Hypertension

1. Hypertension …high blood pressure and you Cyn Kildare NP

2. Your Alegent Creighton Clinic • Open Monday-Friday • 7:00 am to 4:00 pm • Call to make an appointment, or drop in • 402-717-0710 • Reception: Joe • Nurse: Renee • Practitioners: Cyn and Sara

3. What is blood pressure? • The pressure the heart exerts against the arteries during contraction: Systolic • The pressure in your arteries while the heart is filling/relaxing: Diastolic

4. Categories of Hypertension (HTN) • Normal <120 and <80 • Pre-hypertension 120–139 or 80–89 • Hypertension, Stage 1 140–159 or 90–99 • Hypertension, Stage 2 ≥160 or ≥100

5. GOAL • For people with diabetes • BP goal should be <125 and < 75 • If no diabetes • BP goal should be <130 and < 80 Why the stricter control with diabetes?

6. How does hypertension happen? • >85% is called Essential Hypertension • >5% from meds (steroids, BCP, NSAIDS, decongestants) • >5% kidney disease • <2% from endocrine (thyroid disease, etc)

7. Meds/herbs that may raise BP • NSAIDS • Acetaminophen • Antidepressants • Birth Control Pills • Caffeine Pills • Decongestants • Herbal: Bitter orange, ephedra (ma-huang) ginseng, guarana, licorice, St. John’s wort • Stimulants

8. What diet/supplement might be helpful? • Potassium supplements, 40 to 80 meq/day (in conjunction with decreased sodium • Vegetarianism…most due to increased dietary fiber, and soy protein • Flavonoids from fruits and veggies…

9. Risk Factors for essential HTN • Age • Race • Gender • Poor Health Habits

11. Honestly, why do I need treatment? • http://www.youtube.com/watch?v=pPxnIh_WTb8&feature=endscreen&NR=1 Heart disease Heart attack Blindness Kidney disease, Kidney failure Stroke, Dementia, Neuropathy

12. How to treat: Pre-hypertension • Lifestyle modification! • Decrease weight to a BMI of <25 • Limit alcohol: MAX 1 a day for women, 2 a day for men • Exercise: 30 minutes most days • Limit sodium • Stop smoking • RE-CHECK your BP in 1-3 months

13. Why does overweight and obesity matter? • Compresses the kidneys, decreasing their ability to function well • Leptin a neuro-chemical produced by fat cells causes sodium retention • Angiotensin which is partially produced by fat cells also raises the blood pressure • Not fully understood, but seen anecdotally

14. Body Mass Index (BMI) • Normal weight = 18.5-24.9 • Overweight = 25-29.9 • Obesity = BMI of 30 or greater • Extreme = BMI of 40-54

15. Alcohol: Don’t drink, or drink in Moderation • Two drinks a day for men younger than age 65 • One drink a day for men age 65 and older • One drink a day for women of any age • A drink is • 12 ounces of beer, • 5 ounces of wine or • 1.5 ounces of 80-proof distilled spirits.

16. Exercise • Do not exercise vigorously when you have elevated blood pressure. • HOWEVER, walking about the block slowly and conditioning is important. NO heavy lifting until the BP is well controlled. • As the BP becomes controlled. Ask for assistance from your HCP for increasing your exercise regimen

17. TOBACCO • Don’t USE TOBACCO • Nebraska Quitline http://dhhs.ne.gov/Publichealth/pages/tfn_ces.aspx or 1-800-QUITNOW • Seek help from a professional • Call insurance to find out what medications are covered under your plan

18. DASH DIET (Dietary Approaches to Stop HTN) • The Dash diet is all about: • Increasing fruits and vegetables • Decreasing saturated and meat fats • Moderate low fat dairy products • Increasing protein sources from nuts and legumes • Decreasing sodium

19. Why low sodium • Salt = water retention. • Water retention in circulating blood = more circulating fluid • More circulating fluid = more blood to move by one of two ways… • Faster heart rate, or increase in BP by needing a more forceful contraction of the heart to move more fluid • If the heart cannot keep up, SWELLING occurs, and eventually heart failure may occur

20. Those who MUST limit their sodium • You are 51 years of age or older. • You are African American. • You have high blood pressure. • You have diabetes. • You have chronic kidney disease.

