1. Presented by: Lynda Pardo, Jorge Garcia, Rosa Garcia
Pharm.D. Candidates 2010

2. OUTLINE
 Introduction to Lifestyle Modifications
 Overview of Hypertension Disease
 Overview of Diabetes Mellitus
 Lifestyle Modifications for Hypertension
 Lifestyle Modifications for Diabetes Mellitus

3. DID YOU KNOW…?
 ~133 million people in the U.S have at
least one chronic condition
 U.S spends ~ $1.5 trillion on chronic
conditions annually
 U.S is the number one drug market
worldwide

4. INTRODUCTION
 Chronic conditions affect the national
economy and our patient's health
 Lifestyle modifications prevent most of
these conditions
 Lifestyle modifications may be use in the
management of chronic conditions

5. LIMITATIONS
 Difficulties achieving a new lifestyle
 Difficulties maintaining new lifestyle
for long terms

6. BENEFITS
 Low cost
 Safety profile
 Benefits seen rapidly
 Enhance medication efficacy
 Decrease incidence of complications
 Decrease the need for Pharmacotherapy

7. LIFESTYLE MODIFICATIONS
 Prevention and management
 Dyslipidemia
 Gastroesophageal reflux disease
(GERD)
 Obesity
 Hypertension (HTN)
 Diabetes Mellitus (DM)

8. HYPERTENSION

9. HYPERTENSION (HTN)
 Defined as consistently elevated blood
pressure (BP)
 Multifactorial etiology
 Primary or Essential Hypertension
(Unknown)
 Secondary Hypertension

10. CLASSIFICATION
CLASSIFICATION SBP mmHg DBP mmHg
Normal < 120 and - < 80
Pre-hypertension 120 – 139 or - 80 -89
Hypertension Stage 1 140 – 159 or - 90 - 99
Hypertension Stage 2 ≥ 160 or - ≥ 100
SBP = Systolic Blood Pressure
DBP = Diastolic Blood Pressure

11. EPIDEMIOLOGY
 Most common primary diagnosis in
America
 ~ 50 million Americans have high BP that
needs some type of treatment
 Lifetime risk of developing hypertension
between 55 – 65 years old is > 90 %
 Continuous relationship between BP and
risk of cardiovascular events

12. PATHOPHYSIOLOGY
 A variety of systems and mechanisms
involved:
 Renin Angiotensin Aldosterone System
(RAAS)
 Nervous System Regulation
 Peripheral and Vascular mechanisms
 Oxidative Stress

13. CLINICAL PRESENTATION
 Most patients present with no symptoms
 Severe symptoms occur as a result of
organ damage
 Heart
 Brain
 Retinopathy
 Peripheral arterial disease
 Chronic Kidney Disease (CKD)

14. GOALS OF THERAPY
 BP <140/90 mmHg for most patients
 BP <130/80 mmHg for patients with
diabetes or chronic kidney disease

15. TREATMENT
 Pharmacotherapy
 Non-pharmacotherapy

16. DIABETES MELLITUS

17. DIABETES MELLITUS (DM)
 Chronic condition
 Defined as elevated blood glucose
(sugar) levels
 Inadequate insulin secretion or insulin
action

18. CLASSIFICATION
 Type 1 Diabetes Mellitus
 Type 2 Diabetes Mellitus
 Gestational Diabetes Mellitus

19. EPIDEMIOLOGY
 ~ 20.8 million Americans have DM
 Type 2 Diabetes accounts for 90 – 95%
 Elderly 65 - 74 years old have greater
incidence
 Hyperglycemia (high blood glucose levels)
is a strong risk factor for cardiovascular
disease

20. PATHOPHYSIOLOGY
 Metabolic disorder resulting from
deficiencies at multiple organ sites
 Insulin resistance in muscle and adipose
tissue
 Decreased insulin secretion by pancreas
 Excessive hepatic glucose production
 Inadequate glucagon secretion

21. CLINICAL PRESENTATION
 Polyuria (excessive urine)
 Polydipsia (excessive thirst)
 Unexplained weight loss
 Fatigue
 Blurred vision
 Dehydration

22. COMPLICATIONS
 Microvascular Complications
 Nephropathy
 Peripheral neuropathy
 Retinopathy
 Impotence
 Macrovascular Complications
 Cardiovascular disease
 Stroke
 Peripheral vascular disease

