High Cholesterol & Hypertension

1. High Cholesterol &Hypertension CMT Training The Center for Life Enrichment

2. High Cholesterol Section 1

3. What is it? • Cholesterol is necessary for proper digestion, hormone balance, and healthy cell membranes • When the blood cholesterol is too high, it forms deposits or plaque inside the walls of arteries • When the deposits are large enough to decrease blood flow, heart disease, stroke, or peripheral vascular disease develops

4. Why does it occur? • Cholesterol is made by the liver • In some people, the liver makes too much cholesterol • Cholesterol is also contained in food rich in animal fats • Cholesterol circulates in the blood stream bound to proteins of various densities called “lipoproteins”

5. LDL vs. HDL LDL HDL • “Low Density Lipoproteins” (LDL) in excess increase the risk of plaque formation • Commonly called “Bad Cholesterol” • LDL Cholesterol: Less than 100 mg/dl • “High Density Lipoproteins” (HDL) are cardio-protective • Commonly called “Good Cholesterol” • HDL Cholesterol: 40 mg/dl or higher for men; 50 mg/dl or higher for women

6. What the person might complain about/What to look for? • There are no specific symptoms of high cholesterol; that is why it is recommended that everyone have a blood cholesterol test • The “desirable” amount of total cholesterol in the blood is less than 200 mg/dl. This level, if normal, should be rechecked every five years • If the cholesterol level is greater than 200 mg/dl, the doctor may recommend dietary interventions and/or cholesterol lowering medications

7. Other Risk Factors for Heart Disease: • High Blood Pressure • Smoking • Family History of Heart Disease • Diabetes • Elevated LDL or Decreased HDL Cholesterol • Elevated Triglycerides (A type of fat found in your blood) • Obesity • Sedentary Lifestyle

8. What medications are used? • There are numerous medications on the market to lower cholesterol • What to look for while the person is taking medication to lower cholesterol: • Muscle cramping • Rash/Hives • Constipation/Diarrhea • Flushing • Stomach Upset/Pain • Headache • Labs will be routinely followed to monitor liver and kidney function

9. Your Responsibility • The individual/caregiver must know: • Some of these medications may interact with other medications the person may take- Make sure the Healthcare Professional (HCP) is aware of all medications being taken • The person should exercise regularly • Follow a diet low in cholesterol, saturated fats (including “hydrogenated” fats) and transfatty acids

10. Specific Foods to Avoid • Fried Foods: • If not avoided, consider using olive or sunflower oil when frying • A recent study published in the science journal BMJ found that in Spain, where olive and sunflower oils are used for frying, eating fried food is not associated with increased rates of heart disease as it is in Western countries, where saturated fats, like lard and butter, are used • Hydrogenated Oil: • Found in packaged foods, such as cookies, pastries, mayonnaise, crackers, microwave popcorn, frozen dinners, etc. • Hydrogenated oil is used to increase a product’s shelf life • Check food labels and ingredients carefully- if you see the word “hydrogenated,” avoid it! • Meat: • Avoid meat with visible fat • Try to reduce the amount of meat in your diet • When preparing/eating meat, trim off any visible fat on steaks and chops, always remove the skin off turkey and chicken, and choose the leanest ground meat possible • Full-Fat Dairy Products: • Instead, choose dairy products that are fat-free, made with 2% milk, or part skim

11. Foods that Lower Cholesterol • Monounsaturated and polyunsaturated fats: • Can help decrease LDL cholesterol • Eat fish high in omega-3 fatty acids, such as salmon, tuna, trout, herring, or king mackerel, at least twice a week • Other good sources of unsaturated fats include avocados, almonds, walnuts, and olive oil • Soy Foods: • Good sources of soy protein include tofu, soy milk, and edamame • High-Fiber Foods: • High-fiber foods that lower cholesterol include whole grains, such as 100 percent whole-wheat bread, oats, and barley; beans; dark, leafy green vegetables; and fruits with a tough skin • Spices: • Not only do spices help flavor foods, but some in particular are also a good part of a cholesterol-lowering diet, such as turmeric, red cayenne pepper, thyme oil, and ginger

12. Resources • MTTP Student Manual • http://www.everydayhealth.com/health-report/healthy-living-with-high-cholesterol/best-and-worst-foods-for-high-cholesterol.aspx

13. Hypertension Section 2

14. What is it? • Hypertension or “high blood pressure” usually has no symptoms and, because of this, is called the “silent killer” • Normal bloodpressure is generally below 120/80 • 120 represents the systolic measurement • 80 represents the diastolic measurement • Desirable blood pressure is: • Systolic - from 90 to 119 • Diastolic - from 60 to 79 • Pre-hypertension: • When the reading is between 120/80 and 139/89 • Hypertension: • When the reading is at least 140/90 • The persistent elevated pressure in the vascular system can damage the heart, brain, kidney, and eyes. Therefore, untreated high blood pressure can lead to heart disease, stroke, kidney disease, and blindness!

