Hypertension

John Turner, MD
January 14, 2002

Overview
<What is hypertension?
<What causes it?
<Who gets it?
<How is it diagnosed?
<Why is it a problem?
<How is it treated?
<Can it be prevented?

Blood Pressure - Definition

< Blood Pressure
The pressure of blood flowing through your blood vessels
against the vessel walls

Blood Pressure - Definition

< Blood Pressure
The pressure of blood flowing through your blood vessels
against the vessel walls

< Depends on
<
<

Blood Pumped from the heart

Elasticity (tightness) of the blood vessels

< Varies with

<
<

Age
Activity

Blood Pressure - Definition

<Systolic
<

Number on top pressure

in the blood vessels
created by the heart when
it squeezes during a
heartbeat.

<Diastolic
<

Number on the bottom

pressure in the blood
vessels while the heart is
relaxed between
heartbeats.

128
74

How is it Measured?
<Patient sitting
<No smoking or caffeine 30 minutes
before measurement
<Rest at least 5 minutes
<Measure twice and average
<Recheck in the opposite arm if elevated
<Use a reliable blood pressure cuff

Blood
pressure
cuffs
Sphynomanometer

Home Blood Pressure Monitors

< Automatic arm cuff models can be reliably
used but must be calibrated against a regular
cuff in the doctors office.

Home Blood Pressure Monitors

< Dont use wrist or finger cuffs!

Hypertension - Definition
<Systolic blood
pressure of 140
mmHg or greater
or diastolic blood
pressure of 90
mmHg or greater
or taking high
blood pressure
medication

140
90

Symptoms of Hypertension
< Usually None
< Rarely can be
associated with
migraine headaches
< Often called the Silent
Killer because it does
serious damage inside
the body without any
symptoms

How is it diagnosed?
< Blood pressure readings at a physicians office
which show elevated pressures at two visits (2
months apart)

Who gets Hypertension

< 50 million Americans
(25% of population)
< 20% of white adults
< 30% of African
American adults
< 60% of Americans
age 60 or older
< 32% dont know
they have it

Hypertension - Causes
<Unknown Essential Hypertension
90 - 95% of all cases of high blood
pressure
<Medications / OTC drugs / supplements
<Medical problems (kidney, thyroid)
<Hardening of the arteries

Types of Hypertension

Stage 1

Systolic
140-159

Diastolic
90-99

Stage 2

160-179

100-109

Stage 3

>180

>110

What Your Doctor Will Do

< Try to find underlying causes
< Try to determine the damage already done by
high blood pressure
< Thorough Medical History
<
<
<
<
<
<
<

Family history
Diet
Exercise
Medical problems
Medications (OTCs, herbals)
Smoking
Stress level

What Your Doctor Will Do

< Thorough Physical Exam
< Blood tests
<
<
<
<

Blood count
Kidney function
Urinalysis
Cholesterol

< EKG
< Arrange to see you regularly

Why Treat It?

<Hypertension cause
damage to many
important organs
<44,000 deaths a year
<Contributes to 210,000
other deaths a year
<3x risk of Heart Disease
<7x risk of Stroke
<6x risk of Heart Failure

<Hypertension damages
blood vessels in every
part of the body
<Makes them thick and
stiff
<Speeds up the build-up
of cholesterol and fats
in the vessels
<This prevents blood
flow just like rust
building up in a pipe

Atherosclerosis
<Thickening and
hardening of
the blood
vessel
<Seen with age,
obesity, high
cholesterol, and
high blood
pressure

Stroke
<High blood
pressure damages
vessels in the
brain which can
lead to stroke

<Hypertension
reduces blood
flow to the heart
and makes the
heart work much
harder
<Heart Attack
<Heart Failure

<Elevated blood
pressures damage
arteries in the kidneys
<Over time this
weakens the kidneys
and causes a build-up
of wastes inside the
body
<If left uncontrolled
high blood pressure
will lead to kidney
failure and the need
for dialysis

<Hypertension
damages the
blood vessels in
the eye and can
lead to vision
problems and
blindness

Treatment
<Exercise
<Healthy diet
DASH Diet
<Sodium reduction
<Weight reduction
<Limit alcohol
<Quit smoking
<Medications

Exercise
< Goal is moderate
levels of activity
< Exercise most
days of the week
for 30 minutes
< Consult a doctor
if you have other
medical diseases

Moderate Exercise
<Walking briskly (3-4 miles per hour)
<Conditioning or general calisthenics
<Home care and general cleaning
<Home repair, such as painting
<Mowing the lawn (with power mower)
<Gardening
<Dancing
<Racket sports, such as table tennis

Moderate Exercise (cont)

<Walking briskly (3-4 miles per hour)
<Golf (walking the course)
<Fishing (standing and casting, walking,
or wading)
<Swimming (with moderate effort)
<Cycling (at a moderate speed of 10
miles per hour or less)
<Canoeing or rowing (at a speed of about
2-3.9 miles per hour)

Healthy Diet

Dietary
Approach to
Stop
Hypertension

DASH Diet
<Shown to help reduce blood pressure
<
<
<
<
<
<

More fruits
More vegetables
Low fat dairy products
Less total fat
Less saturated fat
Less cholesterol

<Includes red meat, sugar, nuts, chicken,

fish, whole grains

Sodium
< Sodium reduction can help
treat high blood pressure
< Eat no more than 2300 mg
(1 tsp) a day
< Diets with less than 1500 mg
showed even better control of
hypertension

Sodium
<What foods help reduce sodium
in the diet?
< Choose fresh, frozen or canned food items without
added salts.
< Select unsalted nuts or seeds, dried beans, peas
and lentils.
< Avoid adding salt and canned vegetables to
homemade dishes.
< Select unsalted, fat-free broths, bouillons or soups.

