POTENTIAL EFFECTS OF DRUGS AND NUTRIENTS IN HYPERTENSION

POTENTIAL EFFECTS OF DRUGS AND NUTRIENTS IN HYPERTENSION

n  INTRODUCTION

Hypertension is the medical term for high blood pressure. Blood pressure refers to the pressure that the circulating blood applies to the inner walls of the arteries. Arteries carry blood from the heart to other organs and parts of the body.

Blood pressure is based upon two values:

Systolic pressure refers to the pressure in the arteries as the heart contracts (beats) and

Diastolic pressure refers the pressure in the arteries as the heart relaxes between beats.

This is read as systolic pressure over diastolic pressure (e.g., 120 over 70).

Untreated hypertension increases the strain on the heart and arteries, eventually causing organ damage. Hypertension increases the risk of heart failure, heart attack (myocardial infarction), and stroke

n  DEFINITION OF HIGH BLOOD PRESSURE

The standard definition of high blood pressure is determined by the Joint National Committee (JNC) on Detection, Evaluation, and Diagnosis of High Blood Pressure. A person is considered to have high blood pressure after three to six elevated blood pressure measurements over several months.

This definition apply to adults who are healthy and not using medication for high blood pressure.

 If the two pressures fall in different categories, the higher one is used to determine the severity of the hypertension.

n  CLASSIFICATION OF HYPERTENSION

 The ideal blood pressure for an adult is 120 (systolic) / 80 (diastolic).

Hypertension is divided into the following levels:

n  Borderline: 120-160 / 90-94

n  Mild: 140-160 / 95-104

n  Moderate: 140-180 / 105-114

n  Severe: 160 + / 115 + 

Statistically, over 80% of those afflicted with hypertension fall into the borderline to moderate range. 

 

 

n  INCIDENCE

High blood pressure presents a problem in the lives of some 60 million Americans .At least 95 % of these persons have essential hypertension meaning that its cause is unknown

Yet it has become the fourth largest public health problem in America and it is known as the silent killer because carries no overt signs .

PREVALENCE:

Is especially high among African Americans, who develop hypertension earlier in life and sustain higher average blood pressures throughout their lives .

n  BLOOD PRESSURE CONTROL

ARTERIAL PRESSURE :

Blood pressure" as commonly measured" is  an indication of the arterial pressure in the vessels of the upper arm .

It is measured by an instrument called sphygmomanometer.

The higher figure recorded is the systolic pressure from the contraction of the heart muscle . The lower figure recorded is the diastolic pressure produced during the relaxation phase of the cardiac cycle .

The upper limit of  a normal adult blood pressure would be recorded 150/89 .

n  MUSCLE TONE OF BLOOD VESSEL WALL

Normally the body’s tuned mechanism maintain fluid dynamics .

In hypertension , these systems that act to variously dilate or constrict the blood vessels are not acting effectively .

If not effectively treated , uncontrolled elevated blood pressure results .

MAIN SYSTEMS THAT MAINTAIN BLOOD PRESSURE :

n  Neuro endocrine adrenergic system .

n  Renin – angiotensin – aldosterone system .

n  Kallikrein-kinin system

1. Neuroendocrine adrenergic system :

 Adrenergic nerve fibers of the sympathetic nervous system release norepinephrine " the most common neuroendocrine chemical transmitter substance " at synapses .

The hormone norepinephrine is also secreted by the adrenal medulla , the central zone of the adrenal gland , especially in response to stress .

This explains the more forceful heart muscle contraction observed early in the development of essential hypertension and the increased heart rate as the disease is manifested .

II. Renin angiotensin aldosterone system :

This system conserves sodium and body fluids and has a vasopressor effect.

n  III. Kallikrein kinin system :

Acts in a fashion similar to the rennin system .

Kallikrein is an enzyme in the blood plasma and various glands that liberates polypeptide called kinins ( bradykinin) from inactive precursor in the plasma .

Bradykinin dilates blood vessels and increases their permeability , thus reducing blood pressure .

n  DEGREES OF HYPERTENSION

• MILD HYPERTENSION

Diastolic pressure is 90 to 105 mmHg in the mild form.

Take consideration on other risk factors such as weight or stress.

Individual treatment is initiated using non drug approaches and centers on nutritional therapies of weight loss , sodium restriction , and behavioral techniques .

