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2. Expert Care for Chronic Conditions Preventing and Managing High Blood Pressure and High Cholesterol Olivia Forys, MD Internist, Rush University Physicians at Lincoln Park

3. High Blood Pressure • According to data from the National Health and Nutrition Examination Survey (NHANES) 2003–2006: • 33.6% of US adults 20 years of age have hypertension. This amounts to an estimated 74,500,000 US adults with hypertension. • The prevalence of hypertension is nearly equal between men and women. • African-American adults have among the highest rates of hypertension in the world, at 43%. • Among hypertensive adults, approximately 78% are aware of their condition, 68% are using antihypertensive medication, and only 44% of those treated had their hypertension controlled.

4. High Blood Pressure- Symptoms and Stages • Symptoms: Often none. Possibly dizziness, lightheadedness, fatigue, headache. • Normal blood pressure: Below 120/80 mm Hg. • Prehypertension: Systolic pressure 120 to 139 mm Hg or a diastolic pressure ranging from 80 to 89 mm Hg. • NHANES 2005 to 2006 data estimatesthat25% of the US population 20 years of age has prehypertension,including 32,400,000 men and 21,200,000 women (estimated byNHLBI). • Prehypertensionis associatedwith elevated relative and absolute risks forCVD outcomes acrossthe age spectrum. Compared with normal BP(<120/80 mm Hg),prehypertension was associated with a 1.5-to 2-fold risk formajor CVD events in those <60, 60 to 79,and 80 years ofage.

5. High Blood Pressure- Stages • Stage 1 hypertension: • Systolic pressure 140 to 159 mm Hg or a diastolic pressure ranging from 90 to 99 mm Hg. • Stage 2 hypertension: • Systolic pressure of 160 mm Hg or higher or a diastolic pressure of 100 mm Hg or higher.

6. When To Start Screening • At age 20, at least every 2 years. If high blood pressure is diagnosed, more frequent checks will be recommended. • At least 2 elevated blood pressure readings, taken on two separate office visits, are required for diagnosis.

7. Causes • Primary (essential) hypertension:Often inherited. Essential hypertension or primary hypertension often develops over time. • Secondary hypertension:Caused by an identifiable health condition. Appears abruptly and can cause higher blood pressure than does primary hypertension. Causes of secondary hypertension include: • Kidney problems • Adrenal gland tumors • Congenital defects • Some medications: birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs • Illegal drugs, such as cocaine and amphetamines

8. Risk Factors • Nonmodifiable: • Age • Race: • Common in African Americans, often developing at an earlier age. Potential for stroke and heart attack is higher. • Family history

9. Risk Factors • Modifiable • Obesity • Sedentary lifestyle • Tobacco abuse: • Raises blood pressure immediately • Long-term damage to blood vessels, which can lead to narrowing and elevated pressure. • Excess dietary sodium: • Leads to water retention and blood pressure elevation. • Middle aged people become particularly more sensitive to salt content in their diet. • Excessive alcohol intake: • Just 2 or 3 drinks in one sitting can lead to blood pressure elevation. • Long term drinking leads to direct damage to the heart muscle and cardiovascular system. • Stress: • Stress hormones can elevate blood pressure. • Certain chronic conditions: • high cholesterol, diabetes, kidney disease and sleep apnea can raise your risk of developing high blood pressure.

10. Complications of Untreated or Under-treated High Blood Pressure • Heart Attack • Stroke • Kidney Failure • Heart Failure • Vision loss • Memory problems

11. Lifestyle Modifications • Eat healthy foods • DASH Diet- a plan that emphasizes low salt, high vegetable/fruit/fiber, low saturated fat. • For More Details: http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf • Decrease salt intake • 2,400 milligrams (mg) of sodium a day is limit for most adults. • 1,500 mg a day for people with high blood pressure.

12. Lifestyle Modifications • Healthy BMI • Physical activity: • At least 30 minutes of physical activity a day. • Alcohol in moderation: • Up to one drink a day for women and everyone over age 65, and two drinks a day for men. • No smoking • Stress management

13. High Cholesterol • 3 Major Components: • LDL • HDL • Triglycerides

14. LDL • Low-density lipoprotein (LDL).Known as "bad," cholesterol. LDL cholesterol hardens and narrows arterial walls. • <70 mg/dLIdeal for people at very high risk of heart disease • <100 mg/dLIdeal for people at risk of heart disease • 100-129 mg/dLNear ideal • 130-159 mg/dLBorderline high • 160-189 mg/dLHigh • >190 mg/dLVery high

15. HDL • High-density lipoprotein (HDL).Known as "good," cholesterol. Transports excess cholesterol to your liver. • < 40 mg/dL (men) POOR • < 50 mg/dL (women) POOR • 50-59 mg/dL BETTER • > 60 mg/dL BEST

