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http://apps.nccd.cdc.gov/brfss/

http://apps.nccd.cdc.gov/brfss/. http://apps.nccd.cdc.gov/brfss/. http://apps.nccd.cdc.gov/brfss/. http://apps.nccd.cdc.gov/brfss/. BLOOD PRESSURE. Systolic. 140. 90. Diastolic. NORMAL BLOOD PRESSURE. Systolic. Blood Pressure (mmHg). Diastolic. Time of Day (hrs).

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http://apps.nccd.cdc.gov/brfss/

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  1. http://apps.nccd.cdc.gov/brfss/

  2. http://apps.nccd.cdc.gov/brfss/

  3. http://apps.nccd.cdc.gov/brfss/

  4. http://apps.nccd.cdc.gov/brfss/

  5. BLOOD PRESSURE Systolic 140 90 Diastolic

  6. NORMAL BLOOD PRESSURE Systolic Blood Pressure (mmHg) Diastolic Time of Day (hrs) Ntl High BP Committee. Arch Intern Med 150:2270, 1990

  7. HIGH BLOOD PRESSURE Hypertensive Systolic Blood Pressure (mmHg) Diastolic Time of Day (hrs) Ntl High BP Committee. Arch Intern Med 150:2270, 1990

  8. NOCTURNAL HIGH BLOOD PRESSURE Hypertensive Systolic Blood Pressure (mmHg) Diastolic Time of Day (hrs) Ntl High BP Committee. Arch Intern Med 150:2270, 1990

  9. ECG Electrodes Blood Pressure Cuff Microphone Control Box AMBULATORY TECHNOLOGY

  10. AVERAGE PRESSURES 24 hour Mean =139 mmHg Day Time Mean = 139 mmHg 0600 –2200 hrs Night Time Mean =136 mmHg 2200-0600 hrs Work 0600-1700 hrs Leisure 1700-2200 hrs

  11. SLOPE OF MORNING RISE 6:00 am 3:00 am

  12. 47% 48%

  13. 5177 mmHg hr AREA UNDER THE CURVE 9876 mmHg hr

  14. CrestCPS = 10.4 Trough CPS =-15.3 Trough CPS =-12.5 CrestCPS = 7.55

  15. FOURIER ANALYSIS BP(t) = c0 + Σ [ajcos(jπt/12)+bjsin(jπt/12)]

  16. FOURIER ANALYSIS

  17. ANF Baro & Chemo Receptors Central Nervous System Renin-Angiotensin Anti-Diuretic Hormone CARDIAC PERIPHERAL BP =OUTPUT X VASCULAR RESISTANCE

  18. Central Nervous System Heart Arterial Vasculature BARO & CHEMO RECEPTORS • Heart Rate • Contractility Vasoconstriction

  19. Vasoconstriction • Heart Rate • Contractility Baro & Chemo Receptors CARDIAC PERIPHERAL BP =OUTPUT X VASCULAR RESISTANCE

  20. Vasodilation  Heart Rate  Contractility Baro & Chemo Receptors CARDIAC PERIPHERAL BP =OUTPUT X VASCULAR RESISTANCE

  21. Baro & Chemo Receptors CARDIAC PERIPHERAL BP =OUTPUT X VASCULAR RESISTANCE

  22. Central Nervous System Lungs Heart Kidneys Arterial Vasculature RENIN ANGIOTENSIN

  23. Central Nervous System Lungs Heart Kidneys Arterial Vasculature RENIN ANGIOTENSIN • Decrease blood volume • Decrease in renal blood pressure • Increase in sympathetic output

  24. Central Nervous System Lungs Heart Renin Kidneys Arterial Vasculature RENIN ANGIOTENSIN Angiotensinogin Angiotensin I • Decrease blood volume • Decrease in renal blood pressure • Increase in sympathetic output

  25. Central Nervous System Lungs Heart Converting Enzyme Kidneys Arterial Vasculature RENIN ANGIOTENSIN Angiotensin I Angiotensin II Angiotensin III

