management of hypertension

1. patient
with
hyperte
nsion
Nursing management of patient
with hypertension

2. Blood pressure
 In normal circulation, pressure is exerted by the flow of
blood through the heart and blood vessels. It is the
product of cardiac output multiplied by peripheral
resistance. Normal blood pressure at rest is within the
range of 100-140mmHg systolic (top reading) and 60-
90mmHg diastolic .

3. Determinants of BP and regulation
 These are the fundamental factors which determine
the value of BP. They are
 1. Cardiac output
 2.peripheral vascular resistance
These are also called as factors controlling BP.
 BP= cardiac output X PVR

4. Regulatory mechanisms
 Short term: Short term regulations are achieved by
neural regulations where as long term regulations are
achieved by controlling blood volume and Na retension
via renal mechanisms.
 Nervous System Control :BP by changing blood
distribution in the body and by changing blood vessel
diameter. Sympathetic & Parasympathetic activity will
affects veins, arteries & heart to control HR and force of
contraction

5.  Baroreceptors :Baroreceptors are stretch receptors found
in the carotid body, aortic body and the wall of all large
arteries of the neck and thorax. Baroreceptors entered
the medululla Secondary signals inhibit the
vasoconstrictor center of medulla and excite the vagal
parasympathetic center effect vasodilatation of the veins
and arterioles decreased heart rate and strength of heart
contractiont herefore, causes arterial pressure to
decrease (as decrease in PR and CO) Conversely, low
pressure has opposite effects,reflexly causing the
pressure rise back to normal

6.  Increased Parasympathetic Activity: Effect of
increased parasympathetic and decreased sympathetic
activity on heart and blood pressure: Increased activity
of vagus (parasympathetic) nerve .
 Decreased activity of sympathetic cardiac Nerves
Reduction of heart rate .Lower cardiac output .Lower
blood pressure

7. Long term
 long term control is achieved by adjusting the blood
volume and lowering Ca concentration in the VSM.
 Hormones :1)ADH reduces water excreation and
causes water conservation.2) Renin ultimately cause
production of angiotensin II causes aldosterone
production which leads to the water and sodium
retension.
 ANP:released when atria are stretched . it causes
dieresis and reduce blood volume and BP.
 .

8.  Role of Ca ions in the VSM : Its accumulation causes
rise in the vascular tone and increases the vascular
tone
 Endocrine system: stimulation of SNS results in
release of epinephrine along with small fraction of nor
epinephrine by adrenal medulla. epinephrine increases
CO by increasing HR and myocardial contractility

9. Factors affecting BP
 A. PHYSIOLOGICAL
 Age :tends to increase in elder people.
 Sex:before the onset of menopause women have little lower BP
than that of males of same age group.after menopause women
have little higher BP than that of males.
 Meals: after meals BP is higher.
 Emotion: range and panic may rise BP.
 Exposure to cold : increase BP.inorder to preserve body
heat,body tries to keep temperature by Cutaneous vaso
constriction as a result of SNS stimulation.
 Excercise
 Sleep:cause fall of BP.
 Circardian rhythm: BPis highest in the morning and least in
the night.

10.  B. PATHOLOGICAL
 Clinical conditions alter BP include renal artery
senosis, pheochromacytoma and pre eclampsia
 Drug induced: sympathetic stimulants like
adrenalin,nor adrenalin, andphenylephrine rise BP,
while vascular smooth muscle relaxants like
hydralazine reduces BP.

11. Hypertension- definition
 Hypertension is defined by the Seventh Report of the
Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure (JNC
7) as a systolic blood pressure greater than 140 mm Hg
and a diastolic pressure greater than 90 mm Hg based
on the average of two or more accurate blood pressure
measurements taken during two or more contacts with a
health care provider.

12. Hypertension- definition
 Hypertension is defined by the Seventh Report of the
Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure (JNC
7) as a systolic blood pressure greater than 140 mm Hg
and a diastolic pressure greater than 90 mm Hg based
on the average of two or more accurate blood pressure
measurements taken during two or more contacts with a
health care provider.

13.  World hypertension day: May 17
 The theme for World Hypertension Day 2013 is
“Healthy Heart Beat - Healthy Blood
Pressure”.

