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Chapter 3. Hypertension

Which of the following recommendations for lifestyle modifications is correct?

a. A minimum weight loss of 15 pounds.

b. Sodium restriction of 4 g or less per day.

c. Reduce alcohol intake to no more than two drinks a day for a woman, one for a man.

d. Exercise for at least 30 minutes most days of the week.

e. Adopt an eating plan low in potassium and carbohydrates.

Answer d is correct. Physical activity for 30 minutes per day is the minimum recommendation in most patient populations. Regular physical activity can lower BP by 2 to 9 mm Hg. It is important to make sure that all patients have been clinically eligible to engage in physical activity by their primary care provider, cardiologist, or other responsible provider.

Answer a is incorrect. Although many patients may require a weight loss of 15 pounds or more, the recommendation is to maintain normal body weight, which is a body mass index (BMI) of 18.5 to 24.9 kg/m2. Maintaining normal body weight can lower BP by 5 to 20 mm Hg/10 kg weight loss.

Answer b is incorrect. The recommendation is no more than 2.4 grams of sodium per day. Restriction of sodium can decrease BP by 2 to 8 mm Hg.

Answer c is incorrect. Alcohol should be no more than one drink per day for a woman and two drinks per day for a man. A drink is considered to be a 12-oz of beer, a 5-oz glass of wine, or 1.5 oz of 80-proof whiskey. Moderating the intake of alcohol can lower BP by 2 to 4 mm Hg.

Answer e is incorrect. The DASH plan is low in sodium and fat (saturated and total) and high in potassium, fruits and vegetables, and low-fat dairy products. Adopting the DASH eating plan can lower BP by 8 to 14 mm Hg.

JD is a 55-year-old African American woman with newly diagnosed hypertension. Her average BP is 164/91 mm Hg. Which of the following is the best recommendation for JD?

a. Begin hydrochlorothiazide (HCTZ) and return to clinic in 3 months.

b. Begin metoprolol and prescribe monitoring BP at home.

c. Begin two medications since most patients with stage 2 hypertension will not reach goal with one agent alone.

d. Prescribe lifestyle modifications (LSMs) first, and return to clinic in 1 month to determine if pharmacotherapy is warranted.

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