Discharge Plan

M Medications to take at home 1. 2. 3. 4. Gabapentin 100mg/cap 1 cap TID Irbesatran (Approvel) 150 mg/cap 1 cap OD in AM Aspirin 80 mg/tab 1 tab OD after lunch Ciprofloxacin 500 mg/tab 1 tab BID to complete 7 days

E Exercise Being physically active is one of the most important steps you can take to prevent or control high blood pressure. It also helps reduce your risk of heart disease.

Stretching or the slow lengthening of the muscles. Stretching the arms and legs before and after exercising helps prepare the muscles for activity and helps prevent injury and muscle strain. Regular stretching also increases your range of motion and flexibility. Cardiovascular or aerobic exercise is steady physical activity using large muscle groups. This type of exercise strengthens the heart and lungs and improves the body's ability to use oxygen. Aerobic exercise has the most benefits for your heart. Over time, aerobic exercise can help decrease your heart rate and blood pressure and improve your breathing. Strengthening exercises are repeated muscle contractions (tightening) until the muscle becomes tired.

Phase 1: Getting Started Get started by doing 30 minutes of a moderate-level activity on most, and preferably all, days of the week. Brisk walking, bicycling, and gardening are examples. You can even divide the 30 minutes into shorter periods of at least 10 minutes each. For instance:

Use stairs instead of an elevator Get off a bus one or two stops early Park your car at the far end of the lot at work

Phase 2: Moderate-Level Physical Activities Engage in at least 30 minutes of moderate-level activity on most, and preferably all, days of the week. Examples of moderate-level activity are:

Walking briskly (3-4 miles per hour) Conditioning or general calisthenics Home care and general cleaning Home repair, such as painting

Mowing the lawn (with power mower) Gardening Dancing Racket sports, such as table tennis Golf (walking the course) Fishing (standing and casting, walking, or wading) Swimming (with moderate effort) Cycling (at a moderate speed of 10 miles per hour or less) Canoeing or rowing (at a speed of about 2-3.9 miles per hour)

Exercise Warning Stop exercising and rest if you have any of the following symptoms:

Chest pain Weakness Dizziness or lightheadedness Unexplained weight gain or swelling Pressure or pain in your chest, neck, arm, jaw, or shoulder or any other symptoms that cause concern.

T Treatment Lifestyle modifications Lifestyle changes such as the DASH diet, physical exercise, and weight loss have been shown to significantly reduced blood pressure in people with high blood pressure. If hypertension is high enough to justify immediate use of medications, lifestyle changes are initiated concomitantly. Biofeedback Biofeedback devices can be used alone or in conjunction with lifestyle changes or medications to monitor and possibly reduce hypertension. One example is Resperate, a portable, battery-operated personal therapeutic medical device, sold over the counter (OTC) in the United States. However, claims of efficacy are not supported by scientific studies. Testimonials are used to promote such products, while no real evidence exists that the use of resperate like devices lowers any morbidity associated with hypertension.

Medications There are many classes of medications for treating hypertension, together called antihypertensives, which by varying means act by lowering blood pressure. Evidence suggests that reduction of the blood pressure by 56 mmHg can decrease the risk of stroke by 40%, of coronary heart disease by 1520%, and reduces the likelihood of dementia, heart failure, and mortality from vascular disease. The aim of treatment should be blood pressure control to <140/90 mmHg for most patients, and lower in certain contexts such as diabetes or kidney disease (some medical professionals recommend keeping levels below 120/80 mmHg).[154] Each added drug may reduce the systolic blood pressure by 510 mmHg, so often multiple drugs are often necessary to achieve blood pressure control. H Health Teachings Lifestyle Changes to Treat High Blood Pressure A critical step in preventing and treating high blood pressure is a healthy lifestyle. You can lower your blood pressure with the following lifestyle changes:

Losing weight if you are overweight or obese. Quitting smoking. Eating a healthy diet, including the DASH diet (eating more fruits, vegetables, and low fat dairy products, less saturated and total fat). Reducing the amount of sodium in your diet to 2,300 milligrams (about 1 teaspoon of salt) a day or less. Getting regular aerobic exercise (such as brisk walking at least 30 minutes a day, several days a week). Limiting alcohol to two drinks a day for men, one drink a day for women.

In addition to lowering blood pressure, these measures enhance the effectiveness of high blood pressure drugs. O Out patient follow-up After starting high blood pressure drug therapy, you should see your doctor at least once a month until the blood pressure goal is reached. Once or twice a year, your doctor will check the level of potassium in your blood (diuretics can lower this, and ACE inhibitors and ARBs may increase this) and magnesium and BUN/creatinine levels (to check the health of the kidneys). After the blood pressure goal is reached, you should continue to see your doctor every three to six months, depending on whether other diseases such as heart failure are presen

D Diet DASH Diet One step to lower high blood pressure -- incorporate the DASH diet into your lifestyle. Doctors recommend:

Eating more fruits, vegetables, and low-fat dairy foods Cutting back on foods that are high in saturated fat, cholesterol, and total fat Eating more whole grain products, fish, poultry, and nuts Eating less red meat and sweets Eating foods that are rich in magnesium, potassium, and calcium

The DASH diet, which stands for Dietary Approaches to Stop Hypertension, is an example of such an eating plan. In studies, patients who were on the DASH diet reduced their blood pressure within two weeks. Another diet -- DASH-Sodium -- calls for reducing sodium (salt) to 1,500 mg a day (about 2/3 teaspoon). Studies of patients on the DASH-Sodium plan significantly lowered their blood pressure. Vegetarian Diet Vegetarians, in general, have lower blood pressure levels and a lower incidence of hypertension and other cardiovascular diseases. Experts postulate that a typical vegetarian's diet contains more potassium, complex carbohydrates, polyunsaturated fat, fiber, calcium, magnesium, vitamin C and vitamin A, all of which may have a favorable influence on blood pressure. High-Fiber Diet A high-fiber diet has been shown to be effective in preventing and treating many forms of cardiovascular disease, including hypertension. The types of dietary fiber is important. Of the greatest benefit to hypertension are the water soluble gel-forming fibers such as oat bran, apple pectin, psyllium seeds, and guar gum. These fibers, in addition to be of benefit against hypertension, are also useful to reduce cholesterol levels, promote weight loss, chelate out heavy metals, etc. Take one to three tablespoons of herbal bulking formula containing such things as oat fiber, guar gum, apple pectin, gum karaya, psyllium seed, dandelion root powder, ginger root powder, fenugreek seed powder and fennel seed powder. Reduce Salt and Sodium in Your Diet A key to healthy eating is choosing foods lower in salt and sodium. Before the widespread availability of medication to control high blood pressure, people with serious hypertension had only one treatment option, a drastically salt-reduced, low-calorie "rice diet." Some people can significantly lower their blood pressure by avoiding salt.