High Blood Pressure Module
What is it?
Definitions
Hypertension = high blood pressure
Systolic pressure = higher number
Which is the pressure that the heart must generate to pump blood to the rest of the body
Hypertension if 140 or greater for an adult
Diastolic pressure = lower number
Which is the the lowest pressure that the heart must pump against and is the pressure needed to pump blood to the heart’s arteries (that is, the coronary arteries)
Hypertension if 90 or greater for an adult
Primary (essential) hypertension
Elevated blood pressure for which no reason has been determined or for which the reason is not apparent
90 to 95 percent of all high blood pressure cases
Secondary hypertension
Elevated blood pressure which is caused by some other disease or condition
5 to 10 percent of all high blood pressure cases
Prevalence
As many as 50 million Americans aged 6 and older have high blood pressure
One in five Americans (and one in four adults) has high blood pressure
The cause of 90 to 95 percent of the cases of high blood pressure is not known; however, it is easily detected and usually controllable
Symptoms
Called the "silent disease" because often people are unaware of it being present
At higher levels
Headache
Fatigue
Nosebleed
Long term presence
Damage to organs
Brain
Heart
Kidneys
Arteries throughout the body
Risk factor for
Heart attack
Stroke
Kidney failure
Diagnosis
Readings of over 140/90
3 separate occasions
Detection
Physician’s office
Dentist’s office
Blood pressure screening services
Community Hospital Anderson screenings
Pharmacy screenings
Self blood pressure monitoring (Demonstrate use of both mercury manometer and spring-loaded dial-type cuffs on an assistant)
All readings are compared to those obtained by the readings on a column of mercury that is calibrated in height in millimeters (25.4 millimeters = 1 inch)
After 5 minutes of rest and seated
Avoid smoking and avoid ingesting caffeine for 30 minutes prior
Cuff size—inflatable bladder inside the cuff should encircle at least 80 percent of the arm
Systolic pressure should be recorded (when the pressure in the cuff is being slowly reduced) at the first appearance of pulsing sound
Diastolic pressure should be recorded (when the pressure in the cuff is being slowly reduced) at the disappearance of pulsing sound
Two or more readings separated by 2 minutes should be averaged. If the first two readings differ by more than 5 millimeters of mercury, additional readings should be obtained and averaged
Prevention
Regular aerobic exercise
30 minutes
minimum of 3 to 4 times per week
salt restriction
smoking avoidance
low fat diet
maintain desirable body weight
adequate intake of fruits and vegetables
stress reduction
limit alcohol intake
avoidance of over the counter products which might elevate blood pressure
decongestants
appetite suppressants
caffeine (most coffee, tea, and soft drinks)
licorice (as may also be found in chewing tobacco)
nonsteroidal anti-inflammatory medicines for fever, aches, or arthritis
ibuprofen (Advil, Nuprin, Motrin-IB)
naproxen (Aleve)
Treatment
Lifestyle changes
Medications
Diuretics – class of medicines which cause the kidneys to remove more salt (sodium) and water from the bloodstream than usual and convert it to urine
Beta Blockers – class of medicines that reduce the heart’s tendency to beat faster. They do this by blocking specific receptors ("beta receptors") located on cells of the heart , reducing the effects of chemical messages that would have increased heart rate
ACE Inhibitors – (angiotensin converting enzyme inhibitors) – class of medicines which work primarily in the kidneys to interfere with the body’s production of a chemical called angiotensin (angiotensin normally causes constriction of blood vessels and subsequent increase in blood pressure)
Calcium Channel Blockers – Muscles of the blood vessel walls need calcium to contract. These medicines block local inflow of calcium into the muscles which line blood vessels which prevents contraction of these muscles and which in turn allows vessels to dilate and blood pressure to fall.
Alpha Blockers – This class of medicines prevent nerve fiber transmission of impulses from nerve fiber endings on to blood vessel receptor sites (alpha receptors), thus producing dilatation of vessels with subsequent drop in blood pressure).
Angiotensin II Receptor Blockers – (sometimes referred to as ARB’s) – Angiotensin II is a body produced chemical which causes elevation of blood pressure and causes more stress on the heart and causes constriction of small blood vessels. As opposed to ACE-inhibitors discussed previously which block manufacture of angiotensin II, the ARB’s work by blocking the receptors (angiotensin II receptors) where angiotensin II would normally bind and work to raise blood pressure.
Frequent self-monitoring of blood pressure
Goals of Therapy (per JNC-6, i.e., Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure)
Systolic pressure under 140 (and lower if tolerated)
Diastolic pressure under 90 (and lower if tolerated)
Diabetic population
Systolic pressure under 130
Diastolic pressure under 85
When to call your doctor
If blood pressure is over 130/85
Blood pressure checks every few years and yearly as age
What your doctor looks for
Blood pressure reading
Testing
Kidney function
Heart size
E. K. G.
Chest X-ray
Other tests as needed to look for underlying causes
Factors influencing prognosis
Severity of blood pressure
Underlying cause
Degree of control
Co-morbidities (i.e., other illnesses existing at the same time)