Essentials of Blood Pressure Management Session 5: Blood Pressure, Kidneys and Complications

Transcription

1 Kidney and HTN: Tw Beans in a Pd will begin at 12:00 PM ET Dwnlad sessin materials and view archived sessins at Add Flavr and Imprve Nutritin with Fresh Herbs Thursday, July 12 12:00 t 1:00 PM Add flavr and reduce sdium cntent f meals by adding fresh herbs. Tpics include grwing, harvesting, preparing, flavr cmbinatins, recipes and mre. Registratin: University f Flrida IFAS Extensin Institute f Fd and Agricultural Sciences (IFAS) Part f federal-state-cunty partnership dedicated t develping knwledge in agriculture, human and natural resurces, and the life sciences, and enhancing and sustaining the quality f human life by making that infrmatin accessible. IFAS includes: Teaching Research Extensin Extensin Outreach frm IFAS at lcal level All 67 cunties in Flrida have an Extensin presence Mst have a Family & Cnsumer Sciences Agent 1 2 Thank yu fr taking are in the series! We hpe it has prvided the knwledge and mtivatin t better manage yur bld pressure Please cmplete the shrt evaluatin that will be sent fllwing tday s webinar. We need yur feedback Essentials f Bld Pressure Management Series Sessin Five: Bld Pressure, Kidneys and Cmplicatins Anther shrt evaluatin will be sent ut n a week r s asking hw yu viewed the webinars, please cmplete this t. It will help us plan fr future series and Fllw-up survey in 4 t 5 mnths 3 4 1

2 Wendy Dahl, Ph.D. Assciate Prfessr and Extensin Specialist UF/IFAS Fd Science & Human Nutritin Depart. Webinar Team Julie England, M.S.,CFCS Seminle Cunty FCS & Fd Systems Extensin Agent Wendy Wd Lynch, M.S. Putnam Cunty FCS Extensin Agent Essentials f Bld Pressure Management Ptential effects f lifestyle changes n BP are cumulative Physical activity Stress management Quit smking Restrict alchl cnsumptin Reduce weight if needed r maintain healthy weight Nutritin Medicatin May be needed t manage hypertensin Wrk with healthcare prvider t the right medicatin(s) fr yu 5 6 Tday s Presenter Kidney and HTN: Tw Beans in a Pd Rajesh Mhandas, M.D., UF Health Rajesh Mhandas MD MPH Assistant Prfessr f Medicine Directr, Hypertensin Clinic Divisin f Nephrlgy, Hypertensin & Transplantatin University f Flrida 7 2

3 Prevalence f Hypertensin (%) Kidney Plays an Imprtant Rle in Regulating BP Kidney Plays an Imprtant Rle in Regulating BP <30 30 t <40 40 t <50 50 t <60 60 Kidney Functin (egfr in ml/min) Kidney Disease is assciated with high bld pressure Clin J Am Sc Nephrl 4: , 2009 Kidneys Play an Imprtant Rle in Regulating BP Kidneys Play an Imprtant Rle in Regulating BP Gluccrticid-remediable aldsternism Pseudhypaldsternism type 2 Familial hyperaldsternism type III Liddle's syndrme Syndrme f apparent mineralcrticid excess Early-nset AD hypertensin with exacerbatin in pregnancy Cngenital adrenal hyperplasia due t 11-beta-hydrxylase deficiency Cngenital adrenal hyperplasia due t 17-alpha-hydrxylase deficiency In Transplanted Kidneys High BP fllws the kidney All the knwn genetic diseases causing hypertensin are due t defects in salt and water handling by the kidney HYPERTENSION NORMAL BP 3

4 High BP Can Cause Scarring f Kidneys High BP Can Cause Scarring f Kidneys The kidney gets 25% f the ttal utput f the heart. Over time high BP can cause stiffening f vessels in the kidney High BP is an Imprtant Cause f Kidney Failure High BP Affects Mst Organ Systems Strke & Dementia Heart Attack & Heart Failure Artic Aneurysms Peripheral Vascular Disease Data: US Renal Data System

5 What are the Symptms f Kidney Failure? Hw Can Yu Detect Kidney Disease? Fatigue Nausea and Vmiting Lss f appetite Persistent itching Shrtness f Breath Cnfusin Muscle twitches and cramps Symptms f Kidney Failure are cmmn and nn-specific Kidney failure is asymptmatic until irreversible damage has ccurred Prtein in the Urine Hw Can Yu Detect Kidney Disease? Screening fr BPs: When Shuld Yu Start? Increase in Serum Creatinine and Bld Urea Nitrgen Creatinine Agency United States Preventive Task Frce > 18 years Annual fr thse > yr Q 3-5 yrs Annually in thse with risk factr Urea American Heart Assciatin > 20 years Q 2 years 5

