1. High Blood Pressure, Risk Factors, & Preventative Strategies Dr. Sameena Zahoor

2. High Blood Pressure, Risk Factors, & Preventive Strategies What is high blood pressure? Why should you treat blood pressure? Risk factors for developing high blood pressure. Prevention strategies. Treatment options.

3. What is high blood pressure?

4. What Is High Blood Pressure? Force of blood against the walls of arteries. Blood pressure rises and falls during the day. When BP stays elevated over time, it is called high blood pressure, or hypertension.

5. What do the Numbers Mean? The measurement is written one above the other: systolic number diastolic number Top number, systolic pressure measures the pressure in the blood vessels as the heart beats Bottom number, diastolic pressure measures the pressure in the vessels as the heart relaxes between beats

6. What do these Numbers Mean? Normal : BP < 120/80 Pre-hypertension : BP 120--139 / 80—89 Hypertension : BP > 140/90 BP > 130/80 (for people with heart disease, diabetes and kidney disease)

7. Why Should you Treat High Blood Pressure?

8. Why Should You Treat High Blood Pressure? High BP makes the heart work too hard and contributes to atherosclerosis (hardening of the arteries). Increases the risk of heart disease and stroke High BP can also cause other conditions: congestive heart failure, kidney disease, and blindness.

9. Why Should You Treat High Blood Pressure? Ave % Reduction Stroke incidence 35–40% Myocardial infarction 20–25% Heart failure 50%

10. How do you Develop High Blood Pressure?

11. Identifiable Causes of High BP Sleep Apnea Thyroid / Parathyroid disease Chronic Kidney Disease Drugs (e.g. Non-steroidal anti-inflammatories, some Nasal drops and Sprays, some Cough medicines, Appetite Suppressants, Decongestants, Steroids, BC pills) Hormone producing tumors/diseases

12. High blood Pressure – Genetic component 98% of High BP is caused by un-identifiable causes. People with blood relatives who have high BP, like a father, mother or sibling are more likely to develop high BP Researchers are working on identifying the genes that causes HTN and the type of BP med a person responds to

13. Other Risk Factors for Developing High Blood Pressure Men over the age of 55 Women over the age of 65, especially Post Menopausal African Americans, especially women People with diabetes People who smoke

14. Risk factors for developing high blood pressure, cont. Some women who are pregnant People who get little or no regular physical activity People who are overweight People who have high cholesterol

15. What Can you Do to Reduce your Risk of Developing High BP?

16. Prevention Strategies – Healthy Lifestyle Modification Approx SBP reduction (range) Weight reduction 5–20 mmHg/10 kg wt loss Adopt DASH eating plan 8–14 mmHg Dietary sodium reduction 2–8 mmHg Physical activity 4–9 mmHg Decrease alcohol consumption 2–4 mmHg

17. Prevention Strategies – Weight Loss Body Mass Index (BMI) – measure of body fat Overweight: BMI 25 - 29.9 Obese: BMI > 30 BP rises as body weight increases Losing even 10 pounds can lower BP

18. Treatment options

19. Treatment Goals Goal is BP < 140/90 Goal is BP< 130/80 for people with heart disease, diabetes and kidney disease.

20. Treatment Strategies – Healthy Lifestyle Modification Approx SBP reduction (range) Weight reduction Maintain normal BMI < 25 5–20 mmHg/ 10 kg wt loss Adopt DASH eating plan Diet rich in fruits, vegetables & lowfat 8–14 mmHg Dietary sodium reduction Dietary sodium intake to < 2.4 g 2–8 mmHg Physical activity Aerobic physical activity (>30 min/day) 4–9 mmHg Decrease alcohol consumption Men: 2 drinks/ day Women: 1 drink/day 2–4 mmHg

21. Treatment Options - MEDICATION Most patients will require two or more BP meds to achieve BP goal. There are several different classes of medications Factors such as age, gender, race and concurrent medical conditions are considered before choosing the right medication

22. Treatment Options - MEDICATION Diuretics (water pills) - Help the body get rid of extra sodium (salt) and water so your blood vessels don't have to hold so much fluid. – Most often used in combination with others – Helpful when edema/swelling is present – Need to have periodic lab tests to check potassium levels – Examples: hydrochlorothiazide, lasix, maxide

23. Treatment Options - MEDICATION Beta-blockers - Make the heart beat slower so that blood passes through your blood vessels with less force. – Have additional Heart-protective benefits – Examples: Coreg, Toprol XL, Corgard, Inderal

24. Treatment Options - MEDICATION Angiotensin-converting enzyme inhibitors (also called ACE inhibitors) - Keep your body from making a hormone that causes blood vessels to narrow. – Have additional Heart and Kidney-Protective benefits – Cannot be used in pregnant females – “Tickly cough” is common side effect – Examples : Accupril, Altace, Lotensin, Vasotec, Zestril

25. Treatment Options - MEDICATION Angiotensin II receptor blockers (also called ARBs) -- Protect your blood vessels from the effects of the hormone that causes them to narrow. – Also have additional Heart and Kidney-protective benefits – Cannot be used in pregnant females – Examples : Atacand, Avapro, Cozaar, Diovan, Benicar, Micardis

26. Treatment Options - MEDICATION Calcium channel blockers (also called CCBs) Help keep your blood vessels from becoming narrow by blocking calcium from entering your cells. – Eg: Adalat, Cardizem, Calan, Norvasc, Plendil, Procardia,

27. Common BP Med Side effects: Headache Dizziness or lightheadedness Extreme tiredness, weakness, drowsiness or lethargy (extreme lack of energy) Cough, fever, congestion, upper respiratory tract infection or "flu-like" symptoms Skin rash Sexual dysfunction (impotence)

28. References for further reading Guide to lowering blood pressure by NHLBI, www.nhlbi.nih.gov/hbp/index.html www.nhlbi.nih.gov/hbp/index.html The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report.2003 May 21; 289(19):2560-71 Available at: http://www.jama.com http://www.jama.com The DASH eating plan, www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf Info about BP Medicines, www.familydoctor.org/797.xml

29. Final thoughts "The most effective therapy prescribed by the most careful clinician will control hypertension only if patients are motivated.” “Motivation improves when patients have positive experiences with, and trust in, the clinician." JNC 7