14. Global incidence
 As per the World Health Statistics 2012, of the estimated 57
million global deaths in 2008, 36 million (63%) were due to
noncommunicable diseases (NCDs). The largest proportion of
NCD deaths is caused by cardiovascular diseases (48%). In terms
of attributable deaths, raised blood pressure is one of the leading
behavioral and physiological risk factor to which 13% of global
deaths are attributed. Hypertension is reported to be the fourth
contributor to premature death in developed countries and the
seventh in developing countries.

15. National prevalence
 The prevalence of hypertension in the last six decades
has increased from 2% to 25% among urban residents
and from2% to 15% among the rural residents in
India. According to Directorate General of Health
Services, Ministry of Health and Family Welfare,
Government of India, the overall prevalence of
hypertension in India by 2020 will be159.46/1000
population

16. Classification

Blood pressure(mmhg)
Classsification Systolic Diastolic
Normal 119 or lower 79 or lower
Prehypertension 120-139 80-89
Stage1 hypertenson 140-159 90-99
Stage2 hypertension 160 0r higher 100 or higher

17. Causes
 In general the major causes of hypertension are the
following:
 Hectic and stress filled life style
 Unhealthy food habits
 Obesity
 Excessive consumption of liquors
 Smoking
 Over consumption of tea/coffee
 Insufficient rest and sleep
 Metabolic disorders

18. Contd……
 Hardening of the arteries
 Excessive use of pain killers and other strong
medicines
 Genetic disorders
 Over consumption of oily food and fast food
 High salt intake
 Emotional and Physical stress
 Family history of hypertension

19. Secondary causes
 Sleep apnoea
 Drug-induced or drug-related
 Chronic kidney disease
 Primary aldosteronism
 Renovascular disease
 Chronic steroid therapy and Cushing syndrome
 Phaeochromocytoma
 Acromegaly
 Thyroid or parathyroid disease
 Coarctation of the aorta
 Takayasu Arteritis


20. Primary hypertension
 Primary (essential) hypertension is the most common
form of hypertension, accounting for 90–95% of all
cases of hypertension. Insulin resistance, which is
common in obesity and is a component of syndrome X
(or the metabolic syndrome), is also thought to
contribute to hypertension

21. Risk factors for primary
hypertension
 Age: SBP increase progressively with increasing age. After 50, an
SBP>140 mmHg is a more important risk factor for CAD than
DBP.
 Alcohol:
 Cigarette smoking:increase the risk of CVD.
 Diabetes mellitus: hypertension is more common in diabetes
mellitus.
 Elevated serum lipids: primary risk factor for atherosclerosis.
 Excess dietary sodium:contribute to hypertension.
 Gender:Hypertension more prevalent in young adulthood.
After55yr,more prevalent in women.
 .

22.  Family history:
 Obesity
 Ethnicity: Twice as high in African Americans than that
of whites.
 Sedentary life style: Regular physical activity reduce
obesity and decrease BP.
 Socio economic status: more prevalent in people with
low socio economic status.
 Stress: Increase the incidence of hypertension

23. Secondary hypertension
 Secondary hypertension results from an identifiable
cause. Renal disease is the most common secondary
cause of hypertension. Hypertension can also be
caused by endocrine conditions, such as Cushing's
syndrome, hyperthyroidism, hypothyroidism,
acromegaly, Conn's syndrome or hyperaldosteronism,
hyperparathyroidism and pheochromocytoma.

24. Cause of Secondary
Hypertension
Diagnostic Tests Management
Renovascular disease Renal duplex ultrasonography, CT or MR
angiography, renal angiogram.
Balloon angioplasty in patients with FMD;
medical management with ACE inhibitor or
ARB in combination with a diuretic for
patients with atherosclerotic renal artery
disease.
Primary aldosteronism Plasma aldosterone renin ratio, salt loading
test for confirmation, CT scan of adrenal
and adrenal vein sampling for localization.
In a patient with adrenal hyperplasia or
bilateral functional adrenal adenoma, medical
therapy with aldosterone antagonist.
In a patient with unilateral functional
adenoma, adrenalectomy of the affected
adrenal gland.
Cushing syndrome Dexamethasone suppression test, salivary
cortisol levels, CT adrenal gland.
Treat primary cause for excess cortisol levels.
Pheochromocytoma Plasma metanephrines, 24-hour urinary
metanephrines and catecholamines, CT,
MRI, metaiodobenzylguanidine scan if CT or
MRI are not conclusive.
Adrenalectomy of the affected adrenal gland.
Coarctation of aorta Echocardiogram, MR angiography,
aortogram.
Angioplasty or surgical correction.
Renovascular disease Renal duplex ultrasonography, CT or MR
angiography, renal angiogram.
Balloon angioplasty in patient with FMD;
medical management with ACE inhibitor or
ARB in combination with a diuretic for patient
with atherosclerotic renal artery disease.