Sodium
<What foods help reduce sodium
in the diet? (cont)
< Select fat-free (skim) milk or low-fat milk, lowsodium, low-fat cheeses, as well as low-fat yogurt.
< When dining out, be specific about what you want
and how you want it prepared. Ask for your dish to
be prepared without salt.
< Learn to use spices and herbs to enhance the taste
of your food.

Weight Reduction
< Body Mass Index (BMI) > 27
is closely correlated with
hypertension
< Increased waist size has
been associated with
hypertension
<
<

>34 inches in women

>39 inches in men

< Loss of as little as 10 lbs can

decrease blood pressure

Body Mass Index

<Weight in kilograms dived by the square
of your height in meters

wt (kg)
ht 2(m)
www.nhlbisupport.com/bmi/bmicalc.htm

Body Mass Index

< BMI < 25 is normal
< BMI 25-30 is overweight
< BMI > 27 is associated with
hypertension
< BMI 30-35 is obese
< BMI >35 is morbidly obese

Alcohol
<Alcohol can be used in
moderation
<Limit alcohol to 1 oz a day
<
<
<
<
<

12 oz beer
7 oz light wine
5 oz table wine
3.5 oz desert wine
1.5 oz liquor

Medication
<Medication use for high blood pressure
has clearly demonstrated reduction in:
<
<
<
<
<

Stroke
Heart attack
Heart failure
Kidney disease
Overall death rate

<Medicine must be used in a program of

regular visits to your doctor

Medication
<When blood pressure
normalizes on
medication you
cannot stop taking
the pills
<Medications have
side effects and often
blood work must be
repeated

Types of Medication
< Diuretics (fluid pills)
< Beta Blockers
< ACE Inhibitors
< Angiotensin Receptor
Blockers (ARBs)
< Calcium Channel
Blockers (CCBs)
< Alpha Blockers
< Alpha-Beta Blockers
< Nervous System
Inhibitors
< Vasodilators

Common Questions
<Do vitamin, minerals, or certain foods
help treat hypertension?
<

<
<

Potassium and calcium have been proven

helpful for preventing and treating high
blood pressure
Onion does not help
Garlic does not help

Common Questions
<Foods High in Potassium
Apricot
Lean pork
Bananas
Lean veal
Pumpkin
Catfish
Spinach
Cod
Dry beans
Trout
Peaches
Flounder
Plantain
Yogurt
Stewed tomatoes
Sweet potatoes
Green beans
Winter squash
Orange juice

Prunes
Prune juice
Lima beans
Dry peas
Potatoes

Common Questions
<Foods High in Calcium
<
<
<
<
<
<
<
<
<
<
<
<

Milk
Cheese
Yogurt
Soy
Collard greens
Turnip greens
Kale
Okra
Orange juice (fortified)
Figs
Almonds
Waffles & Pancakes

Common Questions
<Does caffeine cause
hypertension?
<

<

<

Caffeine can elevate

blood pressure for
short periods
The body gets used to
caffeine and this effect
goes away with time
Caffeine has not been
shown to be a cause of
prolonged
hypertension

Common Questions
<Do fats in my diet cause hypertension?
<

<

<

No direct link between a high fat diet and

high blood pressure is know
However, a high fat diet leads to higher risk
for all of the problems from hypertension
Both lead you to the same health problems
so a low fat diet is still the best
recommendation

Common Questions
<Do oral contraceptive medications cause
hypertension?
<

They can (not often), so a women should be

monitored for elevation of blood pressure
when she starts this type of medicine

<Does hormone replacement therapy

cause high blood pressure?
<

Extremely rare but still have blood pressure

monitored

Common Questions
<Does stress cause elevated blood
pressure?
<

<

Stress can cause short term rises in blood

pressure but it is not associated with long
term problems
Relaxation techniques and biofeedback have
not proven helpful in the management of
hypertension

Common Questions
<If medication is controlling my blood
pressure can I stop the diet and
exercise changes?

NO

, these changes are still needed

to reduce risk for developing disease

from hypertension

Common Questions
<Are my headaches from high blood
pressure?
<
<

Very doubtful!
Only certain types of specialized headaches
(Migraines) can be associated at all with
hypertension

Common Questions
<Can hypertension be cured?
<
<

<

<

No
Many individuals can make lifestyle changes
that keep them from talking medications
Medications can also make blood pressure
normal
But high blood pressure rarely goes away or
is cured

Summary
< Hypertension is the Silent Killer because it
has no symptoms
< Treatment always involves changes in diet and
exercise
< Without treatment many organs are
permanently damaged
< Treatment works to help people live better and
live longer

Internet Resources
< National Institute of Health
www.nhlbi.nih.gov/hbp.index.html

< American Heart Institute

www.americanheart.org

< Private Industry site

www.bloodpressure.com

Internet Resources
< DASH Diet
www.nhlbi.nih.gov/health/public/heart/
hbp/dash/index.htm

< Facts About Lowering

Blood Pressure
www.nhlbi.nih.gov/health
public/heart/hbp/hbp_low/
index.htm