This document summarizes a presentation on hypertension (high blood pressure). It defines blood pressure and how it is measured. It provides the normal and high blood pressure readings. It describes the risks of uncontrolled hypertension, such as heart disease and stroke. Tips are provided for lifestyle changes to prevent and control hypertension, including a healthy diet low in sodium, weight management, physical activity, and limiting alcohol. Medications that may be prescribed for hypertension are listed. Resources for further information on blood pressure are included at the end.

1. filess/Excel/ex 1.pdf
filess/Excel/ex 2.pdf
filess/Excel/ex 3.pdf
filess/Excel/ex 4.pdf
filess/files/e_md_log.xlsx
Sheet1NumPatient NameDate of BirthGenderInsurance
CompanyInsurance
TypeInsurance
Policy NumberVisit
CodeChargePayment/
Co-PayInsurance
BillingInsurance AdjustmentDiscount
ApplicibleCash DiscountTotal Due After AdjustmentsCharges
Lookup1Chang, Tom16865MaleHumanaPPOAA-144-366-
53701125180Type of VisitCodeChargeTsifo,
Georgia38903FemaleBlue CrossHMOXOF-
455334281123090Office Visit, New7011$ 225Kane,
Chris28616MaleBlue CrossHMOXOF-909384481113070Office
Visit, Est. Level 18111$ 100Mitchell,
Gene23886MaleAetnaHMOHD 8400 392381122090Office Visit,
Est. Level 28112$ 120Miller,

2. Sue29254FemaleNone81131500Office Visit, Est. Level 38113$
150Yong, Samantha32239FemaleHumanaPPOFG-E03-993-
0292112550Office Visit, Consultation9211$ 90Fay,
Mike20352MaleBlue CrossHMOXOF-
5794835701130180Diabetes Education, Individual4055$
80Schreyer, Harmony50555FemaleHumanaPPOAC-178-766-
5437052560Diabetes Education, Group4065$ 40Pattenden,
Kim17563MaleNone81121200Insulin Pump Instruction3705$
95Carrillo, Jose19954FemaleAetnaHMOHD 6480
7823811320110Electrocardiogram1001$ 250Da Silva,
Ramone24353MaleBlue CrossHMOXOF-6678145811330110Flu
Vaccine2011$ 25Hew-Len, Dale22568MaleHumanaPPOHF-
124-386-3981112570Gibbons, Randy19107MaleAetnaHMOHD
8422 5126701120180Cash Discount10%Iketau,
Romeo16025MaleNone4055800Ifediba, Jared22251MaleBlue
CrossHMOXOF-718469840553050Weis,
Jaclyn19897FemaleHumanaPPOOS-594-626-
76100125200Stauffer, Rick16622MaleAetnaHMOHD 8240
8361701120180Corless, Cynthia14728FemaleBlue
CrossHMOXOF-6982455811330110Metcalf,
Donald20305MaleNone9211900Baker,
Marshall17485MaleHumanaPPOUR-857-366-532011250Sovine,
Jaron22064MaleHumanaPPOGD-814-376-7481112570Griffiths,
Craig22865MaleBlue CrossHMOXOF-
791577840653010Wharton,
Leslee21798FemaleNone4065400Whitehead,
Fred15768MaleHumanaPPOUJ-832-368-1140652510Madden,
Trond23955MaleHumanaPPOUJ-934-830-3481112570Mclean,
Jimmy32582MaleNone9211900Rutter, Cathy22537FemaleBlue
CrossHMOXOF-2483405811330110Halter,
Cynthia7408FemaleHumanaPPOAJ-368-316-
66701125180Mortensen, Dean20475MaleAetnaHMOHD 0045
862492113060Dee, Vicki15854FemaleHumanaPPOTO-834-371-
82811325110Churchill, Scott17735MaleBlue CrossHMOXOF-
8479246701130180Casper, Don28367MaleHumanaPPOCX-844-
746-5720112520Gibson,