25. Essential hypertension or
idiopathic hypertension
 It is the most common form of hypertension, which
occurs in almost 90 percent of cases. The causes of
essential hyper tension is unknown, however, medical
studies and research have identified some factors
which cause hypertension. Some of these factors are
unhealthy dietary habits, tension, stress, insufficient
rest, smoking, excessive consumption of liquors,
obesity, metabolic disorders, excessive consumption of
tea and coffee etc

26. Hypertensive crisis
 Hypertensive crisis broadly covers both hypertensive
urgency and emergency. JNC 7 defines hypertensive
emergency as severe elevation in BP (>180/120
mmHg) complicated by evidence of impending or
progressive target organ dysfunction and
damage.When severe elevation in BP occurs without
acute target organ dysfunction or damage, it is defined
as hypertensive urgency

27. Hypertensive emergency
 previously "malignant hypertension", is diagnosed
when there is evidence of direct damage to one or
more organs as a result of the severely elevated blood
pressure. This may include hypertensive
encephalopathy, altered level of consciousness ,Retinal
papilloedema ,Chest pain ,myocardial infarction)
,aortic dissection, , signs of pulmonary
edema,deterioration of kidney function may occur.

28. Resistant hypertension
 Resistant hypertension is defined as hypertension that
remains above goal blood pressure in spite of
concurrent use of three antihypertensive agents
belonging to different antihypertensive drug classes

29. Hypertensive crisis
 Severely elevated blood pressure (equal to or greater
than a systolic 180 or diastolic of 110 — sometime
termed malignant or accelerated hypertension) is
referred to as a "hypertensive crisis.People with blood
pressures in this range may have no symptoms, but are
more likely to report headaches (22% of cases) and
dizziness than the general population.Other symptoms
accompanying a hypertensive crisis may include visual
deterioration or breathlessness due to heart failure or
a general feeling of malaise due to renal failure.

30. Pathophysiology
Etiological factors

sed periphral resistance

 sed venous compliance
sed venous return

cardiac preload

Diastolic dysfunction

31. Signs and symptoms.
 Headaches - Headaches may be experienced due to elevation in blood
pressure. Sometimes morning headaches can also be due to hypertension.
 Dizziness - Dizziness is often experience by people with high blood pressure.
However dizziness cannot always be treated as a symptom of hypertension. If
dizziness is experienced it is always wise to consult a medical practitioner.
 Heart pain
 Palpitations
 Nosebleeds - Nosebleeds without particular reason might be a symptom of
high blood pressure. It is better to check the blood pressure in such cases.
 Difficulty in breathing
 Tinnitus (ringing or buzzing in the ears)
 Blurred Vision
 Frequent urination

32. Diagnosis
 History and physical examination
 24-hour ambulatory blood pressure monitors and
home blood pressure monitoring
 Patterns of Blood Pressure
 Based on 24-hour ambulatory BP monitoring and
office BP readings, 4 patterns of BP have been
described
 sustained hypertension, Masked hypertension white
coat hypertension , normal dipping pattern

33. Home Blood Pressure Monitoring
 Home BP measurement guidelines recommend that a
validated device be used to measure BP at home Blood
pressure measurements using such validated devices
should be taken before an office visit, with at least 2
morning and 2 evening readings everyday for 1 week
(but discarding the readings of the first day), which
gives a total of 12 BP readings over a week, based on
which clinical decisions can be made. Hypertension is
defined as a mean home blood pressure of ≥135/85
mmHg. Home blood pressure monitoring provides an
inexpensive alternative to 24-hour ambulatory BP
monitoring.

34.  The recently released National Institute of Health and
Clinical Excellence (NICE) guidelines published in the
United Kingdom recommend that a diagnosis of
primary hypertension should be confirmed with 24-
hour ambulatory blood pressure monitoring or home
blood pressure monitoring rather than by relying
solely on office blood pressure measurement.

