Hypertension, Dyslipidaemia, and Diabetes

Classification of BP for adults ages 18 and older. Based on JNC7 recommendations.

BP CLASSIFICATION	SBP* MMHG	DBP* MMHG	LIFESTYLE MODIFICATION
NORMAL	< 120	and < 80	Encourage
PREHYPERTENSION	120-139	or 80-89	Yes
STAGE 1 HYPERTENSION	140-159	or 90-99	Yes
STAGE 2 HYPERTENSION	2160	or 2100	Yes

Lifestyle modifications to manage hypertension.

Modification	Recommendation	Approximate SBP Reduction (Range)
Weight reduction	Maintain normal body weight (body mass index 18.5–24.9 kg/m2).	5–20 mmHg/10 kg weight loss.
Adopt DASH eating plan (Dietary Approaches to Stop Hypertension).	Consume a diet rich in fruits, vegetables, and low fat dairy products with a reduced content of saturated and total fat.	8–14 mmHg.
Dietary sodium reduction	Reduce dietary sodium intake to no more than 100 mmol per day (2.4 g sodium or 6 g sodium chloride).	2–8 mmHg
Physical activity	Engage in regular aerobic physical activity such as brisk walking (at least 30 min per day, most days of the week).	4–9 mmHg.
Moderation of alcohol consumption	Limit consumption to no more than 2 drinks (1 oz or 30 mL ethanol e.g. 24 oz beer, 10 oz wine,or 3 oz 80-proof whiskey) per day in most men and to no more than 1 drink per day in women and lighter weight persons.	2–4 mmHg.

ATP III Classification of LDL, Total, and HDL Cholesterol (mg/dL).

Total Cholesterol

< 200	Desirable
200-239	Borderline high
≥240	High

LDL Cholesterol

< 100	Optimal
100-129	Near optimal/above optimal
130-159	Borderline high
160-189	High
≥ 190	Very high

HDL Cholesterols

< 40	Low
≥ 60	High

Modifiable and non-modifiable risk factors and associated disorders for Type 2 diabetes

Modifiable risk factors

• Overweight and obesity (central and total).
• Sedentary lifestyle.
• Previously identified glucose intolerance (IGT and/or IFG).
• Metabolic syndrome:
  
  
  • Hypertension.
  • Decreased HDL cholesterol.
  • Increased trigylcerides.
  • Dietary factors.
  • Intrauterine environment.
  • Inflammation.

Non-modifiable risk factors

• Ethnicity.
• Family history of Type 2 diabetes.
• Age.
• Gender.
• History of gestational diabetes.
• Polycystic ovary syndrome.

The American Diabetes Association (ADA) suggested blood glucose targets

• Preprandial – 70-130 mg/dl (3.9-7.2 mmol/l).
• Postprandial (1-2 hours) - <180 mg/dl (<10.0 mmol/l).
• HbA1c (three month blood sugar average) – 7.0% or lower.