• MODERATE HYPERTENSION

Diastolic pressure is 105 to 119 mmHg .

Prompt evaluation and treatment are indicated , a combination of drugs may be used :

ü  Diuretic agent to decrease the blood volume .

ü  Blocking agent to decrease muscle constriction of blood vessel walls .

ü  The basic nutritional therapy serves as support with the good of reducing the quantity of medication required .

• SEVERE HYPERTENSION

Diastolic pressure is 120 to 130 mmHg and above .

Immediate evaluation and vigorous drug therapy are needed .

Diuretic and B- blocker agents are continued and  a third drug may be added , a peripheral vasodilator to assist in reducing arterial resistance to blood flow .

In all cases the implication of diet therapy revolve around potassium replacement in the use of diuretics and nutritional support for weight management and sodium modification , also physical exercise and stress reduction activities are needed .

n  CAUSES OF HIGH BLOOD PRESSURE:

Essential Hypertension

Hypertension is referred to as essential, or primary, when the physician is unable to identify a specific cause. occurring in up to 95% of patients

Genetic factors appear to play a major role in essential hypertension.

Secondary Hypertension

Secondary hypertension has recognizable causes, which are usually treatable or reversible :

n  Medical Conditions.

 Kidney disease is the most common cause of secondary hypertension, particularly in older people. Other medical conditions that contribute to temporary hypertension are pregnancy, cirrhosis, and Cushing's disease.

n  Medications.

Certain prescription and over-the-counter drugs can cause temporary high blood pressure. Some prescription medications include cortisone, prednisone, estrogen, and indomethacin. Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) may injure the kidney and is an important cause of secondary hypertension in the elderly population. Such drugs include aspirin, ibuprofen , naproxen , and many others

n  Alcohol, Caffeine, Smoking, and Drugs

n  Other Causes of Secondary High Blood Pressure: Temporary high blood pressure can result from stress, exercise, and long-term consumption of large amounts of licorice

n  SERIOUS EFFECTS OF HIGH BLOOD PRESSURE

Hypertensive people can have as high as ten times the risk of stroke and five times the risk of a heart attack, depending on the severity of the hypertension.

• Emergency Conditions : Malignant hypertension, an emergency condition resulting from untreated primary hypertension, can be lethal
• Damage to Other Organs : Hypertension can cause certain organs (called target organs), including the kidney, eyes, and heart, to deteriorate over time, and patients who do not control high blood pressure face a reduced life span
• Bone Loss : Hypertension also increases the elimination of calcium in urine that may lead to loss of bone mineral density, a significant risk factor for fractures, particularly in elderly women
• Sexual Dysfunction : Some form of sexual dysfunction occurs in about a quarter of hypertensive men. It is often caused by medications that treat high blood pressure
• Mental Deterioration : Uncontrolled chronic high blood pressure is associated with mental deterioration in older people, including reduced short-term memory and attention, Alzheimer's disease, and dementia.
• Pregnancy and Preeclampsia : Severe, sudden high blood pressure in pregnant women caused by a condition called preeclampsia can be very serious for both mother and child. It occurs in up to 10% of all pregnancies usually in the third trimester of a first pregnancy, and resolves immediately after delivery.
• Children with Hypertension : A child's blood pressure is normally much lower than an adult's. Children are at risk for hypertension if they exceed the following levels:
  1.Ages three to five: 116/76
  2.Ages six to nine: 122/78
  3.Ages 10 to 12: 126/82
  4.Ages 13 to 15: 136/86
  Results of studies evaluating outcomes of children with hypertension suggest that early abnormalities, including enlarged heart and abnormalities in the kidney and eyes, may occur even in children with mild hypertension.

n  SYMPTOMS OF HIGH BLOOD PRESSURE
 

Hypertension has been aptly called the "silent killer" because it usually produces no symptoms.

Untreated hypertension increases slowly over the years.

