1. Hypertension

2. Blood Flow

3. Blood Pressure
Measure of pressure exerted on the wall of the blood vessels
Measure of the pressure exerted when heart contracts
Normal:
Contraction = systole = mmHg
Relaxation = disystole = mmHg
Hypertension greater than 140/90 mmHg
Symptoms --- often none

4. How controlled Controlled by mechanism in kidney
Blood flow through kidney
Cells sense the decreased volume, pressure and sodium
Produce a enzyme call “renin”
Renin breaks down protein to form angiotensin I
Angiotension I converted to Angiotensin II by another enzyme called “Angiotension Converting Enzyme” or ACE
Angiotension II increase BP and bring water and sodium into blood

5. Types of Hypertension Essential Systolic Secondary
No identifiable cause
Both systolic reading and disystolic readings are high
Systolic
Fewer cases/ more often in elderly
Systolic reading elevated
Secondary
Kidney disease
Cushings disease
Diabetes
Pre-eclampsia

6. Prevalence Less in more physically active group
When controlled for activity, income, smoking, smoking, weight, Black had odds ratio of 1.77 compared to whites (0.73) (Bassett et.al, 2002)
Higher percentage of hypertension in the Southeast- (Hall et.al, 1997) (Glover et.al, 2002)
Black men 35%; Black women 37.7% (40.5%)
White men 36.5%; White women 21.5% (27.4%)
Why?
Obesity– 25%
Diet high in sodium and fat
Lack of education
Access and utilization of health care

7. Complications Earlier onset Stroke- 80% higher stroke mortality
Heart Disease– 50% higher heart disease mortality
Kidney Failure—320% greater End Stage Kidney Disease

8. Treatment Diet Exercise Drugs Diuretics– AKA “water pills”
Beta Blockers—block receptors on heart to reduce the contractions
ACE inhibitors
Ca channel blockers
Angiotension II inhibitors

9. Why more prevalent in African Americans?
Decreased renin
Stress
Genetics
Adaptation
Food
Lack of exercise

10. Race/
Gender
White/male
39.3
41.7
43.5
24.3
36.5
Black/male
48.1
51.8
48.7
34.9
35.5
White/ female
31.7
32.4
32.3
19.3
21.5
Black/ female
50.8
50.3
47.5
33.8
37.7
Centers for Disease Control

11. References
Hall, et. al. (1997) Hypertension-related morbidity and mortality in the southeatern United States
Glover et al. (2005) Racial/ethnic disparities in prevalence, treatment, and control of hypertension, MMWR weekly, January 14, 54, 7-9
National Institutes of Health, Joint National Committee on Prevention , Detection, Evaluation and Treatment of High Blood Pressure (1999),