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found\tin\tphytochemicals\tknown\tas\tcatechins\nand\thave\tbeen\tfound\tto\timprove\tvascular\treactivity.\tRed\tgrapes,\tred\twine,\ttea\t(especially\tgreen\ttea),\nberries,\tand\tbroad\tbeans\t(fava\tbeans)\tare\tpart\tof\tthe\tMeD\t(see\t\nFigs.\t32.5\n\tand\t\n32.6\n).\nStanols\tand\tsterols. | [
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] |
Figs.\t32.5\n\tand\t\n32.6\n).\nStanols\tand\tsterols.\nSince\tthe\tearly\t1950s,\tplant\tstanols\tand\tsterols\tisolated\tfrom\tsoybean\toils\tor\tpine\ttree\toil\thave\tbeen\nknown\tto\tlower\tblood\tcholesterol\tby\tinhibiting\n\tabsorption\tof\tdietary\tcholesterol.\tStanols\tand\tsterols\nhave\tbeen\tshown\tto\tlower\tLDL\tcholesterol\tin\tadults\t(\nYanai\tet\tal,\t2015 | [
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Yanai\tet\tal,\t2015\n).\tBecause\tthese\testers\talso\ncan\taffect\tthe\tabsorption\tof\tand\tcause\tlower\tbeta-carotene,\talpha-tocopherol,\tand\tlycopene\tlevels,\nfurther\tsafety\tstudies\tare\tneeded\tfor\tuse\tin\tnormocholesterolemic\tindividuals,\tchildren,\tand\npregnant\twomen.\nWeight\tloss.\nAccording\tto\tthe\tCenters | [
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pregnant\twomen.\nWeight\tloss.\nAccording\tto\tthe\tCenters\n\tfor\tDisease\tControl\tand\tPrevention\t(CDC),\tin\t2015\tto\t2016\t39.8%\tof\tadults\nand\t18.5%\tof\tchildren\tin\tthe\tUnited\tStates\twere\tclassified\tas\tobese.\tObesity\traises\tthe\trisk\tof\nhypertension,\tdyslipidemia,\ttype\t2\tdiabetes,\tASCVD,\tand\tstroke.\tObesity\tis\tassociated\twith\tincreased | [
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risk\tin\tall-cause\tand\tCVD\tmortality\t(\nStone\tet\tal,\t2014\n).\tRecommendations\tof\tthe\tpanel\tare\nsummarized\tin\t\nBox\t32.5\n.\nBOX\t32.5\nRecommendations\tfrom\tThe\tObesity\tSociety\t(TOS)\tObesity\nGuideline\n1.\t\nPatient/provider\tencounter\tfor\tobesity\tprevention\tand\tmanagement:\tA\tpatient\tencounter\tis | [
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BMI\t30<35\t(class\tI\tobese)\tor\tBMI\t35<40\tclass\tII\tobese\tor\tBMI\n>40\t(class\tIII\tobese):\tthese\tBMI\tcutpoints\tdefine\toverweight\tand\tobese\tindividuals\twho\tare\nat\tincreased\trisk\tof\tcardiovascular\tdisease\t(CVD).\tWithin\tthese\tcategories,\tadditional\npersonal\trisk\tassessment\tis\tneeded.\n4. | [
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questions\tabout\thistory\tof\tweight\tgain\tand\tloss\nover\ttime,\tdetails\tof\tprevious\tweight\tloss\tattempts,\tdietary\thabits,\tphysical\tactivity,\tfamily\nhistory\tof\tobesity,\tand\tother\tmedical\tconditions\tand\tmedications\tthat\tmay\taffect\tweight.\n6.\t\nAssess\tneed\tto\tlose\tweight:\tWeight\tloss\ttreatment\tis\tindicated\tfor\t(1)\tobese\tand\t(2) | [
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overweight\twith\tone\tor\tmore\tindicators\tof\tincreased\tCVD\trisk.\n7.\t\nAdvise\tto\n\tavoid\tweight\tgain\tand\taddress\tother\trisk\tfactors.\nJensen,\tet\tal:\t2013\tAHA/ACC/TOS\tguideline\tfor\tthe\tmanagement\tof\toverweight\tand\tobesity\tin\tadults.\nCirculation\n,\t129:S102,\t2014.\nMedical\tmanagement\nPharmacologic\tmanagement | [
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cholesterol\ttargets.\tThe\tprimary\ttreatment\tfor\tthose\tat\trisk\tof\tASCVD\tare\tthe\t3-hydroxy-3-\nmethylglutaryl–coenzyme\tA\t(HMG-CoA)\treductase\tinhibitors,\tof\twhich\tthere\tare\tmany\t(see\t\nAppendix\n13\n).\tThe\tclasses\tof\tdrugs\tinclude\tthe\tfollowing:\t(1)\t\nbile\tacid\tsequestrants\n\tsuch\tas\tcholestyramine\n(adsorbs\tbile\tacids);\t(2)\tnicotinic\tacid;\t(3)\tstatins,\tor | [
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angina.\tPCI,\tpreviously\tknown\tas\tpercutaneous\ttransluminal\ncoronary\tangioplasty,\tis\ta\tprocedure\tthat\tuses\ta\tcatheter\twith\ta\tballoon\tthat,\tonce\tinflated,\tbreaks\nup\tplaque\tdeposits\tin\tan\toccluded\tartery.\tCoronary\tstenting\tinvolves\ta\twire\tmesh\ttube\tinserted\tto\nhold\tan\tartery\topen;\tit\tcan\trelease\tmedication\tthat\tprevents\tclotting\t(\nThom\tet\tal,\t2006 | [
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benefit\tversus\tlifestyle\tchanges\tcombined\twith\tmedication\t(\nBoden\tet\tal,\t2007\n).\nBecause\tPCI\tis\tperformed\twith\tthe\tpatient\tunder\tlocal\tanesthesia\tin\ta\tcardiac\tcatheterization\nlaboratory,\trecovery\tis\tquicker\tthan\twith\t\ncoronary\tartery\tbypass\tgraft\t(CABG)\n\tsurgery.\tIn\n\tCABG | [
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coronary\tartery\tbypass\tgraft\t(CABG)\n\tsurgery.\tIn\n\tCABG\nsurgery,\tan\tartery\tfrom\tthe\tchest\tis\tused\tto\tredirect\tblood\tflow\taround\ta\tdiseased\tvessel.\tCandidates\nfor\tCABG\tusually\thave\tmore\tthan\ttwo\toccluded\tarteries.\tCABG\tsurgeries\thave\tdecreased\tsince\t1995\nbecause\tmore\tPCI\tprocedures\tare\tbeing\tdone.\tThese\tsurgeries\timprove\tsurvival\ttime,\trelieve | [