6 Hme/Ambulatry SBP mmhg Essentials f Bld Pressure Management Sessin 5: Bld Pressure, Kidneys and Cmplicatins BPs at Dctr s Office Differs frm Hme BPs 200 Ambulatry BP Mnitring Masked Hypertensin Hypertensin Nrmtensin White Cat Hypertensin Office SBP mmhg 135 Pickering et al. Hypertensin 2002: 40: Hw Shuld Yu Check Yur Bld Pressures? Measure at the same time every day. Mrning and evening. 2 weeks after a change in treatment and during the week befre yur next appintment. Be still. Dn't smke, drink caffeinated beverages r exercise within 30 minutes. Empty yur bladder and ensure at least 5 minutes f quiet rest befre measurements. Sit cmfrtably Sit straight and supprted, feet flat n the flr, legs shuld nt be crssed. Yur arm shuld be supprted with the upper arm at heart level Ensure Prper Cuff Placement Crrect size, psitin and n interference frm clthing Take multiple readings Each time yu measure, take tw r three readings ne minute apart When Shuld Yu Treat Bld Pressure? Organizatin Definitin f HTN Start Treatment JNC 8 140/90 150/90 AHA 130/85 130/85 6

7 Prprtipn f HTN Essentials f Bld Pressure Management Sessin 5: Bld Pressure, Kidneys and Cmplicatins Life Style Mdificatins: DASH Diet Life Style Mdificatins: Exercise Ingredients Servings Fruits 4-5 Vegetables 4-5 Grains 6-8 Lean Meat 3-6 Lw Fat Dairy 2-3 Nuts 4-5 a week Oils 2-3 Sweets < 5 a week What kind? Hw hard? Hw much? Hw ften? Mnday Tuesday Wednesday Thursday Friday Saturday Sunday Life Style Mdificatins: Weight Lss Obesity and Hypertensin Obesity and HTN BMI < >30 Circulatin. 2012;126:

8 Life Style Changes and Bld Pressures Percentage Decrease in BP D A S H D i e t -11 A e r b i c s -6.5 L w S a l t -6 Life Style Changes W t L s s I n c K I s m e t r i c A l c h l s -4 Antihypertensive Medicatins Imprve BP and Clinical Outcmes Study Criteria Outcmes VA Cperative Study (1967) DBP mm Hg Established benefits f treating diastlic HTN VA Cperative Study (1970) DBP mm Hg Established benefit f treating milder HTN Systlic Hypertensin in Elderly (2000) SBP > 160 DBP <90 mm Hg Benefit f treating islated systlic HTN Even a 2 mm Hg reductin in BP can result in a 6% reductin in risk f heart disease and 15% reductin in risk f strke and mini-strkes JASH 8(6) (2014) Arch Intern Med Apr 10;155(7):701-9 Chice f Medicatins: ACE r ARB in Kidney Disease and Diabetes Chice f Medicatin: Des it Matter in HTN? Richard Jhnsn: Cmprehensive Clinical Nephrlgy JAMA. 2002;288(23):

9 Percentage (%) Essentials f Bld Pressure Management Sessin 5: Bld Pressure, Kidneys and Cmplicatins Medicatin Adherence is Lw in Hypertensin Medicatin Adherence is Lw in Hypertensin Cmplete nn-adherence 16 Partial nn-adherence 37 Partial nn-adherence (<50%) 31 Any nn-adherence 53 J Hypertens Apr;31(4): Surce: The Natinal Assciatin f Chain Drug Stres, Pharmacies: Imprving Health Reducing Csts, July BP: Hw Lw Can Yu G? ACCORD Study in Diabetics SBP Gal f 120 mm Hg cmpared t 140 mm Hg is assciated with increased adverse events and n apparent benefit SPRINT TRIAL In patients withut DM a SBP f 121 cmpared t 136 was assciated with a 25% risk reductin during a median fllw up f 3.26 years (2.19 % vs 1.65 %) Timing f Medicatins Des it Matter? Clcks Regulate Rhythm f Physilgical Functins N Engl J Med 2010; 362: N Engl J Med 2015; 373: Adapted frm Duma and Gumz, 2017, FRBM 9

10 Timing f Medicatin: Des it Matter? Summary. Kidneys have an imprtant rle in cntrlling bld pressures. Kidney disease can cause HTN and HTN can lead t kidney disease HTN as well as kidney disease is asymptmatic till late, s checking BP is essential t identify hypertensin early The DASH diet, aerbic exercise, weight lss can all help t decrease bld pressures Medicatins effectively decrease bld pressure and prevent lng term cmplicatins Ramón C. Hermida (2010) Chrnbilgy Internatinal, 27:8, Summary Even a difference in bld pressure f 2 mm Hg can have significant benefits in preventing heart disease and strke Recent studies suggest that in thse withut Diabetes, particularly yunger patients, BP shuld be reduced t 130/85 mm Hg r less Thse with DM and Kidney disease might benefit frm an ACE inhibitr r ARB Taking sme r at least ne f the medicatins at night might be beneficial t lwer night time bld pressures and imprve cardivascular utcmes. Please cmplete the shrt evaluatin that will be sent later tday 40 10