3. Greg14304MaleNone81111000McMichael, Rick20352MaleBlue
CrossHMOXOF-187548937053060Griffiths,
Sanford29604MaleHumanaPPOSS-694-386-
5340652510Gibbons, Adrienne22251FemaleAetnaHMOHD 2380
8374100120210Marceau, Marc29933MaleBlue CrossHMOXOF-
823487740553050Tekin, Talat32330MaleBlue CrossHMOXOF-
661294581123090Schenk, Aimee17729FemaleHumanaPPOOJ-
846-224-55701125180Pawlowski,
K.30866FemaleAetnaHMOHD 5540 8387811320110Sanchez,
Maria21466FemaleNone4065400Reed,
Daniel17881MaleHumanaPPOKR-546-396-
7740652510Heikkinen, Erja21125MaleHumanaPPOKW-346-
396-7340652510
filess/files/p_md_hypertension.pptx
High Blood Pressure
Presented by: Dr. Tom Martin
1
10/9/2011
Dr. Tom Martin
What is Blood Pressure?
The pressure of blood against the walls of the arteries.

4. Blood circulates through the body by way of the arteries. Blood
is necessary to provide our vital organs with the oxygen and
food they need to work properly. As the blood travels through
the arteries, it presses against the artery walls. When your heart
contracts, your blood pressure rises. When your heart relaxes
your blood pressure falls. Your blood pressure will rise and fall
throughout the day and night based on your activity.
2
10/9/2011
Dr. Tom Martin
How is Blood Pressure Measured?
A sphygmomanometer
The blood pressure test is easy and painless. Your doctor or
nurse will use a sphygmomanometer to check your blood
pressure. A sphygmomanometer is a device made up of a cuff,
pump, valve, and dial used with a stethoscope for measuring
your blood pressure. Your doctor or nurse will put the cuff
around your upper arm and inflate it using the pump. This
compresses the artery in your arm which stops the blood flow.
Then the air is released through the valve which allows the
blood flow to start again. The doctor or nurse listens using the
stethoscope to hear when the blood starts pulsing back through
the artery again until the pressure in the artery exceeds the
pressure in the cuff.

5. Dr. Tom Martin
10/9/2011
3
What Should Your Blood Pressure Numbers Be?
Diastolic Pressure
The force in the arteries when the heart is at rest
Systolic Pressure
The force in the arteries when the heart beats
By listening to the pulse and checking the dial, the doctor or
nurse can hear when the pulsing sound begins again. This is the
systolic blood pressure, or the force in the arteries when the
heart beats. The force in the arteries when the heart is at rest is
recorded when the doctor or nurse can no longer hear the sound.
This is the diastolic blood pressure.
Blood pressure is measured in millimeters of mercury (mm Hg).
It’s recorded with the systolic pressure listed above the
diastolic.
4
10/9/2011
Dr. Tom Martin
Tips for Blood Pressure Readings
You shouldn’t have coffee, alcohol or cigarettes for 30 minutes
before you go in to have your blood pressure taken.
Sit for five minutes with back supported and feet flat
Be sure to wear a shirt with short sleeves so that the

6. sphygmomanometer touches your skin
You shouldn’t talk while taking the reading
Get two readings and then figure the average of them
Because your blood pressure is constantly changing depending
on your activity, temperature, diet, emotional state, posture,
physical state, and medication use, be sure to ask for two
readings and figure the average of the readings. You will have a
more accurate idea of your blood pressure that way.
Dr. Tom Martin
10/9/2011
5
What is Hypertension?
The condition in which blood pressure levels are above the
normale range.
Hypertension, or high blood pressure, occurs when the arteries
narrow so that it becomes harder for the blood to flow through
them. When it is harder for the blood to flow through, the
pressure inside the artery increases. When that happens the
heart works too hard and makes the walls of the arteries hard.
While your heart, brain, and kidneys can withstand the pressure
for a long time, it increases your risk for heart disease and
stroke. It may cause heart failure, kidney disease, and blindness.

