplements are also reviewed, although specific recommendations cannot be made at present.
MEDLINE searches were conducted from January 2002 to September 2003 to update the 2001 recommendations for the management of hypertension. Supplemental searches in the Cochrane Collaboration databases were also performed. Reference lists were scanned, experts were contacted, and the personal files of the subgroup members and authors were used to identify additional published studies. All relevant articles were reviewed and appraised independently using prespecified levels of evidence by content and methodology experts.
Key recommendations include the following: lifestyle modification should be extended to nonhypertensive individuals who are at risk for developing high blood pressure; 30 min to 45 min of aerobic exercise should be performed on most days (four to five days) of the week; an ideal body weight (body mass index 18.5 kg/m2 to 24.9 kg/m2) should be maintained and weight loss strategies should use a multidisciplinary approach; alcohol consumption should be limited to two drinks or fewer per day, and weekly intake should not exceed 14 standard drinks for men and nine standard drinks for women; a reduced fat, low cholesterol diet that emphasizes fruits, vegetables and low fat dairy products, and maintains an adequate intake of potassium, magnesium and calcium, should be followed; salt intake should be restricted to 65 mmol/day to 100 mmol/day in hypertensive individuals and less than 100 mmol/day in normotensive individuals at high risk for developing hypertension; and stress management should be considered as an intervention in selected individuals.
All recommendations were graded according to the strength of the evidence and voted on by the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. Individuals with irreconcilable competing interests (declared by all members, compiled and circulated before the meeting) relative to any specific recommendation were excluded from voting on that recommendation. Only those recommendations achieving at least 70% consensus are reported here. These guidelines will continue to be updated annually.
A nation-wide campaign aimed at preventing accidents in the home is being implemented in Norway. 95% of the municipalities acknowledge having received information material from the campaign, 33% report having established accident prevention committees, and 26% report having introduced preventive measures as a result of this national campaign. The study indicates that accidents are not recognized as yet as a major health problem in many municipalities. Identification of accidents as a health problem seems to be an important factor in the preventive efforts. To enhance further accident prevention efforts it seems important to increase awareness of accident as a health problem, and to increase the involvement of key personnel within the community.
* Non-adherence is probably an important source of preventable cardiovascular morbidity and mortality. * However, until now there have been very few large effectiveness studies assessing the relationship between adherence levels to antihypertensive medication and major cardiovascular outcomes for primary prevention of cardiovascular disease.
* The study results suggest that there is an association between better adherence to antihypertensive agents and a relative risk reduction of coronary artery disease. * Adherence to antihypertensive agents needs to be improved so that patients can benefit from the full protective effects of antihypertensive therapies.
Antihypertensive (AH) agents have been shown to reduce the risk of cardiovascular events, including coronary artery disease (CAD). Previous surveys have shown that a substantial number of patients with diagnosed hypertension remain uncontrolled. Non-adherence to AH agents may reduce the effectiveness. The aim was to evaluate the impact of better adherence to AH agents on the occurrence of CAD in a real clinical setting.
The mean patient age was 65 years, 37% were male, 8% had diabetes and 18% had dyslipidaemia. High adherence level (96%) to AH therapy compared with lower adherence level (59%) was associated with a relative risk reduction of CAD events (rate ratios 0.90; 0.84, 0.95). Risk factors for CAD were male gender, diabetes, dyslipidaemia and developing a cardiovascular condition disease during follow-up.
Our study suggests that better adherence to AH agents is associated with a risk reduction of CAD. Adherence to AH agents needs to be improved so that patients can benefit from the full protective effects of AH therapies.
Cites: Am J Hypertens. 1997 Oct;10(10 Pt 1):1097-1029370379
The Alpha-Tocopherol, Beta-Carotene (ATBC) Lung Cancer Prevention Study was a randomized, double-blind, placebo-controlled, 2 x 2 factorial design, primary prevention trial testing the hypothesis that alpha-tocopherol (50 mg/day) and beta-carotene (20 mg/day) supplements reduce the incidence of lung cancer and possibly other cancers. Total and disease-specific mortality and incidence of various diseases and symptoms were monitored for safety. Between 1985 and 1993, 29,133 eligible male smokers aged 50 to 69 years at entry were randomized to receive daily active supplements or placebo capsules for 5 to 8 years (median 6.1 years), accumulating 169,751 follow-up years. This report describes the study design, methods, and protocol as well as the baseline characteristics and capsule compliance of the participants. The ATBC Study is the largest lung cancer chemoprevention trial conducted to date.
Comment In: Ann Epidemiol. 1994 Jan;4(1):758205274
Anxiety-related disorders are among the more common ailments of modern societies. Presumably, their prevalence is partly due to environmental factors, which suggests that anxiety may be one of the health problems that are aggravated by discords (adverse mismatches) between the present way of life and what our genes are adapted to. Consequently, it may be possible to find preventive measures by using the perspective of evolutionary medicine. I shall argue that the prevalence of anxiety-related problems reflects that the nerve circuitry and endocrine activity associated with the fear function have developed beyond normal. Moreover, that this expansion is due to excessive or abnormal triggering, particularly at an early age. Possible discords that may be responsible, such as present child care practices, will be discussed.