23. GOALS OF THERAPY
According to the American Diabetes
Association
 70 – 130 mg/dL fasting and preprandial
 <180 mg/dL postprandial
 Glycosylated hemoglobin (A1C) < 7%
 As close as possible to < 6% (normal)
without significant hypoglycemia

24. TREATMENT
 Pharmacotherapy
 Insulin
 Non-pharmacotherapy

25. HYPETENSION: Lifestyle Modifications

26. HTN: Lifestyle Modifications

27. What We’re Up Against
 Larger portions at fast food restaurants
 Little to no availability of healthy food in
schools and jobs
 High cost of healthy food
 High amounts of sodium in processed
foods
 Efficient physical education programs
lacking in schools

28. HTN: Lifestyle Modifications
 Reduction of BP can be achieved by losing
as little as 10 pounds (4.5 kg)
 1,600 mg sodium DASH diet = single
antihypertensive drug
 Multiple lifestyle modifications ideal

29. HTN: Lifestyle Modifications
 Quit smoking!
 Community programs: Preventing
Hypertension
 Employing culturally sensitive
educational messages
 Lifestyle support services
 Cardiovascular risk-factor screening and
referral programs

30. DASH Diet: Daily Calories

31. DASH Diet: Sodium Intake

32. DASH Diet
 Tips to reduce sodium intake
 Buy low or reduced sodium foods whenever
possible
 Limit cured foods (bacon or ham)
 Cook rice or pasta without salt (avoid
instant mixes)
 Rinse canned goods such as tuna and
beans to remove some salt
 Use spices instead of salt

33. DASH Diet
 Tips on getting started
 Baby steps
 Initiate or add one more fruit or
vegetable to every meal
 Meat should NOT be the focus of the
meal, just another part of it
 Snack on fruits or other products which
are low in fat, sodium, and calories

34. DIABETES: Lifestyle Modifications

35. DM: Lifestyle Modifications
 Diet
 Exercise

36. DM: Lifestyle Modifications
 Diet
 Become educated on the types of foods
that help lower or maintain blood glucose
at healthy levels

37. DM: Lifestyle Modifications
 Manage carbohydrate intake by:
 Plate Method
 Carbohydrate Counting
 Glycemic Index

38. DM: Lifestyle Modifications
 How to manage the holidays
 If cooking, plan menu ahead of time
 Include festive, but healthy foods
 Watch your portions!

39. DM: Lifestyle Modifications
 Exercise
 Know the reasons!
 Strive to incorporate exercise into
everyday activities
 Find what motivates you
 For more strenuous physical activities,
always consult your physician
beforehand

40. REFERENCES
1. http://www.diabetes.org/about-diabetes.jsp
2. http://www.diabetes.org/food-nutrition-lifestyle/lifestyle-
prevention.jsp
3. http://www.fightchronicdisease.org/news/pfcd/pr10022007.cfm
4. Chicago Tribune ONLINE Web Site. Available at:
http://newsblogs.chicagotribune.com/triage/2008/06/death-rates-
plu.html. Accessed September 22, 2009.
5. Partnership to Fight Chronic Disease ONLINE Web Site. Available
at: http://www.fightchronicdisease.org/news/pfcd/pr10022007.cfm.
Accessed September 22, 2009.
6. CNN Money ONLINE Web Site. Available at:
http://money.cnn.com/2008/04/15/news/companies/IMS/index.htm
?postversion=2008041511. Accessed September 22, 2009.

41. REFERENCES
7. American Association of Clinical Endocrinologist Medical
Guidelines for Clinical Practice for Management of Diabetes
Mellitus. Endocrine Practice 2007; 13:3-12.
8. Nathan D, Buse J, Davidson Mayer et al. Management of
Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the
initiation and Adjustment of Therapy. Diabetes Care 2006; 29 (8):
1963 – 1969.
9. American Diabetes Association. Standards of medical care in
diabetes. Diabetes Care 2008; 31 (suppl 1) s12 – s44.
10. DiPiro JT, Talbert RL, Hayes PE, et al. Pharmacotherapy: A
Pathophysiologic Approach. 6th ed. New York, NY: McGraw Hill;
2005.