7. High blood pressure is indicated when the systolic pressure is
150 mm Hg or above or when the diastolic pressure is 90 mm
Hg or above.
The ranges in the table apply to most adults who are 18 years
old or older and who do not have short-term illnesses. All
levels above 120/80 mmHg raise the risk, and the risk grows as
blood pressure levels rise. (National Heart Lung and Blood
Institute, U.S. Department of Health and Human Services)
Pre-hypertension means you are likely to end up with high
blood pressure if you don’t take action.
High blood pressure numbers are different for children and
teens.
6
10/9/2011
Dr. Tom Martin
High Blood Pressure
is the number one risk factor for stroke
contributes to
heart attacks
heart failure
kidney failure
atherosclerosis
is more common among people over 35
High blood pressure is the most important risk factor for stroke.
This can happen with a break in a weakened blood vessel which

8. bleeds in the brain. A stroke can also happen when a blood clot
blocks one of the narrowed arteries in the brain.
High blood pressure is also a major risk for heart attack. The
arteries bring oxygen carrying blood to the heart muscle. If the
heart cannot get enough oxygen, angina (chest pain) can occur.
If the flow of blood is blocked a heart attack results.
Hypertension is also the number one risk factor of congestive
heart failure--a condition in which the heart cannot pump
enough blood to meet the body’s needs.
Kidneys help rid the body of wastes. High blood pressure can
narrow and thicken the blood vessels in the kidneys which
makes it hard on the kidneys to filter blood. This results in
waste building up in the blood and may result in the kidneys
failing all together. Dialysis or kidney transplant may be
needed in this situation.
7
10/9/2011
Dr. Tom Martin
Are You at Risk?
Controllable Risk Factors
Stress
Obesity
Too much salt intake
Drinking too much alcohol
Smoking
Uncontrollable Risk Factors
Race
Heredity
Age

9. While anyone can develop high blood pressure, it is more
common in African Americans who get it earlier and more often
than Caucasians or Hispanic Americans. African Americans
tend to get high blood pressure earlier in life and are more
likely to be aware that they have it and to get treatment for it.
Age also raises the risk of high blood pressure. As we get older,
our blood pressure raises. Over half of Americans over age 60
have hypertension. A male older than 45 and a female older than
55 are at more risk for high blood pressure.
A family history of high blood pressure is a strong indicator
that you will develop high blood pressure but you are not
exempted from high blood pressure just because no one in your
family has had problems with it.
Obese people, heavy drinkers, and women who are taking birth
control pills are also at more risk. So are people with diabetes,
gout, and kidney disease.
8
10/9/2011
Dr. Tom Martin
High Blood Pressure Facts
Adults 55 + have a 90% risk of developeing high blood
pressure.
Hypertenstion affects 67% of diabetics.
In 90-95% of high blood pressure cases, the cause is unknown.
Hypertentsion nationally accounts for $66.4 billion in
healthcare costs.

10. These facts are a wake-up call. Whether you are young or old,
modify your lifestyle to prevent high blood pressure. If you
already have high blood pressure, you can control it by
modifying your life style!
9
10/9/2011
Dr. Tom Martin
How Can You Prevent and Control Hypertension?
Monitor your blood pressure
Limit alcohol
Quit smoking
Take medication, if prescribed
Monitor your blood pressure so you are aware of problems when
they occur.
Alcohol raises blood pressure and can harm your liver, brain,
and heart. Reducing your alcohol use to a moderate level can
lower your systolic blood pressure 5 points and your diastolic
pressure 3 points. A medium or large man under the age of 65
should not have more than two drinks a day. A woman, small
man, or anyone older than age 65 should not have more than one
drink a day. What counts as a drink?
12 oz beer (150 calories)
5 oz of wine (100 calories)
1.5 oz of 80 proof whiskey (100 calories)