 In rare cases , the blood pressure rises quickly(with diastolic pressure usually rising to 130 or higher), resulting in malignant or accelerated hypertension. This is a life-threatening condition and must be treated immediately. People should call a physician immediately if these symptoms occur:

n  Drowsiness.

n  Confusion.

n  Headache.

n  Nausea.

n  Loss of vision

n  DIAGNOSIS OF HIGH BLOOD PR-
ESSURE

n  Measuring Blood Pressure by sphygnomometer

n  Physical Examination for Complications of Hypertension :    The physician will check the patient's pulse rate, examine the neck for distended veins or an enlarged thyroid gland, check the heart for enlargement and murmurs, and examine the abdomen and eyes

n  Medical History

If hypertension is suspected, the physician should obtain the following information:

Ø  A family and personal medical history, especially incidence of high blood pressure, stroke, heart problems, kidney disease, or diabetes.

Ø  Risk factors of heart disease and stroke, including tobacco use, salt intake, obesity, physical inactivity, and unhealthy cholesterol levels.

Ø  Any medications being taken.

Ø  Any symptom that might indicate so-called secondary hypertension (that is, caused by another disorder). Such symptoms include headache, heart palpitations, excessive sweating, muscle cramps or weakness, or excessive urination.

Ø  Any emotional or environmental factors that could affect blood pressure.

 

n  Laboratory and Other Tests

If a physical examination indicates hypertension, additional tests may help determine whether it is secondary hypertension (caused by another disorder) or essential hypertension (no other disorder is present) and whether organ damage is present.

o        Blood tests and a urinalysis

o        An electrocardiogram (ECG).

o        An exercise stress test. This could be important for those with borderline hypertension. Stress-induced blood pressure in such patients has been associated with a risk for left ventricular hypertrophy. Studies also suggest that an excessive rise in systolic pressure during exercise indicates a risk for coronary artery disease, and stroke

n  CONTRIBUTING FACTORS FOR HYPERTENSION

Several major risk factors have been implicated in the development of hypertension :

n  AGING : hypertension risk increases with age .

n  GENETIC : hypertension tend to be a family trait , and within certain ethnic groups .

n  OBESITY : rates of hypertension in men and women classified as obese (BMI of 30 or higher ) are 38.4 percent and 32.2 percent respectively .

n  SALT SENSITIVITY : among those with hypertension , 55 percent of whites and 73 percent of African Americans have blood pressure that is sensitive to salt .

n  ALCOHOL : heavy alcohol consumption is strongly associated with hypertension

n  DIET : a person's dietary choices may influence hypertension risk .

n  General Guidelines For Choosing The Appropriate Treatments For High Blood Pressure

Clinical problems associated with hypertension can be divided into two categories, dependent upon the severity and duration of the elevated blood pressure.

Ø   Mild elevations in blood pressure sustained over a period of many years and decades increases the risk of atherosclerosis, stroke, myocardial infarction, heart failure and renal failure.

Ø  Acute elevations in blood pressure, even if sustained for a relatively short time, can cause hypertensive encephalopathy, stroke, retinal hemorrhage, acute myocardial infarction and acute left ventricular failure with pulmonary edema.

The goals of therapy are:

1. Bring the blood pressure down into the normal range
2. Prevent end-organ damage, especially to the heart, brain, eyes and kidneys.

Guidelines for the assessment and management of hypertension change periodically based on new consensus and new research data.

n  TREATMENT CAN BE DIVIDED INTO

NON DRUG APPROACH :

Therapies such as diet , exercise , and behavior modification be pursued aggressively not only in treating mild hypertension but also as an important adjunct in more severe cases .

GOALS :

Is to reduce the quantity of drugs required and avoid some unwanted biochemical effects of drug treatment .

Most hypertensive persons respond to some degree of sodium restriction and are called sodium sensitive .

Adequate potassium levels relate to blood pressure control mainly through its electrolyte balance with sodium and its replacement need when potassium losing diuretics are used .

It is difficult here to determine the amount of calcium that would be adequate to prevent hypertension , and the mechanism of calcium effect on blood pressure is unclear .

The current focus of nutritional therapy is on weight management , sodium control , general nutrient balance and an individualized food plan .

• WEIGHT MANAGEMENT

Body weight is an indicator of an individual energy balance.

Overweight state is associated with hypertension risk factors, a careful planned program of weight reduction is a basic step of therapy .

• SODIUM CONTROL

A moderately reduced daily intake of about 2-3 gm is a reasonable goal

n   

• GENERAL ENERGY NUTRIENT BALANCE

The ratio of carbohydrates , proteins and fat in the diet for hypertensive patient is very important ,because these nutrients contribute kilocalories .

