Urge hypertensive women to change some habits.

SAN FRANCISCO -- Most physicians believe in urging hypertensive patients to alter their lifestyle in beneficial ways, even though this seldom comes to pass, Norman Kaplan, M.D., said at the annual meeting of the American Society of Hypertension.

"I'm not sure that we're going to be depending as much on lifestyle modifications as we have in the past" because of the recognition that high blood pressures need to be lowered quickly, said Dr. Kaplan, professor of medicine at the University of Texas, Dallas.

He described lifestyle modifications that do and don't work in treating hypertension:

* Smoking cessation. Usually found at the bottom of lists of lifestyle modifications for treating hypertension, smoking cessation deserves first mention because it is the major reversible cardiovascular risk factor in hypertensive smokers. Until recently, physicians didn't recognize the pressor effects of nicotine because patients weren't allowed to smoke during blood pressure measurements. Ambulatory monitoring consistently shows higher blood pressures while smoking.

Advise patients repeatedly to stop smoking, and explain or show to them the pressor effect of smoking, Dr. Kaplan said. Nicotine replacement products such as patches should not have persistent pressor effects but advise patients to check their blood pressure on these products anyway because some people may be particularly sensitive.

* Weight loss. Significant weight loss reduces blood pressure, but most dieters put the pounds back on in a short amount of time. Studies comparing weight loss diets suggest that the cheapest and "probably the most logical" method--Weight Watchers--may be the best diet strategy, he said.

For morbidly obese people (body mass index greater than 40 kg/[m.sup.2]), gastric bypass surgery typically results in a 30% weight loss over a 10-year follow-up, as shown in a study of 1,000 patients. The surgery reduced the incidence of diabetes by about one-third and lowered the risk of dyslipidemia and hyperuricemia, compared with not having gastric bypass surgery, Dr. Kaplan said. But the surgery did not radically alter the risk for hypertension.