Abstract: . . .  regular aerobic physical activity,e.g.,brisk walking (at least 30 minutes per day,most days of the week) Limit consumption to 2 drinks (1 oz or 30 mL ethanol,20 oz beer,10 oz wine,or 2 oz 80-proof whiskey) per day in most men;=1 drink in women and lighter-weight people Approximate SBP reduction (range),mm Hg 520 per 10 kg lost 814 28 49 24 * Body mass index 18.524.9 kg/m 2 . DASH=Dietary Approaches to Stop Hypertension .The effects of implementing these modifications are dose- and time- dependent and could be more dramatic for some individuals. SOURCE:JNC-7 2003 Page 18 16 P&T DIGEST JNC-7 GUIDELINES diuretic/beta blocker combination, renin levels remain essentially at baseline. Aldosterone levels may also rise with a diuretic but are re- duced with a beta blocker. When the two agents are used together,al- dosterone levels remain essentially unchanged. The rise in renin or aldosterone may not negate the BP-lowering ef- fects of the diuretic, but adding an agent that neutralizes the effects of activation of the RAAS, such as a beta blocker,ACE inhibitor,or ARB, increases effectiveness. Response rates go from 40 to 50 percent for monotherapy to as high as 75 to 80 percent. Racial differences in response  . . .
. . .  (48,000 subjects), diuretic- or beta blocker-based % reduc tion in ev ents* CHF Strokes LVH CVD CHD events (fatal/nonfatal) deaths (fatal/nonfatal) * All differences are statistically significant. CHF=coronary heart failure;LVH=left ventricular hypertrophy;CVD=cerebrovascular disease;CHD=coronary heart disease. SOURCE:HEBERT 1993,MOSER 1996 16 21 35 38 52 Diastolic BP Systolic BP Page 19 the benefit or if specific medica- tions affect outcomes. In 1999, a World Health Orga- nization committee reviewed the available data on the treatment of hypertension and concluded that reducing BP, as opposed to the choice of medication, accounted for most of the benefit (WHO 1999). The committee recom- mended diuretics, beta blockers, ACE inhibitors, CCBs, or alpha blockers as initial therapy. But is there is at least some difference in outcome with different medica- tions? Most available medications diuretics, beta blockers, ACE inhibitors,ARBs,and CCBs re- duce BP with appropriate doses. There may be a slight differencein the degree of reduction, but this may not be of great significance. Another pertinent question is, Is there a difference in the effect of various medications on certain  . . .
--3000,2,750,3162,64472