The relative ratios according to the U.S.Dietary  Goals are :

Carbohydrates should have the largest allowance 50-55% of the total kilocalories with a large portion of complex carbohydrates .

Proteins should make up about 15-20% with monitoring of excess protein intake which usually carries animal fat with in

Fats modified to take only 25-30%of total kilocalories with focus on unsaturated fat food forms .

• FOOD PLAN

o        FOOD PREPARATION

Numerous guide for preparation of primary foods with alternative seasonings to salt are available , as in the salt free food guide .

A variety of condiments , with avoidance of high sodium ones , and spices can help the client develop a taste for less salt .

A reduced use of high sodium soft drinks and mineral waters as well as other processed foods, will eliminate still more salt .

o               FOOD PRODUCTS

Close attention to food product labeling is important to control sodium intake . Current labeling provide information for the consumer who wishes to control the intake of sodium and other food additives .

o                SPECIAL NEEDS

Special attention will be needed to those types of ethnic diets such as the Chinese , that are traditionally high in sodium .

DRUG APPROACH:

All who have hypertension should be under the care of a physician for a complete work-up and treatment. It is necessary for those with severe and moderate hypertension to use drugs to bring the blood pressure down to normal levels.

Patients with borderline to mild hypertension , it is recommended that non-drug therapies be used as the first step treatment.

But large scale studies have shown that drugs offer minimal in protecting against heart disease in people with borderline and mild hypertension .

In addition , drugs carry significant risks and associated side effects.

Traditional hypertension medications range from beta-blockers, vasodilators, and diuretics, to calcium channel blockers. They are prescribed under the supervision of a physician and many have unpleasant side effects

n  Drugs for hypertension :

Dozens of antihypertensive drugs are available. They usually fall into the following categories

Ø  Diuretics: which cause the body to excrete water and salt. They are inexpensive, but some people find the increased urination inconvenient. Diuretics deplete sodium and potassium, which can cause weakness and heart rhythm disturbances. As a result, many doctors add a potassium supplement or a second, potassium-sparing diuretic to counter this effect.

Three primary types of diuretics exist:

o        Thiazides and thiazide-related drugs; some common ones are chlorothiazide , chlorthalidone , indapamide , and hydrochlorothiazide .

o        Loop diuretics block sodium transport in parts of the kidney; include bumetanide , furosemide , and ethacrynic acid .

o        Potassium-sparing diuretics include amiloride , spironolactone , and triamterene .

Ø  Beta-blockers:

 which block the effects of adrenaline, thus easing the heart's pumping action and widening blood vessels. Some beta blockers also block alpha receptors with even greater blood pressure lowering effects.

 The potential adverse effects of beta and/or alpha blockade are weakness, shortness of breath, fainting, slow heart rate, cold extremities and sometimes depression and erectile dysfunction including :

propranolol , acebutolol , atenolol , betaxolol , carteolol , metoprolol , nadolol , penbutolol , pindolol , carvedilol , and timolol .

Ø  ACE inhibitors:

which reduce the production of angiotensin, a chemical that causes arteries to constrict. ACE inhibitors have adverse effects, such as, a cough or hives which rarely can be life threatening. Also ACE inhibitors cause the kidneys to retain potassium so they can be used in combination with a diuretic to offset the latter's potassium loss, but sometimes they can cause potassium levels to become dangerously high ,

 it  include captopril , enalapril , quinapril , benazepril , ramipril , perindopril , and lisinopril .

Ø  Vasodilators: which expand blood vessels. They are sometimes used in conjunction with other blood pressure medications to augment their effect or for short term use to lower blood pressure quickly in an emergency. They have not been as well tolerated as newer medications; they often require multiple doses daily and typically are not used alone because, like alpha blockers, they make the heart work harder. include hydralazine , clonidine (Catapres, available in tablets or as a skin patch), and Minoxidil .   

Ø  Calcium-channel blockers: which help decrease the contractions of the heart and widen blood vessels. Muscles in the heart can also relax, slowing the heart's rate and strength of contraction. Relaxed arteries allow blood to pool in the legs, leading to swelling. Relaxed muscles in the intestines slow intestinal movement. Heart rate abnormalities, swelling in the legs and constipation are the most common side effects of this class of drug. include diltiazem , amlodipine , felodipine, isradipine , verapamil , nisoldipine , nicardipine , and nifedipine .

