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Hypertension: The Whole Story Raven Voora, MD Hypertension Specialist UNC Kidney Center.

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Presentation on theme: "Hypertension: The Whole Story Raven Voora, MD Hypertension Specialist UNC Kidney Center."— Presentation transcript:

1 Hypertension: The Whole Story Raven Voora, MD Hypertension Specialist UNC Kidney Center

2 Hypertension = elevated blood pressure CategorySystolic Blood Pressure Diastolic Blood Pressure Normal< 120<80 Pre-hypertension Hypertension – Stage Hypertension – Stage 2 >160>100 Classification of hypertension: JNC 7

3 Symptoms of Hypertension Hypertension is dangerous because it gives off no warning signs or symptoms Having your blood pressure checked regularly is the only way to tell if your blood pressure is high

4 Diagnosis of Hypertension Based upon the average of two or more properly measured readings at each of two or more visits after an initial screen

5 White Coat Hypertension Blood pressure is repeatedly normal when measured outside of the providers office (home, work) but persistently elevated in the office.

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7 How to Measure Your Blood Pressure Use an automatic monitor – Check the accuracy of your home monitor at the doctors office Use a monitor with an arm cuff – Not a wrist or finger cuff – Use a large cuff if you have a large arm After putting on the cuff, sit quietly for a few minutes before checking your pressure

8 Why do people get hypertension?

9 Essential vs Secondary Hypertension The majority of patients with hypertension have essential hypertension (90-95% of cases) Less frequently, there is an underlying condition that may lead to hypertension. This is called secondary hypertension (5-10% of cases)

10 Pathogenesis of Essential Hypertension Poorly understood – Complex interaction between genetic and environmental factors These factors lead to narrowing of blood vessels – If vessels wide open blood flows easily – If vessel narrows pressure inside increases causing hypertension

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12 Factors Influencing the Development of Hypertension Uncontrollable Factors Family History of hypertension Reduced kidney mass at birth African-American ancestry Age Controllable Factors Obesity and weight gain Physical inactivity Excess sodium intake Alcohol consumption

13 Controllable Factors Influencing the Development of Hypertension Excess sodium intake Certain segments of the population are salt sensitive because their blood pressure is affected by salt consumption

14 Controllable Factors Influencing the Development of Hypertension Alcohol consumption

15 How Can Hypertension Be Treated?

16 Treatment of Hypertension Engage in Lifestyle Modifications Avoid Medicines That Can Raise Blood Pressure Take Medications That Can Lower Blood Pressure

17 Treatment of Hypertension Engage in Lifestyle Modifications Avoid Medicines That Can Raise Blood Pressure Take Medications That Can Lower Blood Pressure

18 Lifestyle Modifications Maintain a healthy weight, lose weight if overweight. Be more physically active. Drink alcoholic beverages in moderation. Reduce the intake of sodium in the diet to approximately 2400 mg/day.

19 Lifestyle Modifications ModificationApproximate SBP Reduction Reduce Weight5-20 mmHg for every 10 kg (22 lb) loss Limit ETOH consumption2-4 mmHg Reduce Na intake to < 2.4 gm/day2-8 mmHg Aerobic activity for min/day4-9 mmHg

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21 Reading a Food Label for Sodium Content

22 Food Labels ClaimAmount Low Sodium>140 mg/serving Very Low Sodium>35 mg/serving Sodium Free>5 mg/serving Reduced Sodium25% less than original

23 Reducing Sodium in the Diet Use fresh poultry, fish and lean meat, rather than canned or processed. Buy fresh, plain frozen or canned with no salt added vegetables. When available, buy low- or reduced-sodium or no-salt-added versions of foods like: – Canned soup, canned vegetables, vegetable juices – cheeses, lower in fat – condiments like soy sauce – crackers and snack foods like nuts – processed lean meats

24 The DASH Diet DAS H The D ietary A pproaches to S top H ypertension clinical trial (DASH) Hypothesis: Does a diet rich in fruits, vegetables, and low fat dairy foods lower blood pressure in individuals with hypertension and high normal blood pressure?

25 DASH Study Control: – Ca, Mg, & K ~ 25% of US diet – Macronutrients and fiber ~ US average Fruits and Vegetables – Fruits and vegetables increased to 8.5 servings – K and Mg to 75% Combination: – Add 2-3 servings low-fat dairy to fruit & vegetable diet. – Ca, K and Mg increased to 75%

26 DASH Study Outcomes Fruit and Vegetable Diet: – Decrease in systolic and diastolic blood pressure in entire study group and in the hypertensive subgroup. Combination Diet: – Significant decrease in both systolic and diastolic blood pressure in both groups. – Greatest drop was in systolic BP in hypertensive group (11.4 mmHg)

27 DASH Diet Implications Combination diet affects comparable to pharmacological trials in mild hypertension. Population wide reductions in blood pressure similar to DASH results would reduce CHD by ~ 15% and stroke by ~27% Great potential in susceptible groups: African Americans and elderly.

28 Treatment of Hypertension Engage in Lifestyle Modifications Avoid Medicines That Can Raise Blood Pressure Take Medications That Can Lower Blood Pressure

29 Medicines Can Raise Blood Pressure Analgesics – NSAIDs, COX-2 inhibitors, Aspirin Decongestants/Allergy Medicines Diet pills Stimulants – Methylphenidate Herbals (Ephedra or Ma Huang)

30 Treatment of Hypertension Engage in Lifestyle Modifications Avoid Medicines That Can Raise Blood Pressure Take Medications That Can Lower Blood Pressure

31 Antihypertensive Medications Most common types of medicines used to treat hypertension: – Diuretics Rid the body of excess fluid and salt – Ace-inhibitors or Angiotensin Receptor Blockers Block hormones that cause arteries to narrow – Calcium channel blockers Reduce the heart rate and relax blood vessels – Beta blockers Reduce the heart rate and work of the heart

32 Guidelines Have Established Treatment Goals Conditionmm Hg Essential HTN< 140/90 Diabetes Mellitus< 130/80 Chronic Kidney Disease<130/80 Age > 65???? JNC 7

33 What new therapies are there?

34 Hypertensive N = 73.6 million Aware (79%)Treated (69%) Controlled (45%) Uncontrolled (55%) Untreated (10%) Unaware (21%) Control of Hypertension is Not Adequate Nearly 55% of US hypertensive patients do not achieve systolic pressure goal of less than 140/90 mmHg Based on Data from NHANES/NCHS

35 Renal Denervation ABLATION OF RENAL SYMPATHETIC NERVES

36 Baroreflex Activation Therapy ELECTRICAL STIMULATION OF CAROTID SINUS BARORECEPTORS

37 Remember …. Hypertension is a lifelong disease. It can be controlled, not cured Know your blood pressure. Have it checked regularly Maintain a healthy lifestyle If you do have hypertension, take your medications as prescribed

38 Questions? From all the things I discussed today, what can you do to help control your blood pressure? What is most important for you and how can you make that part of your routine?


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