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Blood Pressure

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  1. Blood Pressure Coronado Thunderbirds Linda Macdonald, M.D. October 9, 2007 Clinical Services 3331 Disease Management Clinic 505-844-HBES (4237) hbe@sandia.gov

  2. Blood Pressure • The pressure in the arterial blood vessels results from: • flow of blood from the heart • resistance of the arterial blood vessel walls • The higher the blood pressure, the harder the heart has to pump in order to supply the body with blood Clinical Services 3331 Disease Management Clinic 505-844-HBES (4237) hbe@sandia.gov

  3. Blood Pressure

  4. Blood Pressure • The first (top) number is the systolic blood pressure (SBP) and indicates the pressure in the artery when the heart is actively pumping blood • The second (bottom) number is the diastolic blood pressure (DBP) and indicates the pressure in the artery when the heart is resting between beats Clinical Services 3331 Disease Management Clinic 505-844-HBES (4237) hbe@sandia.gov

  5. Measuring Blood Pressure Clinical Services 3331 Disease Management Clinic 505-844-HBES (4237) hbe@sandia.gov

  6. Measuring Blood Pressure • Blood pressure is measured in the sitting position after at least 5 minutes of rest • The blood pressure cuff should be the correct size and should not be placed over clothing • At least two blood pressure measurements should be made and blood pressure categorized based on the average Clinical Services 3331 Disease Management Clinic 505-844-HBES (4237) hbe@sandia.gov

  7. Blood Pressure Categories Clinical Services 3331 Disease Management Clinic 505-844-HBES (4237) hbe@sandia.gov

  8. Blood Pressure & Aging • There is an age-related increase in blood pressure due to: • Increased arterial wall tension • Increased peripheral resistance • Increased arterial stiffness • This is not benign: The blood pressure categories are not adjusted upwards to compensate for aging Clinical Services 3331 Disease Management Clinic 505-844-HBES (4237) hbe@sandia.gov

  9. Why Do We Worry About High Blood Pressure? Clinical Services 3331 Disease Management Clinic 505-844-HBES (4237) hbe@sandia.gov

  10. Objective: “…identify the common factors or characteristics that contribute to cardiovascular disease by following its development over a long period of time in a large group of participants who had not yet developed overt symptoms of cardiovascular disease or suffered a heart attack or stroke.” Framingham Heart Study Clinical Services 3331 Disease Management Clinic 505-844-HBES (4237) hbe@sandia.gov

  11. Framingham Heart Study: Risks of Hypertension • Cardiac disease • Heart attack and heart failure • Cerebrovascular disease • Stroke • Peripheral vascular disease • Circulation in the extremities • Microvascular disease • Kidney and eye disease Clinical Services 3331 Disease Management Clinic 505-844-HBES (4237) hbe@sandia.gov

  12. Benefits of Blood Pressure Control • Blood pressure control can reduce the risk of heart attack by 20% to 25% • Blood pressure control can reduce the risk of heart failure by more than 50% • Blood pressure control can reduce the risk of stroke by 35% to 40% • A 10mmHg drop in SBP lowers the risk of death from stroke by 50-60% and the risk of death from heart attack by 40-50% Clinical Services 3331 Disease Management Clinic 505-844-HBES (4237) hbe@sandia.gov

  13. Blood Pressure Control Clinical Services 3331 Disease Management Clinic 505-844-HBES (4237) hbe@sandia.gov

  14. Lowering Blood Pressure • Lifestyle modification • Smoking cessation • Increased physical activity • Limitation of alcohol intake • Maintenance of a healthy body weight • Diet comprised of healthy foods • Pharmacotherapy (medications) Clinical Services 3331 Disease Management Clinic 505-844-HBES (4237) hbe@sandia.gov

  15. Lifestyle Modification Clinical Services 3331 Disease Management Clinic 505-844-HBES (4237) hbe@sandia.gov

  16. Diet Clinical Services 3331 Disease Management Clinic 505-844-HBES (4237) hbe@sandia.gov

  17. Diet & Blood Pressure Salt • Excess can increase blood pressure Potassium • Insufficient can increase blood pressure Weight • Excess can increase blood pressure Alcohol • Excess can increase blood pressure Clinical Services 3331 Disease Management Clinic 505-844-HBES (4237) hbe@sandia.gov

  18. Diet & Blood Pressure • Several research studies have shown beneficial effects of diets rich in magnesium, potassium, calcium, fiber, and protein • Studies looking at supplementation of individual nutrients have not shown much improvement in blood pressure Clinical Services 3331 Disease Management Clinic 505-844-HBES (4237) hbe@sandia.gov

  19. DASH Clinical Trial • Looked at the effect of dietary patterns rather than individual nutrients for blood pressure lowering • Studied three different diet patterns: • Control (typical) diet • Fruits and vegetables diet • Combination (DASH) diet Clinical Services 3331 Disease Management Clinic 505-844-HBES (4237) hbe@sandia.gov

  20. Control Diet • Potassium, magnesium, and calcium levels were close to 25th percentile of U.S. consumption • Macronutrients (carbohydrate, fat, protein) and fiber were similar to average U.S. consumption • Typical “American” diet Clinical Services 3331 Disease Management Clinic 505-844-HBES (4237) hbe@sandia.gov