Ø  Angiotensin receptor blockers: Rather than inhibit angiotensin production, angiotensin receptor blockers (ARB's) block the effect angiotensin has on the kidney and blood vessels. They eliminate the cough that ACE inhibitors can cause, but they promote the retention of potassium and can lead to elevated potassium levels. Otherwise, they tend to be very well tolerated. include losartan , candesartan telmisartan, eprosartan, irbesartan and valsartan

Ø  Alpha blockers: These inhibit the constricting effect epinephrine and norepinephrine have on the blood vessels. They are rarely used alone for blood pressure as they cause the heart to work harder and can increase the pressure inside the kidneys. When used for blood pressure, they are commonly used with other medications for additive effect. doxazosin (Cardura) and prazosin (Minipress).

Ø  Experimental Agents : Neutral Endopeptidase Inhibitors (NEPs). Neutral endopeptidase inhibitors (NEPs) are similar to ACE inhibitors. Their primary action is to produce higher levels of an enzyme called atrial natriuretic peptide, which has the following effects:
1.It opens blood vessels.
2.Induces fluid elimination.
3.Opposes the actions of the compensating systems responsible for ongoing damage of the failing heart.
Agents under investigation include omapatrilat ,candoxatril, and ecadotril..

n  Antihypertensive drugs combination

To treat hypertension, physicians don't simply pick a drug from a list. They must also consider the patient's preexisting medical problems, his age, ethnicity, and other medications, as well as the cost of medications.

Approximately one third of all people suffering from hypertension can control their condition using one medication. However, most people will eventually need to use several medications at once.

Here are five reasons for combining medications:

n  Higher doses of one medication may increase the risk of side effects.

n  Combining medications balances the effects on the organs being protected by treatment.

n  Some medical problems, such as diabetes or heart failure, improve with the use of certain medications, so these are often used even in small doses to get these benefits.

n  Some medications will counteract the adverse effects of another blood pressure   medication.

n  Adding a medication may lower the pressure more than by increasing the dose.

n  High Blood Pressure Protocol October 2006

The following 4 step protocol should be followed concurrently for at least 60 days. In most cases , the clients  will see lowering of blood pressure. It includes (Nutritional Supplementation , Modified Mediterranean Diet , Exercise , Hydration )

   1. Nutritional Supplementation

Because of tremendous individual variation, the use of nutritional supplementation  should therefore be personalized for your body. One person’s nutrient can be another person’s toxin.

A . Short-term supervised fasting: Short-term, inpatient, supervised fasting appears to be the most effective documented treatment for chronic hypertension. Documented reductions in hypertension of 60/17 in patients with severe hypertension and reductions of 37/13 in patients with moderate hypertension. Generally, the program begins with four to seven days of a raw vegetarian diet, followed by one to two weeks of fasting, and concluded with reintroduction of a vegetarian and health-promoting diet. Laboratory tests and professional supervision help ensure patient safety.

B. Coenzyme Q10 (CoQ10), L-Carnitine, and Lipoic Acid

A 12-week course of intake is needed before a decline in blood pressure is seen.
Daily Nutritional Supplement consideration:
Coenzyme Q10: 60 - 120 mg
L-Lipoic Acid: 70 - 300 mg
L-Carnitine: 300 - 1200 mg
CoQ10, also known as ubiquinone, is a coenzyme essential for the proper functioning of the mitochondria. . CoQ10 deficiency has been found in 39% of patients with high blood pressure.

As documented in several clinical studies, some of which showed that CoQ10 is more effective and safer than the use of antihypertensive drugs.

 Reductions in blood pressure generally are in the range of 17/12 and are dose-dependent. A patient who does not respond to 100 mg per day might respond very well to 200 mg per day.

The exact mechanism of action for lowering blood pressure remains unknown. It may be due to CoQ10's ability to lower levels of the dangerous oxidized form of cholesterol and to stabilize the vascular system via its antioxidant properties

CoQ10 is very safe and drug interactions are rare; caution should be used in patients taking coumadin.

Working synergistically with CoQ10 as anti-aging cardio-protective and vaso-protective agents are two endogenous antioxidants that also enhance mitochondrial function and reduce free radical damage - L-carnitine and lipoic acid.

