Candida Weiss
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Anabolic Steroids: What They Are, Uses, Side Effects & Risks
# Hypertension (High Blood Pressure) – A Clinical Overview
Hypertension is one of the most common chronic conditions worldwide and a leading cause of cardiovascular morbidity and mortality. The following guide synthesizes current evidence to help clinicians assess, diagnose, manage, and follow patients with high blood pressure.
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## 1. Epidemiology & Risk Factors
| Factor | Impact on BP | Modifiable? |
|--------|--------------|-------------|
| Age (≥45 y) | ↑ systolic BP | No |
| Male sex (early onset) | ↑ risk | No |
| African‑American ancestry | ↑ prevalence, earlier onset | No |
| Diabetes mellitus | ↑ risk, more difficult control | Yes |
| Hypertension family history | ↑ risk | No |
| Obesity (BMI ≥ 30 kg/m²) | ↑ BP | **Yes** |
| Excessive sodium intake (> 2.3 g/day) | ↑ BP | **Yes** |
| Physical inactivity | ↑ BP | **Yes** |
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### 2. Screening / Risk‑stratification
1. **Initial visit (any age ≥18):**
- Take a 12‑lead ECG if any of the following present: abnormal chest pain, palpitations, syncope, or known cardiovascular disease.
- Use the *SCORE* risk chart (or QRISK3 in the UK) to estimate 10‑year CVD risk.
2. **If SCORE/QRISK ≥5 %** → treat as high risk → start statin + lifestyle advice.
- If risk is <5 %, counsel on lifestyle, repeat assessment every 5 years or sooner if new risk factors appear.
3. **Screen for diabetes**:
- Use fasting glucose or HbA1c if age >45 yr or overweight with additional risk factor.
### Lifestyle Advice – "The Four Pillars"
| Pillar | Practical Tips | Evidence |
|--------|----------------|----------|
| **Nutrition** | • Mediterranean/low‑carb diet (evidence: PREDIMED, Lyon Diet Heart).
• Reduce refined carbs; increase fiber, omega‑3 fish or EPA supplements. | 10–20 % risk reduction for MI. |
| **Exercise** | • 150 min moderate aerobic per week (walk, bike) + resistance training twice a week.
• Short bouts of brisk walking after meals can lower postprandial glucose spikes. | Meta‑analysis: 30 % mortality reduction. |
| **Weight & Sleep** | • Aim for BMI 18–24.5; sleep 7–8 h/night.
• Use CPAP if OSA present. | Improves insulin sensitivity by up to 25 %. |
| **Stress Management** | • Mindfulness, breathing exercises, social support. | Lowers cortisol, improves HRV (heart rate variability). |
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## 5. How to Talk with the Patient
- **Explain the link:** "High blood sugar can damage your heart’s blood vessels over time, just like high cholesterol does. That’s why keeping your glucose under control is crucial for preventing a heart attack."
- **Use visual aids:** Show graphs of HbA1c trends and risk curves.
- **Set realistic goals:** "We’re aiming to keep your A1C below 7%. That usually means an average blood sugar level around 140 mg/dL."
- **Emphasize lifestyle changes first:** "Small steps—like adding a daily walk or cutting back on sugary drinks—can make a big difference."
- **Offer support resources:** Diabetes education, dietitian referrals, medication counseling.
By linking diabetes management directly to heart health in a clear, actionable way, patients are more likely to see the importance of controlling their blood glucose and adopt healthier habits.
