Importance of Lifestyle Modifications During the Treatment of Hypertension

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Background The 2004 Japanese Society of Hypertension guideline for the management of hypertension calls for lifestyle modifications as the initial therapy. If the blood pressure (BP) goal is not achieved by lifestyle modification, pharmacological treatment should be used as a second therapy. Although optimizing dosages or adding additional drugs is recommended until the BP goal is achieved, lifestyles that should be modified during the further drug therapy are not described. This study was conducted to determine the risk factors relating to uncontrolled hypertension in pharmacological therapy before optimizing dosages or adding additional drugs.<br>Methods This cross-sectional study was of 1064 treated hypertensive subjects (785 men and 279 women, mean age,59.1 years) visiting the Center for Multiphasic Health Testing and Services, Mitsui Memorial Hospital. Logistic regression was used to assess the odds ratio (OR) between having controlled office BP and clinical characteristics. Obesity and 8 lifestyles were put into a multivariate logistic regression model to obtain adjusted ORs and 95% confidence intervals.<br>Results Five hundred ninety-one (55.5%) of subjects did not reach their target BP level. Multivariate analysis indicated that inadequate BP control was associated with obesity, irregular meal times, and drinking of alcohol every day. OR of obesity was significantly increased according to the cutoff value of body mass index (BMI) of 23 kg/m2. However, OR of irregular meal times and drinking alcohol everyday were not changed by BMI.<br>Conclusion Dosages should be optimized or additional antihypertensive drugs added after lifestyle modifications such as weight reduction, alcohol intake reduction, and scheduling regular mealtimes for subjects with inadequate BP control.

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