L-carnitine assists in the process of bringing fatty acids from the extracellular space into the mitochondria.

Lipoic acid is called the "universal antioxidant". As such, it has the ability to recycle both Vitamin C and E in our body. It also helps break down sugars so that energy can be produced from them through cellular respiration

C. Magnesium:

Nuts, whole grains, and legumes are excellent dietary sources of magnesium.

Magnesium is a critical mineral and cofactor in over 300 enzymatic reactions in our body, including the production of energy. In one double-blind study, 21 male patients with high blood pressure were given 600 mg of magnesium (as magnesium oxide) or a placebo. Mean blood pressure decreased 10%.

Daily Nutritional Supplement Consideration:
Magnesium Oxide: 200 - 400 mg 3 times a day

D. Garlic

Modern use of garlic also focuses on its ability to lower cholesterol and blood pressure, Allicin is the primary compound responsible for its pharmacology

Daily Nutritional Supplement Consideration:
Standardized commercial preparations that provide a daily dose of at least 10 mg alliin, or a total allicin potential of 4,000 mcg, or 1-4 cloves of fresh garlic a day.

E. Hawthorn (Crataegus monogyna)

Extracts from hawthorn berries and from the flowering tops of hawthorn are widely used by physicians in Europe for their cardiovascular enhancing properties. The exact mechanism is not fully known, although it appears that hawthorn has vasodilating properties. 

Daily Nutritional Supplement Consideration:
Standardized Hawthorn Extract: 100 - 400 mg (2% flavonoids and 18.75% procyanidins).

F. Vitamin C

Clinical studies show that vitamin C intake has a modest effect (a drop of 5 mm Hg) on lowering blood pressure in people with mildly elevated of blood pressure. More importantly, vitamin C increases HDL cholesterol (the good cholesterol). It also helps shift the blood lipid levels toward a favorable HDL/LDL ratio by increasing HDL.

 Daily Nutritional Supplement Consideration:
Vitamin C: 1,000 - 3,000 mg

G. Vitamin D and calcium: Vitamin D3 (cholecalciferol) and calcium supplementation can reduce blood pressure in hypertensive patients by approximately 13/7,  reasonable dose of vitamin D3 for adults is in the range of 2,000 to 4,000 IU per day.

The most important drug interaction with vitamin D is seen with hydrochlorothiazide, a commonly used anti-hypertensive diuretic that promotes hypercalcemia; vitamin D therapy in patients taking hydrochlorothiazide must be implemented slowly, with professional supervision and with weekly laboratory monitoring of serum calcium. Vitamin D probably corrects hypertension via several mechanisms, including, but not limited to, increased absorption of magnesium and reduction in intracellular calcium

Calcium, while primarily associated with the prevention of osteoporosis, has other anti-aging benefits such as anti-hypertensive properties.

Daily Nutritional Supplement consideration: 1,000 - 1,500 mg

n  H . Fish oil: Fish oil supplementation has been shown to reduce blood pressure by approximately 3/2.
I . Food allergy elimination the more allergic symptoms seen and the more complete the response to allergy elimination, the more likely a reduction in blood pressure.

n  2. Modified Mediterranean Diet

Anti-aging diet and lifestyle changes are the first and foremost step in the treatment of borderline to mild hypertension.

The anti-aging pyramid is a simple graphic format based on the modified Mediterranean Diet. This food choice program consists of 50-55% complex carbohydrates of low glycemic index type food such as legumes, nuts, whole-wheat, and whole fruits, 20-25% protein (preferably from plant sources), 25-30% fat, and 5% sweets, candies and dessert

Consider the following anti-aging tips, which, if followed, are highly effective in normalizing hypertension.

n  Maintain an ideal body weight.

n  Follow the anti-aging diet that emphasizes plant foods.

n  Two blood pressure lowering foods

o        Celery  .

o        Garlic .

n  Avoid stimulants such as coffee or stress because their    adrenergic simulative effects constrict blood vessels which leads to hypertension.

n  Maintain a high potassium and low salt diet by decreasing salt intake and increasing intake of fruits, vegetables and legumes. Clinical responsiveness to low-sodium diets ranges from minimal to a maximal reduction in the range of 22/14 - 16/9.