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symptoms,\tand\tmarkedly\timprove\tthe\tquality\tof\tlife\tfor\tpatients\twith\tASCVD.\tHowever,\tCABG\tdoes\nnot\tcure\tatherosclerosis;\n\tthe\tnew\tgrafts\tare\talso\tsusceptible\tto\tatherogenesis.\tConsequently,\nrestenosis\tis\tcommon\twithin\t10\tyears\tof\tsurgery.\nHypertension\nHypertension | [
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Hypertension\nHypertension\n\tis\tpersistently\thigh\tarterial\tblood\tpressure,\tthe\tforce\texerted\tper\tunit\tarea\ton\tthe\nwalls\tof\tarteries.\tThe\t\nsystolic\tblood\tpressure\t(SBP)\n,\tthe\tupper\treading\tin\ta\tblood\tpressure\nmeasurement,\tis\tthe\tforce\texerted\ton\tthe\twalls\tof\tblood\tvessels\tas\tthe\n\theart\tcontracts\tand\tpushes | [
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heart\tcontracts\tand\tpushes\nblood\tout\tof\tits\tchambers.\tThe\tlower\treading,\tknown\tas\t\ndiastolic\tblood\tpressure\t(DBP)\n,\tmeasures\nthe\tforce\tas\tthe\theart\trelaxes\tbetween\tcontractions.\tBlood\tpressure\tis\tmeasured\tin\tmillimeters\t(mm)\nof\tmercury\t(Hg).\tAdult\tblood\tpressure\tis\tconsidered\tnormal\tat\t120/80\tmm\tHg.\tThe\tblood\tpressure | [
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] |
cutoffs\tfor\televated\tblood\tpressure\t(formerly\t\nprehypertension\n),\tstage\t1\tand\tstage\n\t2\thypertension\nare\tfound\tin\t\nTable\t32.1\n.\nTABLE\t32.1\nCategories\tof\tBlood\tPressure\tin\tAdults\nSBP\t(mm\tHg)\n*\nDBP\t(mm\tHg)\n*\nNormal\n<120\tmm\tHg\nand\n<80\tmm\tHg\nElevated\n120-129\tmm\tHg\nand\n<80\tmm\tHg\nHypertension\nStage\t1\n130-139\tmm\tHg\nor\n80-89\tmm\tHg\nStage\t2\n>130-139\tmm\tHg\nor | [
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J\tAm\tColl\tCardiol\n\t71:\te127-e240,\t2018.\n*\nIndividuals\twith\tSBP\tand\tDBP\tin\t2\tcategories\tshould\tbe\tdesignated\tto\tthe\thigher\tblood\tpressure\tcategory.\tBlood\tpressure\tis\tbased\ton\tan\taverage\nof\t≥2\tcareful\treadings\tobtained\ton\t≥2\toccasions.\nThe\tclinical\tpractice\tguidelines\tfrom\tthe\tACC/AHA\tTask\tForce\tfor\tthe\tPrevention,\tDetection, | [
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Evaluation,\tand\tManagement\tof\tHigh\tBlood\tPressure\tin\tAdults\t(\nWhelton\tet\tal,\t2018\n)\tstate\tthat\tthe\ncombination\tof\tdiet\tand\tlifestyle\ttherapy\tis\tespecially\tuseful\tin\tadults\tfor\tthe\tprevention\tof\nhypertension\tand\tfor\tthe\tmanagement\tof\televated\tblood\tpressure\tand\tstage\t1\thypertension\twithout | [
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clinical\tASCVD\tor\testimated\t10-year\tASCVD\trisk\tof\t≤10%\t(see\t\nhttp://tools.acc.org/ASCVD-Risk-\nEstimator-Plus/#!/calculate/estimate/\n).\tFor\tadults\twith\tstage\t1\thypertension\twith\tclinical\tASCVD\n\tor\nestimated\t10-year\trisk\tof\tASCVD\t≥10%\tor\tstage\t2\thypertension,\tthe\tACC/AHA\tguidelines | [
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recommends\tblood\tpressure–lowering\tmedication\tin\tcombination\twith\tnonpharmacotherapy\tfor\nprimary\tprevention\tof\tCVD.\tThe\tguidelines\talso\tcall\tfor\tindividuals\twith\tdiabetes,\tHF,\tand\tchronic\nkidney\tdisease\tto\tbe\ttreated\twith\tblood\tpressure–lowering\tmedication\twhen\ttheir\tblood\tpressure\nexceeds\t130/80\tmm\tHg.\tThe\trecommendations | [
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exceeds\t130/80\tmm\tHg.\tThe\trecommendations\n\tare\tbased\ton\tclinical\tevidence\tshowing\tthat\tstricter\nguidelines\tfor\tthese\tpatients\tmay\tprevent\tacceleration\tof\ttarget\torgan\tdamage\t(kidney,\theart,\tand\npancreas)\tand\trelated\tcomorbidities.\tImportantly,\tthe\tguidelines\temphasize\tthat\tpeople\twith\thigh | [
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and\tlifestyle\tmodifications\tare\timportant\n\tparts\tof\tprimary\tprevention\tof\thypertension.\nHypertension\tis\ta\tcommon\tpublic\thealth\tproblem\tin\tdeveloped\tcountries.\tIn\tthe\tUnited\tStates\tone\nin\tthree\tadults\thas\thigh\tblood\tpressure\t(\nCDC,\t2017\n).\tUntreated\thypertension\tleads\tto\tmany | [
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CDC,\t2017\n).\tUntreated\thypertension\tleads\tto\tmany\ndegenerative\tdiseases,\tincluding\tHF,\tend-stage\trenal\tdisease,\tand\tperipheral\tvascular\tdisease.\tIt\tis\noften\tcalled\ta\t“silent\tkiller”\tbecause\tpeople\twith\thypertension\n\tcan\tbe\tasymptomatic\tfor\tyears\tand\nthen\thave\ta\tfatal\tstroke\tor\theart\tattack.\tAlthough\tno\tcure\tis\tavailable,\thypertension\tis\teasily | [
