Management of hypertension

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# Ideal body weight is not realistic goal for lifestyle intervention {#article-title-2} EDITOR—Ramsay et al have produced a clear and authoritative document with their recent guidelines for the treatment of hypertension.1 The section on lifestyle modification, however, includes the statement that weight loss to achieve an ideal body weight will lower blood pressure. Although this is undoubtedly true, it undermines most recent guidelines that recognise the practical near impossibility of achieving ideal body weight in most obese subjects2–4 and evidence that suggests that more modest (and achievable) reductions in weight of 5-10% of body weight can be effective at lowering systolic and diastolic blood pressure in the range of 4–7 and 3–6 mm Hg respectively.5 It should be made explicit in the guidelines that this degree of weight loss is likely to be beneficial in reducing cardiovascular risk, rather than perpetuating the myth that “ideal” body weight is a realistic goal of lifestyle modification in overweight and obese subjects. 1. 1.↵1. Ramsay LE, 2. Williams B, 3. Johnston GD, 4. MacGregor GA, 5. Poston L, 6. Potter JF, 7. et al .British Hypertension Society guidelines for hypertension management 1999: summary. BMJ 1999;319: 630–635. (4 September.) [OpenUrl][1][FREE Full Text][2] 2. 2.↵1. Royal College of Physicians . Clinical management of overweight and obese patients, with particular reference to the use of drugs. London: Royal College of Physicians, 1998. 3. 3.Obesity in Scotland: integrating prevention with weight management. Edinburgh: SIGN, 1996. 4. 4.↵Clinical guidelines on the identification, evaluation and treatment of overweight and obesity in adults. Bethesda, MD: National Institutes of Health, 1998. 5. 5.↵1. Trials of Hypertension Collaborative Research Group .Effects of weight loss and sodium reduction intervention in blood pressure incidence in overweight people with high-normal blood pressure: the trials of hypertension prevention, phase 2. Arch Intern Med 1997;157: 657–667. [OpenUrl][3][CrossRef][4][PubMed][5][Web of Science][6] # Patients from ethnic minorities are at greater risk {#article-title-5} EDITOR—The latest guidelines by the British Hypertension Society aim to address the incomplete detection, treatment, and control of hypertension prevalent across all sections of the community.1 The emphasis on the assessment and reduction of cardiovascular risk rather than just the maintenance of an optimal blood pressure is to be welcomed. One group at high risk is, however, hardly mentioned. Sections of the ethnic community, particularly Afro-Caribbeans and South Asians, are at greatly increased risk of end organ damage owing to hypertension. They also exhibit an increased incidence of concomitant cardiovascular risk factors such as diabetes and obesity. The guidelines note that differences in average response between drug groups are related to ethnic group, but the reader is … [1]: {openurl}?query=rft.jtitle%253DBMJ%26rft.stitle%253DBMJ%26rft.issn%253D0007-1447%26rft.aulast%253DRamsay%26rft.auinit1%253DL.%2BE%26rft.volume%253D319%26rft.issue%253D7210%26rft.spage%253D630%26rft.epage%253D635%26rft.atitle%253DBritish%2BHypertension%2BSociety%2Bguidelines%2Bfor%2Bhypertension%2Bmanagement%2B1999%253A%2Bsummary%26rft_id%253Dinfo%253Apmid%252F10473485%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=FULL&journalCode=bmj&resid=319/7210/630&atom=%2Fbmj%2F320%2F7234%2F576.atom [3]: {openurl}?query=rft.jtitle%253DArchives%2Bof%2BInternal%2BMedicine%26rft.stitle%253DArch%2BIntern%2BMed%26rft.issn%253D0003-9926%26rft.aulast%253DThe%2BTrials%2Bof%2BHypertension%2BPrevention%2BCollaborativ%26rft.auinit1%253D%2B%26rft.volume%253D157%26rft.issue%253D6%26rft.spage%253D657%26rft.epage%253D667%26rft.atitle%253DEffects%2Bof%2BWeight%2BLoss%2Band%2BSodium%2BReduction%2BIntervention%2Bon%2BBlood%2BPressure%2Band%2BHypertension%2BIncidence%2Bin%2BOverweight%2BPeople%2BWith%2BHigh-Normal%2BBlood%2BPressure%253A%2BThe%2BTrials%2Bof%2BHypertension%2BPrevention%252C%2BPhase%2BII%26rft_id%253Dinfo%253Adoi%252F10.1001%252Farchinte.1997.00440270105009%26rft_id%253Dinfo%253Apmid%252F9080920%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [4]: /lookup/external-ref?access_num=10.1001/archinte.1997.00440270105009&link_type=DOI [5]: /lookup/external-ref?access_num=9080920&link_type=MED&atom=%2Fbmj%2F320%2F7234%2F576.atom [6]: /lookup/external-ref?access_num=A1997WN84600008&link_type=ISI

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