Asian patients. · In a review article, the authors of the Spanish studies (Smolensky 2010) recommend taking an individualized approach and considering the harms and benefits of bedtime therapy for patients with certain comorbidities. They explained that for certain conditions, such as glaucoma and advanced vascular ischemic disorders, a too-low asleep BP could be detrimental. · The benefit of bedtime antihypertensive medication was observed for ACE inhibitors, ARBs, and diuretics, as well as other commonly prescribed antihypertensive medications and combinations (Hermida 2011 [Am J Hypertens], Hermida 2011 [Chronobiol Int], Zeng 2011). Lifestyle modification The literature on the effect of lifestyle change on the control of hypertension is limited. All trials were small to moderate in size and only addressed the effect of lifestyle modification on BP control, not on morbidity and mortality. The PREMIERE trial that compared three interventions among patients with pre- or mild hypertension showed that the prevalence of hypertension was significantly lower in the group that received established recommendations plus the DASH diet than in the group that received advice only (Elmer 2006). There is also fair evidence from meta-analyses of small studies with some methodological flaws that a weight-reducing diet and salt and alcohol restrictions are associated with significant reductions in blood pressure. However, it is unclear whether these short-term lifestyle changes can reduce the need for medications or improve morbidity and mortality (Horvath 2008, Dickinson 2006). Recommendations on lifestyle modification in the current guideline were adopted from JNC 8 panel recommendations, which were based on the 2013 ACC/AHA guideline on lifestyle management to reduce cardiovascular risk. Home monitoring of blood pressure There is evidence from several meta-analyses that patients diagnosed with hypertension in the office who monitor their blood pressure at home are more likely to achieve their target BP value than those monitored in the office (Cappuccio 2004, Verberk 2005, Ishikawa 2008). The studies included in the meta-analyses were conducted in different settings and used different criteria for including patients, different methods for monitoring blood pressure, and different, higher targets than those currently recommended. According to the published literature and external guidelines reviewed, the goal of blood pressure < 140/90 mm Hg when BP is measured in the office is equivalent to < 135/85 mm Hg when measured at home. hrough your body. Blood pressure rises and falls naturally during the day. But if it stays too high, over time it can lead to health problems, such as a heart attack, stroke or heart failure. High blood pressure is also called hypertension. Often, there may be no signs or symptoms that tell you when your blood pressure is too high. The good news: High blood pressure can be treated or even prevented. What the Numbers Mean Blood pressure is given as two numbers. Systolic blood pressure is the top number, and diastolic blood pressure is the bottom number. Under new guidelines, high blood pressure is now defined as 130 mmHg/80 mmHg or greater. Normal blood pressure is less than 120 mmHg/80 mmHg. Research shows that lower blood pressure goals improve heart health. Lifestyle changes are the main treatment for those with elevated (120-129 mmHg/<80 mmHg) or stage 1 high blood pressure (130- 139 mmHg/80-89 mmHg). They are also important in treating individuals with stage 2 high blood pressure (>140 mmHG/>90 mmHG) and for good health overall. Lifestyle Changes to Lower Your Blood Pressure Lose weight, if needed, and maintain a healthy body weight. Focus on healthy eating: Follow the Dietary Approaches to Stop Hypertension (DASH) diet, high in fruits, vegetables, and low-fat dairy. Cut the amount of salt (sodium) you eat. For people with high blood pressure or at risk for it, less than 1,500 mg per day is often the goal. Eat potassium-rich foods, such as sweet potatoes, spinach, bananas. Get regular physical activity. Limit alcohol (no more than one drink per day for women, two drinks per day for men). HOW MUCH SALT? 1/4 tsp salt = 575 mg sodium 1/2 tsp salt = 1,150 mg sodium 3/4 tsp salt = 1,725 mg sodium 1 tsp salt = 2,300 mg sodium LIFESTYLE CHANGE RECOMMENDATION LOWERS SYSTOLIC BLOOD PRESSURE (TOP NUMBER) Lose weight - Maintain a normal body weight - For those who are overweight, aim to lose at least 1 kg 2-5 mmHg; expect to lower systolic blood pressure 1 mmHg per kg lost Follow DASH diet Eat lots of fruits, vegetables, low-fat dairy 3-11 mmHg Reduce salt Aim for less than 1,500 mg per day 2-6 mmHg Boost potassium Aim for 3,500 mg-5,000 mg per day 2-5 mmHg Be more active 90-150 minutes of aerobic exercise per week 2-8 mmHg Limit alcohol For men, less than 2 drinks daily; for women, less than 1 3-4 mmHg Lifestyle changes can be hard to do every day, but they can go a long way to lowering your blood pressure. Role of Medicine Some people also will need one or more blood pressure-lowering medications to help control their blood pressure. For example: • People with stage 1 high blood pressure who are likely to develop cardiovascular disease or other known risk factors such as chronic kidney disease or diabetes • People with stage 2 hypertension (140 mmHg/90 mmHg or greater) You may need multiple medications, especially if your numbers are very much above your