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)