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detected\tand\tusually\tcontrollable.\tSome\tof\tthe\tdecline\tin\tCVD\tmortality\tduring\tthe\tlast\ttwo\tdecades\nhas\tbeen\tattributed\tto\tthe\tincreased\tdetection\tand\tcontrol\tof\thypertension.\tThe\temphasis\ton\tlifestyle\nmodifications\thas\tgiven\tdiet\ta\tprominent\trole\tin\tthe\tprimary\tprevention\n\tand\tmanagement\tof\nhypertension. | [
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and\tmanagement\tof\nhypertension.\nOf\tthose\tpersons\twith\thigh\tblood\tpressure,\t90%\tto\t95%\thave\t\nessential\thypertension\n(hypertension\tof\tunknown\tcause)\tor\tprimary\thypertension.\tThe\tcause\tinvolves\ta\tcomplex\tinteraction\nbetween\tpoor\tlifestyle\tchoices\tand\tgene\texpression.\tLifestyle\tfactors\tthat\thave\tbeen\timplicated | [
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include\tpoor\tdiet\t(i.e.,\thigh\tsodium,\tlow\tfruit\tand\tvegetable\tintake),\tsmoking,\tphysical\n\tinactivity,\nstress,\tand\tobesity.\tVascular\tinflammation\thas\talso\tbeen\timplicated\t(\nDe\tMiguel\tet\tal,\t2015\n).\tMany\ngenes\tplay\ta\trole\tin\thypertension;\tmost\trelate\tto\tthe\trenal\tor\tneuroendocrine\tcontrol\tof\tblood | [
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pressure.\tGenome-wide\tassociation\tstudies\thave\trevealed\tmore\tthan\t100\tvariants\tassociated\twith\nblood\tpressure,\talthough\tcumulatively\tthese\texplain\tonly\ta\tsmall\tpercent\tof\tblood\tpressure\nvariability\n\t(\nSeidel\tand\tScholl,\t2017\n).\tThe\tmajority\tof\tthe\tgenetic\tcontributors\tto\tblood\tpressure\nregulation\tare\tcurrently\tunknown\t(see\t\nChapter\t6 | [
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regulation\tare\tcurrently\tunknown\t(see\t\nChapter\t6\n).\tHypertension\tthat\tarises\tas\tthe\tresult\tof\tanother\ndisease,\tusually\tendocrine,\tis\treferred\tto\tas\t\nsecondary\thypertension\n.\tDepending\ton\tthe\textent\tof\nthe\tunderlying\tdisease,\tsecondary\thypertension\tcan\tbe\tcured.\nPrevalence\tand\tincidence\nApproximately\t85.7\tmillion | [
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Prevalence\tand\tincidence\nApproximately\t85.7\tmillion\n\tAmerican\tadults\tage\t20\tand\tolder\thave\thypertension\tor\tare\ttaking\nantihypertensive\tmedication\t(\nBenjamin\tet\tal,\t2018\n).\tProjections\tshow\tthat\tby\t2030,\tprevalence\tof\nhypertension\twill\tincrease\tby\t8.4%\tfrom\t2013\testimates.\tNon-Hispanic\tblack\tadults\thave\ta\thigher | [
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age-adjusted\tprevalence\tof\thypertension\t(45.0%\tof\tmen;\t46.3%\tof\twomen)\tthan\tnon-Hispanic\twhites\n(34.5%\tof\tmen;\t32.3%\tof\twomen)\tand\tMexican\n\tAmericans\t(30.1%\tof\tmen;\t28.8%\tof\twomen)\n(\nBenjamin\tet\tal,\t2018\n).\tThe\tprevalence\tof\thigh\tblood\tpressure\tin\tblacks\tis\tone\tof\tthe\thighest\trates | [
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seen\tanywhere\tin\tthe\tworld.\tBecause\tblacks\tdevelop\thypertension\tearlier\tin\tlife\tand\tmaintain\thigher\nblood\tpressure\tlevels,\ttheir\trisk\tof\tfatal\tstroke,\theart\tdisease,\tor\tend-stage\tkidney\tdisease\tis\thigher\nthan\twhites\t(\nBenjamin\tet\tal,\t2018\n).\nA\tperson\tof\tany\n\tage\tcan\thave\thypertension.\tApproximately\t12.9%\tof\tboys\tand\t6.5%\tof\tgirls\thave | [
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] |
elevated\tblood\tpressure\t(\nMa\tet\tal,\t2016\n;\t\nXi\tet\tal,\t2016\n).\tWith\taging,\tthe\tprevalence\tof\thigh\tblood\npressure\tincreases\t(\nFig.\t32.7\n).\tBefore\tthe\tage\tof\t45\tmore\tmen\tthan\twomen\thave\thigh\tblood\npressure,\tand\tafter\tage\t65\tthe\trates\tof\thigh\tblood\tpressure\tamong\twomen\tin\teach\tracial\tgroup\nsurpass\tthose\tof\tthe\tmen\tin\ttheir\tgroup\n\t(\nGo\tet\tal,\t2014 | [
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surpass\tthose\tof\tthe\tmen\tin\ttheir\tgroup\n\t(\nGo\tet\tal,\t2014\n).\tBecause\tthe\tprevalence\tof\thypertension\nrises\twith\tincreasing\tage,\tmore\tthan\thalf\tthe\tolder\tadult\tpopulation\t(more\tthan\t65\tyears\tof\tage)\tin\nany\tracial\tgroup\thas\thypertension.\tAlthough\tlifestyle\tinterventions\ttargeted\tto\tolder\tpersons\tmay | [
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reduce\tthe\tprevalence\tof\thypertension,\tearly\tintervention\tprograms\tprovide\tthe\tgreatest\tlong-term\npotential\tfor\treducing\toverall\tblood\tpressure-related\n\tcomplications\t(\nWhelton\tet\tal,\t2018\n).\nFIG.\t32.7\nAge-specific\tand\tage-adjusted\tprevalence\tof\thypertension\tin\tadults:\tUnited\tStates,\t2005\tto\n2006.\n\tSource:\t(Ostchega\tY,\tet\tal: | [