3.Exercise

A well-balanced exercise must include three components:
a. Flexibility training
b. Cardiovascular training.
c. Strength training.
Ideally, about 2000 calories should be burned per week. Working out with  30 minutes of aerobics exercise at moderate intensity 5 times a week plus 15-20  minutes of strength training 3 times a week will accomplish this goal.

4.Hydration.

High blood pressure can be a state of adaptation of the body to generalized chronic long-term dehydration. 

One of the first  and most effective screening test and treatment for those who have hypertension that falls in the class of " borderline" hypertensive  is a trail course on hydration (together with regular salt intake) treatment for 3 months instead of the reverse. This is often accompanied by the return to ideal body weight in the case of those who are obese.

n   FOOD- DRUG AND DRUG-DRUG INTERACTIONS 
It is a difficult and complex problem to accurately determine the effects of food and nutrients on a particular drug. There are many dramatic results or problems caused by food-drug and drug-drug interactions

 

 

 

 

 

 

 

 

Interactions/ Guidelines	Use	DRUG
Food: Some diuretics cause loss of potassium, calcium and magnesium. Triamterene is known as a “potassium sparing” diuretic. When taking triamterene avoid eating large amounts of potassium-rich foods such as bananas, oranges and green leafy vegetables or salt substitutes. Monosodium glutamate (MSG): Often used in seasoned salts, meat tenderizers, and frozen vegetables. In addition, avoid natural licorice . Monosodium glutamate and diuretics both act to remove excess water from body tissue. In combination they may deplete essential quantities of water-soluble vitamins (C and B-complex) and minerals (sodium and potassium).	To help eliminate water, sodium and chloride from the body.	Diuretics Furosemide ,Triamterene hydrochlorothiazide Trimterene Bumetamide Metolazone
Alcohol: Avoid drinking alcohol with propranolol/INDERAL because these drugs lower blood pressure too much. Natural licorice and imported licorice candy and flavoring( which are  often natural.) A substance contained in natural licorice root causes salt and water retention that can lead to elevated blood pressure. In addition to natural licorice, avoid tyramine-rich foods	To decrease the nerve impulses to blood vessels.	Beta Blockers Atenolol, Metoprolol Propranolol , Nadolol
ALCOHOL: Avoid alcohol because it may add to the blood vessel-relaxing effect of nitrates and result in dangerously low blood pressure.	To relax blood vessels and lower the demand for oxygen by the heart.	Nitrates Isosorbide dinitrate, Nitroglycerin
FOOD: Take one hour before or two hours after meals. May increase the amount of potassium in the body. Too much potassium can be harmful. Avoid eating large amounts of potassium-rich foods such as bananas, oranges and green leafy vegetables or salt substitutes. Natural licorice and imported licorice candy and flavoring which are  often natural.) A substance contained in natural licorice root causes salt and water retention that can lead to elevated blood pressure.	To relax blood vessels by preventing angiotension II, a vasoconstrictor, from being formed.	Angiotension Converting Enzyme (ACE Inhibitors) Captopril, Enalapril Lisinopril, Quinapril Moexipril
Grapefuit Juice   Inhibition of cytochrome P-450 system increases bioavailability and reduces drug disposition, resulting in high serum levels of these medications.   Hypotension, dysrhythmias, bradycardia, blockade of SA and AV nodal conduction; dis-association, CNS depression   Avoid Grapefuit Juice . To ensure these drugs perform their functions most effectively, avoid drinking grapefruit juice or eating grapefruit within four hours of taking your medications	Relax blood vessels	Ca Channel Blockers (nifedipine, amlodipine, nicardipine, diltiazem)

 

 

 

 

Antihypertensive drug interactions:

There are many drug interactions with antihypertensive agents and some of these are highly significant. Patients with hypertension frequently take multiple medications and may be at increased risk for drug interactions. Nearly every elderly patient with multiple medical problems will have the potential for one drug interaction in their regimen. These drug interactions can lead to morbidity or even mortality if appropriate steps are not taken to minimize this risk. Drug interactions may occur due to pharmacokinetic (i.e., absorption, distribution, metabolism, elimination) or pharmacodynamic interactions. Physicians and pharmacists must remain vigilant in their monitoring of potential drug interactions and make appropriate dosage or therapy adjustments.