Presented by: Lynda Pardo, Jorge Garcia, Rosa Garcia

Pharm.D. Candidates 2010

OUTLINE

Introduction to Lifestyle Modifications

Overview of Hypertension Disease

Overview of Diabetes Mellitus

Lifestyle Modifications for Hypertension

Lifestyle Modifications for Diabetes Mellitus

DID YOU KNOW…?

~133 million people in the U.S have at

least one chronic condition

U.S spends ~ $1.5 trillion on chronic

conditions annually

U.S is the number one drug market

worldwide

INTRODUCTION

Chronic conditions affect the national

economy and our patient's health

Lifestyle modifications prevent most of

these conditions

Lifestyle modifications may be use in the

management of chronic conditions

LIMITATIONS

Difficulties achieving a new lifestyle

Difficulties maintaining new lifestyle

for long terms

BENEFITS

Low cost

Safety profile

Benefits seen rapidly

Enhance medication efficacy

Decrease incidence of complications

Decrease the need for Pharmacotherapy

LIFESTYLE MODIFICATIONS

Prevention and management

Dyslipidemia

Gastroesophageal reflux disease

(GERD)

Obesity

Hypertension (HTN)

Diabetes Mellitus (DM)

HYPERTENSION

HYPERTENSION (HTN)

Defined as consistently elevated blood

pressure (BP)

Multifactorial etiology

Primary or Essential Hypertension

(Unknown)

Secondary Hypertension

CLASSIFICATION

CLASSIFICATION SBP mmHg DBP mmHg

Normal < 120 and - < 80

Pre-hypertension 120 – 139 or - 80 -89

Hypertension Stage 1 140 – 159 or - 90 - 99

Hypertension Stage 2 ≥ 160 or - ≥ 100

SBP = Systolic Blood Pressure

DBP = Diastolic Blood Pressure

EPIDEMIOLOGY

Most common primary diagnosis in

America

~ 50 million Americans have high BP that

needs some type of treatment

Lifetime risk of developing hypertension

between 55 – 65 years old is > 90 %

Continuous relationship between BP and

risk of cardiovascular events

PATHOPHYSIOLOGY

A variety of systems and mechanisms

involved:

Renin Angiotensin Aldosterone System

(RAAS)

Nervous System Regulation

Peripheral and Vascular mechanisms

Oxidative Stress

CLINICAL PRESENTATION

Most patients present with no symptoms

Severe symptoms occur as a result of

organ damage

Heart

Brain

Retinopathy

Peripheral arterial disease

Chronic Kidney Disease (CKD)

GOALS OF THERAPY

BP <140/90 mmHg for most patients

BP <130/80 mmHg for patients with

diabetes or chronic kidney disease

TREATMENT

Pharmacotherapy

Non-pharmacotherapy

DIABETES MELLITUS

DIABETES MELLITUS (DM)

Chronic condition

Defined as elevated blood glucose

(sugar) levels

Inadequate insulin secretion or insulin

action

CLASSIFICATION

Type 1 Diabetes Mellitus

Type 2 Diabetes Mellitus

Gestational Diabetes Mellitus

EPIDEMIOLOGY

~ 20.8 million Americans have DM

Type 2 Diabetes accounts for 90 – 95%

Elderly 65 - 74 years old have greater

incidence

Hyperglycemia (high blood glucose levels)

is a strong risk factor for cardiovascular

disease

PATHOPHYSIOLOGY

Metabolic disorder resulting from

deficiencies at multiple organ sites

Insulin resistance in muscle and adipose

tissue

Decreased insulin secretion by pancreas

Excessive hepatic glucose production

Inadequate glucagon secretion

CLINICAL PRESENTATION

Polyuria (excessive urine)

Polydipsia (excessive thirst)