  26. Central Nervous System Lungs Heart Kidneys Arterial Vasculature RENIN ANGIOTENSIN Vasoconstriction Angiotensin II

  27. Central Nervous System  Vegal Tone  Catecholamines Lungs Heart Kidneys Arterial Vasculature RENIN ANGIOTENSIN • Heart Rate • Contractility Angiotensin II Vasoconstriction

  28. Central Nervous System Lungs Heart Aldosterone Kidneys Arterial Vasculature RENIN ANGIOTENSIN Reabsorb Fluid Angiotensin II

  29. Heart Rate • Contractility • Fluid Vasoconstriction Renin-Angiotensin CARDIAC PERIPHERAL BP =OUTPUT X VASCULAR RESISTANCE

  30. Central Nervous System Heart Kidneys Arterial Vasculature ATRIAL NATURETIC FACTOR • Renin  Fluid Loss Vasodilation

  31.  Fluid Loss Vasodilation Heart CARDIAC PERIPHERAL BP =OUTPUT X VASCULAR RESISTANCE

  32. Pituitary Gland Kidneys ANTI-DIURETIC HORMONE  Fluid Reabsorption

  33.  Fluid Reabsorption Atrial Naturetic Factor CARDIAC PERIPHERAL BP =OUTPUT X VASCULAR RESISTANCE

  34. ANF Baro & Chemo Receptors Central Nervous System Renin-Angiotensin Anti-Diuretic Hormone CARDIAC PERIPHERAL BP =OUTPUT X VASCULAR RESISTANCE

  35. Salt Stress Transient Changes NATURAL HISTORY Genetic Predisposition Low High Stabilizing Factors

  36. Category Follow-up Optimal Recheck 2 yrs Prehypertension Recheck in 1 yr Hypertension Stage 1 Confirm within 2 months Stage 2 Evaluate or refer within 1 mo >180/>110 Evaluate and treat immediately or within 1 week depending on clinical situation and complications FOLLOW-UP • JAMA 289:2534-2573, 2003 • Hypertension 42:1206-1252, 2003 • Department of Health & Human Services Pub No. 03-5233, 2003

  37. TREATMENT: MEDICATIONS • DIURETICS • ALDOSTERONE-RECEPTOR BLOCKERS  BLOCKERS 1 BLOCKERS 2 AGONISTS ACE INHIBITORS ANGIOTENSIN II ANTAGONISTS (Angiotensin Receptor Blockers-ARB) Ca++ CHANNEL BLOCKERS VASODILATORS

  38. ANF Baro & Chemo Receptors Central Nervous System Renin-Angiotensin Anti-Diuretic Hormone CARDIAC PERIPHERAL BP =OUTPUT X VASCULAR RESISTANCE

  39. Recheck Blood Pressure Not at Goal At Goal • Add Medications • Stage of Hypertension • Compelling Indications Continue TREATMENT ALGORITHM Lifestyle Modifications

  40. Without Compelling Indications With compelling Indications Stage 1 Stage 2 • Thiazide-type Diuretics • Consider • ACE Inhibitors • Angiotensin Receptor Blockers • Beta Blockers • Ca++ Channel Blockers • Thiazide-type Diuretics • With • ACE Inhibitors • Angiotensin Receptor Blockers • Beta Blockers • Ca++ Channel Blockers Initial Drug Choices

  41. COMPELLING INDICATIONS Indication DIUR BB ACEI ARB Ca++ AldoANT Heart Failure      Post MI    Hi Risk     Diabetes     Chronic   Kidney Stroke  

  42. Adjust dosage if not at Blood Pressure Goal

  43. TREATMENT

  44. Exercise Effectiveness Resistance Cardiovascular Whelton, S.P., et al., Annals of Internal Medicine, 2002. 136(7): p. 493-503. Kelley, G.A. and K.S. Kelley, Hypertension, 2000. 35(3): p. 838-843.

  45. Med Sci Sports Exerc 36:533-553, 2004

  46. INTENSITY Change in Blood Pressure (mmHg) Fagard & Tipton, Physical Activity, Fitness and Health, p 633-668, 1994.

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