NON-PHARMACOLOGICAL

TREATMENT OF
HYPERTENSION

Stella Palar
 Hypertension treatment strategy: JNC VII
Lifestyle modifications

Not at goal blood pressure (<140/90 mmHg)

(<130/80 mmHg for patients with diabetes or chronic kidney disease)

Initial drug choices

Without compelling With compelling
indications indications

Stage 1 hypertension Stage 2 hypertension

(SBP 140-159 or DBP (SBP 160 or DBP 100 mmHg) Drug(s) for the
90-99 mmHg) Two-drug combination for compelling indications
Thiazide-type diuretics most (usually thiazide-type
for most. May consider diuretic and ACE-I or Other antihypertensive
ACE-I, ARB, BB, CCB ARB, or BB, or CCB) Drugs (diuretics, ACE-I,
or combination ARB, BB, CCB) as needed

Not at blood pressure goal

Optimize dosages or add additional drugs until goal blood pressure is achieved.
Consider consultation with hypertension specialist.
SBP, systolic blood pressure; DBP, diastolic blood pressure; ACE-I,
angiotensin-converting enzyme inhibitor; ARB, angiotensin II JNC VII. JAMA 2003;289:2560-2572
receptor blocker; BB, beta-blocker; CCB, calcium-channel blocker
 Treatment initiation: JNC VII
Normal Pre- Stage 1 Stage 2
hypertension hypertension hypertension

Lifestyle Encourage Yes Yes Yes

modification

Initial drug therapy

Without No antihypertensive drug Thiazide-type Two-drug
compelling indicated diuretics for most; combination for
indication may consider most (usually
ACE-I, ARB, BB, thiazide-type
CCB, or diuretic and
combination ACE-I or ARB or
BB or CCB)
With Drug(s) for compelling Drug(s) for compelling indications;
compelling indications other antihypertensive drugs
indications (diuretics, ACE-I, ARB, BB, CCB) as
needed
ACE-I, angiotensin-converting enzyme inhibitor; ARB, angiotensin II JNC VII. JAMA 2003;289:2560-2572
receptor blocker; BB, beta-blocker; CCB, calcium-channel blocker
Hypertension Stage 1
BP 140/90 - 159/99 mmHg

Evaluate cardiovascular risk

Evaluate target organ damage
Evaluate compelling condition and DM

Start lifestyle modification

Correction of cardiovascular risk factor
Treat the compelling condition and DM

Defined total risk /absolute

Pharmacological management
HIPERTENSI STAGE 2
BP 166/100 mmHg

Pharmacological management

Evaluate cardiovascular risk

Evaluate target organ damage
Evaluate compelling condition and DM

Additional lifestyle modification

Correction of cardiovascular risk factor
Treat the compelling condition and DM
LIFESTYLE MODIFICATION
Definitive therapy for group of
hypertensive patient and also supported
for other patients group.
Should be performed at the first 6-12
months before pharmacological treatment.
Increase efficacy treatment and improving
other CV risk.
 Lifestyle Modification
Modification Recommendation Decrease of Sistolic
Blood Pressure
Body weight Maintain normal body weight 5-20 mm Hg every decrease
(BMI 18.5-24.9) of 10 kg BW

DASH diet Consumption of fruits, 8-14 mm Hg

vegetables, low fat milk and
low fat cheese
Reducing salt/sodium Reducing sodium to not more 2-8 mm Hg
intake than 2.4 g/ day or NaCl 6
g/day
Increasing physical Aerobic exercise ie. Walking 4-9 mm Hg
activity (30 min/day 4-5 days in a
week)
Reducing alcohol Limiting alcohol 2-4 mm Hg
consumption consumption to not more
than 2 oz/day for man and 1
oz / day for women.
Source: The Seventh Report of the Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure JNCVII. JAMA. 2003;289:2560-2572.
 1. Overweight

Hypertension prevalence:
BMI >30 38% (male), 32% (female)
BMI <25 18% (male), 17% (female)

BP in overweight 2-6 x > BW normal.

 Overweight
Physiological changes explain correlation
overweight & BP:
Insulin resistance & hyperinsulinemia,
Activation of n. simpatetik & renin-angiotensin system,
Kidney changes.

energy intake plasma insulin (fc. natriuretik

potent cause reabsorbtion Na kidney BP)
 Overweight Management
Intake: 25 kkal/kgBW or 500-1000 kkal/day
BW 0,5-1 kg/week
could reach total BW: 4,5 kg/month

Reducing 5 kg BW:
BP 10/5 mmHg
improving profile lipid & blood glucose.
 Overweight Management
Hypertension Stage 1 BW BP normal

Other benefit:
Synergic effect to anti hypertensive medicine
BW dosage & amount of anti
hypertensiove.

daily intake Na intake

Low salt diet more effective

 2. DIET

Gizi DASH
DASH
3. Salt
 4. Exercise
Physical activity
Regular physical activity reduce risk of
hypertension by 30-50%

Warming up Exercise Cooling down

Stretching Aerobic Stretching

10-15 min 10-15 min
4. Exercise
 5. Alcohol

One of the important environment factor

BP.
BP of heavy drinker > moderate / non
drinker
Systolic BP are not affected
Mechanism still unclear: possibly alcoholic
beverages volume of red blood cells
blood viscosity BP .
 5. Alcohol

Alcohol consumption SBP 3,8

mmHg
Suggestion: alcohol intake equal to 60 ml
whisky, 300 ml red wine
 6. Stop Smoking
Hypertension are more difficult to controlled
in smokers.
Smoking Pressure effect, effect with
caffeine, beta-blocker effect
ABPM 24 hours: BP in hypertensive
patient who are smoker
Stop Smoking risk of CV
Counseling is needed