HYPERTENSION GUIDELINES

REVIEW

• Organs and tissues in your body need oxygen to survive. • Oxygen is bound to your blood and is delivered (after an

exchange of carbon dioxide for oxygen in your lungs) to your body by blood vessels.

• When your heart beats, it creates pressure that pushes blood through your arteries and veins.

• Blood pressure is the force of blood pushing against your blood vessel walls.

• Your blood pressure must be within a normal range to properly deliver this oxygen rich blood to your organs and tissues in order to survive.

REVIEW

• When someone has HIGH BLOOD PRESSURE, this increased force makes the heart work harder to pump blood to the body.

• The increased force puts a strain on both the heart and vessels.• If the force of the blood flow is high for some time, eventually the

tissue that makes up the walls of the arteries gets stretched beyond its healthy limit.

• Overstretching of blood vessels makes them more prone to rupture.• Damages to the vessels results in the development of hardening of

the arteries (atherosclerosis).

• Uncontrolled high blood pressure increases your risk of serious health problems, including HEART ATTACK AND STROKE.

BLOOD PRESSURE

• expressed as two numbers, these represent the pressure against the walls of your blood vessels as the blood moves through them

• example: 120/80 mmHg

read as: 120 over 80 millimeters Mercury• the top number (or first number) represents the

SYSTOLIC PRESSURE, which occurs when the heart contracts.

• the bottom number (or second number) represents the DIASTOLIC PRESSURE, which occurs when the heart relaxes.

HYPERTENSION

• High Blood Pressure

• medical condition in which constricted arterial blood vessels increase the resistance to blood flow, causing an increase in blood pressure against vessel walls

• the most common disease in primary care, with estimated about 1 billion people affected worldwide

Medical Education & Information – for all Media, all Disciplines, from all over the WorldPowered by

2013 ESH/ESC Guidelines for the management of arterial hypertension

The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) - J Hypertension 2013;31:1281-1357

Definitions and classification of office BP levels (mmHg)*

Category Systolic Diastolic

Optimal <120 and <80

Normal 120–129 and/or 80–84

High normal 130–139 and/or 85–89

Grade 1 hypertension 140–159 and/or 90–99

Grade 2 hypertension 160–179 and/or 100–109

Grade 3 hypertension ≥180 and/or ≥110

Isolated systolic hypertension ≥140 and <90

* The blood pressure (BP) category is defined by the highest level of BP, whether systolic or diastolic. Isolated systolic hypertension should be graded 1, 2, or 3 according to systolic BP values in the ranges indicated.

Hypertension:SBP >140 mmHg ± DBP >90 mmHg

TYPES OF HYPERTENSION

PRIMARY•also called “essential hypertension”•most cases the causes of this type is not known•majority of people with this type feel no different from those who have normal blood pressure.

SECONDARY•this is when high blood pressure is as a result of other medical problems (like kidney or liver problem) or medication

CAUSES AND RISK FACTORS

• Age- Blood pressure rises with increasing age.• Gender- Hypertension is more common in young

adulthood men and middle aged men (<55 years of age). After the age of 55, it is more common in women.

• Family history- Having a close blood relative (parents or siblings) with hypertension increases your risk of developing hypertension.

• Ethnicity- The incidence of hypertension is twice as high in African Americans as they are in whites.

CAUSES AND RISK FACTORS

• Obesity- Weight gain is highly associated with increased frequency of hypertension, especially with central abdominal obesity.

• Diabetes Mellitus- Hypertension is more common in diabetic patients

• Elevated Cholesterol and Triglycerides- High levels of cholesterol and triglycerides are primary risk factors for atherosclerosis (plaque build up in your blood vessels).

• Too much salt in your diet- High sodium intake contributes to high blood pressure and causes water retention.

CAUSES AND RISK FACTORS

• Alcohol- Excessive alcohol intake is associated with hypertension

• Cigarette smoking- Smoking increases your risk for cardiovascular disease. If you have hypertension and smokes, you have a greater risk for cardiovascular disease and blood clots.

• Sedentary lifestyle- Inactivity and weight gain are associated with high blood pressure and increases the risk for heart disease.

• Stress- People exposed to repeated stress may develop hypertension more frequently than others.

SIGNS AND SYMPTOMS

• Hypertension is often called the “Silent killer” because it is frequently asymptomatic- meaning “without symptoms” until it has become severe and damage to organs have occurred.

