Question

A 47-year-old black man who is an executive in a law firm has his blood pressure taken at a screening program and is told that his pressure is 142/90mm Hg. His father and older brother have hypertension, and his paternal grandparents had a history of stroke and myocardial infarction. The patient enjoys salty foods and routinely uses a saltshaker to add salt to meals his wife prepares, drinks about four beers while watching television in the evening, and gained 15 pounds in the past year. Although his family has encouraged him to engage in physical activities with them, he states he is either too busy or too tired.

A. According to the JNC 7 guidelines, into what category does the patient’s blood pressure fall?

B. What are his risk factors for hypertension?

C. Explain how an increased salt intake might contribute to his increase in blood pressure.

D. What lifestyle changes would you suggest to the patient? Explain the rationale for your suggestions.

Answer 1

A.

JNC7 is Joint National Committee 7 has given guidelines for detection, prevention and treatment of hypertension.

JNC 7 guidelines are

1. For patients age 50 or older, elevated SBP is a stronger cardiovascular risk factor than elevated DBP.
2. Within the BP range of 115/75 mm Hg to 185/115 mm Hg, each increment of 20/10 mm Hg doubles cardiovascular risk.
3. Prehypertension should be managed with lifestyle modification (e.g., low-salt diet, regular physical activity).
4. For patients with hypertension, the basic BP-control target is <140/<90 mm Hg, but the target is <130/<80 mm Hg for patients with diabetes or renal disease.
5. Thiazide diuretics are recommended as initial therapy for uncomplicated hypertension, either alone or in combination with other agents.
6. Most hypertensive patients will require 2 or more medications to achieve BP goals. So that clinician has to start treatment with 2 agents.
7. The essential to maintain physician patient relationship for the motivation and followup treatment.

Hypertension classification as below

Category	Blood pressure
Normal	120/80 mm og Hg
Prehypertension	121/81 to 139/89 mm ig Hg
Stage 1 hypertension	140/90mm of Hg to 159/99 mm of Hg
Stage 2 hypertension	>160/100 mm og Hg

According to JNC 7 guidelines above patient falls under the category of stage 1 hypertension.

B.

Risk factors for hypertension:-

Non- modifiable risk factors:

• Age > 35 years
• Male sex
• Ethnicity
• Race
• Hereditary

Modifiable risk factors:

• Obesity or higher BMI
• Smoking
• Stress
• Salt intake
• Potassium intake
• Hormonal contraceptives use

C.

Salt intake in the body retains potassium with sodium, as they are co transporter.

Salt increases sodium retention and ultimately water also retains in the body. Thus increases blood pressure leads to hypertension

4.Lifestyle changes to be habituated are

• Reduce salt intake. This salt restricted diet reduces fluid over load in the heart.
• Increase the physical activity. Physical activity reduces blood cholesterol level, and body becomes activated.
• Maintain normal BMI
• Cessation of smoking and alcoholism if any.