35. laboratoryTests
 Renal
 Microscopic urinalysis, proteinuria, BUN and/or
creatinine

 Endocrine
 Serum sodium, potassium, calcium, TSH

 Metabolic
 Fasting blood glucose, HDL, LDL, and total
cholesterol, triglycerides

36. Others
Electrocardiogram
Echo cardiography
On physical examination, hypertension may be
suspected on the basis of the presence of hypertensive
retinopathy detected by examination of the optic
fundus found in the back of the eye using
ophthalmoscopy

37. Prevention
 Maintain normal body weight for adults (e.g. body mass
index 20–25 kg/m2)
 Reduce dietary sodium intake to <100 mmol/ day (<6 g of
sodium chloride or <2.4 g of sodium per day)
 Engage in regular aerobic physical activity such as brisk
walking (≥30 min per day, most days of the week)
 Limit alcohol consumption to no more than 3 units/day in
men and no more than 2 units/day in women
 Consume a diet rich in fruit and vegetables (e.g. at least five
portions per day);
 Effective lifestyle modification may lower blood pressure

38. Management of Hypertension
Goals of Therapy
 The primary goal of therapy of hypertension should be
effective control of BP in order to prevent, reverse or
delay the progression of complications and thus reduce
the overall risk of an individual without adversely
affecting the quality of life. Patients should be
explained that the lifestyle modifications and drug
treatment is generally lifelong and regular drug
compliance is important

39. Initiation of therapy
 Having assessed the patient and determined the overall risk
profile, management of hypertension should proceed as
follows:
 In low risk patients, it is suggested to institute life style
modifications and observe BP for a period of 2-3 months,
before deciding whether to initiate drug therapy.
 In medium risk patients, institute life style modifications
and initiate drug therapy after 2-4 weeks, in case BP
remains above 140/90.
 In high and very high-risk groups, initiate immediate drug
treatment for hypertension and other risk factors in
addition to instituting life-style modification

40. Management
Me d i c a l M a n a g e m e n t
Lifestyle modifications
Medications

41. Modification Recommendation
Weight reduction Maintain normal body weight (body mass
index, 18.4–24.9 kg/m2)
Adopt DASH eating plan Consume diet rich in fruits, vegetables, low-
fat dairy products, with reduced content of
saturated and total fats
Dietary sodium reduction Reduce dietary sodium intake to no more
than 100 mmol/day (2.4g sodium or 6g
sodium chloride)
Physical activity Engage in regular aerobic physical activity
(e.g., brisk walking) at least 30 min/day,
most days of the week
Moderation of alcohol consumption Most men: limit consumption to no more
than two drinks/day‡
Most women and those who weigh less than
normal: no more than one drink/day

42. Adopt DASH (Dietary Approaches
to Stop Hypertension
 Eating more fruits, vegetables, and low-fat dairy foods
 Cutting back on foods that are high in saturated fat,
cholesterol, and trans fats
 Eating more whole grain products, fish, poultry, and
nuts
 Eating less red meat (especially processed meats) and
sweets
 Eating foods that are rich in magnesium, potassium,
and calcium

43. DASH diet
Food group No. of servings per day
Grains and grain products 7 or 8
vegetables 4 or 5
fruits 4or5
Low fat or fat free dairy products 2or 3
Meat, fish, poultry 2 or fewer
Nuts, seeds,and dry beans 4 or 5 weekly

44.  Different programs aimed to reduce psychological
stress such a biofeedback, relaxation or meditation are
advertised to reduce hypertension

45. Principles of drug treatment
 Over the past decade, the goals of treatment have gradually
shifted from optimal lowering of blood pressure, to patient’s
overall well being, control of associated risk factors and
protection from future target organ damage
 Achieve gradual reduction of blood pressure. Use low doses of
antihypertensive drugs to initiate therapy.
 Five classes of drugs can be recommended as first line treatment
for stage 1-2 hypertension1,2 These include :1) ACE inhibitors,
2) angiotensin II receptor blockers, 3) calcium channel blockers,
4) diuretics and 5) newer β-blockers.
 The Blood Pressure Lowering Treatment Trialists’ Collaboration
concluded that treatment with any commonly used regimen
reduces the risk of total major cardiovascular events and larger
reductions in blood pressure produce larger reductions in risk.

