Lifestyle Modification for the Prevention and Treatment of Hypertension PDF

Preface

Hypertension is an important public health challenge in the world because of its high prevalence and the concomitant increase in risk of cardiovascularrenal disease. In the United States and other economically developed countries, hypertension represents a major health and financial burden. For example, as many as 43 million Americans have hypertension, defined as having a systolic blood pressure > 140 mmHg and/or diastolic blood pressure >90 mmHg and/or taking antihypertensive medications. According to the National Heart, Lung, and Blood Institute and the American Heart Association, in 2003 the estimated direct health expenditures (physician or other health care provider visits, hospital/nursing home stays, and antihypertensive medications) for care of patients with hypertension in the United States were $37.2 billion and the associated indirect costs (lost productivity due to morbidity and mortality) were $13.1 billion. In many economically developing countries, hypertension has become a significant cause of mortality and disability. In the People's Republic of China the estimated number of hypertensive cases has increased from 30 million in the 1960s to 94 million in the 1990s. Similar trends have been shown in other developing regions.

Hypertension is the most important modifiable risk factor for coronary heart disease, stroke, congestive heart failure, end-stage renal disease, and peripheral vascular disease. Prospective studies have repeatedly identified an increasing risk of cardiovascular disease, stroke, and renal insufficiency with progressively higher levels of both systolic and diastolic blood pressure. These studies have demonstrated a positive, continuous, and independent association between blood pressure and the incidence of coronary heart disease, stroke, congestive heart failure, and end-stage renal disease. They have shown no evidence of a J-shaped relationship or a threshold below which increasing levels of blood pressure are not associated with a corresponding increase in the risk of stroke, coronary heart disease, and renal disease. Randomized controlled trials have demonstrated that antihypertensive drug therapy reduces the risk of cardiovascular disease and stroke among patients with hypertension. However, antihypertensive medications are also associated with increased health care costs and adverse effects. Furthermore, treatment of hypertension cannot entirely eliminate the risk of cardiovascular- renal disease associated with elevated blood pressure. Lifestyle Modification/ or the Prevention and Treatment of Hypertension therefore provides an attractive complementary approach to dealing with the societal burden of hypertension.

Substantial achievements have been made in the identification of effective lifestyle modification approaches for the prevention and treatment of hypertension over the past 20 years. However, the totality of clinical and epidemiological evidence supporting these approaches, as well as the feasibility and cost-effectiveness of each approach, has not been previously synthesized and made widely available to health care providers in office and community settings. This book attempts to fill these gaps by providing a compendium of the scientific evidence on the efficacy of lifestyle modification, while focusing on the interventional techniques and skills necessary to help clinicians implement the interventions that have been proven to be efficacious in treatment trials. Chapters by leading authorities in clinical hypertension and public health provide valuable insights and the strategies necessary to translate the theory of lifestyle modification intervention into practice. This book is written primarily for health care providers, including general internists, family physicians, geriatricians, nurse practitioners, and physician assistants, as well as medical subspecialists, such as cardiologists and nephrologists. It will also be invaluable to dietitians, psychologists, and epidemiologists, as well as students, practitioners, and researchers in preventive medicine and public health.