22. Sodium surprises! Most Americans consume twice what they need • Chicken Noodle Soup 870 mg • Hot Dog w bun 700 mg • 1 slice American Cheese 270 mg • 1 slice bread 138 mg • 10 potato chips 126 mg • 4 short bread cookies 105 mg

23. Lunch: fast food • McDonalds • Hamburger, fries, Diet cola: 700 mg • Burger King • Hamburger, fries, Diet cola: 1100 mg • Wendy’s • Hamburger, fries, Diet cola: 1750 mg • Panera • Almond Chicken Sand, chips, Diet cola: 1420 mg

24. Diuretics • Diuretics work by flushing excess water and sodium from the body, thus lowering blood pressure. (They work in the kidneys) • Types: Thiazides, Loops, Potassium Sparing

25. Medications • Angiotensin II • A-II is a natural substance in your body that affects your cardiovascular system in many ways, such as by narrowing your blood vessels. This narrowing can increase your blood pressure and force your heart to work harder. • A-II also starts the release of a hormone that increases the amount of sodium and water in your body, which can lead to increased blood pressure. • A-II can also thicken and stiffen the walls of your blood vessels and heart.

26. Medications • AngiotensinCoverting Enzyme Inhibitors (ACE) • ACE inhibitors prevent an enzyme in your body from producing angiotensin II, a substance in your body that affects your cardiovascular system by narrowing your blood vessels and releasing hormones that can raise your blood pressure. This narrowing can cause high blood pressure and force your heart to work harder.

27. Medications • Angiotensin II • A-II is a natural substance in your body that affects your cardiovascular system in many ways, such as by narrowing your blood vessels. This narrowing can increase your blood pressure and force your heart to work harder. • A-II also starts the release of a hormone that increases the amount of sodium and water in your body, which can lead to increased blood pressure. • A-II can also thicken and stiffen the walls of your blood vessels and heart.

28. Medications • Beta Blockers • Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. When you take beta blockers, the heart beats more slowly and with less force, thereby reducing blood pressure.

29. Med ications • Calcium Channel Blockers • Calcium channel blockers prevent calcium from entering cells of the heart and blood vessel walls, resulting in lower blood pressure. • They relax and widen blood vessels by affecting the muscle cells in the arterial walls

30. How to treat: Hypertension • Do not delay treatment! • You will begin with at least 1 antihypertensive medication* • If Stage 2 hypertension (>160 or >100) begin 2 antihypertensive medications. • MAKE LIFESTYLE CHANGES, pills are needed, but not enough

31. Not making it to goal? We will refer to Nephrology or Cardiology for resistant hypertension • Echocardiogram • Renal Ultrasound • Sleep apnea study

32. I only had high blood pressure 2 times! • If you have a recording of 2 BP readings that are elevated at least 7 days apart, you have met the DEFINITION of HYPERTENSION. • OR… if only one reading is >180/110 .

33. Once again… why is it so important to treat… • In pre-hypertension alone… • For every 20/10 mm Hg increase there is a doubling of risk of heart and artery (aneurisms) events

34. RECAP • In pre-hypertension alone… • For every 20/10 mm Hg increase there is a doubling of risk of heart and artery (aneurisms) events • Hypertension: • 3 times more likely to have heart disease • 6 times more likely to have congestive heart disease • 7 times more likely to have a stroke

35. How to prepare for a Health Care Appt. • Write down any symptoms you're experiencing • Write down key personal information • Make a list of all medications • Take a family member or friend along • Be prepared to discuss your diet and exercise habits • Write down questions to ask

36. Cont… • Wear a shirt or blouse that allows for BP check and blood draw. • Avoid caffeine one hour before your appointment • Avoid sexual activity for 48 hours before prostate and pap test screening • You may need to do a urine test, so drink plenty of fluids. If required, fast except for water for 8-12 hours.

37. WEB RESOURCES • http://www.nhlbi.nih.gov/health/ • http://health.gov/dietaryguidelines/default.asp • http://www.mayoclinic.com/health/ • http://www.webmd.com/ • http://www.cdc.gov/DiseasesConditions/ • http://www.framinghamheartstudy.org/ (Search: “risk score profiles”) • http://www.alegentcreighton.com/ (Search: “programs for your health”)