15. Taking a blood pressure measurement • The procedure is straightforward and provides the HCP with vital data regarding the condition of the individual’s blood vessels and heart • Two blood pressure readings are measured: • The Systolic Pressure: the maximum pressure in an artery. It occurs when the heart contracts; when it is beating, and blood is being pumped through • The Diastolic Pressure: the minimum pressure in an artery. It occurs just before the heart contracts; in between heartbeats. It occurs when the heart is resting • Both readings are important. If either the systolic or diastolic pressure is too high, the individual has hypertension • Blood pressure readings may be taken while the individual is sitting or standing • Several different readings (on different days) are usually taken before the diagnosis of high blood pressure, or hypertension, is made

16. Why does it occur? • In 90% of individuals, there is no known cause for high blood pressure or hypertension • However, many factors may contribute to hypertension including: • Obesity • High Salt Intake • Alcohol Use • Sedentary Lifestyle • Use of Certain Medications (which may cause a rise in blood pressure) • A Family History of High Blood Pressure • Excessive Stress • In 10% of people with high blood pressure, there is a known cause for high blood pressure. Known causes include: kidney disease, diabetes mellitus, adrenal tumors, or diseases of the blood vessels

17. What the individual might complain about/What to look for? • High blood pressure is generally without symptoms • Having blood pressure checked routinely is the best method for detecting the problem • In some people with high blood pressure, signs and symptoms may be present. If the following signs or symptoms are noted, report them to the RN CM/DN or HCP: • Change in vision • Chest pain • Confusion • Dizziness (blackout) • Nausea and vomiting • Nosebleeds • Shortness of breath

18. What medications are used? • There are many different types of medications that can be used to treat high blood pressure • Some medications are a combination of two ormore medications • It often takes more than one medication to manage hypertension

19. How to determine if the medication is working? • The individual’s blood pressure should be checked regularly in order to tell if the blood pressure is within the target range identified by the HCP • The following side effects are common to many medications used to treat high blood pressure. They often disappear after a few weeks of treatment. If they continue to be a problem, contact your RN CM/DN and the HCP. It may be necessary for the HCP to reduce the dose or change the medication: • Dizziness • Persistent coughing • Mood changes • Change in bowel habits • Loss of energy • Sexual impotence • Fatigue • Muscle Weakness

20. Your Responsibility • It is important for the individual/caregiver to understand the following: • Individuals who are on a diuretic need to have their blood tested to be certain that their potassium, sodium, and other important electrolytes remain normal. Individuals should not buy/take potassium supplements on their own • Many individuals who receive a diuretic are also on digoxin. If this is true, more careful monitoring of side effects is necessary • It is very important for individuals to drink plenty of fluids and limit salt intake, unless told otherwise by the HCP • The individual should move from a sitting to standing position or from a lying to standing position slowly to avoid becoming dizzy • Be sure to tell the HCP if the individual has gout or diabetes. Diuretics may interfere with the treatment of both of these diseases

21. Your Responsibilities Continued… • Report any side effects to the RN CM/DN or HCP. The HCP may decide to change the medication or reduce the dose • If the individual’s blood pressure is being monitored, have the equipment checked each year to be certain it is working correctly • The individual should not stop taking any medication suddenly as this could be life-threatening! If the individual wants to discontinue a blood pressure medication, it must be discussed with the HCP • Be certain that you know exactly how to operate the blood pressure measuring equipment

22. Blood Pressure Monitors • Digital Blood Pressure Monitors are available at TCLE and our off-sight locations to measure blood pressure • On occasion, CMTs may need to use a Blood Pressure Monitor to measure a participant’s blood pressure; please contact the agency nurse with any questions or concerns (301-373-8100)

23. Resources • http://www.medicalnewstoday.com/articles/241527.php • MTTP Student Manual