11. Smoking injures blood vessel walls and speeds up the process of
hardening of the arteries. So even though smoking does not
cause high blood pressure it is a bad idea for anyone, especially
those with high blood pressure. Once you quit, your risk of
having a heart attack or stroke is reduced after one year.
Dr. Tom Martin
10/9/2011
10
Change Your Lifestyle!
Eat a healthy diet
Maintain a healthy weight
Be active 30 minutes per day
Healthy lifestyle changes can help control high blood pressure,
but you will have to treat it for life. Treatment will not cure
high blood pressure.
Take a pro-active approach--prevent problems by maintaining a
healthy lifestyle.
Get 30-minutes of moderate activity most days of the week.
Being physically active helps lower blood pressure. Use stairs
instead of an elevator, get off two bus stops early, park your car
at the far end of the parking lot and walk!
Lose weight or if you are at a healthy weight, maintain it.
Dr. Tom Martin
10/9/2011
11

12. Reduce Sodium in Diet
Use fresh poultry, lean meat, and fish
Use herbs, spices, and salt-free seasonings
Buy fresh, frozen, or canned “no salt added” vegetables
Eating healthy can reduce the risk of your developing high
blood pressure. One of the most important things you can do is
reduce the sodium in your diet. Most Americans eat way too
much salt in their diets. The current recommendation is to
consume less than 2.4 grams of sodium a day. Figure that 2
grams of sodium is equal to 1 teaspoon of salt. All our bodies
actually need is 500 mg or ¼ teaspoon. Americans consume on
the average 4000 to 6000 mg of sodium a day. For a person
with high blood pressure the doctor may recommend a 1500 mg
sodium diet. These low sodium diets can keep blood pressure
from rising and help medications work better.
Dr. Tom Martin
10/9/2011
12
What if I Need Medication?
Diuretics
Beta blockers
ACE inhibitors
Angiotensin II Receptor Blockers
Calcium Channel Blockers
Alpha blocker
Alpha-beta blockers

13. Nervous system inhibitors
Vasodilators
If you are diagnosed with high blood pressure, you will need
treatment to get your blood pressure under control. You will
need regular blood pressure tests and you will need to stay on
treatment. Blood pressure medication is easy to take and side
effects tend to be minor. Remember, though, that if your blood
pressure is only under control while on medication, you may be
taking medication for your lifetime. Change your lifestyle
NOW!
Diuretics (also called water pills) work on the kidney to remove
excess water and fluid from your body to lower blood pressure.
Beta Blockers reduce impulses to the heart and blood vessels
which helps your heart beat slower with less force.
ACE Inhibitors keep your body from making a hormone that
causes blood vessels to narrow. ACE inhibitors cause blood
vessels to relax and blood to flow freely.
Angiotensin II Receptor Blockers are a newer medicine that
causes blood vessels to relax and widen.
Calcium Channel Blockers keep calcium from entering the
muscle cells of your heart and blood vessels causing blood
vessels to relax.
Alpha Blockers block nerve impulses that tighten blood vessels
causing blood to flow more freely.
Alpha-Beta Blockers work the same as alpha blockers and also
slow the heartbeat like beta blockers.
Nervous System Inhibitors increase nerve impulses from the
brain to relax and widen blood vessels.
Vasodilators relax the muscles in blood vessel walls causing
blood to flow more freely.

14. Dr. Tom Martin
10/9/2011
13
Resources for Good Health
American Heart Association
National Heart Lung and Blood Institute
Mayo Clinic
filess/files/p_md_image1.jpg
filess/files/p_md_image2.jpg
filess/files/p_md_image3.jpg
filess/files/p_md_image4.tiff
filess/files/p_md_image5.jpg
filess/files/w_md_vaccinations.docx
Immunization Basics
Welcome to the Hilltop Family Practice immunization program.
Comment by JM Behle: Yes, you have covered the sections
we want included. There are some additions to the
Recommended Vaccinations section, however. I’ve included the
information in the section, but please make sure the table is
updated.
“Today, children in the United States routinely get vaccines that
protect them from more than a dozen diseases such as measles,

