Heart Disease and Prevention PRESENTED BY: DOTTIE CRAIG NP- C, JANE ARCHER NP-C, KATHY DAPPER RN, NICCI FRAVEL RN

Heart Disease and Prevention PRESENTED BY: DOTTIE CRAIG NP- C, JANE ARCHER NP-C, KATHY DAPPER RN, NICCI FRAVEL RN

Objectives Identify Normal Systolic and Diastolic Blood pressures Recognize common Antihypertensive Agents Implement patient education into onsite activities and participants interactions

Stats About 600,000 people die of heart disease in the United States every year that s 1 in every 4 deaths. 1 Heart disease is the leading cause of death for both men and women. More than half of the deaths due to heart disease in 2009 were in men. 1 Coronary heart disease is the most common type of heart disease, killing more than 385,000 people annually. 1 Every year about 715,000 Americans have a heart attack. Of these, 525,000 are a first heart attack and 190,000 happen in people who have already had a heart attack. 2 Coronary heart disease alone costs the United States $108.9 billion each year. 3 This total includes the cost of health care services, medications, and lost productivity. 1. Kochanek KD, Xu JQ, Murphy SL, Miniño AM, Kung HC. Deaths: final data for 2009. [PDF-2M] National vital statistics reports. 2011;60(3).

What is a Normal Blood Pressure? Systolic Diastolic The top number, which is also the higher of the two numbers, measures the pressure in the arteries when the heart beats (when the heart muscle contracts). This is your heart at work. The bottom number, which is also the lower of the two numbers, measures the pressure in the arteries between heartbeats (when the heart muscle is resting between beats and refilling with blood). This is your heart at rest.

JNC 8 Guidelines Stages Normal <120/ <80 Prehypertension 120-139/ 80-89 Stage I 140-159/90-99 Stage II Treatments Healthy lifestyle with a good diet and exercise. Lifestyle changes that include diet, exercise, and wt loss. Starting BP control medication. If not at BP goal within 1 month of treatment, intiate second BP medication

Common Classes of Antihypertensive Drugs Beta-blockers Action: Reduces the heart rate, the heart's workload and the heart's output of blood, which results in lower blood pressure Examples: Atenolol (Tenormin), Metoprolol Tartrate (Lopressor), Nadolol (Corgard) Propranolol Hydrochloride (Inderal) Possible side effects: Insomnia, Cold hands and feet, Fatigue and Depression, Slow heartbeat Women who are pregnant should notify Healthcare provider, may not be safe

Common Classes of Antihypertensive Drugs ARB s Action: Angiotensin receptor blockers are similar to ACE s, but act by blocking the receptors for angiotensin, relaxing the blood vessels and decreasing blood pressure. Examples: Olmesartan (Benicar), Losartan (Cozaar), Valsartan (Diovan) Possible side effects: Dizziness, angioedema (swelling of face or tongue) Women should not take if pregnant or planning to become pregnant Avoid salt substitutes while taking ARB s due to potential to increase potassium

Common Classes of Antihypertensive Drugs ACE inhibitors Action: Angiotensin is a chemical that causes the arteries to become narrow, especially in the kidneys but also throughout the body. ACE stands for Angiotensin-converting enzyme. ACE inhibitors help the body produce less angiotensin, which helps the blood vessels relax and open up, which, in turn, lowers blood pressure. Examples: enalapril maleate (Vasotec), benazepril hydrochloride (Lotensin), ramipril (Altace) lisinopril (Prinivel, Zestril), perindopril (Aceon) Possible side effects: Skin rash, Loss of taste, Chronic dry, hacking cough, Kidney damage, Women should not take during pregnancy or become pregnant while taking ACE inhibitors

Common Classes of Antihypertensive Drugs Diuretics Potassium sparing, loop, thiazide and combination Action: Help the body get rid of excess sodium and water which results in lower blood pressure. They are often used in combination with additional prescription therapies Examples: Chlorthalidone (Hygroton), Chlorothiazide (Diuril), Furosemide (Lasix), Spironolactone (Aldactone), Hydrochlorothiazide (Microzide), Spironolactone+Hydrochlorothiazide (Aldactazide), Triamterene+Hydrochlorothiazide (Maxzide) Possible side effects: Low potassium blood level causing muscle weakness, leg cramps, fatigue. May cause increased blood sugar for diabetics

Common Classes of Antihypertensive Drugs Calcium channel blockers Action: This drug prevents calcium from entering the smooth muscle cells of the heart and arteries. When calcium enters these cells, it causes a stronger and harder contraction, so by decreasing the calcium, the hearts' contraction is not as forceful. Calcium channel blockers relax and open up narrowed blood vessels, reduce heart rate and lower blood pressure. Examples: Diltiazem Hydrochloride (Cardizem), Verapamil Hydrochloride (Calan SR) Nifedipine (Procardia), Bepridil (Vasocor), Amlodipine (Norvasc) Possible Side effects: Palpitations, Swollen ankles, Constipation, Headache, Dizziness

Considerations when taking Antihypertensives Nonsteroidal anti-inflammatory drugs like ibuprofen (Advil) or naproxen (Aleve) may decrease effectiveness Over the counter cold medications and decongestants (pseudoephedrine) should be avoided because they can cause a severe increase in blood pressure and kidney failure. Options such as Coricidin and saline nasal spray may be acceptable Abrupt discontinuation may cause chest pain, shortness of breath, rapid or irregular heart rate Absorption of antihypertensive medications may be decreased when taken with orange (atenolol) or grapefruit juice (Calcium channel blockers effects may be increased)

Heart Disease Risk Factors High blood pressure (hypertension) Family history of premature heart disease Example: female with MI before age 65 or male before 55 Diabetes Elevated cholesterol levels (hyperlipidemia or dyslipidemia) Low HDL (good cholesterol) less than 40 Age (men >45 or women >55) Cigarette smoking Obesity (BMI > 30) Carotid artery disease (CAD) Peripheral vascular disease (PVD)

DASH Diet and Diet recommendations Grains 7-8 servings daily Fats, oils, or fat-free dairy products 2-3 servings daily Fruits and veggies 4-5 servings daily Meat, poultry, and fish 2 or less servings daily Nuts and beans 4-5 servings per week Sweets Try to limit to less than 5 servings per week Avoid high sodium foods: Cold cuts, readymade/processed foods, and any pickled foods.

Lifestyle Recommendations STOP SMOKING!!! Lose wt if BMI is >25 Normal wt in BMI is 18.5-24.9 Reduce stress level Reduce sodium less than 2.3 grams per day Limit alcohol intake 1 ounce or less/day for men 0.5 ounce or less/day for women Eat fatty cold-water fish that are high in Omega 3 oils 3 times/day Salmon, anchovies (sardines), flaxseed Exercise moderately: 30 to 45 minutes at least 5 times a week

References American Heart Association (2011). Expert Consensus Document on Hypertension in the Elderly; 20:2037-114. American Heart Association (2014). Retrieved from http://www.heart.org/ Centers for Disease Control and Prevention (2013). Retrieved from http://www.cdc.gov/heartdisease/ Joint National Committee (2003). Assessment, Evaluation, and Treatment for High Blood Pressure in Adults; 7 th Report. Kochanek KD, Xu JQ, Murphy SL, Miniño AM, Kung HC. Deaths: final data for 2009. [PDF-2M] National vital statistics reports. 2011;60(3).