For A Healthy Heart: Blood Pressure Management Presented by: Daniel Schimmel, MD, MS Assistant Professor of Medicine, Cardiology Bluhm Cardiovascular Institute November 17, 2014

What is blood pressure? Blood pressure is the force of blood on the arteries in the body Systolic blood pressure = pressure when the heart beats or squeezes Diastolic blood pressure = pressure when the heart is relaxing A normal blood pressure is approximately 120/80, but it is normal for there to be some variability from measurement to measurement

When is a blood pressure too high? We may have different goals for different people with a focus on their overall health Age, diabetes and kidney function will impact goals A blood pressure over 140/90 should prompt discussion with your doctor

High blood pressure = Hypertension A blood pressure over 140/90, measured at 2 different times, is required to diagnose hypertension Hypertension often has no symptoms Commonly incidentally diagnosed at an annual physical

Hypertension classification Normal: Systolic < 120 mm Hg, diastolic < 80 mm Hg Prehypertension: Systolic mm Hg, diastolic mm Hg Stage 1: Systolic mm Hg, diastolic mm Hg Stage 2: Systolic 160 mm Hg or greater, diastolic 100 mm Hg or greater

How do we measure blood pressure? Seated quietly in a chair for 5 minutes Feet resting on floor Arm supported at heart level No caffeine, smoking or exercise for 30 minutes prior Appropriately sized BP cuff

Why is diagnosing hypertension important? Associated with many diseases including: Stroke Heart attack Heart failure Kidney disease

Am I at risk for hypertension? Risk of getting hypertension increases with age 50% of people over the age of 60 years old Strong family/genetic component Very modifiable by lifestyle Primary causes and secondary causes

If I am diagnosed with hypertension, what further testing is needed? History and exam are crucial components Possible tests include: Blood work (electrolytes, kidney function and others) EKG Echocardiogram Ultrasound X-ray imaging

What are the treatments for hypertension? Weight loss (5-20 points per 10 kg loss) Limit alcohol to no more than one drink per day Reduce sodium to less than 2400 mg per day Maintain adequate potassium, magnesium and calcium in diet Stop smoking Aerobic activity 30 min/day most days of week

What are the dietary recommendations to treat high blood pressure? Vegetables, fruits, and whole grains Dairy should be low-fat Protein from poultry, fish, legumes and nuts When using oils, consider olive oil or canola oil Limit intake of sweets, sodas, juice and red meats. Keep a stable weight Sodium, optimally to less than 2400mg/day.

What are the dietary recommendations to treat high blood pressure? DASH Diet pressure/guide/dash-diet

Where can I go for overall lifestyle recommendations?

What are the treatments for hypertension? Many types of medications (the main 4) Thiazide diuretics Calcium channel blockers ACE inhibitors or ARBs Beta blockers

Are there side effects to the medications? Yes, but infrequent: Diuretics -> need to urinate, electrolyte abnormalities Calcium channel blockers -> swelling in ankles ACE inhibitors or ARBs -> cough, lip or tongue swelling Beta blockers -> fatigue, depression, loss of libido

Which is the best medication to take? Dependent on other conditions Coronary artery disease -> beta blockers Heart failure -> beta blockers and ACE inhibitors Kidney disease -> ACE inhibitors or ARB African-American -> Diuretic and calcium channel blocker

What are the treatments for hypertension? Often requires multiple medications to control If a secondary cause is found, it may be treated so that less medications are required to get blood pressure to goal.

What are the treatments for hypertension? An internist or general practitioner can treat most people with hypertension Some people with resistant hypertension will need a specialist, further lab testing or imaging

Is there a blood pressure that should make me immediately worried? If your blood pressure is above 180/100, you should contact your physician If your blood pressure is above 220/120, or it is elevated with symptoms of chest discomfort, shortness of breath, headache or other significant symptoms, you should seek medical attention immediately and call

Thank you for your attention Daniel Schimmel MD MS Assistant Professor of Medicine, Cardiology Bluhm Cardiovascular Institute heart.nm.org (312)