High Blood Pressure, Risk Factors, & Preventative Strategies

1. High Blood Pressure, Risk Factors, & Preventative Strategies Dr. Sameena Zahoor

2. High Blood Pressure, Risk Factors, & Preventive Strategies • What is high blood pressure? • Why should you treat blood pressure? • Risk factors for developing high blood pressure. • Prevention strategies. • Treatment options.

3. What is high blood pressure?

4. What Is High Blood Pressure? • Force of blood against the walls of arteries. • Blood pressure rises and falls during the day. When BP stays elevated over time, it is called high blood pressure, or hypertension.

5. What do the Numbers Mean? • The measurement is written one above the other: systolic number diastolic number • Top number, systolic pressure measures the pressure in the blood vessels as the heart beats • Bottom number, diastolic pressure measures the pressure in the vessels as the heart relaxes between beats

6. What do these Numbers Mean? • Normal : BP < 120/80 • Pre-hypertension : BP 120--139 / 80—89 • Hypertension : BP > 140/90 BP > 130/80(for people with heart disease, diabetes and kidney disease)

7. Why Should you Treat High Blood Pressure?

8. Why Should You Treat High Blood Pressure? • High BP makes the heart work too hard and contributes to atherosclerosis (hardening of the arteries). • Increases the risk of heart disease and stroke • High BP can also cause other conditions: congestive heart failure, kidney disease, and blindness.

9. Why Should You Treat High Blood Pressure? Ave % Reduction Stroke incidence 35–40% Myocardial infarction 20–25% Heart failure 50%

10. How do you Develop High Blood Pressure?

11. Identifiable Causes of High BP • Sleep Apnea • Thyroid / Parathyroid disease • Chronic Kidney Disease • Drugs (e.g. Non-steroidal anti-inflammatories, some Nasal drops and Sprays, some Cough medicines, Appetite Suppressants, Decongestants, Steroids, BC pills) • Hormone producing tumors/diseases

12. High blood Pressure – Genetic component • 98% of High BP is caused by un-identifiable causes. • People with blood relatives who have high BP, like a father, mother or sibling are more likely to develop high BP • Researchers are working on identifying the genes that causes HTN and the type of BP med a person responds to

13. Other Risk Factors for Developing High Blood Pressure • Men over the age of 55 • Women over the age of 65, especiallyPost Menopausal • African Americans, especially women • People with diabetes • People who smoke

14. Risk factors for developing high blood pressure, cont. • Some women who are pregnant • People who get little or no regular physical activity • People who are overweight • People who have high cholesterol

15. What Can you Do to Reduce your Risk of Developing High BP?

16. Prevention Strategies – Healthy Lifestyle Modification Approx SBP reduction (range) Weight reduction 5–20 mmHg/10 kg wt loss Adopt DASH eating plan 8–14 mmHg Dietary sodium reduction 2–8 mmHg Physical activity 4–9 mmHg Decrease alcohol consumption 2–4 mmHg

17. Body Mass Index (BMI) – measure of body fat Overweight: BMI 25 - 29.9 Obese: BMI > 30 BP rises as body weight increases Losing even 10 pounds can lower BP Prevention Strategies – Weight Loss

18. Treatment options

19. Treatment Goals • Goal is BP < 140/90 • Goal is BP< 130/80 for people with heart disease, diabetes and kidney disease.

20. Treatment Strategies – Healthy Lifestyle

21. Treatment Options - MEDICATION • Most patients will require two or more BP meds to achieve BP goal. • There are several different classes of medications • Factors such as age, gender, race and concurrent medical conditions are considered before choosing the right medication

22. Treatment Options - MEDICATION • Diuretics (water pills) - Help the body get rid of extra sodium (salt) and water so your blood vessels don't have to hold so much fluid. • Most often used in combination with others • Helpful when edema/swelling is present • Need to have periodic lab tests to check potassium levels • Examples: hydrochlorothiazide, lasix, maxide

23. Treatment Options - MEDICATION • Beta-blockers - Make the heart beat slower so that blood passes through your blood vessels with less force. • Have additional Heart-protective benefits • Examples: Coreg, Toprol XL, Corgard, Inderal

24. Treatment Options - MEDICATION • Angiotensin-converting enzyme inhibitors (also called ACE inhibitors) - Keep your body from making a hormone that causes blood vessels to narrow. • Have additional Heart and Kidney-Protective benefits • Cannot be used in pregnant females • “Tickly cough” is common side effect • Examples : Accupril, Altace, Lotensin, Vasotec, Zestril

25. Treatment Options - MEDICATION • Angiotensin II receptor blockers (also called ARBs) -- Protect your blood vessels from the effects of the hormone that causes them to narrow. • Also have additional Heart and Kidney-protective benefits • Cannot be used in pregnant females • Examples : Atacand, Avapro, Cozaar, Diovan, Benicar, Micardis

26. Treatment Options - MEDICATION • Calcium channel blockers (also called CCBs) Help keep your blood vessels from becoming narrow by blocking calcium from entering your cells. • Eg: Adalat, Cardizem, Calan, Norvasc, Plendil, Procardia,

27. Common BP Med Side effects: • Headache • Dizziness or lightheadedness • Extreme tiredness, weakness, drowsiness or lethargy (extreme lack of energy) • Cough, fever, congestion, upper respiratory tract infection or "flu-like" symptoms • Skin rash • Sexual dysfunction (impotence)

28. References for further reading • Guide to lowering blood pressure by NHLBI, www.nhlbi.nih.gov/hbp/index.html • The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report.2003 May 21; 289(19):2560-71  Available at: http://www.jama.com • The DASH eating plan, www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf • Info about BP Medicines, www.familydoctor.org/797.xml

29. Final thoughts • "The most effective therapy prescribed by the most careful clinician will control hypertension only if patients are motivated.” • “Motivation improves when patients have positive experiences with, and trust in, the clinician." JNC 7