HYPERTENSION

AND HIV
A Training Guide for Health Professionals

JNC-8 Guidelines of Hypertension

New guidelines released by Joint National Committee to simplify the care of

HYPERTENSION (high blood pressure)

Advise setting blood pressure goals pertaining to specific comorbidities of

each patient
Comorbidities can affect disease progression and/or response to treatment
Common comorbidities:
Heart disease
Kidney disease
Diabetes

For clients 60 years or older who do not have diabetes or chronic kidney

disease, new goal blood pressure is less than 150/90 mmHg.

For clients age 18-59 without major comorbidities, and for clients 60 years

or older who have diabetes, chronic kidney disease, or both, new blood
pressure goal is less than 140/90 mmHg.

Hypertension/High Blood Pressure

When blood pressure is high, this is
called hypertension.
A measurement of 140/90 mmHg is
considered to be hypertensive.

http://en.wikipedia.org/wiki/Blood_pressure

Approximately 76.4 million adults in the US are hypertensive.

Blood pressure is the force of blood against artery walls as it circulates.
When arteries are narrowed or constricted, it is harder for the blood to flow, and pressure in arteries rises.
When pressure rises, the heart must work harder to pump blood through these arteries.

Cardiovascular morbidity and mortality increase as both systolic and diastolic blood pressure

(SBP and DBP) rise.

"Systolic" refers to blood pressure when the heart beats (heart pumps out blood).
"Diastolic" refers to blood pressure when the heart is at rest between beats (heart is filled with blood).

BP Category

Systolic BP
(mmHg)

Diastolic BP
(mmHg)

Normal

Less than 120

And

Less than 80

Pre-Hypertension

120-139

Or

80-89

High BP Stage 1

140-159

Or

90-99

High BP Stage 2

160 or higher

Or

100 or higher

Hypertensive Crisis

Higher than 180

Or

Higher than 110

Clients in the pre-hypertension category should be counseled

on lifestyle changes to prevent high blood pressure.

Clients with high blood pressure need to be counseled and

assessed by their primary care provider.

Hypertensive crisis is an emergency, and clients are at risk for

organ damage.

Effects on the Body

Hypertension is known as a silent

killer because it is usually

asymptomatic.
Clients usually have no warning from the body

that their blood pressure is high.

Long term hypertension has many

complications. It can lead to:

Heart attack
Stroke
Heart failure
Kidney damage
Vision loss
Erectile dysfunction
Pulmonary edema
Memory loss
Death

http://en.wikipedia.org/wiki/Hypertension

Other Complications

Hypertensive
retinopathy can
lead to vision
changes, optic
nerve damage,
and vision
loss.
http://en.wikipedia.org/wiki/Hypertensive_retinopathy

Hypertension
increases risk
of blood vessel
damage in the
brain, leading
to stroke.
https://www.nhlbi.nih.gov/health/health-topics/topics/heartattack/

Hypertension increases plaque formation in the coronary arteries,

which can lead to thrombosis, myocardial ischemia, and infarct.
Complications include heart failure and life-threatening arrhythmias.

http://en.wikipedia.org/wiki/Stroke

Risk Factors

Genetics
Family history of HBP
African American race

Age
Risk increases with age

Gender
Males are at more risk

Overweight
Lack of physical activity
Diabetes mellitus

Poor diet
High salt intake
High saturated fat intake
Restaurant, processed foods

Tobacco use
Excessive alcohol consumption
Cholesterol

Elevated LDL levels

Low HDL levels

Reducing Blood Pressure:

Positive Lifestyle Changes
digitalart / FreeDigitalPhotos.net

Reduce dietary salt

DASH (Dietary Approaches to Stop Hypertension) eating plan:

Eat less saturated fat, cholesterol, and total fat

Focus on fruits, vegetables, and fat-free or low-fat dairy products
Have a diet rich in whole grains, fish, poultry, beans, seeds, and nuts
Eat less sweets, added sugars, sugary beverages, and red meats

Avoid alcohol and smoking

Manage weight
Reduce stress
Add physical activity to routine
American Heart Association recommends:
At least 150 minutes of moderate intensity aerobic physical activity each week
30 minutes a day for 5 days

Reducing Blood Pressure:

*Wrist monitor

Getting Informed
Healthcare provider-client relationship
Monitor blood pressure
Local pharmacy and home monitoring

Master isolated images / FreeDigitalPhotos.net

Shown to help in addition to regular monitoring in a

healthcare providers office

American Heart Association recommends an

automatic, cuff-style, bicep (upper-arm) monitor

Wrist monitors* are available and easy to use
Chart blood pressures
Measure at same time each day, morning or night
Avoid caffeine and cigarette smoking for more

accurate measurements
Consult healthcare provider after 5-10 high readings
Heart360 Blood Pressure Tracker Tool (heart360.org)

Reducing Blood Pressure:

Treatment Compliance
digitalart / FreeDigitalPhotos.net

Following recommendations of the health care team

Includes taking prescribed medicines, making lifestyle

changes, maintaining healthy physical activity

Clients should:
Develop routine of taking medicines at same time each day
Pill box
Pill reminder app on smart phone (try before suggesting to clients)
RxmindMe
MyPillBox

Encourage family and friends to help remember medicines

Journal or write on calendar (place calendar in most frequently visited

spot in house refrigerator door)

Ask healthcare provider about the medicine purpose, proper use,

side effects, withdrawal effects, and any other concerns or questions

Affording Treatment
ddpavumba / FreeDigitalPhotos.net

Encourage clients to talk to provider and pharmacists

about financial options

Think about generic brands for medicines
Usually less expensive than brand name drugs

Assistance Programs
RxAssist
Most current and comprehensive directory of Assistance Programs

Partnership for Prescription Assistance

Helps qualifying clients without prescription drug coverage
Helps find a program free of charge
More than 2,500 medicines and 475 assistance programs
NeedyMeds

More Resources
American Heart Association
www.americanheart.org
National Heart, Lungs, and Blood Institute
www.nhlbi.nih.gov
Million Hearts: Heart Disease & Stroke
http://millionhearts.hhs.gov/about_hd.html

Healthy Diet Tips

http://www.cdc.gov/nutrition/everyone/basics/fat/saturatedfat.html
Medication Financial Assistance Programs
Prescription Assistance: https://www.pparx.org
RxAssist: http://www.rxassist.org
NeedyMeds: http://www.needymeds.org