What is hypertension?

Transcription

1 HYPERTENSION

2 What is hypertension? Abnormally elevated arterial blood pressure that is usually indicated by an adult systolic blood pressure of 140 mm Hg or greater or a diastolic blood pressure of 90 mm Hg or greater, checked in two different occasions. Hypertension can be primary, or essential, and secondary to other medical conditions (e.g. renal, endocrine pathology etc.). More than 90% of cases are essential, or idiopathic

3 Statistics 1 billion people worldwide suffer from HTN In the US, 1 in 3 adults (approximately 73 million people) have some degree of high blood pressure. The treatment of HTN is the most common reason for office visits of nonpregnant adults to clinicians in the US and for use of prescription drug. HTN is a contributing factor to many other diseases including MI, stroke, heart failure, renal failure, and retinopathy, and is a leading cause of death, even more than death from malignancy. In 2004, an estimated 55,000 deaths were directly attributed to hypertension, and it was considered an underlying or contributing factor in at least another 300,000.

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5 Prevalence of HTN in the us

6 What is Blood Pressure? Is the pressure exerted on the artery walls by circulating blood. Measures the force of blood pushing outwards on arterial walls. Is written as twe numbers such as 117/79 High BP means the pressure in the arteries is elevated. Over time, if the force of the blood flow is often high, the tissue that makes up the walls of arteries gets stretched beyond its healthy limit.

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8 Effects of HTN Over the time the arterial wall becomes more stiff (sclerotic) and thick (fibrotic) to resist elevated BP and tension of the wall

9 jns 7 GUIDELINES The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) issued guidelines for classification and treatment of HTN

10 How IS high blood PRESSURE diagnosed? Accurate picture of blood pressure and chart what happens over time Starting at age 20, the American Heart Association recommends a BP screening with every regular visit every 2 years, BP < 120/80 mm Hg. Yearly screening is recommended if SBP mmhg or DBP mmhg. In the absence of end-organ damage, the diagnosis of mild HTN

11 symptoms Usually asymptomatic Headache Tinnitus Altered vision Vertigo Fainting

12 Hypertensive crises Hypertensive crises can present as hypertensive urgency or as a hypertensive emergency. American heart association recommends: If SBP180 mm Hg or higher OR a DBP 110 mm Hg or higher, wait a couple of minutes and take it again. If still at or above that level, seek immediate emergency medical treatment for a hypertensive crisis.

13 Hypertensive urgency Severe hypertension (SBP 180mmHg or higher, and DBP mmhg or higher) in asymptomatic patients. In other words, there is not associated organ damage. Symptoms may include: 1. Shortness of breath 2. Nosebleeds 3. Severe anxiety 4. Headache 1. How quickly should the BP be reduced? Over hours or days, or even slower 2. What is the BP target? <160 / < 100 mmhg 3. Too rapid lowering of BP can result to ischemia (stroke, MI)

14 Hypertensive Emergencies Generally occur at SBP > 180 or DBP > 120 diastolic Can occur at even lower levels in patients whose BP had not been previously high When BP reaches levels that are damaging organs Severe hypertension is associated with acute end-organ damage In some situations the patient needs to be hospitalized, even when BP is moderately elevated, but accompanied by following

15 Hypertensive Emergencies 1. Malignant HTN (uncontrollable and progressive) with retinal hemorrhages or papilledema, malignant nephrosclerosis 2. Cerebrovascular encephalopathy, ischemic CVA, intracerebral hemorrhage, subarachnoid hemoarrhage 3. Cardiac acute aortic dissection, acute LV failure, acute MI, s/p CABG 4. Renal involvement acute glomerulonephritis, s/p kidney transplant, hemolytic anemia 5. Excessive catecholamines pheochromocytoma crisis, cocaine overdose, rebound HTN s/p cessation of antihypertensives 6. Eclampsia 7. Surgical patients requiring immediate surgery, postop bleeding 8. Severe body burns 9. Severe epistaxis (nose bleeding)

16 If you are having hypertensive emergency If your SBP > 180 or DBP > 110, and are having any symptoms of possible organ damage (chest pain, shortness of breath, back pain, numbness/weakness, change in vision, difficulty speaking) do not wait to see if your pressure comes down on its own!!!seek emergency medical assistance immediately. If you can't access the emergency medical services (EMS), have someone drive you to the hospital right away.

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18 Consequences of uncontrolled BP Atherosclerosis (also contributing factor for HTN) Stroke Memory loss and Vascular dementia CAD and Heart attack Damage to the eyes Loss of kidney function Aneurism and Aortic dissection Angina (unstable chest pain) Pulmonary edema (fluid backup in the lungs) Eclampsia

19 Bp and esrd development

20 Stroke mortality related to bp and age

21 Chd mortality related to htn and age

22 Who should be treated?

23 Risk factors for primary HTN More common and severe in African Americans Family history parents Excess sodium intake Excess alcohol intake Obesity and weight gain Physical inactivity Diabetes mellitus and metabolic syndrome Dyslipidemia, independent of obesity More common among those with certain personality traits, such as hostile attitudes and time urgency/impatience (type A) Vitamin D deficiency is associated with an increased risk of hypertension

24 Possible contributing factors Stress Smoking and second-hand smoking Sleep Apnea

25 Nonpharmacologic therapy Cessation of smoking Dietary salt restriction Weight loss DASH (dietary approaches to stop HTN) diet consists of increased intake of fruits and vegetables and low-fat dairy products and can be combined with salt restriction Exercise Limited alcohol Vitamin D Vitamin D supplementation should be initiated in those with low or lownormal Comprehensive intervention lifestyle modification Patient education

26 Weight loss induced fall in dbp Maintain normal body weight with BMI kg/m mmhg per 10-kg weight loss

27 BP change and sodium reduction The mean change is compared with control values Recommended Na intake is < 2.4 g Na intake or < 6 g NaCl intake

28 Lifestyle changes Engage in regular aerobic physical activity such as brisk walking (at least 30 minutes per day, most days of the week) Consume a diet rich in fruits, vegetables, and low-fat dairy products with a reduced content of saturated and total fat

29 Icd codes

30 Icd codes

31 Icd codes

32 Any Questions?