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2006.\n\tSource:\t(Ostchega\tY,\tet\tal:\t\nHypertension\tawareness,\ttreatment,\tand\tcontrol—continued\tdisparities\tin\tadults:\tUnited\tStates,\n2005-2006.\n\tNCHS\tdata\tbrief\tno.\t3,\tHyattsville,\tMd,\t2008,\tNational\tCenter\tfor\tHealth\tStatistics.)\nThe\trelationship\tbetween\tblood\tpressure\tand\trisk\tof\tCVD\tevents\tis\n\tcontinuous\tand\tindependent\tof | [
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continuous\tand\tindependent\tof\nother\trisk\tfactors.\tThe\thigher\tthe\tblood\tpressure,\tthe\tgreater\tis\tthe\tchance\tof\ttarget\torgan\tdamage,\nincluding\tleft\tventricular\thypertrophy\t(LVH),\tHF,\tstroke,\tchronic\tkidney\tdisease,\tand\tretinopathy\n(\nBenjamin\tet\tal,\t2018\n).\tAs\tmany\tas\t13%\tof\tadults\twith\thypertension\thave\ttreatment-resistant | [
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secondary\tcauses\tand\tuse\tof\teffective\tmultidrug\tregimens,\tare\tessential\ttreatment\tstrategies.\nThe\tprevalence\tof\thypertension\tamong\tadults\twith\tdiabetes\tis\t80%\tand\thypertension\tis\tat\tleast\ntwice\tas\tcommon\tamong\tpersons\twith\ttype\t2\tdiabetes\tas\tpersons\tof\tthe\tsame\tage\twithout\tdiabetes\n(\nWhelton\tet\tal,\t2018 | [
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(\nWhelton\tet\tal,\t2018\n).\tAdults\twith\tdiabetes\thave\tCVD\tdeath\trates\ttwo\tto\tfour\ttimes\thigher\tthan\nadults\n\twithout\tdiabetes\t(\nBenjamin\tet\tal,\t2018\n).\tConsequently,\tnational\thealth\torganizations,\nincluding\tthe\tACC/AHA,\thave\tset\tthe\ttarget\tblood\tpressure\tgoal\tfor\tantihypertensive\ttherapy\tfor | [
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Whelton\tet\tal,\t2018\n).\nAlthough\thypertensive\tpatients\tare\n\toften\tasymptomatic,\thypertension\tis\tnot\ta\tbenign\tdisease.\nCardiac,\tcerebrovascular,\tand\trenal\tsystems\tare\taffected\tby\tchronically\televated\tblood\tpressure\n(\nTable\t32.2\n).\tHigh\tblood\tpressure\twas\tthe\tprimary\tor\ta\tcontributory\tcause\tin\t427,631\tof\tthe\t2.7\nmillion\tU.S.\tdeaths\tin\t2009\t( | [
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] |
million\tU.S.\tdeaths\tin\t2009\t(\nBenjamin\tet\tal,\t2018\n).\tBetween\t2005\tand\t2015\tthe\tage-adjusted\tdeath\nrate\tfrom\thypertension\tincreased\tby\t10.5%;\toverall\n\tdeaths\tfrom\thypertension\tincreased\tby\t37.5%.\nDeath\trates\tfrom\thypertension\tare\tapproximately\tthree\ttimes\thigher\tin\tblacks\tthan\tin\twhites\n(\nBenjamin\tet\tal,\t2018 | [
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0.010970629751682281
] |
(\nBenjamin\tet\tal,\t2018\n).\tHypertension\tis\ta\tmajor\tcontributing\tfactor\tto\tatherosclerosis,\tstroke,\trenal\nfailure,\tand\tMI.\tFactors\tassociated\twith\ta\tpoor\tprognosis\tin\thypertension\tare\tshown\tin\t\nBox\t32.6\n.\nTABLE\t32.2\nManifestations\tof\tTarget\tOrgan\tDisease\tfrom\tHypertension\nOrgan\tSystem\nManifestations\nCardiac | [
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Organ\tSystem\nManifestations\nCardiac\nClinical,\telectrocardiographic,\tor\tradiologic\tevidence\tof\tarterial\twall\tthickening\tleft\nventricular\thypertrophy;\tleft\tventricular\tmalfunction\tor\tcardiac\tfailure\nCerebrovascular\nTransient\tischemic\tattack\tor\tstroke\nPeripheral\nAbsence\tof\tone\tor\tmore\tpulses\tin\textremities\t(except\tfor\tdorsalis\tpedis)\tAnkle-Brachial | [
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Index\t<0.9\nRenal\nSerum\tcreatinine\televated:\n\tmen\t1.3-1.5\tmg/dL,\twomen\t1.2-1.4\tmg/dL\nCalculated\tGFR\t<60\tmL/min/1.73\tm\n2\nElevated\talbumin\texcretion\nRetinopathy\nHemorrhages\tor\texudates,\twith\tor\twithout\tpapilledema\nGFR\n,\tGlomerular\tfiltration\trate.\nAdapted\tfrom\tSchmieder\tR:\tEnd\torgan\tdamage\tin\thypertension,\t\nDtsch\tArztebl\n\t107:866,\t2010.\nBOX\t32.6 | [
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Dtsch\tArztebl\n\t107:866,\t2010.\nBOX\t32.6\nRisk\tFactors\tand\tAdverse\tPrognosis\tin\tHypertension\nRisk\tfactors\nBlack\trace\nYouth\nMale\tgender\nPersistent\tdiastolic\tpressure\t>115\tmm\tHg\nSmoking\nDiabetes\tmellitus\nHypercholesterolemia\nObesity\nExcessive\talcohol\tintake\nEvidence\tof\tend\torgan\tdamage\nCardiac\nCardiac\tenlargement | [
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Evidence\tof\tend\torgan\tdamage\nCardiac\nCardiac\tenlargement\nElectrocardiographic\tsigns\tof\tischemia\tor\tleft\tventricular\tstrain\nMyocardial\tinfarction\nHeart\tfailure\nEyes\nRetinal\texudates\tand\themorrhages\nPapilledema\nRenal\nImpaired\trenal\tfunction | [
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Nervous\tsystem\nCerebrovascular\taccident\nFrom\tFisher\tND,\tWilliams\tGH:\tHypertensive\tvascular\tdisease.\tIn\tKasper\tDL,\tet\tal,\teditors:\t\nHarrison’s\nprinciples\tof\tinternal\tmedicine,\n\ted\t16,\tNew\tYork,\t2005,\tMcGraw-Hill.\nPathophysiology\nBlood\tpressure\n\tis\ta\tfunction\tof\tcardiac\toutput\tmultiplied\tby\tperipheral\tresistance\t(the\tresistance\tin | [
