This document discusses hypertension management and cardiovascular health. It begins by defining normal blood pressure and examining hypertension as a risk factor for cardiovascular disease. It then explores guidelines for diagnosing and treating hypertension from the US, Taiwan, and China. The document outlines methods for measuring blood pressure and deriving hemodynamic parameters from pulse wave analysis. Examples are given of how hemodynamic profiling can help personalize hypertension treatment. Lifestyle factors that can impact blood pressure and cardiovascular health are also discussed. The document promotes using an online health diary to track metrics and receive advice from doctors.

1. Hypertension Management
What’s New? What’s Next?
Normal Blood Pressure
Normal Hemodynamics
(From 140/90 BP to Hemodynamic Profiling)
Personalized Medicine (Big data)
Shiu-Shin Chio, Ph.D.
www.preventagen.com

2. Hypertension: BP >= 140/90
Hypertension  Cardiovascular Diseases (CVD)
Three
Major CVD Risk Factors:
• High Cholesterols
• High Blood Pressures
• High Blood Glucose
Watch for the “3 Highs” when
Turned 35 (Information came
from a Taiwan health Magazine)

3. CVD in Taiwan
5 out of 10 leading causes
of death in Taiwan were
from the “3-Highs”…
The Top 3 leading causes
of Death in Taiwan:
1. Cancers
2. Heart Diseases
3. Stroke and Diabetes

4. Symptoms of Stroke
( 腦血栓前兆 )
Abnormal BP ( 血
壓 )
* 血壓 (BP) 突然持續升高到
> 200/120 mmHg 以上時，
是發 生腦血栓的前兆
* 血壓突然降至 < 80/50
mmHg
以下時，是形成腦血栓的前
兆
Yawning a lot Bleeding noses
Out of balance Dizziness Sever Headache

5. Cardiovascular
System & CVD
– Stroke
– Heart attacks
– Heart failure
– Diabetes
– Kidney failure
– Artery blockage

6. What’s Normal BP?
< 140/90 or 150/90? 120/80 Pre-hypertension?

7. Hypertension Guidelines (USA)

8. Hypertension Guidelines (Taiwan)
Follows the US JNC-7 Hypertension Guidelines.

9. Hypertension Guidelines (China)
New to
JNC-7

10. BP Measurement with a Cuff
• 1905: Korotkoff Sounds K1/K5
(Auscultatory BP)
• 1976: Oscillometric BP (Aus. Eq.)
• 1979: MAP (DinaMAP of J&J)
• 1989: DynaPulse (Central BP)
• 1990-now: Ambulatory 24-hr BP
• 1998-now: Hemodynamic Profile
Cuff
Cuff
Cuff

11. K-sound BP vs. Oscillometric BP
Ref.: JASH, 2011: Vol.5 (1): 12-20
K1 K4
K5

12. 24-Hour Ambulatory BP
Circadian Rhythm

13. BP Waveform via Catheterization
Central BP
Central Systolic
Central Diastolic
LV-BP
ECG
Heart Sounds
DynaPulse
DynaPulse vs. Cath
DynaPulse

14. Brachial Artery Pulse Waveform
Analysis  Hemodynamic Parameters
MAP
Ref. 1) Hypertension. 1996; 28:596-603; 2) Am. J. Cardiology 1997; 80: 323-330

15. DynaPulse Brachial ArteryDynaPulse Brachial Artery ParametersParameters::
CCompliance,ompliance, DDistensibility &istensibility & RResistanceesistance
Systolic wave analysis
Diastolic wave analysis
= BAC
BAD = BAC/Volume ~ 4*PI/[(dP/dt)pp*Tpp]sw * 100%
= BAR

16. Equations for deriving otherEquations for deriving other
Hemodynamic ParametersHemodynamic Parameters
Pulse Pressure (PP) = Systolic - Diastolic
LV Contractility = (LV dP/dt max)/SBP
Cardiac Index = Cardiac Output/Body Surface Area (BSA)
Stroke Volume (SV) = Cardiac Output (CO)/HR
Stroke Volume Index = SV/BSA
Systemic Vascular Compliance (SVC) = SV/PP
Systemic Vascular Resistance (SVR) = MAP/CO
Brachial Artery Distensibility = (BA.Compliance)/(BA.Volume)
(BAD ~ 4*PI/[(dP/dt)pp*Tpp]sw * 100%)