• A person with severe hypertension may have symptoms caused by the effects on the blood vessels which my be:

– Fatigue– Reduced activity tolerance– Dizziness– Blurred visions– Nape pain– Palpitations– Angina (chest pain)– Difficulty breathing

SIGNS AND SYMPTOMS

• According to the American Heart Association, there is a common misconception that people with high blood pressure will experience symptoms such as nervousness, sweating, difficulty sleeping, or facial flushing.

• The truth is that HBP (high blood pressure) is largely a symptomless condition.

• If you ignore your blood pressure because you think symptoms will alert you to the problem, you are taking a dangerous chance with your life.

• Everybody needs to know their blood pressure numbers, and everyone needs to prevent high blood pressure from developing.

TREATMENT

• Step 1: lifestyle modifications • Diet and exercise• Limit alcohol and tobacco use• Reduce stress factors

• Step 2: seek medical advise– If lifestyle changes are not enough, drug therapy will be introduced

• Step 3:– If previous steps did not work, drug dose or type will be changed

or another drug is added• Step 4:

– More medications are added until blood pressure is controlled

COMPLICATIONS

• Cardiovascular Disease • Atherosclerosis – “Hardening of the arteries” • Coronary Artery Disease- damage to the heart and coronary arteries• Cerebrovascular Disease• Peripheral Vascular Disease• Stroke or Heart Attack• Angina- Chest pain • Kidney damage• Vision loss

• HEART FAILURE- Over time as the heart works harder to push the blood throughout the body, the heart (which is a muscle) enlarges.

Medical Education & Information – for all Media, all Disciplines, from all over the WorldPowered by

2013 ESH/ESC Guidelines for the management of arterial hypertension

The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) - J Hypertension 2013;31:1281-1357

LIFESTYLE CHANGES FOR HYPERTENSIVE PATIENTS

* Unless contraindicated. BMI, body mass index.

RECOMMENDATIONS TO REDUCE BP AND/OR CV RISK FACTORS

Salt intake Restrict 5-6 g/day

Moderate alcohol intakeLimit to 20-30 g/day men,

10-20 g/day women

Increase vegetable, fruit, low-fat dairy intake

BMI goal 25 kg/m2

Waist circumference goalMen: <102 cm (40 in.)*

Women: <88 cm (34 in.)*

Exercise goals≥30 min/day, 5-7 days/week

(moderate, dynamic exercise)

Quit smoking

PREVENTION

MAINTAIN A HEALTHY WEIGHT•a weight loss of even 10 pounds can decrease your systolic by 5-20mmHg

INCREASE LEVEL OF PHYSICAL ACTIVITY

MONITOR BLOOD PRESSURE •know if it is high, low, normal, or borderline

REGULAR CHECK UPS WITH YOUR PRIMARY CARE PHYSICIAN.

Frequently Asked Questions

• How dangerous is hypertension? – It is called the silent killer for good reason

• contributes to more than 200,000 deaths each yea, • afflicts more than 1 billion worldwide • is on the rise, increasing 35 percent in just ten years from the

late 1980s to the late 1990s• costs more than $37 billion per year in health care

• What is the DASH diet? – The Dietary Approaches to Stop Hypertension (DASH) diet is an

eating plan designed to prevent and treat hypertension.• Does potassium help lower blood pressure?

– Yes, potassium has a favorable effect on blood pressure. Potassium is richly present in the DASH diet, which is recommended for persons with hypertension

BP Monitoring

• Your blood pressure should be taken during your regular health check ups.

• Your doctor may recommend checking your blood pressure at home if you have risk factors of hypertension or if you have been diagnosed with pre-hypertension (systolic: between 120 and 139mmHg OR diastolic: between 80 and 89mmHg).

• A record of readings taken over time can provide you and your healthcare provider a clearer picture of your blood pressure.

AHA Recommendation:• The American Heart Association recommends an automatic, cuff-

style, bicep (upper-arm) monitor. Wrist and finger monitors are not recommended because they yield less reliable readings.

BP Monitoring

• Use a bicep (upper-arm) monitor for more accurate readings as recommended by the AHA.

• Electronic or automatic versions at work or in your local pharmacy/shopping center may be used but can give inaccurate readings.

• A manual blood pressure cuff can also be used if you have someone that knows how to accurately use it.

• Make sure the cuff fits• Be still • Sit correctly with your back straight and supported (using a dining

chair instead of a sofa is recommended), feet flat (do not cross your legs), and upper arm supported at heart level.

• Make sure the middle of the cuff is directly over the brachial artery.

BP Monitoring

• Record all your readings and understand the readings (optimal BP is <120/80mmHg).

• The average of three readings, at least one minute apart, should be used as the BP reading.

• Consult your health care provider if you get several high recordings.

THANK YOU!