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the\tblood\tvessels\tto\tthe\tflow\tof\tblood).\tThus\n\tthe\tdiameter\tof\tthe\tblood\tvessel\tmarkedly\taffects\tblood\nflow.\tWhen\tthe\tdiameter\tis\tdecreased\t(as\tin\tatherosclerosis)\tresistance\tand\tblood\tpressure\tincrease.\nConversely,\twhen\tthe\tdiameter\tis\tincreased\t(as\twith\tvasodilator\tdrug\ttherapy),\tresistance\tdecreases\nand\tblood\tpressure\tis\tlowered. | [
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and\tblood\tpressure\tis\tlowered.\nMany\tsystems\tmaintain\thomeostatic\tcontrol\tof\tblood\tpressure.\tThe\tmajor\tregulators\tare\tthe\tSNS\nfor\tshort-term\n\tcontrol\tand\tthe\tkidney\tfor\tlong-term\tcontrol.\tIn\tresponse\tto\ta\tfall\tin\tblood\tpressure,\nthe\tSNS\tsecretes\tnorepinephrine,\ta\tvasoconstrictor,\twhich\tacts\ton\tsmall\tarteries\tand\tarterioles\tto | [
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increase\tperipheral\tresistance\tand\traise\tblood\tpressure.\tConditions\tthat\tresult\tin\toverstimulation\tof\nthe\tSNS\t(i.e.,\tcertain\tadrenal\tdisorders\tor\tsleep\tapnea)\tresult\tin\tincreased\tblood\tpressure.\tThe\nkidney\tregulates\n\tblood\tpressure\tby\tcontrolling\tthe\textracellular\tfluid\tvolume\tand\tsecreting\trenin,\nwhich\tactivates\tthe | [
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which\tactivates\tthe\t\nrenin-angiotensin\tsystem\t(RAS)\n\t(\nFig.\t32.8\n).\tAbnormal\tblood\tpressure\tis\nusually\tmultifactorial.\tIn\tmost\tcases\tof\thypertension,\tperipheral\tresistance\tincreases.\tThis\tresistance\nforces\tthe\tleft\tventricle\tof\tthe\theart\tto\tincrease\tits\teffort\tin\tpumping\tblood\tthrough\tthe\tsystem.\tWith\ntime,\tLVH\tand\teventually\n\tHF\tcan\tdevelop. | [
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time,\tLVH\tand\teventually\n\tHF\tcan\tdevelop.\nFIG.\t32.8\nRenin-angiotensin\tcascade.\nACE,\n\tAngiotensin-converting\tenzyme.\n\tSource:\t(Reprinted\twith\tpermission\tfrom\nFox\tSI:\t\nHuman\tphysiology\n,\ted\t6,\tNew\tYork,\t1999,\tMcGraw-Hill.)\nCommon\tgenetic\tvariants\tof\tthe\tRAS\tgene,\tincluding\tangiotensin-converting\tenzyme\t(ACE)\tand | [
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angiotensinogen,\thave\tshown\trelationships\twith\thypertension\t(\nHeidari\tet\tal,\t2017\n).\tAn\tincreased\nproduction\tof\tthese\tproteins\tmay\n\tincrease\tproduction\tof\tangiotensin\tII,\tthe\tprimary\tmediator\tof\tthe\nRAS,\tthus\tincreasing\tblood\tpressure.\tAngiotensin\tII\tmay\talso\ttrigger\tlow-grade\tinflammation\twithin | [
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the\tblood\tvessel\twall,\ta\tcondition\tthat\tpredisposes\tto\thypertension\t(\nMcMaster\tet\tal,\t2015\n).\nHypertension\toften\toccurs\twith\tother\trisk\tfactors\tfor\tCVD,\tincluding\tvisceral\t(intraabdominal)\nobesity,\tinsulin\tresistance,\thigh\ttriglycerides,\n\tand\tlow\tHDL\tcholesterol\tlevels.\tThe\tcoexistence\tof | [
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and\tlow\tHDL\tcholesterol\tlevels.\tThe\tcoexistence\tof\nthree\tor\tmore\tof\tthese\trisk\tfactors\tleads\tto\tmetabolic\tsyndrome.\tIt\tis\tunclear\twhether\tone\tor\tmore\tof\nthese\trisk\tfactors\tprecede\tthe\tothers\tor\twhether\tthey\toccur\tsimultaneously.\tAccumulation\tof\tvisceral | [
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fat\tsynthesizes\tincreased\tamounts\tof\tangiotensinogen,\twhich\tactivates\tthe\tRAS\tand\tincreases\tblood\npressure\t(\nZhou\tet\tal,\t2012\n).\tAlso,\tangiotensin\n\tII,\tthe\tprimary\tmediator\tof\tthe\tRAS,\tpromotes\tthe\ndevelopment\tof\tlarge\tdysfunctional\tadipocytes,\twhich\tproduce\tincreased\tamounts\tof\tleptin\tand | [
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reduced\tquantities\tof\tadiponectin.\tHigher\tlevels\tof\tleptin\tand\tlower\tamounts\tof\tcirculating\nadiponectin\tactivate\tthe\tSNS,\ta\tkey\tcomponent\tof\tthe\thypertensive\tresponse\t(\nDeMarco\tet\tal,\t2014\n). | [
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Primary\tprevention\nPositive\tchanges\tin\thypertension\tawareness,\n\ttreatment,\tand\tcontrol\thave\toccurred\tduring\tthe\tlast\nseveral\tyears.\tBased\ton\tanalysis\tof\tNational\tHealth\tand\tNutrition\tExamination\tSurvey\t(NHANES)\ndata\tfrom\t2011\tto\t2014,\t84.1%\tof\tpeople\twith\thypertension\tare\taware\tthat\tthey\thave\tit\t(\nBenjamin\tet\nal,\t2018 | [