  21. Fruits & Vegetables Diet • Potassium and magnesium close to the 75th percentile of U.S. consumption • High amount of fiber • More fruits and vegetables and fewer snacks and sweets than control diet, but was otherwise similar Clinical Services 3331 Disease Management Clinic 505-844-HBES (4237) hbe@sandia.gov

  22. Combination (DASH) Diet • Potassium, magnesium, and calcium close to the 75th percentile of U.S. consumption • High amounts of fiber and protein • Rich in fruits, vegetables, and low fat dairy foods • Reduced amount of saturated fat, total fat, and cholesterol Clinical Services 3331 Disease Management Clinic 505-844-HBES (4237) hbe@sandia.gov

  23. DASH Clinical Trial • Study subjects were provided with meals that were prepared in research kitchens • All diets contained approximately 3 grams sodium per day • Each subject was given the appropriate calories to maintain weight and diet was adjusted for weight loss or weight gain Clinical Services 3331 Disease Management Clinic 505-844-HBES (4237) hbe@sandia.gov

  24. Results (Change in SBP/Change in DBP) Clinical Services 3331 Disease Management Clinic 505-844-HBES (4237) hbe@sandia.gov

  25. DASH Results Systolic Blood Pressure Weeks Clinical Services 3331 Disease Management Clinic 505-844-HBES (4237) hbe@sandia.gov

  26. DASH Meal Plan • Fruits: 4-5 servings/day • 1 medium fruit; 6 ounces fruit juice • Vegetables: 4-5 servings/day • 1 cup raw leafy; ½ cup cooked • Low fat dairy products: 2-3 servings/day • 8 ounces milk/yogurt; 1.5 ounces cheese • Grains: 7-8 servings/day • 1 slice bread; ½ cup cereal, rice, pasta • Meat, Fish, Poultry: 2 or less servings/day • 3 ounces • Nuts, Seeds, Dried Beans: 4-5 servings/week • 1/3 cup nuts; 2 tablespoons seeds, ½ cup cooked beans Clinical Services 3331 Disease Management Clinic 505-844-HBES (4237) hbe@sandia.gov

  27. Exercise Clinical Services 3331 Disease Management Clinic 505-844-HBES (4237) hbe@sandia.gov

  28. Aerobic Activity To promote and maintain health, all healthy adults age 18-65 years need moderate-intensity physical activity for a minimum of 30 minutes on five days each weekORvigorous-intensity for a minimum of 20 minutes on three days each week. Also, combinations of moderate- and vigorous-intensity activity can be performed to meet this recommendation. American College of Sports Medicine American Heart Association 2007 Recommendations Clinical Services 3331 Disease Management Clinic 505-844-HBES (4237) hbe@sandia.gov

  29. Muscle-Strengthening Activity To promote and maintain good health and physical independence, adults will benefit from performing activities that maintain or increase muscular strength and endurance for a minimum of two days each week. It is recommended that 8-10 exercises be performed on two or more nonconsecutive days each week using the major muscle groups. American College of Sports Medicine American Heart Association 2007 Recommendations Clinical Services 3331 Disease Management Clinic 505-844-HBES (4237) hbe@sandia.gov

  30. Pharmacotherapy Clinical Services 3331 Disease Management Clinic 505-844-HBES (4237) hbe@sandia.gov

  31. Antihypertensive Medications • All antihypertensive medications are effective at lowering blood pressure • Some provide additional benefits • Newer medications are not necessarily better than older medications • Medications control hypertension, they don’t cure it • Medications only work if they are taken every day Clinical Services 3331 Disease Management Clinic 505-844-HBES (4237) hbe@sandia.gov

  32. Antihypertensive Medications • ACE Inhibitors (ACEI) • Angiotensin receptor blockers (ARB) • Diuretics • Beta blockers (BB) • Calcium channel blockers (CCB) • Alpha blockers • Nitrates Clinical Services 3331 Disease Management Clinic 505-844-HBES (4237) hbe@sandia.gov

  33. TreatmentRecommendations *Diabetes, chronic kidney disease, known CAD or CAD equivalent, or 10y Framingham risk score >10% Clinical Services 3331 Disease Management Clinic 505-844-HBES (4237) hbe@sandia.gov

  34. Side Effects • Unintended effects of a medication • Many medications cause minor side effects • All antihypertensive medications can cause you to feel dizzy if you stand up quickly, especially when you first start taking the medication Clinical Services 3331 Disease Management Clinic 505-844-HBES (4237) hbe@sandia.gov

  35. Monitoring • Blood pressure should be rechecked within 2 to 4 weeks after starting a new blood pressure medication • Blood pressure can be monitored at home or in the clinic • Some antihypertensive medications also require laboratory or heart rate monitoring (ACEI, ARB, diuretic, BB, some CCBs) Clinical Services 3331 Disease Management Clinic 505-844-HBES (4237) hbe@sandia.gov

  36. Adherence to Therapy • Medications won’t work if you don’t take them as prescribed • Medications must be taken daily to keep blood pressure under control • Talk to your provider about any problems that you have with taking your medication Clinical Services 3331 Disease Management Clinic 505-844-HBES (4237) hbe@sandia.gov

  37. Summary • High blood pressure increases risk of cardiovascular, kidney, and eye disease • Lifestyle modification is an effective means of lowering blood pressure • Medications are needed to achieve optimal blood pressure levels in many people Clinical Services 3331 Disease Management Clinic 505-844-HBES (4237) hbe@sandia.gov