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1 hypertension, with an SBP of 130 to 139 mm Hg or a DBP of 80 to 89 mm Hg. 6 hours of the acute event and have an SBP between 150 mm Hg and 220 mm Hg is not of benefit to reduce death or severe disability and can be potentially harmful. 110 mm Hg before thrombolytic therapy is initiated. 105 mm Hg for at least the first 24 hours after initiating drug therapy. Adult men and women with elevated BP or hypertension who currently consume alcohol should be advised to drink no more than two and one standard drinks per day, respectively. 80 mm Hg in most adults with hypertension, especially in black adults with hypertension. Women with hypertension who become pregnant should not be treated with ACEIs, ARBs, or direct renin inhibitors.

SBP of 130 mm Hg or higher or an average DBP of 80 mm Hg or higher. SBP of 140 mm Hg or higher or a DBP of 90 mm Hg or higher. BP evaluation within 3 to 6 months. Lifestyle modifications Lifestyle modifications are essential for the prevention of high BP, and these are generally the initial steps in managing hypertension. As the cardiovascular disease risk factors are assessed in individuals with hypertension, pay attention to the lifestyles that favorably affect BP level and reduce overall cardiovascular disease risk. A relatively small reduction in BP may affect the incidence of cardiovascular disease on a population basis.

In a study that attempted to formulate a predictive model for the risk of prehypertension and hypertension, as well as an estimate of expected benefits from population-based lifestyle modification, investigators reported that the majority of risk factors have a larger role in prehypertension and stage 1 hypertension than in stage 2 hypertension. Surgical intervention Aortorenal bypass using a saphenous vein graft or a hypogastric artery is a revascularization technique for renovascular hypertension that has become much less common since the advent of renal artery angioplasty with stenting. Surgical resection is the treatment of choice for pheochromocytoma and for patients with a unilateral solitary aldosterone-producing adenoma, because hypertension is cured by tumor resection. Consultations Consultations with a nutritionist and exercise specialist are often helpful in changing lifestyle and initiating weight loss. Consultation with a hypertension specialist is indicated for management of secondary hypertension attributable to a specific cause. The effect of sodium chloride is particularly important in individuals who are middle-aged to elderly with a family history of hypertension. A moderate reduction in sodium chloride intake can lead to a small reduction in blood pressure.

BP in nondiabetic patients with modest chronic kidney disease. The DASH eating plan encompasses a diet rich in fruits, vegetables, and low-fat dairy products and may lower blood pressure by 8-14 mm Hg. The 2011 ADA standard of care supports the DASH diet, with the caution that high-quality studies of diet and exercise to lower blood pressure have not been performed on individuals with diabetes. Dietary potassium, calcium, and magnesium consumption have an inverse association with BP. Lower intake of these elements potentiates the effect of sodium on BP. Oral potassium supplementation may lower both systolic and diastolic BP. Calcium and magnesium supplementation have elicited small reductions in BP.

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In population studies, low levels of alcohol consumption have shown a favorable effect on BP, with reductions of 2-4 mm Hg. However, the consumption of 3 or more drinks per day is associated with elevation of BP. Daily alcohol intake should be restricted to less than 1 oz of ethanol in men and 0. The 2011 ADA standard supports limiting alcohol consumption in patients with diabetes and hypertension. Emerging evidence based on small randomized controlled trials suggests that dark chocolate may lower BP via improved vascular endothelial function and increased formation of nitric oxide. A meta-analysis of 13 randomized controlled trials that compared dark chocolate with placebo confirmed a significant mean SBP reduction of -3. 2 mm Hg and DBP reduction of -2 mm Hg in hypertensive and prehypertensive subgroups.

Although many studies implicate a high fructose diet as a contributing factor to the metabolic syndrome and hypertension, a 2012 review of Cochrane database disputed this relationship. The centripetal fat distribution is associated with insulin resistance and hypertension. Regular aerobic physical activity can facilitate weight loss, decrease BP, and reduce the overall risk of cardiovascular disease. Blood pressure may be lowered by 4-9 mm Hg with moderately intense physical activity. These activities include brisk walking for 30 minutes a day, 5 days per week. More intense workouts of 20-30 minutes, 3-4 times a week, may also lower BP and have additional health benefits.

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