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Hypertension …high blood pressure and you Cyn Kildare NP.

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2 Hypertension …high blood pressure and you Cyn Kildare NP

3 Your Alegent Creighton Clinic Open Monday-Friday 7:00 am to 4:00 pm Call to make an appointment, or drop in Reception: Joe Nurse: Renee Practitioners: Cyn and Sara

4 What is blood pressure? The pressure the heart exerts against the arteries during contraction: Systolic The pressure in your arteries while the heart is filling/relaxing: Diastolic

5 Categories of Hypertension (HTN) Normal <120 and <80 Pre-hypertension 120–139 or 80–89 Hypertension, Stage 1 140–159 or 90–99 Hypertension, Stage 2 ≥160 or ≥100

6 GOAL For people with diabetes BP goal should be <125 and < 75 If no diabetes BP goal should be <130 and < 80 Why the stricter control with diabetes?

7 How does hypertension happen? >85% is called Essential Hypertension >5% from meds (steroids, BCP, NSAIDS, decongestants) >5% kidney disease <2% from endocrine (thyroid disease, etc)

8 Meds/herbs that may raise BP NSAIDS Acetaminophen Antidepressants Birth Control Pills Caffeine Pills Decongestants Herbal: Bitter orange, ephedra (ma-huang) ginseng, guarana, licorice, St. John’s wort Stimulants

9 What diet/supplement might be helpful? Potassium supplements, 40 to 80 meq/day (in conjunction with decreased sodium Vegetarianism…most due to increased dietary fiber, and soy protein Flavonoids from fruits and veggies…

10 Risk Factors for essential HTN Age Race Gender Poor Health Habits

11 Hypertension Risk Prediction from the Framingham Heart Study Risk FactorUnitsEnter ValueNotes Gendermale(m) or female(f)M Ageyears40 Systolic blood pressuremg/dL110 Diastolic blood pressuremg/dL60 Heightinches68 Weightpounds120 Body mass indexkg/m²22.0 Current smokeryes(y) or no(n)n Parental hypertensionnone(0), one(1), or both(2)0 Time Frame for Risk Estimate4 years1% 2 years0% 1 year0%

12 Honestly, why do I need treatment? www. youtu be.co m/wat ch?v= pPxnI h_WT b8&fe ature =ends creen &NR= 1http:// www. youtu be.co m/wat ch?v= pPxnI h_WT b8&fe ature =ends creen &NR= 1 Heart disease Heart attack Stroke, Dementia, Neuropathy Kidney disease, Kidney failure Blindness

13 How to treat: Pre-hypertension Lifestyle modification! Decrease weight to a BMI of <25 Limit alcohol: MAX 1 a day for women, 2 a day for men Exercise: 30 minutes most days Limit sodium Stop smoking RE-CHECK your BP in 1-3 months

14 Why does overweight and obesity matter? Compresses the kidneys, decreasing their ability to function well Leptin a neuro-chemical produced by fat cells causes sodium retention Angiotensin which is partially produced by fat cells also raises the blood pressure Not fully understood, but seen anecdotally

15 Body Mass Index (BMI) Normal weight = Overweight = Obesity = BMI of 30 or greater Extreme = BMI of 40-54

16 Alcohol: Don’t drink, or drink in Moderation Two drinks a day for men younger than age 65 One drink a day for men age 65 and older One drink a day for women of any age A drink is 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof distilled spirits.

17 Exercise Do not exercise vigorously when you have elevated blood pressure. HOWEVER, walking about the block slowly and conditioning is important. NO heavy lifting until the BP is well controlled. As the BP becomes controlled. Ask for assistance from your HCP for increasing your exercise regimen

18 TOBACCO Don’t USE TOBACCO Nebraska Quitline or QUITNOW Seek help from a professional Call insurance to find out what medications are covered under your plan

19 DASH DIET (Dietary Approaches to Stop HTN) The Dash diet is all about: Increasing fruits and vegetables Decreasing saturated and meat fats Moderate low fat dairy products Increasing protein sources from nuts and legumes Decreasing sodium

20 Why low sodium Salt = water retention. Water retention in circulating blood = more circulating fluid More circulating fluid = more blood to move by one of two ways… –Faster heart rate, or increase in BP by needing a more forceful contraction of the heart to move more fluid If the heart cannot keep up, SWELLING occurs, and eventually heart failure may occur

21 Those who MUST limit their sodium You are 51 years of age or older. You are African American. You have high blood pressure. You have diabetes. You have chronic kidney disease.

