Lifestyle modifications to prevent and control hypertension. 1. Methods and an overview of the Canadian recommendations. Canadian Hypertension Society,Canadian Coalition for High Blood Pressure Prevention and Control,Laboratory Centre for Disease Control at Health Canada,Heart and Stroke Foundation of Canada

OBJECTIVE: To provide updated, evidence-based recommendations for health care professionals on lifestyle changes to prevent and control hypertension in otherwise healthy adults (except pregnant women). OPTIONS: For people at risk for hypertension, there are a number of lifestyle options that may avert the condition--maintaining a healthy body weight, moderating consumption of alcohol, exercising, reducing sodium intake, altering intake of calcium, magnesium and potassium, and reducing stress. Following these options will maintain or reduce the risk of hypertension. For people who already have hypertension, the options for controlling the condition are lifestyle modification, antihypertensive medications or a combination of these options; with no treatment, these people remain at risk for the complications of hypertension. OUTCOMES: The health outcomes considered were changes in blood pressure and in morbidity and mortality rates. Because of insufficient evidence, no economic outcomes were considered. EVIDENCE: A MEDLINE search was conducted for the period January 1996 to September 1996 for each of the interventions studied. Reference lists were scanned, experts were polled, and the personal files of the authors were used to identify other studies. All relevant articles were reviewed, classified according to study design and graded according to level of evidence. VALUES: A high value was placed on the avoidance of cardiovascular morbidity and premature death caused by untreated hypertension. BENEFITS, HARMS AND COSTS: Lifestyle modification by means of weight loss (or maintenance of healthy body weight), regular exercise and low alcohol consumption will reduce the blood pressure of appropriately selected normotensive and hypertensive people. Sodium restriction and stress management will reduce the blood pressure of appropriately selected hypertensive patients. The side effects of these therapies are few, and the indirect benefits are well known. There are certainly costs associated with lifestyle modification, but they were not measured in the studies reviewed. Supplementing the diet with potassium, calcium and magnesium has not been associated with a clinically important reduction in blood pressure in people consuming a healthy diet. RECOMMENDATIONS: (1) It is recommended that health care professionals determine the body mass index (weight in kilograms/[height in metres]2) and alcohol consumption of all adult patients and assess sodium consumption and stress levels in all hypertensive patients. (2) To reduce blood pressure in the population at large, it is recommended that Canadians attain and maintain a healthy body mass index. For those who choose to drink alcohol intake should be limited to 2 or fewer standard drinks per day (maximum of 14/week for men and 9/week for women). Adults should exercise regularly. (3) To reduce blood pressure in hypertensive patients, individualized therapy is recommended. This therapy should emphasize weight loss for overweight patients, abstinence from or moderation in alcohol intake, regular exercise, restriction of sodium intake and, in appropriate circumstances, individualized cognitive behaviour modification to reduce the negative effects of stress. VALIDATION: The recommendations were reviewed by all of the sponsoring organizations and by participants in a satellite symposium of the fourth international Conference on Preventive Cardiology. They are similar to those of the World Hypertension League and the Joint National committee, with the exception of the recommendations on stress management, which are based on new information. They have not been clinically tested. SPONSORS: The Canadian Hypertension Society, the Canadian Coalition for High Blood Pressure Prevention and Control, the Laboratory Centre for Disease Control at health Canada, and the Heart and Stroke Foundation of Canada.     

Nutritional effects on the hop curl disease and comparison of the chemical composition of diseased and healthy hop plants

Whereas experiments directed towards proving the infectious character of the hop curl disease did not give reliable proof of its virus character (we have not been able to transfer it neither by cuttings nor by graft), but made possible its differentiation from the English nettlehead hop virus disease, the practical experiences and results presented in this paper show that nutritional conditions essentially affect the known variability of the external manifestations of the hop curl disease. Especially such nutrients play a role which with the normal fertilising techniques are not returned to the soil in sufficient quantity. Since the hop curl disease was noticeably inhibited in a nutritional field experiment on application of the salts of some elements, predominantly of B, Mg, Mo, Mn, Ni, I and Zn, it appears possible to apply “symptomatic therapy” of the hop curl disease, which could have wide practical importance for limiting this disease. In order to supplement the provocation field experiments, comparative investigations of the chemical composition of the leaves from healthy and hop curl diseased plants were carried out. Quantitative analysis of the biogenic elements carried out by the usual methods and by polarography showed a regularly higher content of P, K, Ca and a lower content of Zn in the diseased plants as compared to healthy ones. The differences observed in the content of N, Na, Mg, S, Fe and Cu were not always in the same sense. Chemical analysis was accompanied by parallel spectral analysis of ash. This made it possible to obtain a considerably complete survey of the qualitative and approximately quantitative representation of a whole series of other elements in healthy and diseased plants; however, no characteristic differences were recorded. Finally the results obtained in the present work are confronted with the findings of other researches, especially from Germany, and discussed.