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Hypertension: The Whole Story
Raven Voora, MDHypertension Specialist
UNC Kidney Center
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Hypertension = elevated blood pressure
Category Systolic Blood Pressure
Diastolic Blood Pressure
Normal < 120 <80
Pre-hypertension 120-139 80-89
Hypertension – Stage 1
140-159 90-99
Hypertension – Stage 2
>160 >100
Classification of hypertension: JNC 7
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Symptoms of Hypertension
• Hypertension is dangerous because it gives off no warning signs or symptoms
• Having your blood pressure checked regularly is the only way to tell if your blood pressure is high
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Diagnosis of Hypertension
• Based upon the average of two or more properly measured readings at each of two or more visits after an initial screen
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White Coat Hypertension
• Blood pressure is repeatedly normal when measured outside of the provider’s office (home, work) but persistently elevated in the office.
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How to Measure Your Blood Pressure
• Use an automatic monitor– Check the accuracy of your home monitor at the
doctor’s office• Use a monitor with an arm cuff
– Not a wrist or finger cuff– Use a large cuff if you have a large arm
• After putting on the cuff, sit quietly for a few minutes before checking your pressure
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Essential vs Secondary Hypertension
• The majority of patients with hypertension have “essential hypertension” (≈90-95% of cases)
• Less frequently, there is an underlying condition that may lead to hypertension. This is called “secondary hypertension” (≈5-10% of cases)
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Pathogenesis of Essential Hypertension
• Poorly understood– Complex interaction between genetic and
environmental factors• These factors lead to narrowing of blood
vessels – If vessels wide open blood flows
easily– If vessel narrows pressure inside
increases causing hypertension
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Factors Influencing the Development of Hypertension
Uncontrollable Factors• Family History of
hypertension• Reduced kidney mass at
birth• African-American ancestry• Age
Controllable Factors• Obesity and weight gain• Physical inactivity• Excess sodium intake• Alcohol consumption
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Controllable Factors Influencing the Development of Hypertension
• Excess sodium intake
• Certain segments of the population are ‘salt sensitive’ because their blood pressure is affected by salt consumption
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Controllable Factors Influencing the Development of Hypertension
• Alcohol consumption
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How Can Hypertension Be Treated?
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Treatment of Hypertension
• Engage in Lifestyle Modifications
• Avoid Medicines That Can Raise Blood Pressure
• Take Medications That Can Lower Blood Pressure
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Treatment of Hypertension
• Engage in Lifestyle Modifications
• Avoid Medicines That Can Raise Blood Pressure
• Take Medications That Can Lower Blood Pressure
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Lifestyle Modifications
• Maintain a healthy weight, lose weight if overweight.
• Be more physically active.• Drink alcoholic beverages in moderation.• Reduce the intake of sodium in the diet to
approximately 2400 mg/day.
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Lifestyle Modifications
Modification Approximate SBP Reduction
Reduce Weight 5-20 mmHg for every 10 kg (22 lb) loss
Limit ETOH consumption 2-4 mmHg
Reduce Na intake to < 2.4 gm/day 2-8 mmHg
Aerobic activity for 30-34 min/day 4-9 mmHg
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Reading a Food Label for Sodium Content
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Food LabelsClaim Amount
Low Sodium >140 mg/serving
Very Low Sodium >35 mg/serving
Sodium Free >5 mg/serving
Reduced Sodium 25% less than original
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Reducing Sodium in the Diet
• Use fresh poultry, fish and lean meat, rather than canned or processed.
• Buy fresh, plain frozen or canned with “no salt added” vegetables.
• When available, buy low- or reduced-sodium or ‘no-salt-added’ versions of foods like:– Canned soup, canned vegetables, vegetable juices– cheeses, lower in fat– condiments like soy sauce– crackers and snack foods like nuts– processed lean meats
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The DASH Diet
• The Dietary Approaches to Stop Hypertension clinical trial (DASH)
• Hypothesis: Does a diet rich in fruits, vegetables, and low fat dairy foods lower blood pressure in individuals with hypertension and high normal blood pressure?
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DASH Study
• Control:– Ca, Mg, & K ~ 25% of US diet– Macronutrients and fiber ~ US average
• Fruits and Vegetables– Fruits and vegetables increased to 8.5 servings– K and Mg to 75%
• Combination:– Add 2-3 servings low-fat dairy to fruit & vegetable diet.– Ca, K and Mg increased to 75%
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DASH Study Outcomes
• Fruit and Vegetable Diet:– Decrease in systolic and diastolic blood pressure in entire
study group and in the hypertensive subgroup.
• Combination Diet:– Significant decrease in both systolic and diastolic blood
pressure in both groups.– Greatest drop was in systolic BP in hypertensive group
(11.4 mmHg)
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DASH Diet Implications
• Combination diet affects comparable to pharmacological trials in mild hypertension.
• Population wide reductions in blood pressure similar to DASH results would reduce CHD by ~ 15% and stroke by ~27%
• Great potential in susceptible groups: African Americans and elderly.
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Treatment of Hypertension
• Engage in Lifestyle Modifications
• Avoid Medicines That Can Raise Blood Pressure
• Take Medications That Can Lower Blood Pressure
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Medicines Can Raise Blood Pressure
• Analgesics– NSAIDs, COX-2 inhibitors, Aspirin
• Decongestants/Allergy Medicines• Diet pills• Stimulants
– Methylphenidate• Herbals (Ephedra or Ma Huang)
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Treatment of Hypertension
• Engage in Lifestyle Modifications
• Avoid Medicines That Can Raise Blood Pressure
• Take Medications That Can Lower Blood Pressure
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Antihypertensive Medications
• Most common types of medicines used to treat hypertension:– “Diuretics”
• Rid the body of excess fluid and salt
– “Ace-inhibitors” or “Angiotensin Receptor Blockers”• Block hormones that cause arteries to narrow
– “Calcium channel blockers”• Reduce the heart rate and relax blood vessels
– “Beta blockers”• Reduce the heart rate and work of the heart
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Guidelines Have Established Treatment Goals
Condition mm Hg
Essential HTN < 140/90
Diabetes Mellitus < 130/80
Chronic Kidney Disease <130/80
Age > 65 ????
JNC 7
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HypertensiveN = 73.6 million
Aware (79%)
Treated (69%)
Controlled (45%)
Uncontrolled (55%)
Untreated (10%)
Unaware (21%)
Control of Hypertension is Not Adequate
• Nearly 55% of US hypertensive patients do not achieve systolic pressure goal of less than 140/90 mmHg
Based on Data from NHANES/NCHS 2005-6
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Renal Denervation
ABLATION OF RENAL SYMPATHETIC NERVES
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Baroreflex Activation Therapy
ELECTRICAL STIMULATION OF CAROTID SINUS BARORECEPTORS
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Remember ….
• Hypertension is a lifelong disease. It can be controlled, not cured
• Know your blood pressure. Have it checked regularly
• Maintain a healthy lifestyle• If you do have hypertension, take your
medications as prescribed
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Questions?
• From all the things I discussed today, what can you do to help control your blood pressure?
• What is most important for you and how can you make that part of your routine?