16. Triglycerides • Lipid found in your blood. Body converts any calories it doesn't need to use right away into triglycerides, and triglycerides are stored in your fat cells. • Levels reflect intake of simple sugars, carbs, fats and alcohol. • Normal — Less than 150 (mg/dL) • Borderline high — 150 to 199 mg/dL • High — 200 to 499 mg/dL • Very high — 500 mg/dL

17. Prevalence • An estimated 35,700,000 adults 20 years of age and over have total serum cholesterol levels 240 mg/dL, with a prevalence of 16.2%

18. When to Start Screening • The U.S. Preventive Services Task Force suggests that physicians screen men 20 to 35 and women 20 to 45 if they are at increased risk for coronary heart disease. • The task force strongly recommends screening all men 35 and older and women 45 and older at 5 year intervals, more frequently if treated with medication.

19. Complications of High Cholesterol • Angina: • Chest pain associated with narrowed or blocked arteries to the heart. • Myocardial Infarction: • Known as “Heart Attack”. If plaques are disturbed, a blood clot may form at the site. It can block the artery or break off. • Stroke: • Bloodflow blockage in artery located in the brain.

20. Non-Modifiable Risk Factors • Male Gender • Advanced Age • Family history

21. Modifiable Risk Factors • Smoking: • Damages the walls of your blood vessels, making them likely to accumulate plaque. Lowers your level of HDL cholesterol. • Obesity: • (BMI) of 30 or greater. • Poor diet: • Excessive red meat and full-fat dairy products, which contain high amounts of saturated and trans fats.

22. Modifiable Risk Factors • Sedentary Lifestyle • High blood pressure: • Increased pressure on your arteries can hasten plaque formation. • Diabetes: • Can lead to higher LDL cholesterol and lower HDL cholesterol, and high sugar damages the lining of your arteries.

23. Diet and Lifestyle Changes to Help Lower Cholesterol • Oatmeal, oat bran and high-fiber foods • Active ingredient: Soluble fiber- can lower LDL. Also in kidney beans, apples, pears, barley and prunes. Can reduce the absorption of cholesterol into your bloodstream. • 5 to 10 grams or more of soluble fiber a day decreases your total and LDL cholesterol, and is expected to reduce LDL-C by 3% to 5%. • Example: Eating 1 1/2 cups of cooked oatmeal provides 6 grams of fiber. If you add fruit, such as bananas, you'll add about 4 more grams of fiber.

24. Diet and Lifestyle Changes to Help Lower Cholesterol • Omega-3 fatty acids • Highest amount found in fatty fish. Can reduce your blood pressure and risk of developing blood clot. Eat at least two servings of fish a week. The highest levels of omega-3 fatty acids are in: • Mackerel • Lake trout • Herring • Sardines • Albacore tuna • Salmon • Halibut

25. Diet and Lifestyle Changes to Help Lower Cholesterol • If you don’t like fish: • Also found in: • ground flaxseed • canola oil. • Omega-3 or fish oil supplement- DHA and EPA amounts should equal 1000 mg combined.

26. Diet and Lifestyle Changes to Help Lower Cholesterol • Nuts • Walnuts, almonds and other nuts contain polyunsaturated fatty acids. • May reduce risk of heart disease - WATCH portions! Limit to a handful a day.

27. Diet and Lifestyle Changes to Help Lower Cholesterol • Olive oil • The Food and Drug Administration recommends using about 2 tablespoons of olive oil a day. • Of note: • choose extra-virgin olive oil (not “Light”), • meaning the oil is less processed, and has more • antioxidants.

28. Diet and Lifestyle Changes That Lower Cholesterol • Plant sterols or stanols • Help block the absorption of cholesterol- affect LDL. No effect on triglycerides or HDL. • Found in margarines (like Benecol) and fortified orange juices. • 2 g/day of plant stanols/sterols would be expected to reduceLDL-C by 6% to 15%.

29. Diet and Lifestyle Changes That Lower Cholesterol • Physical Activity and Weight Loss • According to USPTFS: • "Physical activity" includes any activity that raises your heart rate, such as brisk walking, working in the house or yard, or playing sports. • Do activity for 10 minutes or more at a time. Aim for at least 2 hours and 30 minutes of activity each week

30. Diet and Lifestyle Changes That Lower Cholesterol • A 10-lb weight loss would be expected todecrease LDL-C by 5% to 8%. • In conjunction with reductions insaturated fat and cholesterol, the inclusion of the above therapeuticdiet options (including weight loss) is expected to decreaseLDL-C by 20% to 30%.

31. Conclusion QUESTIONS??