46. • Choice of an antihypertensive agent is influenced by age, concomitant
risk factors, presence of target organ damage, other co-existing
diseases,
• socioeconomic considerations, availability of the drug and past
experience of the physician.
• Combining low doses of two or more drugs having synergistic effect is
likely to produce lesser side effects. In 60-70 % of patients, goal blood
pressure will be achieved with two or more agents only. • Use of fixed
dose formulations should be considered to improve compliance.
• Drugs with synergistic effects should be combined pertinently to
enhance BP lowering effect so as to achieve target BP.
• Use of long acting drugs that provide 24-hour efficacy with once daily
administration ensures smooth and sustained control of blood
pressure; which in turn is expected to provide greater protection
against the risk of major cardiovascular events and target organ
damage. Once daily administration also improves patient compliance.
• Although antihypertensive therapy is generally lifelong, an effort to
decrease the dosage and number of antihypertensive drugs should be
considered after effective control of hypertension (step-down therapy).
• Due to a greater seasonal variation of temperatures in India, marginal
alterations in dosages of drugs may be needed from time to time.

47. Medications
 Several classes of medications, collectively referred to
as antihypertensive drugs, are currently available for
treating hypertension.. .One or more of these blood
pressure medicines are often used to treat high blood
pressure:
 Diuretics are also called water pills. They help your
kidneys remove some salt (sodium) from your body.
As a result, your blood vessels don't have to hold as
much fluid and your blood pressure goes down.

48.  Beta-blockers make the heart beat at a slower rate and with
less force.
 Angiotensin-converting enzyme inhibitors (also called ACE
inhibitors) relax your blood vessels, which lowers your blood
pressure.
 . Angiotensin II receptor blockers (also called ARBs)
work in about the same way as angiotensin-converting
enzyme inhibitors

49. .
 Calcium channel blockers relax blood vessels by stopping
calcium from entering cells.
Blood pressure medicines that are not used as often include:
 Alpha-blockers help relax your blood vessels, which
lowers your blood pressure.
 Centrally acting drugs signal your brain and nervous
system to relax your blood vessels.
 Vasodilators signal the muscles in the walls of blood
vessels to relax.

50.  Renin inhibitors, a newer type of medicine for treating
high blood pressure, act by relaxing your blood vessels
 Renin inhibitors work, as the name would suggest, by
inhibiting the activity of renin, the enzyme largely
responsible for angiotensin II levels. In clinical trials, renin
inhibitors have proven effective in not only lowering blood
pressure, but also keeping blood pressure levels steadier
throughout the day.One renin inhibitor, aliskiren
(Tekturna), was approved by the FDA in 2007. Other drugs
in this class are in development

53.  Two new techniques to treat resistant hypertension that are
undergoing clinical trials involve baroreceptor activation therapy and
renal artery denervation in order to lower blood pressure:
 Baroreceptor activation therapy is performed using a Rheos
baroreflex hypertension therapy system which is surgically implanted
in the subclavicular region. The electrodes connected to this device are
attached to the carotid body on each side of the neck. Activation of
baroreceptors leads to significant lowering of blood pressure.

55. The renal denervation system
 uses a catheter to perform radiofrequency ablation
when applied to the lumen of renal arteries through a
femoral access. In a study, 153 patients with resistant
hypertension (baseline BP of 176/98 + 17/15 mmHg)
underwent catheter-based renal sympathetic
denervation. Patients experienced a sustained BP
reduction averaging 32/14 mmHg at 24 months; 92%
had an office blood pressure reduction of >10mmHg
and 97% of patients were free of procedure-related
Complication

57. Conditions for which clinical trials demonstrate benefit
of specific classes of antihypertensive drugs.
 Heart Failure . In asymptomatic individuals with demonstrable
ventricular dysfunction, ACEIs and BBs are recommended. For
those with symptomatic ventricular dysfunction or end-stage
heart disease, ACEIs, BBs, ARBs and aldosterone blockers are
recommended along with loop diuretics.
 Diabetic Hypertension
 Combinations of two or more drugs are usually needed to
achieve the target goal of <130/80 mmHg. Thiazide diuretics,
BBs, ACEIs, ARBs, and CCBs are beneficial in reducing CVD and
stroke incidence in patients with diabetes. ACEI- or ARB-based
treatments favorably affect the progression of diabetic
nephropathy and reduce albuminuria, and ARBs have been
shown to reduce progression to macroalbuminuria.

