A 62-year-old woman comes to the office for follow-up on hypertension. She has no history of heart disease or stroke and currently takes no medications. The patient has a sedentary lifestyle, is a lifetime nonsmoker, and drinks 2 or 3 glasses of wine each evening. She typically salts her food before tasting it; her diet is high in snacks, processed meats, and saturated fat, and low in fruits and vegetables.
Recent blood pressure readings are 145-155/88-95 mm Hg. BMI is 28 kg/m².
Laboratory results are as follows:
The patient previously had a "bad reaction to many different blood pressure pills" and would like to lower her blood pressure through healthier lifestyle habits rather than medication. Which of the following would most likely result in the greatest decrease in this patient's blood pressure?

Question

A 62-year-old woman comes to the office for follow-up on hypertension. She has no history of heart disease or stroke and currently takes no medications. The patient has a sedentary lifestyle, is a lifetime nonsmoker, and drinks 2 or 3 glasses of wine each evening. She typically salts her food before tasting it; her diet is high in snacks, processed meats, and saturated fat, and low in fruits and vegetables.
Recent blood pressure readings are 145-155/88-95 mm Hg. BMI is 28 kg/m².
Laboratory results are as follows:

The patient previously had a "bad reaction to many different blood pressure pills" and would like to lower her blood pressure through healthier lifestyle habits rather than medication. Which of the following would most likely result in the greatest decrease in this patient's blood pressure?

Quizplus · Accepted Answer

11ec193a_9740_171c_853d_d3908c2009af_MD0002_00 The Dietary Approaches to Stop Hypertension (DASH) diet is an effective and widely used intervention in the management of hypertension. Compared with a typical American diet, the DASH diet is higher in fruits and vegetables, low-fat dairy products, plant protein sources (eg, legumes), and fiber, and lower in saturated and total fats, processed meats, and sweets. The DASH diet is also lower in sodium than a typical diet (2000-2500 mg/day vs >3000 mg/day) and higher in calcium, potassium, and magnesium. The original DASH diet confers a reduction in systolic blood pressure of 8-14 mm Hg (mean: 11 mm Hg). Subsequent studies have found that combining more rigorous sodium restriction (≤1500 mg/day) with the standard DASH diet can yield additional blood pressure lowering, approaching that of antihypertensive medication. Older individuals, women, Black patients, and those with metabolic syndrome may be especially responsive. (Choice A) Flavonoids are a family of compounds found in fruits and vegetables, tea, and cocoa. Increased intake of flavonoid-rich foods can lower systolic blood pressure slightly, approximately 2-3 mm Hg. (Choice B) A low-carbohydrate diet can assist weight loss and lower systolic blood pressure modestly (~5 mm Hg) but is less effective than the DASH diet. (Choice C) Hypertensive patients should engage in regular exercise to improve cardiovascular fitness, but the lowering of blood pressure attributable to exercise (7 mm Hg) is less than the reduction attainable with a low-sodium DASH diet. (Choice E) Women with hypertension should limit alcohol intake to 1 beverage a day. Although elimination of binge drinking (≥4 drinks in a single session) can have a significant impact on blood pressure, changing this patient's more moderate habits would yield only a small reduction in systolic blood pressure. Educational objective: Combining rigorous sodium restriction with the standard Dietary Approaches to Stop Hypertension (DASH) diet can yield significant blood pressure lowering, approaching that of antihypertensive medication. Older individuals, women, Black patients, and those with metabolic syndrome may be especially responsive. __________ References: Non-pharmacological aspects of blood pressure management: what are the data? (http://www.ncbi.nlm.nih.gov/pubmed/21389976) Nonpharmacologic therapy for hypertension: does it really work? (http://www.ncbi.nlm.nih.gov/pubmed/17059793) A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. (http://www.ncbi.nlm.nih.gov/pubmed/9099655)

A 62-Year-Old Woman Comes to the Office for Follow-Up on Hypertension