Hypertensive Patients

Paper Summary:

This proposal investigates whether the concurrent implementation of lifestyle modification techniques, such as weight loss, sodium reduction, increased physical activity, and limited alcohol intake can improve pharmacotherapy in the treatment of hypertension.

I. Abstract
II. Introduction
III. Literature Review
IV. Problem Statement and Significance
V. Goal and Objectives
VI. Methods and Procedures
VII. Evaluation
VIII. Ethical Considerations
IX. References
X. Budget and Justifications
XI. Appendices

From the Paper:

"When treating and evaluating the disease of hypertension, it is important that the full scope and consequences of the disease be understood as well as the underlying diseases which may be responsible for hypertension. Although fewer than five percent of patients have secondary hypertension (hypertension attributed to an underlying disease) rather than primary hypertension, clinicians must be alert to these secondary causes once a patient has been identified with hypertension. Some of the secondary causes of hypertension include renovascular disease, thyroid disease, pheochromocytoma, Cushing's syndrome, hyperaldosteronism, hyperparathyroidism, renal parenchymal disease or sleep apnea. When the secondary causes for hypertension have been ruled out, the clinician must then make the decision as to which patients require drug therapy after diagnosis. It is noted that for patients who do not have additional cardiovascular risk factors, the patient may initially be prescribed a regimen of aggressive lifestyle modification to include weight loss, aerobic exercise, sodium restriction and alcohol limitation. This aggressive lifestyle modification may be continued for up to six months if the risk factors warrant such intervention and if the patient is one who is highly motivated to alter his or her lifestyle. For those patients in whom end organ damage has already occurred (as identified by abnormal renal function testing, abnormal EKG, etc.) patients with diabetes, or stage 2 or 3 hypertension (appendix A) drug therapy is generally the preferred initial treatment. For all other patients, the stratification of risk factors should determine the therapy to be initiated. The major risk factors for cardiovascular risk stratification are smoking, dyslipidemia, diabetes, age greater than 60 years, sex (men and postmenopausal women) and any family history of cardiovascular disease of women younger than 65 and men younger than 65. The target end organ damage associated with clinical cardiovascular disease includes left ventricular hypertrophy, angina, or prior myocardial infarction, prior coronary revascularization, heart failure, stroke or transient ischemic attack, nephropathy, peripheral arterial disease or retinopathy. (Appendix B)."

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