Hypertension

• Hypertension is defined as SBP 140mmHg or higher and/or DBP 90mmHg or higher
• SBP represents the pressure in blood vessels when the heart contracts or beats.
• DBP represents the pressure in the vessels when the heart rests between beats.
• Elevated BP: SBP 120-129 and DBP less than 80
• Hypertension Stage 1: SBP 130-139 and DBP 80-89
• Hypertension Stage 2: SBP 140 or higher and DBP 90 or higher
• Hypertensive Crisis: SBP higher than 180 and DBP higher than 120
• NICE Guidelines (2016) - Lifestyle interventions: Healthy diet and regular exercise, reduce stress, limit alcohol, caffeine and salt, stop smoking, support groups.
• NICE Guidelines (2016) - Antihypertensive drug treatment. Aged under 55 - ACE inhibitor or aged 55 and over/ black person of African or Caribbean family origin - Calcium-channel blocker.
• SPRINT: US adults ≥50yrs with hypertension. More intensive antihypertensive therapy than currently recommended. Rapid and sustained difference in SBP.
• Potassium: Lower BP and greater effect in presence of high salt intake and hypertension. Need to be careful with other conditions: chronic kidney disease.
• Calcium and Magnesium: inconsistent results - modest positive effects. Inverse associations between risk of high BP and intake of low-fat dairy foods, milk and yogurt.
• Sodium: avoid excessive intake, keep <6g/day.
• Caffeine: u shaped curve - lower BP in those who abstain or drink high amounts but increase BP in moderate intake (5 cups/day)
• Omega 3: meta-analyses shown EPA and DHA lower BP
• Alcohol: dose related response, reducing alcohol intake lowers SBP (3.3) and DBP (2.0)
• Prospective Urban Rural Epidemiology (PURE): dairy consumption associated with lower risk of mortality and major CVD events in a diverse multinational cohort.
• Dietary Approaches to Stop Hypertension (DASH): 6-8 servings/day of whole grains, 4-5 servings/day of vegetables, 4-5 servings/day of fruits, 2-3 servings/day of fat-free or low- fat dairy, 4-5 servings/week of nuts, seeds and legumes, less than 6 servings/day of lean meat, poultry and fish, less than 5 servings/week of sweets, 2-3 servings/day of fats and oils