15. polio and tetanus. Most of these diseases are now at their lowest
levels in history, thanks to years of immunization.”
This document has been prepared by our office to help you
understand the necessity for vaccines to ensure the health of
your child and the health of others with whom your child comes
into contact.
What is a vaccine?
A vaccine is administered to help prevent your child getting a
particular type of disease. The vaccine is a preparation
containing weakened or dead microbes that cause disease. When
it is administered, it stimulates your child’s immune system to
produce antibodies. These antibodies protect aggainst the
disease.
Are vaccines safe for my child?
Generally vaccines are safe. There is a small risk of problems,
but the protection vaccines provide far outweighs this small
risk. If your child has had a reaction to a first shot in a series,
Dr. Mangus will discuss the pros and cons of continuing with
the rest of the shots in the series. Please talk to Dr. Mangas if
you have any questions or concerns.
What side effects could my child experience?
We Dr. Mangas will discuss possible side effects of each
vaccine as it is administered and will inform you of ways you
can help lessen these side effects. Possible side effects are
temporary and may include slight fever, soreness at the site
where a shot is given, or redness or swelling where the shot was
given. Comment by JM Behle: In addition to Dr. Mangas,
the nurses and I also administer some of the vaccines.
When should my child be vaccinated?
The timetable for your child’s vaccines will depend on your
child’s health, the type of vaccine, and the vaccines available.
Section 3 of this document contains two tables with suggested
vaccination times.
Recommended Vaccinations
HBV (Hepatitis B Vaccine)
The HBV vaccine helps prevent hepatitis B virus (HBV), a

16. disease affecting the liver. It can lead to liver cancer and death.
The vaccine is given as a series of three shots beginning at
birth. The HBV vaccine will protect your child from childhood
and into their adult years.
Rotavirus Comment by Sherry Wright: Update table.
Rotavirus is one of the most common causes of dehydration and
diarrhea in infants and young children. It is extremely
contagious and is particularly a problem in child-care centers
and children’s hospitals. It’s recommended that the vaccine be
given in three doses by mouth at 2, 4, and 6 months of age.
IPV (Inactivated Poliovirus) Comment by JM Behle: Make
sure this is included in the table for children 0 to 6 years old.
Polio is a viral infection that can result in permanent paralysis.
Until recently the oral poliovirus was given in the United
States, but there was a very small risk of developing polio after
receiving the live oral vaccine. Now, however, the inactivated
poliovirus vaccine is recommended. It should be given at 2, 4, 6
to 18 months, and 4 to 6 years.
PCV (Pneumococcal Conjugate Vaccine)
The pneumococcal conjugate vaccine (PVC) protects your child
against the bacterium that is the leading cause of infections
including pneumonia, blood infection, and bacterial meningitis.
The vaccine is given as a series of four shots starting at 2
months of age.
DTaP (Diphtheria, Tetanus, Acellular Pertussis)
The DTaP vaccine is given in a series of shots administered
between the ages of 2 months and 4 to 6 years. The vaccine is a
combination inoculation against three diseases/infections which
are: Diphtheria, Tetanus, and Pertussis.
Diphtheria
Diphtheria is a highly contagious disease but exceptionally rare.
Diphtheria is an infection that occurs in the throat, nose, and
mouth. The symptoms include a cough as well as a sore throat.
Diphtheria can lead to pneumonia, heart failure and paralysis if

