michigan hypertension core curriculum - State of Michigan
michigan hypertension core curriculum - State of Michigan
michigan hypertension core curriculum - State of Michigan
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
foods and turn out <strong>of</strong> necessity to calorie-rich but nutritionally poor foods. Second, the poor tend to<br />
have lower education levels and less access to medical care, further increasing the risk for obesity<br />
and HTN. In addition, such individuals may be less likely to have their HTN diagnosed and even after<br />
diagnosis, may be less able to afford the recommended treatments.<br />
Obesity is particularly relevant because it adds to and exacerbates the co-morbidities <strong>of</strong>ten<br />
seen in individuals presenting for medical care. Obesity can not only contribute to HTN, DM and<br />
hyperlipidemia, but also makes such diseases harder to control. In the treatment <strong>of</strong> HTN in obese<br />
individuals, weight management needs to be a central focus <strong>of</strong> the overall treatment plan. 14 Weight loss<br />
can result decreases in BP similar to what can be realized with most medications. Not only has obesity<br />
been linked to an increased risk for developing <strong>hypertension</strong>, it is also a marker for pharmacological<br />
treatment resistance. In addition, aerobic activity done as part <strong>of</strong> weight loss can further decrease<br />
BP. For example, regular walking has been shown to attenuate weight gain associated with<br />
age. 15 Instruction on low sodium diets (such as the DASH diet) can also play a positive role in HTN<br />
management. As up to half <strong>of</strong> patients being treated report that their provider has not discussed their<br />
weight with them, it is incumbent on all providers to elevate weight control and weight reduction to the<br />
same status reserved for discussions <strong>of</strong> DM. HTN and other medical disease.<br />
Patients should be reminded that becoming overweight or obese typically has taken years if<br />
not decades. As such, lifestyle modifications designed to promote weight loss will also take weeks<br />
to months before significant weight loss may be realized. At the same time, patients may feel<br />
symptomatically improved with modest weight loss. The promotion <strong>of</strong> lifestyle modifications should<br />
proceed in parallel with pharmacologic treatment. The first priority <strong>of</strong> HTN management is control<br />
<strong>of</strong> the blood pressure. Medications can always be withdrawn as patients make the lifestyle changes<br />
necessary to reduce their tendency towards HTN. Often, encouraging patients with the possibility <strong>of</strong><br />
freedom from some <strong>of</strong> all <strong>of</strong> their anti-hypertensive medications if they adjust their diet and exercise<br />
regimens can be a potent inducement for action. Obesity is a significant but manageable contributor to<br />
HTN and CV disease overall and must be approached on multiple fronts simultaneously for maximum<br />
effect.<br />
Figures:<br />
1. Graph showing prevalence <strong>of</strong> obesity in the U.S., NHANES<br />
2. Graphic showing risk <strong>of</strong> CVD associated with obesity<br />
66 Hypertension Core Curriculum