Blood Pressure

Exercise with endurance emphasis reduces bp in normal and hypertensives. But req daily 30mins of exercises. Can be divided into 10mins tds. Needs 150mins a week minimal or 30mins a day for 5 days a week minimal!

Beta blockers substantially reduces exercise capacity

Those on CCB shd not stop exercise abruptly but slow down gradually with a cooling down period.
They may have hypotension if exercise is stopped abruptly. Cool down as in opposite to warm up.

32.7% or 5.8 million msians are hypertensive

3.9% of msian children are obese!

Mortality risk increases from 23 bmi for asians. Hence overwt is above 23 and obese is above 27.5

1kg wt loss equals 1mmhg sbp

10kg wt loss equals 10mm reduction in both systoloc and diastolic bp

Aim to lose 5 to 10% of original wt

Loose 0.5 to 1kg per week over a 6 month period

Crash diet fails as body goes into starvation mode and rapidly gains wt when there is food.

Accumulated excess of 7300calories equals 1kg fat! stored on fix deposit!

A plate of nasi lemak is 500calories for easy comparison.

27.8% prevalence of adult hpt in msia

Only 35% are aware of their hpt!

Out of this 32% is treated but only 9% is well controlled to target!!

One third can be controlled with 1 drug, one third with 2 drugs and one third only with 3 drugs.

Doubling the dose of any drug will only give a little further reduction

A single drug will reduce systolic bp by 9mmhg
Doubling its dose will only reduce the systolic by 10.1mmhg

Hence using 2 drugs of synergistic class is better than doubling the dose of a single agent

Evidence for benefit with alpha blockers in hpt is weak

The combination of ARB and ACEI for hpt is not recommended based on Valiant and On Target results

The most effective combination is either an ACEI or ARB plus a CCB

Avoid diuretics in high metabolic risk groups eg DM

When 3 drugs are required the best combination is ACEI or ARB plus CCB plus diuretic

Vasodilation and loss of volume and sodium will reflexly activate the RAS system. Hence the combination of CCB PLUS ARB OR ACEI is effective. The Diuretics plus ACEI OR ARB is effective. One blocks the reflex response of the other to overcome the bodies’ compensation.

The use of 3 drugs in combination will help to control 90 to 95% of all hypertensive patients