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The authors investigated the efficacy of a lifestyle educational program, organized in small group meetings, in improving the outcome of a nonpharmacologic intervention. One hundred and eighty-eight hypertensive patients with stable blood pressure (BP) levels and drug therapy in the previous 6 months were randomly divided into educational care (EC) and usual care (UC) groups. They were followed at 3-month intervals up to 2 years. In addition to the visits in an outpatient clinic, patients in the EC program participated in small group meetings in order to improve their knowledge of the disease and reinforce their motivation for treatment. At baseline, EC and UC groups were similar for age, sex, body mass index (BMI), blood pressure (BP) levels, and pharmacologic treatment. Patients in the EC group had significantly reduced total energy, total and saturated fats, and sodium intake. Physical activity was significantly increased in the EC group as well. At the end of the 1-year follow-up, BMI (P<.001), visceral fat (P<.001), and BP (P<.001) were significantly lower in the EC group compared with the UC group. Pharmacologic treatment during the study was similar for all classes of drugs apart from diuretics whose dose was higher in the UC group at the end of the study. J Clin Hypertens (Greenwich). 2012;14:767-772. Ó2012 Wiley Periodicals, Inc.The association between arterial hypertension and other metabolic diseases has been frequently observed in the literature by several investigators and by ourselves in both clinical studies in the outpatient clinic and in observational studies in large population samples.1-4 Overweight status particularly seems to influence the development of hypertension but impairment in blood lipids and glucose are also involved, as seen in the metabolic syndrome.5 Accordingly, guidelines for optimal treatment of arterial hypertension indicate that nonpharmacologic intervention is the first approach in patients with low global cardiovascular risk and is associated with drug therapy in patients with moderate to high global risk. 6Despite the interest to prevent the vascular complications of hypertension, the goal of normal blood pressure (BP) levels is achieved in only <25% patients with hypertension worldwide. Reasons for this disappointing result vary, including low dosage of antihypertensive drugs, patients not taking prescribed pills, resistant hypertension, and poor compliance to prescribed nonpharmacologic measures. We have described the difficulties found by our patients in continuing a dietary approach to improve BP over a long period of time despite achieving significant improvement in BP and body weight (BW) control, associating lifestyle changes with pharmacologic treatment. The aim of the present study was to evaluate whether an educational program dedicated to nonpharmacologic measures to treat hypertension, including small group meetings with doctors and dieticians in addition to usual controls in the outpatient clinic would be useful in achieving better and long-lasting results i...

Although it is well known that some dietary measures are able to beneficially affect blood pressure (BP) levels, hypertensive patients find it very difficult to definitively change their nutritional habits. The aim of this study was to evaluate the effects on BP of a return to the habitual diet following a dietary intervention period. Three hundred and seven hypertensive patients (149 females, 158 males) with a mean age of 52 ± 12 years were included in the study. All enrolled patients had reported having reverted to their habitual diet after a period of at least 6 months on a prescribed low-energy and/or low-sodium diet.

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A 74-year-old woman with history of hypertension presented to the Emergency Department (ED) with severe resting dyspnea and swelling in the feet, ankles and legs. She was on treatment with furosemide and a beta blocker. At the time of admission blood pressure was 145/88 mmHg, heart rate (HR) 99 bpm, regular, oxygen saturation was 89% (FiO2 21%) and respiratory rate was 17 breaths/min. Abbreviation List AST: Aspartate aminotransferase ED: Emergency Department GFR: Glomerular Filtration Rate HCC: Hepatocellular Carcinoma HF: Heart Failure HR: Heart rate IVC: Inferior vena cava LAFB: Left anterior fascicular block LV: Left ventricle NT-pro-BNP: N-Terminal pro-Brain Natriuretic peptide POCUS: Point-of-care ultrasound RA: Right atrium RBB: Right bundle branch block RV: Right ventricle TS: Tricuspid stenosis