17. DAC Report
Sample

18. Managing 140/90 Borderline HypertensionManaging 140/90 Borderline Hypertension
with DynaPulse Hemodynamic Parameterswith DynaPulse Hemodynamic Parameters
Case-1 had blood pressure of
140/91 with higher cardiac output
(CO=8.42 vs. 4.25) and lower
systemic vascular resistance
(SVR=1016 vs. 2053), suggested
case-1 use beta-blocker for
treatment.
Case-2: Had blood pressure of
142/91, but with lower brachial
artery distensibility (BAD=4.49 vs.
6.46) and compliance (BAC=0.047
vs. 0.123), which indicated Case-2
had stiffer peripheral arterials and
vessel-dilating drug ACEI was
suggested.
Hypertension Management:
Hemodynamic values provide beyond Systolic/Diastolic for managing
hypertension……
Case 1 (140/91 mmHg) Case 2 (142/91 mmHg)

19. BP & CV Circulation
What’s Normal?

20. What Causes High Blood Pressure?
MAP = CO * PR
• Family history (Genetic, gender, race, etc.)
• LV hypertrophy (Aging or CVD)
• Stress from anxiety, work, sickness, cold weather,
etc. (Lifestyle)
• Coffee, alcohol, etc. (Lifestyle)
• Poor blood circulation (Aging or CVD)
• Stiff arteries (Aging or CVD)
• Overweight (Lifestyle)

21. Samples of Hemodynamic Profile
1. Aging

22. Samples of Hemodynamic Profile
2. Gender

23. Samples of Hemodynamic Profile
3. Stress (Cold weather)

24. Samples of Hemodynamic Profile
4. Weight Loss

25. Samples of Hemodynamic Profile
5. Exercise (Ping-Pong)

26. Samples of Hemodynamic Profile
6. Coffee & Wine

27. Samples of Hemodynamic Profile
7. Vacation

28. What to know about BP & Hypertension?
• Have irregular heartbeats (arrhythmias)?
• K-sound (K1/K5 for JNC) or Central BP?
• Taking BP at Resting (at normal HR)?
• Left-arm vs. Right-arm BP (<15 mmHg?)
• 150/90 for Age 60 & up (JNC-8)?
• 24-hr ambulatory BP (Circadian Rhythm)?
• Anti-Hypertension drugs taking?

29. Irregular Pulses & BP Measurement?
Arrhythmia
Arm movement
Atrial Fibrillation

30. What to do to keep a healthy CV?
• Weight control (BMI <25 and >=18.5)
• Exercise (keep normal resting HR)
• Stress control (Lifestyle modification)
• Healthy and balanced diet (Avoid late
evening meal)
• Watch for irregular heartbeats (arrhythmias)
• Watch for sudden increase of BP due to
cold weather or sickness like flu, etc.

31. What to do if taking hypertension drugs?
• Know your hemodynamic profile to help
doctors prescribing the right types of anti-
hypertension drugs and needed dosages.
• Know your 24-hr BP (circadian rhythm) for
the best time of taking medicines.
• Routine monitoring of BP for right amount
of drugs taking (titration), and to avoid
overdose (BP <90/60 of Hypo-tension)

32. Hemodynamic Profiling helped
Hypertension Treatment

33. Our Goal in CV Medicine is
Normal BP and Normal Hemodynamics

34. What’s Next in CV Medicine?
• Precision Medicine
CVD Pulse waveform
phenotype & genotype
studies…
• Personalized Medicine
Big Data Analysis of BP &
Hemodynamic profiles…

35. Cardiovascular Health Advisor
MyDiary4Health.com

36. MyDiary4Health is FREE for
Cardiovascular Health Care
It helps keeping your personal health
data and getting advices from doctors.
•Input blood pressure from any BP
monitor, or saved from DynaPulse-
PLUS app with Bluetooth enabled
DynaPulse monitors automatically
•Record Medication, Blood Glucose,
Weight, Exercise and Stress, etc.
Lifestyle parameters
Visit www.preventagen.com and its You-Tube videos for details.

37. Now you are ready to take Advantage of
CardiovascularHealth Advisorto Improve your
CardiovascularHealth
YourCV HealthDiaryandDataareessential forgettingthebest and
most effectiveadvices fromyourdoctors to manageandprevent
cardiovasculardiseases (CVD).
An Apple a Day, keeps doctors
away !
MyDiary4HealthDaily,
makes lifeHealthyandHappy!

38. ThankYou!
Preventagen, Inc.
Vista, California USA
www.preventagen.com & www.dynapulse.com

39. Whose Using It:Whose Using It:
BOGALUSA Heart Study, SWAN, TODAY, COMPASS, PTSD,
etc. Studies in USA, and other clinical studies overseas.

40. Whose Using It:Whose Using It:
Parke Davis
Medical Schools:
New York U.
Colorado U.
Chicago U.
UCSD, NTU, IIT,
Carabobo U...
Cincinnati Children H.
VA Hospitals (La Jolla, etc.)
Beijing People’s Hospital
Beijing 301 General H.
Taipei Municipal Hospital
Taipei General VA H.
Hundreds of Pharmacy
Stores in the US...