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Benjamin\tet\nal,\t2018\n),\tup\tfrom\t81%\tin\t2007\tto\t2010.\tAlthough\tcurrent\thypertension\ttreatment\tand\tcontrol\trates\nhave\tincreased\tfrom\t48.4%\tto\t53.3%,\tduring\tthis\tsame\n\ttime\tperiod,\tadditional\tefforts\tare\tneeded\tto\nmeet\tthe\t\nHealthy\tPeople\t2020\n\tobjective\tof\t61.2%.\tIn\t2015\twomen,\tyounger\tadults\t(aged\t18\tto\t39 | [
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objective\tof\t61.2%.\tIn\t2015\twomen,\tyounger\tadults\t(aged\t18\tto\t39\nyears),\tand\tHispanic\tindividuals\thad\tlower\trates\tof\tblood\tpressure\tcontrol\tcompared\twith\tmen,\nyounger\tindividuals,\tand\tnon-Hispanic\twhites.\tImproving\thypertension\ttreatment\tthrough\ttargeted\nintervention\tprograms\tshould\thave\ta\tpositive\teffect\ton\tCVD\toutcomes. | [
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intervention\tprograms\tshould\thave\ta\tpositive\teffect\ton\tCVD\toutcomes.\n\tBlood\tpressure\ttreatment\nguidelines\thighlight\tthe\timportance\tof\tevaluating\tpatients\tfor\tthe\tpresence\tof\tmultiple\tCVD\trisk\nfactors\tand\tindividualizing\tlifestyle\tmodification\tand\tdrug\ttherapies\taccordingly. | [
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Changing\tlifestyle\tfactors\thave\tdocumented\tefficacy\tin\tthe\tprimary\tprevention\tand\tcontrol\tof\nhypertension.\tThese\tfactors\twere\tsystematically\treviewed\tand\tcategorized\tby\tthe\tAcademy\tof\nNutrition\n\tand\tDietetics\t(AND)\tin\t2015\t(\nLennon\tet\tal,\t2017\n)\tand\tmore\trecently\tby\tthe\tACC\tand\tAHA\nin\t2018\t(\nWhelton\tet\tal,\t2018 | [
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)\tand\tmore\trecently\tby\tthe\tACC\tand\tAHA\nin\t2018\t(\nWhelton\tet\tal,\t2018\n).\tThese\tguidelines\tmade\ta\tstrong\trecommendation\t(i.e.,\thigh\nbenefit/risk\tratio\twith\tsupporting\tevidence)\tfor\treducing\tintake\tof\tdietary\tsodium\tin\tadults\twith\nelevated\tblood\tpressure\tand\thypertension\tand\tfor\tweight\tloss\tin\tadults\twith\televated\tblood\tpressure | [
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consumption,\tparticularly\tamong\theavy\tdrinkers.\tThe\tACC/AHA\talso\tincluded\ta\tstrong\nrecommendation\tfor\tsupplementation\twith\tpotassium\tto\tlower\tblood\tpressure.\tIncreased\tpotassium\nintake\tshould\tpreferably\tbe\tin\tthe\tform\tof\tdiet\tmodification\tand\tmay\tbe\tcontraindicated\n\tfor\tsome | [
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] |
for\tsome\npatients\twith\tCKD.\tA\tsummary\tof\trecommendations\tand\tratings\tfrom\tthe\tACC/AHA\tand\tthe\tAND\tcan\nbe\tfound\tin\t\nTable\t32.3\n.\nTABLE\t32.3\nRecommendations\ton\tBlood\tPressure\tin\tHypertensive\tAdults\tfrom\tEvidence\tAnalysis\tLibrary\t(2015)\tand\nAmerican\tCollege\tof\tCardiology/American\tHeart\tAssociation\t(2018)\nFood\tor\nNutrient\nEAL\tRecommendation\nRating | [
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-0.016524964943528175,
-0.04038608446717262,
0.06367569416761398,
0.1102522611618042,
-0.017789602279663086,
0.015578658320009708,
-0.0017279349267482758,
0.07990576326847076,
0.003848173888400197,
0.053687285631895065,
0.019796816632151604
] |
Food\tor\nNutrient\nEAL\tRecommendation\nRating\nACC/AHA\tRecommendation\nRating\nSodium\nThe\tRDN\tshould\tcounsel\non\treducing\tsodium\nintake\tfor\tblood\npressure\treduction\tin\nadults\twith\tHTN.\nLowering\n\tdietary\nsodium\tintake\tto\n1500-2000\tmg/day\nreduced\tSBP\tand\tDBP\nup\tto\t12\tand\t6\tmm\nHg,\trespectively.\nStrong\nLower\tsodium\tintake\nConsume\tno\tmore\tthan\t2400 | [
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0.04847168177366257,
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0.007415442261844873,
4.3035237566107656e-33,
0.02537473663687706,
0.06366104632616043,
0.05509580299258232,
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0.03496961295604706,
0.08875390887260437,
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0.004562730900943279,
0.023769177496433258,
0.0801517441868782,
0.054377857595682144,
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0.01960599049925804,
0.011230647563934326,
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0.03815416991710663,
0.043251536786556244,
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0.08706488460302353,
0.028300726786255836,
0.0012006061151623726,
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0.05310361459851265,
0.08982466161251068,
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0.07139471918344498,
0.004207400139421225,
0.0002308309485670179,
0.08621131628751755,
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0.0733376145362854,
0.0623503252863884,
0.003156423568725586,
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0.028802452608942986,
0.011128515936434269,
0.07709064334630966,
0.05221027508378029,
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0.022339588031172752,
