Kidney and HTN: Tw Beans in a Pd will begin at 12:00 PM ET Dwnlad sessin materials and view archived sessins at http://bit.ly/ufbpwebpage 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: https://ufl.zm.us/webinar/register/wn_w8ulbveqd6-jeqyvryp9g 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
Wendy Dahl, Ph.D. Assciate Prfessr and Extensin Specialist UF/IFAS Fd Science & Human Nutritin Depart. wdahl@ufl.edu Webinar Team Julie England, M.S.,CFCS Seminle Cunty FCS & Fd Systems Extensin Agent julieeng@ufl.edu Wendy Wd Lynch, M.S. Putnam Cunty FCS Extensin Agent wendyw74@ufl.edu 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
Prevalence f Hypertensin (%) Kidney Plays an Imprtant Rle in Regulating BP Kidney Plays an Imprtant Rle in Regulating BP 100 90 80 70 60 50 40 30 20 10 0 <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: 1302 1311, 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
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 2015 4
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 >40 18-39 yr Q 3-5 yrs Annually in thse with risk factr Urea American Heart Assciatin > 20 years Q 2 years 5
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 180 160 Masked Hypertensin Hypertensin 140 120 100 Nrmtensin White Cat Hypertensin 100 120 140 160 180 200 Office SBP mmhg 135 Pickering et al. Hypertensin 2002: 40: 795-796 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
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 70 60 50 40 30 20 10 0 Obesity and HTN 20-39 40-59 60 BMI < 25 25-27 27-30 >30 Circulatin. 2012;126:2983-2989 www.statefbesity.rg 7
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 -5-5 -5 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 115-129 mm Hg Established benefits f treating diastlic HTN VA Cperative Study (1970) DBP 90-114 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) 437 447 Arch Intern Med. 1995 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):2981-2997 8
Percentage (%) Essentials f Bld Pressure Management Sessin 5: Bld Pressure, Kidneys and Cmplicatins Medicatin Adherence is Lw in Hypertensin 60 50 40 Medicatin Adherence is Lw in Hypertensin 30 20 10 0 1 Cmplete nn-adherence 16 Partial nn-adherence 37 Partial nn-adherence (<50%) 31 Any nn-adherence 53 J Hypertens. 2013 Apr;31(4):766-74 Surce: The Natinal Assciatin f Chain Drug Stres, Pharmacies: Imprving Health Reducing Csts, July 2010. 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; 362:1575-1585 N Engl J Med 2015; 373:2103-2116 Adapted frm Duma and Gumz, 2017, FRBM 9
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, 1629-1651 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