17. left untreated.
Pertussis
Pertussis is a life threatening disease especially children under
a year old. It is also commonly referred to as whooping cough.
Tetanus
Tetanus is an infecion that can occur from bacteria that is
associated with dirt, gravel, or rusty metals. The baceria enter
the body through a cut. The infection usually results in lock
jaw.
Hib (Meningitis)
The Hib vaccine protects against the Haemophilus influenzae
type b bacteria, the leading cause of meningitis before the
vaccine was developed. The Hib vaccines is administered as a
series of three shots beginning at 2 months with a booster shot
at 12 to 15 months.
Influenza
The influenza vaccine gives your child a chance to build up
immunity to an influenza “flu” virus before the flu season.
Because flu viruses constantly change, the vaccine is updated
each year. If your child is between 6 and 59 months old, you
should have your child vaccinated every fall. If your child—or
you—have a chronic medical condition such as asthma or
diabetes, the flu shot should be given every year.
MMR Vaccine
The MMR vaccine is an immunization against the following:
Measles, Mumps, and Rubella. All three of these diseases are
highly contagious and occur during childhood.
Measles
Measles is a virus which causes a rash on the body. Symptoms
include a cough, runny nose, fever, and eye irritation. This
virus can cause pneumonia, seizures, brain damage and in rare
cases death.
Mumps
The symptoms of the mumps virus include fever, headache, and
swollen glands. It can also cause deafness, meningitis, and
death in some cases.

18. Rubella
Rubella is also known as the German Measles. This is the
mildest disease of the three. This disease may cause serious
birth defects of a baby if the woman is pregnant and becomes
infected.
Varicella (Chickenpox)
The varicella vaccine protects your child against the highly
contagious and common chickenpox viral illness that can cover
your child with an itchy rash of spots and is accompanied by
flu-like symptoms. The vaccine is given between the ages of 12
to 15 months with a booster shot at 4 to 6 years old.
MCV4 (Bacterial Meningitis)
Bacterial meningitis is an inflammation of the membrane that
protects the brain. While rare, it is highly contagious. The
MCV4 vaccine protects against the disease and should be given
to your child between ages 11 or 12 years, before high school,
or before entering college and living in a dorm.
Hepatitis A
The hepatitis A vaccine protects your child against the fever,
nausea, vomiting, and jaundice caused by hepatitis A. This
disease can be epidemic in a community. The vaccination is a
series of two shots administered between the ages of 12 to 23
months.
Suggested Schedules Comment by Sherry Wright: Please
insert the information about the Rotavirus vaccine.
Recommended Immunization Schedule for Children 0-6 Years
Old Comment by Sherry Wright: This should include the same
reference/footnote information as the next table.
Vaccine
Age
Comments
HBV (Hepatitis B vaccine)
Birth, between 1 and 2 months, and between 6 to 18 months
PCV (Pneumococcal Conjugate Vaccine)

19. 2 months, 4 months, 6 months, and between 12 to 15 months
High-risk groups booster between 2 to 6 years old
DTaP (Diphtheria, Tetanus, Acellular Pertussis)
2 months, 4 months, 6 months, between 15 to 18 months of age,
and final dose between ages 4 to 6 years
Hib (Meningitis)
2 months, 4 months, 6 months, between 12 to 15 months
Influenza
Annually between 6 months to 59 months
High-risk groups continue annually
MMR Vaccine (Measles, Mumps, Rubella)
12 to 15 months.
Second dose between 4 and 6 years
Varicella (Chickenpox)
12 to 15 months.
Second dose between 4 and 6 years of age
MCV4 (Bacterial Meningitis)
Between 2 to 6 years old
Hepatitis A
Two doses six months apart between 12 and 23 months
High-risk groups booster between 2 to 6 years old
PPV (Pneumococcal Vaccine) 1 dose between 7 to 18 years old
Administer to certain high-risk groups
Tdap (Diphtheria, Tetanus, Acellular Pertussis) 1 dose

20. between 11 to 12 years for those who have completed the
recommended DTP/DTaP vaccination series
Influenza 1 dose annually Administer to certain high-risk
groups annually
MCV4 (Bacterial Meningitis) 1 dose between 11 to 12 years
old
Hepatitis A 2 doses between 7 to 18 years old Administer
to certain high-risk groups
HPV (Human Papillomavirus 3 doses between 11 and 12 years
Females only
filess/powerpoint/pp1.pdf
filess/powerpoint/pp2.pdf
filess/powerpoint/pp3.pdf
filess/powerpoint/pp4.pdf
filess/word/w1.pdf
filess/word/w2.pdf

21. filess/word/w3.pdf
filess/word/w4.pdf