1. HYPERTENSION Objectives –Understand the importance of blood pressure –Know how to get the most out of self monitoring of blood pressure

2. What We Will Cover Definitions Importance Self Monitoring

3. Defining Blood Pressure (BP) The force of blood exerted on the inside walls of the blood vessels that carry blood from the heart Systolic BP is the highest the BP gets (as the heart finishes a pumping cycle) Diastolic BP is the lowest the BP gets (as the heart gets ready to pump)

4. Defining Hypertension A diagnosis applied to people who routinely have a high enough blood pressure that it warrants treatment. # High blood pressure (or hypertension) is defined in an adult as a blood pressure greater than or equal to 140 mm Hg systolic or 90 mm Hg diastolic pressure. * # Jeff Whittle, MD * American Heart Association

5. Key Points Cannot be diagnosed with one measure!!! –2 or more readings on separate visits –BP often goes up temporarily When patients are uncomfortable for other reasons Because of normal responses For unknown reasons The definition has changed before and will likely change again

6. Blood Pressure Predicts Stroke Risk Blood pressure is the most consistent predictor of stroke The risk of stroke doubles for every 20 mm Hg increase in systolic BP –Starting at 115 –No upper limit But on any one day the risk of stroke is not very high

7. White Coat Effect BP is higher when measured in doctor’s office than when at home More common with older people More common if being treated People with white coat effect... –More often develop high BP –More often have stroke, etc.

8. Home BP Measurement Predicts who suffers bad things –Even if office BPs are the same –When done as part of studies Improves office BP control –Decreases over-medication –No proof yet it prevents events Makes it clear that patients and doctors are partners

9. Measuring BP at Home: Part 1 Lots of machines work well –Wrist and finger, not as well –But this is on average Two approaches to time of day: –Always in AM = more stable –All day = more representative Avoid other sources of variation

10. Measuring BP at Home: Part 2 Caffeine and nicotine close blood vessels, raise BP Exercise opens vessels, but increases heart rate  ?? Movement confuses machines Food opens intestinal vessels Alcohol opens skin vessels, but can increase heart work  ??

11. Measuring BP at Home: Part 3 BP that matters is at heart/head –Right and left arms are easier –Since pressure does not go up as you move away from the pump, the arm with the higher reading is closer to the heart Blood is a liquid –Pressure is higher downhill No blood pressure is perfect

12. Helping Your Doctor Help You: Part 1 Self monitor blood pressure –Record ALL measures –Use correct technique Take medications as directed Make small lifestyle changes Get help from your family and friends

13. Estimated Effects of Treatment LIFESTYLE CHANGEEffect on Systolic BP Weight loss (10% reduction) 5-20 mmHg Adopt DASH diet8-14 mmHg Restrict sodium2-8 mmHg Increase physical activity4-9 mmHg Modest doses of most BP medications 8-12 mmHg

14. The DASH Diet * More: –Fruits and vegetables –Low fat dairy (mostly skim milk) –Whole grains Less: –Saturated fats –Concentrated sweets No change in calories or salt * DASH = Dietary Approaches to Stop Hypertension http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf

15. Helping Your Doctor Help You: Part 2 Work with your doctor –Know what drugs you take and why –Agree on your target blood pressure Share information with your doctor + other health team members –Your home BP recordings –Any side effects from medications –Barriers to achieving your lifestyle goals

16. Icebreaker Activity If you could take us to one healthy, favorite place you’ve been to, or know about in Wisconsin... Where is it, and why would you choose to take us there?

17. Instructions Pair up with someone you don’t know Learn: name, where he/she lives Find out: favorite place in Wisconsin and why Time: 3 minutes GO!

18. BREAK