American College of Physicians: Internal Medicine — Doctors for Adults ®

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The MKSAP Challenge

From the November ACP Observer, copyright 2003 by the American College of Physicians.

Clinical scenario

A 55-year-old woman was recently found to have mild hypertension; her blood pressure has ranged from 140-151/90-96 mm Hg. She would like to avoid taking medication and asks what else she can do to lower her blood pressure.

Which of the following lifestyle changes would most effectively lower this patient's blood pressure?

A. Biking vigorously for 30 minutes three days per week.
B. Walking one mile four days per week.
C. Sodium restriction to 6 g/d.
D. Potassium supplementation of 10 meq/d.
E. Calcium supplementation, 1000 mg/d.


Answer: A

Educational objective: Understand the effect of lifestyle interventions for hypertension.

A recent meta-analysis has reconfirmed that aerobic exercise (30 minutes of exercise vigorous enough to cause a sweat) significantly reduces blood pressure. Each of the other interventions lowers blood pressure modestly, but not as much as aerobic exercise, which lowers blood pressure in both hypertensive and normotensive patients. Weight loss lowers blood pressure by about 1 point systolic and diastolic for every kg lost. Other lifestyle interventions of importance include sodium restriction (the average American consumes 10 g of salt per day; 4 grams per day is a no-added-salt diet), and adequate dietary potassium and calcium intake. Limiting alcohol to 1 drink per day is also recommended, as is smoking cessation.

Reference. Whelton SP, Chin A, Xin X, He J. Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med. 2002;136:493-503.

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