HYPERTENSION

ARE YOU AT RISK

FOR A HEART

ATTACK? STROKE?

OR HEART

DISEASE?

THESE ARE

COMLPLICATIONS OF

HYPERTENSION

LEARN WHAT

HYPERTENSION IS

AND HOW TO PREVENT

IT.

Teaching Objectives

Explain the prevalence and affects of hypertension in the U.S.

Define hypertension.Describe the mechanisms involved in the regulation of

blood pressure.Name the risks of Hypertension.Describe the signs & symptoms and complications of

hypertension. Define the classifications of hypertension. Describe preventative measures for hypertension.Explain how to monitor blood pressure at home using

manual and/or electronic devices.

Considerations

Hypertension is an important medical and public health issue.

It is estimated that 1 billion people Worldwide are affected by hypertension.

At least 65 million American adults, or 1 in 3, have high Blood pressure.

There is a direct relationship between hypertension and Cardiovascular disease (CVD).

There is a proportional risk for heart attack, heart failure, stroke, and renal disease with higher Blood pressure.

WHAT IS HYPERTENSION?

Blood pressure is expressed as two numbers, for example 120/80 mmHg These numbers represent the pressure against the walls of your blood

vessels as the blood moves through them. 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. Normal blood pressure is less than 120 (systolic) over 80 (diastolic),

typically written as 120/80 mm Hg (read 120 over 80 millimeters of mercury).

Hypertension, or High blood pressure is persistent Systolic blood pressure SBP ≥140 mmHg, and

Diastolic blood pressure DBP ≥ 90 mmHg.

Lets take a step back and learn a little about what happens in our bodies……..

The organs and tissue 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, also known as blood vessels and capillaries.

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.

Okay……so what does this mean?

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 the blood 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.

This overstretching of the blood vessels makes them more prone to rupture.

Damages to the vessels results in the development of Atherosclerosis ( hardening of the arteries).

Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke.

Who is at risk for Hypertension?

Age- Blood pressure rises with increasing age. Alcohol- Excessive alcohol intake is associated with Hypertension Cigarette smoking- Smoking increases your risk for Cardiovascular disease. If you have

hypertension & smoke and/or take Oral contraceptives you have a greater risk for Cardiovascular disease and blood clots.

Diabetes Mellitus- Hypertension is more common in Diabetics Elevated Cholesterol & Triglycerides- High levels of cholesterol & 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. Gender- Hypertension is more common in young adulthood men & middle aged men (<55 yr of

age). After the age off 55 Hypertension is more common in women. Family history- Having a close blood relative ( parents or sibling) with hypertension increases

your risk of developing hypertension. Obesity- Weight gain is highly associated with increased frequency of hypertension, especially

with central abdominal obesity. Ethnicity- The incidence of hypertension is twice as high in African Americans as they are in

whites. Sedentary lifestyle- Inactivity and weight gain are associated with high blood pressure &

increases the risk for heart disease. Stress- People exposed to repeated stress may develop hypertension more frequently than others.

Signs & Symptoms Of Hypertension

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 Palpitations Angina (chest pain) And difficulty breathing

• According to the American Heart Association There's 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.

There are also myths of headaches/nosebleeds believed to be related to HBP. According to the AHA studies have shown that people with higher systolic (top number) blood pressure were up to 40% less likely to have headaches ( except in the cases of Hypertensive crisis SBP ≥180mmHg and DSP ≥110mmHg)

It is important to know that nosebleeds can be associated with other factors,. Most common reasons for nosebleeds are dry air especially in hot climates like the desert Southwest (Arizona). Other causes may be allergies, sinusitis or anticoagulants such as Warfarin or aspirin.

Cardiovascular disease

Atherosclerosis – “ Hardening of the arteries”

Coronary Artery Disease- damage to the heart & 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.

Just like any other muscle in your body enlarges when you work it out.

This enlargement causes stretching of the heart muscle and eventually not enough blood is pumped out of the heart to the body to meet the body’s requirements of oxygen as discussed earlier.

Complications of Hypertension

Classifications of Blood Pressure

Normal BP ‘SBP <120 mmHg & DBP < 80 mmHg

PrehypertensionSBP 120-139 mmHg or DBP 80-89

Stage 1 HypertensionSBP 140-159 mmHg or DBP 90-99

Stage 2 HypertensionSBP ≥ 160 mmHg or DBP ≥ 100

mmHg

Prevention Of Hypertension

Maintain a healthy weight- A weight loss of even 10 pounds can decrease your SBP ( top number of your blood pressure)by 5-20mmHg .

Exercise- at least 30 minutes of aerobic physical activity (brisk walking, jogging, swimming) most days of the week.

Reduce salt and sodium intake- Foods that have a lot of salt are processed foods ( frozen dinners, canned foods) and Lunch meats.

Increase level of physical activity. Limit alcohol consumption to moderate

levels- Men should limit their alcohol intake to no more than 2 drinks per day and women to no more than one drink per day.

1 drink = 1.5 oz. alcohol or 12 0z. Beer, 5 oz. of wine, 1.5 oz 80 proof whiskey.

Monitor Blood pressure and know if it is high, low, normal, or borderline for hypertension.

Regular check ups with your Primary care Physician.

How can I prevent Hypertension ?

Prevention: Numbers to Remember

LifestyleMaintain a healthy weight

BMI < 25%Waist circumferenceMen: 40 in. or less

Women: 35 in. or l less

Diet5 or more servings of fruits &

veggies a day1 tsp or less of salt per day

ExerciseJogging, walking, swimming30 minutes a day most days

of the week

Quit smokingLimit Alcohol consumption to

1 0z per day

Regular Health Check upsLDL Cholesterol < 130 mg/dlHDL Cholesterol 50 mg/dl or

higher

Monitoring your Blood pressure

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 -top number between 120 and 139 mm Hg OR diastolic -bottom number between 80 and 89 mm Hg).

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.

Monitoring your blood pressure cont.

How to monitor your blood pressure 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 & supported (using a dining chair instead of a

sofa is recommended), feet flat (don’t cross your legs), and upper arm supported at heart level.

Make sure the middle of the cuff is directly over the brachial artery. Record all your readings & understand the readings (optimal BP is < 120/80

mmHg). 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.

Blood pressure monitoring devices

Prevention is Key

According to the U.S. Health and Human Services a combination of increased physical activity, moderation in alcohol intake, and consumption of an eating plan that is lower in sodium content and higher in fruits, vegetables and low-fat dairy products than the average American diet represents the best approach for preventing high blood pressure in the general population and in high risk groups.

References

Lewis, S.L., & Heitkemper, M.M., & Dirksen, S. R., & O’Brien, P. G., & Bucher, L. (2007). Medical Surgical Nursing. Philadelphia, PA: Mosby Elsevier.

Primary prevention of hypertension. (2002). National Institutes of Health , 14.

What is high blood pressure. (2010). Retrieved October 20th, 2010, from http://www.heart.org.