Let’s Understand Hypertension

WHAT WE DO

  1. We review the current literature on specific diseases and note the key points as well as questions that come from the literature to help guide in conversations with clinicians and caretakers.
  2. We deliver the literature review and key points so that you do not have to do it.
  3. Still…

This is a lot of information!!!!

We also condense it (see Diabetes) to make it easier to understand.

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HYPERTENSION (High blood pressure)

Key Points

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  • Lifestyle modification is the number one guideline and recommendation from associations and committees including:
    • American Society of Hypertension and the International Society of
    • The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure
    • Hypertension

Additional information about lifestyle modifications:

  • A study of the Dietary Approaches to Stop Hypertension “DASH” diet proved to be the best lifestyle change over prescription medication to date.
    • Fruit and vegetables were the food groups of the DASH diet associated with reduced BP values in patients with type 2 diabetes and that eating them may play protect against increased BP, This was a cross-sectional study involving 225 patients (de Paula TP, 2012).
    • Being physically active is recommended throughout the literature
    • Maintaining a healthy weight is recommended throughout the literature
    • Limiting alcohol intake is recommended throughout the literature
    • Managing and coping with stress is recommended throughout the literature

Take away: Ask for a consultation with a dietitian for education on the DASH diet. This should be covered under insurance if the dietitian is part of a hospital where you see your doctor.

Considerations should be taken for African Americans who have very high rates of increased blood pressure.

  • Calcium channel blockers and diuretics work best
  • Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and beta-blockers show lower response rates.
  • Combination Therapies work even better

Take away: If you are African American (black), ask your physician what type of medication you are on between a and b above)

  • If you have secondary hypertension (caused by something else going on in your body), it may be treated. Take away: make sure that you get checked for/remember the following. Especially if it is an isolated event and your BP has always been “Normal.”Chronic kidney disease
    • Renal artery stenosis (the narrowing of one of the renal arteries)
    • Excessive aldosterone secretion (aldosterone is a hormone made by the adrenal glands helps regulate sodium and potassium levels in the body)
    • Pheochromocytoma (a type of rare, usually noncancerous tumor that develops in cells in the center of an adrenal gland)
    • Sleep apnea (when sleep is interrupted by inability to breath properly)

The numbers

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  • In a study by Wright JD, et al, “mean systolic blood pressure was 122 mm Hg for all adults aged 18 and over; it was 116 mm Hg for normotensive adults, 130 mm Hg for treated hypertensive adults, and 146 mm Hg for untreated hypertensive adults.
  • Mean diastolic blood pressure was 71 mm Hg for all adults 18 and over; it was 69 mm Hg for normotensive adults, 75 mm Hg for treated hypertensive adults, and 85 mm Hg for untreated hypertensive adults.
  • There was a trend of increasing systolic blood pressure with increasing age” (Wright JD, et al, 2011)
  • “Men had higher mean systolic and diastolic pressures than women.
  • There were some differences in mean blood pressure by race or ethnicity, with non-Hispanic black adults having higher mean systolic and diastolic blood pressures than non-Hispanic white and Mexican-American adults, but these differences were not consistent after stratification by hypertension status and sex” (Wright JD, et al, 2011)
  • In a study, “Independent effects of weight change and attained body weight on prevalence of arterial hypertension in obese and non-obese men,” changes in body weight showed to have a great influence on arterial hypertension. Men with higher BMI had more increased chances of hypertension. Hypertension was most common in those patients who became obese during adulthood (Sonne-Holm S, 1989).
  • The National Heart, Lung and Blood Institute currently defines a blood pressure under 120/80 as “normal” (Taylor BC, Wilt TJ, Welch HG, 2011)
  •  BP provides relatively little independent mortality risk information in adults over 50.
  • Diastolic is an important predictor of mortality in younger adults.
  • Systolic BP is more important in older adults than in younger adults (Taylor BC, Wilt TJ, Welch HG, 2011).
  • The 2007 Guidelines for Management of Hypertension provide the following for blood pressure:
    • 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 (Mancia G, De Backer G, et al., 2007)

Distinct Concerns with Black Patients (African Ancestry)

  • According to an article “Clinical practice guidelines for the management of hypertension in the community a statement by the American Society of Hypertension and the International Society of Hypertension,” Hypertension is more common finding in black people (Weber MA et al., 2014).
  • It occurs at a younger age as black people are more sensitive to blood pressure raising with increased salt intake and obesity.
  • Black patients with hypertension are more susceptible to strokes and hypertensive kidney disease (3-5 times more than white people).
  • Black patients have a tendency to also respond to antihypertensive drugs in a different manner than whites patients.
  • There is a tendency for black patients to have differing blood pressure responses to the available antihypertensive drug classes:
    • Calcium channel blockers and diuretics work best
    • Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and beta-blockers show lower response rates.
    • Combinations of therapies, however, show high response rates. Most will need to be on more than one medication to get the best effects (Weber MA et al., 2014).

Causes of Hypertension

  • Primary hypertension (sometimes called essential hypertension) affects about 95% of all cases according to the article “Clinical practice guidelines for the management of hypertension in the community a statement by the American Society of Hypertension and the International Society of Hypertension” (Weber MA et al., 2014).
    • Cause is unknown but environmental and genetic factors are being studied
    • Environmental causes are:
      • Excess salt intake
      • Obesity
      •  inactive lifestyle
    • Genetic factors are
      • Abnormally high renin-angiotensin-aldosterone system activity
      • Abnormally high sympathetic nervous system activity
      • Predisposition to the effects of dietary salt on blood pressure.
    •  Stiffening of the aorta with age is another factor.
      • Symptoms are high systolic blood pressure with normal diastolic blood pressure
        • (Systolic (top number)/Diastolic (bottom number)
  • Secondary Hypertension affects about 5% of all hypertension cases (Weber MA et al., 2014)
    • The cause can be identified and sometimes treated.
    • The main types are:
      • Chronic kidney disease
      • Renal artery stenosis (the narrowing of one of the renal arteries)
      • Excessive aldosterone secretion (aldosterone is a hormone made by the adrenal glands helps regulate sodium and potassium levels in the body)
      • Pheochromocytoma (a type of rare, usually noncancerous tumor that develops in cells in the center of an adrenal gland)
      •  Sleep apnea (when sleep is interrupted by inability to breath properly)

Diet and Lifestyle

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  • In a study “Diet and lifestyle risk factors associated with incident hypertension in women” body mass index alone was the most powerful predictor of hypertension. This included people with a BMI of 25 or greater. Patients used the Dietary Approaches to Stop Hypertension (DASH) diet and did at least 30 minutes of exercise per day, and had moderate alcohol intake
  • Low-risk dietary and lifestyle factors were associated with a significantly lower incidence of hypertension (Forman JP, 2009)
  • In an article, “An effective Approach to high Blood Pressure control”. American Heart Association, American College of Cardiology and the CDC all say that the first line treatment is lifestyle change.  The second line of treatment is medication

See the image below (Alan S. Go, 2013).

See Table 1 below:

…Continued upon request.