©LTPHN 2008 Blood Pressure – the highs and lows Speaker, name,affiliation,etc

©LTPHN 2008 Why is Blood Pressure Important? Raised BP is a known risk factor for CHD CVD Renal disease

©LTPHN 2008 ‘Rule of Halves’ Currently, about Half the people with raised BP are unaware of it Half of those who are aware are on optimal management

©LTPHN 2008 Causes of hypertension Idiopathic – by far the commonest Drugs – esp OTC And rarer causes: Renal disease Phaeocromocytoma Conn’s syndrome Coarctation Cushing’s

©LTPHN 2008 Special Groups at risk People with diabetes mellitus (Type I and II) During pregnancy

©LTPHN 2008 Evidence-Based Treatment Goals Aim: to reduce mortality and preventable morbidity General population: <140/<85 For people with diabetes, chronic renal or CVD: <130/<80

©LTPHN 2008 ‘White Coat Hypertension’ Artefact: raised BP in doctor’s surgery or hospital More common in women Lesson: always have more than one raised reading before diagnosis Ambulatory BP monitoring excludes

©LTPHN 2008 Epidemiology – population impact Prevalence: 25% adults in developed countries Prevalence increases with age – older people do not naturally have ‘higher than normal’ BP Risk of adverse events greater in women 10% weight loss associated with 10mmHg decrease in systolic BP, 20mmHg diastolic BP Weight gain associated with rise in systolic Ethnicity: In UK, African Caribbeans at highest risk of H/T

©LTPHN 2008 Racial & Ethnic Influences Are explained by: Genetic Pathophysiological Environmental Dietary Psychosocial factors

©LTPHN 2008 Socioeconomic factors More common in poorest SE groups: Correlates with lifestyle factors – lack of exercise obesity salt intake smoking

©LTPHN 2008 Impact of Lifestyle Lifestyle modification can decrease BP: Reduce dietary saturated fat, cholesterol, sodium; maintain adequate intake K,Ca,Mg Attain normal body weight Moderate alcohol intake [3u/day men; 1.5/day women] Aerobic physical activity Stop smoking BUT Compliance often poor at individual or population level

©LTPHN 2008 Potential impact of lifestyle changes Morbidity - lower incidence of hypertension In known hypertensive patients, fewer prescribed drugs needed – fewer side effects Macroeconomic - lower prescribing costs Self management – promoting patient empowerment

©LTPHN 2008 BP and cardiovascular risk BP should be seen in context of overall CVD risk Charts of risk prediction readily available Absolute risk is meaningful to the public