Unexplained weight loss

Fatigue

Blurred vision

Dehydration

COMPLICATIONS

Microvascular Complications

Nephropathy

Peripheral neuropathy

Retinopathy

Impotence

Macrovascular Complications

Cardiovascular disease

Stroke

Peripheral vascular disease

GOALS OF THERAPY

According to the American Diabetes Association

70 – 130 mg/dL fasting and preprandial

<180 mg/dL postprandial

Glycosylated hemoglobin (A1C) < 7%

As close as possible to < 6% (normal) without significant hypoglycemia

TREATMENT

Pharmacotherapy

Insulin

Non-pharmacotherapy

HYPETENSION: Lifestyle Modifications

HTN: Lifestyle Modifications

What We’re Up Against

Larger portions at fast food restaurants

Little to no availability of healthy food in

schools and jobs

High cost of healthy food

High amounts of sodium in processed

foods

Efficient physical education programs

lacking in schools

HTN: Lifestyle Modifications

Reduction of BP can be achieved by losing

as little as 10 pounds (4.5 kg)

1,600 mg sodium DASH diet = single

antihypertensive drug

Multiple lifestyle modifications ideal

HTN: Lifestyle Modifications

Quit smoking!

Community programs: Preventing

Hypertension

Employing culturally sensitive

educational messages

Lifestyle support services

Cardiovascular risk-factor screening and

referral programs

DASH Diet: Daily Calories

DASH Diet: Sodium Intake

DASH Diet

Tips to reduce sodium intake

Buy low or reduced sodium foods whenever possible

Limit cured foods (bacon or ham)

Cook rice or pasta without salt (avoid instant mixes)

Rinse canned goods such as tuna and beans to remove some salt

Use spices instead of salt

DASH Diet

Tips on getting started

Baby steps

Initiate or add one more fruit or

vegetable to every meal

Meat should NOT be the focus of the

meal, just another part of it

Snack on fruits or other products which

are low in fat, sodium, and calories

DIABETES: Lifestyle Modifications

DM: Lifestyle Modifications

Diet

Exercise

DM: Lifestyle Modifications

Diet

Become educated on the types of foods

that help lower or maintain blood glucose

at healthy levels

DM: Lifestyle Modifications

Manage carbohydrate intake by:

Plate Method

Carbohydrate Counting

Glycemic Index

DM: Lifestyle Modifications

How to manage the holidays

If cooking, plan menu ahead of time

Include festive, but healthy foods

Watch your portions!

DM: Lifestyle Modifications

Exercise

Know the reasons!

Strive to incorporate exercise into

everyday activities

Find what motivates you

For more strenuous physical activities,

always consult your physician

beforehand

REFERENCES

1. http://www.diabetes.org/about-diabetes.jsp

2. http://www.diabetes.org/food-nutrition-lifestyle/lifestyle-prevention.jsp

3. http://www.fightchronicdisease.org/news/pfcd/pr10022007.cfm

4. Chicago Tribune ONLINE Web Site. Available at: http://newsblogs.chicagotribune.com/triage/2008/06/death-rates-plu.html. Accessed September 22, 2009.

5. Partnership to Fight Chronic Disease ONLINE Web Site. Available at: http://www.fightchronicdisease.org/news/pfcd/pr10022007.cfm. Accessed September 22, 2009.

6. CNN Money ONLINE Web Site. Available at: http://money.cnn.com/2008/04/15/news/companies/IMS/index.htm?postversion=2008041511. Accessed September 22, 2009.

REFERENCES

7. American Association of Clinical Endocrinologist Medical

Guidelines for Clinical Practice for Management of Diabetes

Mellitus. Endocrine Practice 2007; 13:3-12.

8. Nathan D, Buse J, Davidson Mayer et al. Management of

Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the

initiation and Adjustment of Therapy. Diabetes Care 2006; 29 (8):

1963 – 1969.

9. American Diabetes Association. Standards of medical care in

diabetes. Diabetes Care 2008; 31 (suppl 1) s12 – s44.

10. DiPiro JT, Talbert RL, Hayes PE, et al. Pharmacotherapy: A

Pathophysiologic Approach. 6th ed. New York, NY: McGraw Hill;

2005.