Blood Pressure


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Blood Pressure

  1. 1. Clinical Guidelines—Lowering High BloodPressure in Adults
  2. 2. HypertensionScopeHigh Blood Pressure(hypertension)•is the most commonprimary diagnosis in theU.S.,•affects approximately 1in 3 adults in the U.S.,and•affects more than 65% ofpeople over 65 years old. 2
  3. 3. HypertensionEffectsHypertension can damage the Brain Heart It’s the most It’s a major risk factor important risk factor for heart attack and the for stroke. #1 risk for congestive heart failure. Kidneys Arteries It can cause the It’s associated with kidneys to fail, stiffer arteries, resulting in dialysis causing the heart and or a kidney kidneys to work transplant. harder. 3
  4. 4. HypertensionAdults at RiskPercentage of adults with hypertension by age 4
  5. 5. HypertensionAdults at RiskPercentage of adults with hypertension by ethnicity 5
  6. 6. HypertensionAdults at RiskPercentage ofadults withhypertensionby state(Source: CDC BehavioralRisk Factor SurveillanceSystem) 6
  7. 7. Blood PressureKnow the Numbers 7
  8. 8. Blood PressureCardiovascular Disease (CVD)According to the 7th Report from the Joint National Committeeon Prevention, Detection, Evaluation, and Treatment ofHigh Blood Pressure (JNC7)•BP relationship to risk of CVD is “continuous, consistent, and independent of other risk factors.”•For people 40-70 years old, each increment of 20/10 mmHg doubles the risk of CVD across the entire BP range, starting from 115/75 mmHg.•Hypertension can be prevented if prehypertension is discovered. 8
  9. 9. Blood PressureBenefits of Lowering Heart Stroke Myocardial Failure Incidence Infarction (Source: JNC7) 9
  10. 10. HypertensionEvaluation1. Assess lifestyle and identify major CVD risk factors or concomitant disorders that affect prognosis and guide treatment.2. Identify causes of hypertension.3. Assess the presence or absence of target organ damage and CVD. 10
  11. 11. Hypertension Evaluation1. Assess Lifestyle & CVD Risk Factors Assess Lifestyle Identify CVD Risk Factors •Weight •Hypertension •Eating routine •Obesity •Sodium intake •Dyslipidemia •Physical activity •Diabetes mellitus •Alcohol consumption •Microalbuminuria or estimated •Smoking habits glomerular filtration rate <60 ml/min •Age •Family history of premature CVD* *CVD is considered premature when it occurs in men <55 years and women age <65 years. 11
  12. 12. Hypertension Evaluation2. Identify Causes of Hypertension Identify Causes of Hypertension •Sleep apnea •Drug-related causes •Chronic kidney disease (CKD) •Primary aldosteronism •Renovascular disease •Chronic steroid therapy and Cushing’s syndrome •Pheochromocytoma •Coarctation of the aorta •Thyroid or parathyroid disease 12
  13. 13. Hypertension Evaluation3. Assess Presence of Target Organ Damage Brain Kidneys • Stroke or transient • CKD ischemic attack Arteries Heart • Peripheral arterial • Left ventricular hypertrophy disease • Angina or prior myocardial infarction Eyes • Prior coronary • Retinopathy revascularization • Heart failure 13
  14. 14. TreatmentGoal of Therapy• Reduce CVD and renal morbidity and mortality.• Treat to BP <140/90 mmHg or BP <130/80 mmHg in patients with diabetes or CKD.• Achieve the systolic BP (SBP) goal, which is especially important in persons ≥50 years old. 14
  15. 15. TreatmentLifestyle ModificationModify Lifestyle to Reduce SBP approximately•Reduce weight 5-20 mmHg/10kg weight loss•Adopt healthy eating plan 8-14 mmHg•Reduce dietary sodium intake 2-8 mmHg•Increase physical activity 4-9 mmHg•Moderate alcohol intake 2-4 mmHg 15
  16. 16. TreatmentPharmacological•Lowering BP with several classes of drugs will reduce the•Most hypertension patients will need two or more (*See algorithm for Treatment of Hypertension in the JNC7 report) 16
  17. 17. TreatmentOther Considerations• CVD risk factors should be treated and tobacco avoided.• Low-dose aspirin therapy should be considered but only when BP is controlled (risk of hemorrhagic strokes increases in patients with uncontrolled hypertension). 17
  18. 18. Care ManagementFollow-UpPatients should be checked:•monthly for follow-up andmedication adjustment until BP goalis reached•more frequently for Stage 2Hypertension or complicatingcomorbid conditions•1-2 times/year to check serumpotassium and creatinine•every 3-6 months after BP is stable 18
  19. 19. Care ManagementFollow-UpAdditional factors that can affect how often patients shouldfollow-up with their physicians:Comorbidities Other special considerations• Ischemic heart disease • Minorities• Heart failure • Obesity• Diabetic hypertension • Left ventricular hypertrophy• CKD • Peripheral arterial disease• Cerebrovascular disease • Hypertension in older persons • Postural hypotensionNeed for additional • Dementialab tests • Gender and age • Urgencies and emergencies 19
  20. 20. The Patient’s ChoiceThe patient must bemotivated to follow his/hercare management plan andto establish and maintain ahealthy lifestyle. 20
  21. 21. The Patient’s ChoiceBarriers to motivationThe patient might•not understand the •not afford the medicationcondition or treatment •not have transportation to•deny the illness appointments•dislike taking medication•feel uninvolved in his/herhealthcare plan•feel uncomfortable talkingto the healthcare team 21
  22. 22. Patient Tools and ResourcesFor Motivation and Self-ManagementLifestyle Management – Types & Tips Blood Pressure Readings Risk Calculator Tracker 22
  23. 23. ContactSandy Pogonesspogones@primaris.org314-374-6451 23
  24. 24. Resources• The 7th Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7)• Million Hearts Blood Pressure Toolkit• National Heart Lung and Blood Institute (NHLBI)• NHLBI: Culturally Appropriate Education Materials 24