Clinical Monograph: Hypertension

Therapeutic Category

Hypertension

Summary

Hypertension, commonly known as high blood pressure, is a medical condition in which the blood pressure in the arteries is persistently elevated. The blood pressure is a measure of the force of blood against the arterial walls as it is pumped by the heart. It is expressed as two numbers: the systolic blood pressure, which is the pressure when the heart contracts and pushes blood out, and the diastolic blood pressure, which is the pressure when the heart relaxes and refills with blood.

Normal blood pressure is generally considered to be a systolic pressure less than 120 mmHg and a diastolic pressure less than 80 mmHg. Blood pressure is classified as follows:

• Normal: less than 120/80 mmHg
• Prehypertension: 120-139/80-89 mmHg
• Stage 1 hypertension: 140-159/90-99 mmHg
• Stage 2 hypertension: 160 or higher/100 or higher mmHg

Hypertension is a significant risk factor for a number of serious health conditions, including stroke, heart attack, heart failure, kidney disease, and vision loss. It is often referred to as the “silent killer” because it typically has no symptoms, and many people are unaware that they have it. It is important for people to have their blood pressure checked regularly to diagnose and treat hypertension if necessary.

Foods That Positively Impact Hypertension: Clinical Evidence

1. Fruits and Vegetables: Numerous studies have demonstrated the beneficial effects of fruits and vegetables on blood pressure. A meta-analysis published in the journal Hypertension in 2017 found that increased consumption of fruits and vegetables was associated with a lower risk of hypertension(1). Additionally, a study published in the British Medical Journal in 2014 reported that each serving per day increase in fruit intake was associated with a significant reduction in systolic blood pressure(2). The potassium, magnesium, and fiber content of fruits and vegetables are thought to contribute to their antihypertensive effects.
2. Whole Grains: Whole grains have been consistently linked to lower blood pressure in various studies. A systematic review and meta-analysis published in the American Journal of Clinical Nutrition in 2010 concluded that whole grain intake was inversely associated with blood pressure levels(3). The high fiber content of whole grains, particularly soluble fiber, is believed to contribute to their ability to lower blood pressure.
3. Lean Protein Sources: Several studies have suggested that incorporating lean protein sources into the diet can help lower blood pressure. For example, a randomized controlled trial published in the American Journal of Clinical Nutrition in 2011 found that consuming lean poultry as the primary protein source resulted in significant reductions in systolic and diastolic blood pressure compared to a diet high in red meat(4). The lower saturated fat content of lean protein sources may contribute to their antihypertensive effects.
4. Low-Fat Dairy Products: The Dietary Approaches to Stop Hypertension (DASH) diet, which includes low-fat dairy as a key component, has been shown to effectively lower blood pressure. A meta-analysis published in the American Journal of Clinical Nutrition in 2012 concluded that the DASH diet, which emphasizes low-fat dairy products, fruits, vegetables, and whole grains, significantly reduced both systolic and diastolic blood pressure compared to control diets(5). The calcium and bioactive peptides found in dairy products are believed to contribute to their blood pressure-lowering effects.
5. Nuts and Seeds: Clinical trials have provided evidence supporting the beneficial effects of nuts and seeds on blood pressure. A systematic review and meta-analysis published in the American Journal of Clinical Nutrition in 2015 found that nut consumption was associated with significant reductions in both systolic and diastolic blood pressure(6). The high unsaturated fat content, along with other bioactive compounds such as fiber, minerals, and phytochemicals, may contribute to the antihypertensive effects of nuts and seeds.
6. Herbs and Spices: Certain herbs and spices have been shown to have potential antihypertensive effects in clinical studies. For example, a randomized controlled trial published in the Journal of Nutrition in 2015 found that supplementation with garlic extract significantly reduced both systolic and diastolic blood pressure compared to placebo(7). Other herbs and spices, such as ginger, turmeric, and cinnamon, have also demonstrated potential blood pressure-lowering effects in animal and human studies, although more research is needed to confirm their efficacy.

Foods to Avoid

1. High-Sodium Foods: Excessive sodium intake is strongly linked to hypertension as it promotes fluid retention and increases blood pressure. Foods high in sodium include processed meats (e.g., bacon, deli meats), canned soups, salty snacks (e.g., chips, pretzels), and fast food.

2.  

3. Processed Foods: Processed foods often contain high levels of sodium, unhealthy fats, and added sugars, all of which can contribute to hypertension. These include packaged snacks, frozen meals, and pre-made sauces or dressings.

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5. Sugar-Sweetened Beverages: Regular consumption of sugary drinks like soda, fruit juices with added sugars, and energy drinks can contribute to weight gain and increase the risk of hypertension.

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7. Alcohol: Excessive alcohol consumption can raise blood pressure and increase the risk of hypertension. It’s recommended to limit alcohol intake to moderate levels (up to one drink per day for women and up to two drinks per day for men).

Evidence Summary

Evidence Grading Definitions

Insomnia, chronic Level of Evidence [B, D]Data from a randomized, single blind study support the use of the web-based, cognitive behavior therapy insomnia (CBT-I) program “Sleep Health Using the Internet” (SHUTi) for the treatment of chronic insomnia; SHUTi has demonstrated improvements in insomnia severity, sleep-onset latency, and wake after sleep onset (Ritterband 2017).

Based on the American College of Physicians and VA/DoD guidelines for the management of chronic insomnia disorder, CBT-I is recommended as the initial treatment of chronic insomnia disorder. CBT-I includes cognitive therapy around sleep, behavioral restrictions (eg, sleep restriction and stimulus control) and education (eg, sleep hygiene) (ACP [Qaseem 2016); VaDOD 2019].

Clinical Practice Guidelines

ACP, “Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians,” May 2016

VA/DoD, “Clinical Practice Guideline for the Management of Chronic Insomnia Disorder and Obstructive Sleep Apnea,” October 2019

Formulary: US

References

Product SKU/PLO

ICD-10-CM Diagnosis Code G47.0
Initial Assessment Session(s) (CPT 90791)
Individual Treatment Session (CPT 90837 -53 minutes or longer)
Individual Treatment Session (CPT 90834 – 45 minutes)
Individual Treatment Session (CPT 90832 – 20-22 minutes, scheduled only)

References