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23 Sodium surprises! Most Americans consume twice what they need Chicken Noodle Soup870 mg Hot Dogw bun700 mg 1 slice American Cheese270 mg 1 slice bread138 mg 10 potato chips126 mg 4 short bread cookies105 mg

24 Lunch: fast food McDonalds Hamburger, fries, Diet cola: 700 mg Burger King Hamburger, fries, Diet cola: 1100 mg Wendy’s Hamburger, fries, Diet cola: 1750 mg Panera Almond Chicken Sand, chips, Diet cola: 1420 mg

25 Diuretics Diuretics work by flushing excess water and sodium from the body, thus lowering blood pressure. (They work in the kidneys) Types: Thiazides, Loops, Potassium Sparing

26 Medications Angiotensin II A-II is a natural substance in your body that affects your cardiovascular system in many ways, such as by narrowing your blood vessels. This narrowing can increase your blood pressure and force your heart to work harder. A-II also starts the release of a hormone that increases the amount of sodium and water in your body, which can lead to increased blood pressure. A-II can also thicken and stiffen the walls of your blood vessels and heart.

27 Medications Angiotensin Coverting Enzyme Inhibitors (ACE) ACE inhibitors prevent an enzyme in your body from producing angiotensin II, a substance in your body that affects your cardiovascular system by narrowing your blood vessels and releasing hormones that can raise your blood pressure. This narrowing can cause high blood pressure and force your heart to work harder.

28 Medications Angiotensin II A-II is a natural substance in your body that affects your cardiovascular system in many ways, such as by narrowing your blood vessels. This narrowing can increase your blood pressure and force your heart to work harder. A-II also starts the release of a hormone that increases the amount of sodium and water in your body, which can lead to increased blood pressure. A-II can also thicken and stiffen the walls of your blood vessels and heart.

29 Medications Beta Blockers Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. When you take beta blockers, the heart beats more slowly and with less force, thereby reducing blood pressure.

30 Medications Calcium Channel Blockers Calcium channel blockers prevent calcium from entering cells of the heart and blood vessel walls, resulting in lower blood pressure. They relax and widen blood vessels by affecting the muscle cells in the arterial walls

31 How to treat: Hypertension Do not delay treatment! You will begin with at least 1 antihypertensive medication* If Stage 2 hypertension (>160 or >100) begin 2 antihypertensive medications. MAKE LIFESTYLE CHANGES, pills are needed, but not enough

32 Not making it to goal? We will refer to Nephrology or Cardiology for resistant hypertension Echocardiogram Renal Ultrasound Sleep apnea study

33 I only had high blood pressure 2 times! If you have a recording of 2 BP readings that are elevated at least 7 days apart, you have met the DEFINITION of HYPERTENSION. OR… if only one reading is >180/110.

34 Once again… why is it so important to treat… In pre-hypertension alone… For every 20/10 mm Hg increase there is a doubling of risk of heart and artery (aneurisms) events

35 RECAP In pre-hypertension alone… For every 20/10 mm Hg increase there is a doubling of risk of heart and artery (aneurisms) events Hypertension: 3 times more likely to have heart disease 6 times more likely to have congestive heart disease 7 times more likely to have a stroke

36 How to prepare for a Health Care Appt. Write down any symptoms you're experiencing Write down key personal information Make a list of all medications Take a family member or friend along Be prepared to discuss your diet and exercise habits Write down questions to ask

37 Cont… Wear a shirt or blouse that allows for BP check and blood draw. Avoid caffeine one hour before your appointment Avoid sexual activity for 48 hours before prostate and pap test screening You may need to do a urine test, so drink plenty of fluids. If required, fast except for water for 8-12 hours.

38 WEB RESOURCES (Search: “risk score profiles”) (Search: “programs for your health”)


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