4. Hoge bloeddruk = hypertensie
1. Wat is (hoge) bloeddruk?
2. Hoe wordt de bloeddruk gemeten?
3. Wat zijn de oorzaken van hoge bloeddruk?
4. Wat is de behandeling van hoge bloeddruk?
5. Wat is (hoge) bloeddruk?
hart-minuut volume
x
vaatweerstand
8. Classificatie hypertensie
Bovendruk Onderdruk
mm Hg mm Hg
Normaal <120 en <80
Prehypertensie 120-139 of 80-89
Stadium 1 Hypertensie 140-159 of 90-99
Stadium 2 Hypertensie ≥ 160 of ≥100
45. Meta-analyse
He F J, MacGregor G A. Effect of modest salt reduction on blood pressure: a meta-analysis of
randomized trials. Implications for public health. J Hum Hypertens. 2002;16:761-70.
46. Gereguleerd alcoholgebruik
Low risk alcohol consumption
• 0-2 standard drinks/day
• Men: maximum of 14 standard drinks/week
• Women: maximum of 9 standard drinks/week
Alcoholbeperking: bloeddrukverlaging 3.3 mm Hg
47. Voedingsadviezen bij hypertensie!
Interventie Hoeveelheid Systolisch ↓
Gewichtsverlies BMI 18-25 5-20
Beweging > 30 min/dag 4-9
Zoutbeperking 6 g/dag 2-8
meer groente en fruit,
DASH dieet minder zout en vet 8-14
Alcohol inname 1-2 glazen/dag 2-4
53. Conclusies hoge bloeddruk
Hoge bloeddruk komt veel voor (25% volwassenen).
Hoge bloeddruk ontstaat door aanleg, overgewicht,
te weinig beweging en ongezonde voeding.
Hoge bloeddruk veroorzaakt schade aan
hart- en bloedvaten, hersenen en nieren.
De bloeddruk kun je goed verlagen door een
gezonde leefstijl en zo nodig medicijnen.
Voorkomen is beter dan genezen, gezond gedrag
kun je beter meteen aanleren dan later ongezond
gedrag afleren.
56. Gezonde voeding!
Neem een goed ontbijt, eet daarna niet teveel
Voeg geen zout aan het eten toe
Gebruik elke dag verse groente
Neem fruit in plaats van een koekje
Nuttig alcohol alleen bij het eten
Gebruik magere melk of yoghurt
Neem een kleine hoeveelheid noten tussendoor
Gebruik minder kant en klaar producten (frisdrank)
Hinweis der Redaktion
Johnson and colleagues17,18 also suggested that in- creasing fructose consumption raises BP by increasing se- rum uric acid, which could have direct vascular effects to limit endothelial nitric oxide production or activate the re- nin-angiotensin system.
Exercise Physical activity is a key feature of the treatment of hypertension in obese patients. Increased physical activity, when combined with a reduction in calories, is essential to weight loss success.44,62 Available studies have also shown that adequate dynamic endurance training may decrease the SBP and DBP in hypertensive patients by 11 and 6 mm Hg, respectively.63 Based on the available evidence, the recommendation is to engage in regular physical activity for at least 30 minutes per day most days of the week.45,64 In addition, physical activity is critical to the maintenance of weight loss and is important for overall reduction in cardiovascular risk.64 Exercise programs appear to be beneficial at any age and are associated with overall reductions in cardiovascular disease outcomes by about 50%.45 The cardiovascular disease benefits of slow walking appear to be comparable with those of walking faster, suggesting that the most important predictor of benefit was walking time, not speed.65 It is now well accepted that increased physical activity of appropriate intensity and duration is associated with a reduced incidence of hypertension.23-25 Thus, for primary prevention of hypertension an appropriate recommendation for a public health policy should include the implementation of a low to moderate intensity exercise program most, preferably all, days of the week.35 Recent data suggest that structural and functional changes in the heart occur much earlier that first thought. Over 26% of pre-hypertensive individuals have LVH. The stimulus for the changes in the left ventricle appears to be an increased daily hemodynamic load resulting from relatively high BP levels during routine daily activities. This increased workload provides the stimulus for increases in LVM. The relatively high exercise BP, daytime BP, and LVM observed in low-fitness compared to moderate and high-fitness individuals suggests that low-fitness individuals exhibit higher BP during routine daily activities. Conversely, increased physical activity is associated with lower exercise BP at submaximal workloads. This suggests that increased physical activity consisting of daily brisk walks of 30-40 minutes in duration can lower BP and prevent the development of LVH.36,65 The predicted reductions in mortality from stroke, CHD and all causes are substantial, even with modest reductions in systolic BP in the entire hypertensive population. 12 For individuals who are already hypertensive, the implementation of regular exercise, alone or as an adjunct to medical therapy, can improve BP control at relatively lower doses of antihypertensive pharmacological agents, and reduce adverse events. The intensity of exercise required can easily be achieved by middle aged hypertensive individuals.35,43
Lifestyle Modifications Adoption of healthy lifestyles by all persons is critical for the prevention of high BP and is an indispensable part of the management of those with hypertension. Major lifestyle modifications shown to lower BP include weight reduction in those individuals who are overweight or obese,23,24 adoption of the Dietary Approaches to Stop Hypertension (DASH) eating plan25 which is rich in potassium and calcium,26 dietary sodium reduction,25–27 physical activity, 28,29 and moderation of alcohol consumption. (See table 5.)30 Lifestyle modifications reduce BP, enhance antihypertensive drug efficacy, and decrease cardiovascular risk. For example, a 1,600 mg sodium DASH eating plan has effects similar to single drug therapy. Combinations of two (or more) lifestyle modifications can achieve even better results.