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0.09565385431051254,
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0.10532952845096588,
0.018999477848410606,
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0.07256112992763519,
0.01983032375574112,
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0.047902293503284454,
0.01790020242333412,
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0.05044566094875336,
0.11316148936748505,
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0.003605749923735857,
0.08060866594314575,
0.021105019375681877,
0.030271824449300766,
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] |
Strong\nLower\tsodium\tintake\nConsume\tno\tmore\tthan\t2400\nmg\tof\tsodium/day;\tfurther\nreduction\tof\tsodium\tto\t1500\nmg/day\tis\tdesirable\tbecause\nit\tis\tassociated\twith\teven\ngreater\treduction\tin\tblood\npressure;\treduce\tintake\tby\tat\nleast\t1000\tmg/day\tbecause\nthat\twill\tlower\tblood\npressure,\teven\tif\tthe\tdesired\ndaily\n\tsodium\tintake\tis\tnot\nachieved.\nStrong | [
-0.011600927449762821,
-0.041145384311676025,
0.061059657484292984,
0.026925375685095787,
-0.09725573658943176,
-0.03953935578465462,
0.09045281261205673,
0.020981663838028908,
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0.02986280992627144,
0.08951365202665329,
-0.06596692651510239,
0.02943277359008789,
0.026219360530376434,
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0.031641509383916855,
0.005241868551820517,
0.01048966683447361,
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0.008806126192212105,
0.03812030330300331,
0.0480794794857502,
0.032477304339408875,
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0.08114777505397797,
0.09957233816385269,
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0.029933609068393707,
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0.05150569975376129,
0.01354022417217493,
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0.01909344457089901,
0.025096984580159187,
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0.016628392040729523,
0.07514887303113937,
0.019586000591516495,
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0.03856819495558739,
0.010327812284231186,
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0.029756272211670876,
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0.08541709929704666,
0.017409944906830788,
0.014358432963490486,
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0.017051948234438896,
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0.023535694926977158,
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0.013914239592850208,
0.025025615468621254,
0.007401148788630962,
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0.020060988143086433,
0.10494545847177505,
0.012127883732318878,
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0.06756816059350967,
0.06944901496171951,
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0.04685286432504654,
0.02253766916692257,
0.044310759752988815,
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0.03340008482336998,
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0.06635937094688416,
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0.01898956298828125,
0.0019465192453935742,
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0.046360600739717484,
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0.022106537595391273,
0.04834107682108879,
0.05473428592085838,
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0.016382286325097084,
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0.05605820566415787,
0.10116817057132721,
0.06679967790842056,
0.05373363196849823,
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0.048322178423404694,
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0.002793250372633338,
2.7436855484107997e-33,
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0.00908151175826788,
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0.007392433006316423,
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0.0242554172873497,
0.07165200263261795,
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0.011696252040565014,
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0.0039833905175328255,
0.03704582527279854,
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0.07541881501674652,
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0.018619630485773087,
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0.06485398858785629,
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0.03814370185136795,
0.00021057733101770282,
0.08813364803791046,
0.0048769875429570675,
0.08345227688550949,
0.0031813306268304586,
0.11033559590578079,
0.0714094489812851,