58.  Chronic Kidney Disease: Hypertension appears in the
majority of these patients, and they should receive aggressive BP
management, often with three or more drugs to reach target BP
values of <130/80 mmHg. ACEIs and ARBs have demonstrated
favorable effects on the progression of diabetic and nondiabetic
renal disease.
 Cerebrovascular Disease
 The risks and benefits of acute lowering of BP during an acute
stroke are still unclear; control of BP at intermediate levels
(approximately 160/100 mmHg) is appropriate until the
condition has stabilized or improved. Recurrent stroke rates are
lowered by the combination of an ACEI and thiazide-type
diuretic.

59. Obesity and the metabolic syndrome
 Intensive lifestyle modification should be pursued in all
individuals with the metabolic syndrome, and appropriate
drug therapy should be instituted for each of its
components as indicated
 Left ventricular hypertrophy
Left ventricular hypertrophy (LVH) is an independent risk
factor that increases the risk of subsequent CVD. Regression
of LVH occurs with aggressive BP management, including
weight loss, sodium restriction, and treatment with all
classes of antihypertensive agents except the direct
vasodilators hydralazine, and minoxidil.

60.  Peripheral arterial disease
 Peripheral arterial disease (PAD) is equivalent in risk to
IHD. Any class of antihypertensive drugs can be used in
most PAD patients. Other risk factors should be managed
aggressively, and aspirin should be used.
 Hypertension in older persons
 Hypertension occurs in more than two-thirds of individuals
after age 65.This is also the population with the lowest
rates of BP control.Treatment recommendations for older
people with hypertension, including those who have
isolated systolic hypertension, should follow the same
principles outlined for the general care of hypertension

61. Hypertension in pregnancy
 Women with hypertension who become pregnant
should be followed carefully because of increased risks
to mother and fetus. Methyldopa, BBs, and
vasodilators are preferred medications for the safety
of the fetus.ACEI and ARBs should not be used during
pregnancy because of the potential for fetal defects and
should be avoided In some patients, preeclampsia may
develop into a hypertensive urgency or emergency and
may require hospitalization, intensive monitoring,
early fetal delivery, and parenteral antihypertensive
and anticonvulsant therapy

62. Agent Onset Duration Advantages Disadvantages
Nitroprusside Immediate 1-2 minutes Potent,
titratable
Cyanide,
isocyanide
Nitroglycerine 2-5 minutes 3-5 minutes Coronary
perfusion
Tolerance,
variable
efficacy
Fenoldopam <5 minutes 5-10 minutes Renal
perfusion
Increased
intraocular
pressure
Hydralazine 10-20 minutes 3-8 hours Eclampsia Tachycardia,
headache
Nicardipine 5-15 minutes 1-4 hours CNS protection Avoid in CHF
and cardiac
ischemia
Enalaprilat 15-30 minutes 6 hours CHF, acute LV
failure
Avoid in MI
Intravenous Agents for Hypertensive Emergencies

63. Complications of hypertension
 Hypertension is the most important preventable risk
factor for premature death.
 Ischemic heart disease
 Strokes
 Peripheral vascular disease,
 Other cardiovascular diseases
 , Including heart failure, aortic aneurysms, diffuse
atherosclerosis, and pulmonaryembolism

64.  Hypertension is also a risk factor for cognitive
impairment and dementia, and chronic kidney disease.
Other complications include hypertensive retinopathy
and hypertensive nephropathy.
 Bleeding from the aorta
 Target organ disease,POVD, nephrosclerosis
 Hypertensive encephalopathy

65. Nursing management
 Assessment
 History
 Past and present medical history
 Family history
 Risk factors
 symptoms
 Physical examination
 Checking vital signs

66. Nursing problems
 Decreased Cardiac Output related to increased
peripheral resistance and arterial stiffneff
 Acute Pain secondary to hypertension
 Activity Intolerance
 Imbalanced Nutrition : more than body
requirements
 Deficient Knowledge
 Ineffective therapeutic regimen

67. Researches
 Sesame and rice bran oil can treat high blood
pressure and cholesterol, study show Significant
blood pressure, cholesterol level reductions
Yoga benefits high blood pressure through promoting
relaxation of the mind and body. Practicing yoga helps
decrease the negative impacts of stress, including
tension, shallow breathing and elevated heart rate. It
also improves physical strength and flexibility, plus
may assist with weight loss