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0.00011841538071166724,
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0.02797108329832554,
0.005443081259727478,
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0.05033271387219429,
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0.09807006269693375,
-0.13000524044036865,
0.0272283423691988,
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as\tDASH,\tUSDA\tfood\tpattern,\tor\nthe\tAHA\tDiet;\tcombine\tthe\nDASH\tdietary\tpattern\twith\tlower\nsodium\tintake.\nStrong\nFruits\tand\nvegetables\nFruits\tand\tvegetables\nshould\tbe\nrecommended\tat\ta\nlevel\tof\t5\tto\t10\nservings\tper\tday\tfor\nsignificant\tblood\npressure\treduction.\nStrong\nNot\nevaluated\nWeight\nmanagement\nOptimal\tbody\tweight\nshould\tbe\tachieved\nStrong | [
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physical\tactivity\tto\tlower\tblood\npressure:\tthree\tto\tfour\tsessions\na\tweek,\tlasting\ton\taverage\t40\nminutes\tper\tsession,\tand\ninvolving\tmoderate-to-vigorous-\nintensity\tphysical\tactivity.\nModerate\nAlcohol\nFor\tindividuals\twho\tcan\nsafely\tconsume\nalcohol,\tconsumption\nshould\tbe\tlimited\tto\nno\tmore\tthan\ttwo\ndrinks\t(24\toz\tbeer,\t10\noz\twine,\tor\t3\toz\tof\t80- | [
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] |
no\tmore\tthan\ttwo\ndrinks\t(24\toz\tbeer,\t10\noz\twine,\tor\t3\toz\tof\t80-\nproof\tliquor)\tper\tday\nin\tmost\tmen\tand\tto\tno\nmore\tthan\tone\tdrink\nper\tday\tin\twomen.\nConsensus\nNot\nevaluated\nPotassium\nStudies\tsupport\ta\nmodest\trelationship\nbetween\tincreasing\nintake\tof\tpotassium\nand\ta\tlower\tsodium-\npotassium\tratio\twith\nlowered\tblood\npressure.\nFair\nInsufficient\tevidence | [
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AHA\n,\tAmerican\tHeart\tAssociation;\t\nBMI\n,\tbody\tmass\tindex;\t\nDASH\n,\tDietary\tApproaches\tto\tStop\n\tHypertension;\nDBP\n,\tdiastolic\tblood\tpressure;\t\nHb\tA1C\n,\themoglobin\tA1C;\t\nHTN\n,\thypertension;\t\nRDN\n,\tregistered\tdietitian\tnutritionist;\t\nSBP\n,\tsystolic\tblood\tpressure;\nTG\n,\ttriglyceride;\t\nUSDA\n,\tU.S.\tDepartment\tof\tAgriculture. | [
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] |
TG\n,\ttriglyceride;\t\nUSDA\n,\tU.S.\tDepartment\tof\tAgriculture.\nRecommendations\tlisted\tare\tfor\tthose\trated\tby\tthe\tAcademy\tof\tNutrition\tand\tDietetics\tand\tthe\tAmerican\tAcademy\tof\tCardiology\t(ACC)/American\nHeart\tAssociation\t(AHA)\tas\tstrong,\tfair/moderate,\n\tand\tconsensus;\tfor\tthose\twith\tweak\tratings\tconsult\tthe\tAmerican\tDietetic\tAssociation\tEvidence | [
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] |
Analysis\tLibrary\tfor\tHypertension\t(2009)\t\nhttp://www.adaevidencelibrary.com/topic.cfm?cat=3259\n\tor\tthe\tACC/AHA\tdata\tsupplement\tat\nhttp://circ.ahajournals.org/lookup/suppl/doi:10.1161/01.cir.0000437740.48606.d1/-DC1\n*\nWeight\tmanagement\tguidelines\tare\tfrom\tJensen\tMD,\tet\tal:\t2013\tAHA/ACC/TOS\tguideline\tfor | [
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] |
with\tanother\thave\tgenerally\tshown\tno\tor\tonly\ta\tsmall\teffect\ton\tblood\n\tpressure\t(\nAl-Khudairy\tet\tal,\n2015\n;\t\nMaki\tet\tal,\t2018\n).\tSupplementation\twith\tn-3\tPUFAs\t(EPA\t+\tDHA)\tin\tdoses\thigher\tthan\t2\tg/day\nshowed\tmodest\treductions\tin\tSBP\tand\tDBP,\tespecially\tin\tuntreated\thypertensive\tadults\t(\nMiller\tet\tal,\n2014\n). | [
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] |
Protein\nEvidence\tfrom\tobservational\tstudies\tand\tRCTs\tsuggests\treplacement\tof\tprotein\tfor\tfat\tor\ncarbohydrate\tin\tan\tisocaloric\tdiet\tresults\tin\tlowered\tblood\tpressure\n\t(\nBazzano\tet\tal,\t2013\n).\tProtein\nsupplementation\tin\tdoses\tof\t60\tg/day\treduced\tSBP\tby\t4.9\tmm\tHg\tand\tDBP\tby\t2.7\tmm\tHg\tcompared | [
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with\t60\tg/day\tof\tcarbohydrate\tin\toverweight\tindividuals\twith\televated\tblood\tpressure\tand\tuntreated\nstage\t1\thypertension\t(\nTeunissen-Beekman\tand\tvan\tBaak,\t2013\n).\nDietary\tpatterns\temphasizing\tfruits\tand\tvegetables\nSeveral\tdietary\tpatterns\thave\tbeen\tshown\tto\tlower\tblood\tpressure.\n\tPlant-based\tdietary\tpatterns\thave | [
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Plant-based\tdietary\tpatterns\thave\nbeen\tassociated\twith\tlower\tSBP\tin\tobservational\tstudies\tand\tclinical\ttrials\t(\nAlexander\tet\tal,\t2017\n).\nAverage\tSBP\treductions\tof\t5\tto\t6\tmm\tHg\thave\tbeen\treported.\tSpecifically,\tthe\t\nDietary\tApproaches\nto\tStop\tHypertension\t(DASH)\n\tcontrolled\tfeeding\tstudy\tshowed\tthat\ta\tdietary\tpattern\temphasizing | [
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