Unit 2: HypertensionHigh Blood PressureSlide 3Slide 4Slide 5Silent KillerBlood PressureSlide 8High Blood Pressure: 4 major problemsSystemic BPMeasuring Blood Pressure24-hr BP monitoringDippers and Non-dippersDefining high blood pressureHypertension Risk FactorsComplicationsSlide 17Treatment of HypertensionTreatment of HypertensionSlide 20Prospective/observational studiesPaffenbarger et al. (1983) Study DesignStudy ResultsSlide 24Slide 25Slide 26Study SummaryAerobics Center Longitudinal StudyACLS & Hypertension IncidenceSlide 30ACLS and HypertensionNurses’ Health StudySlide 33Slide 34Unit 2: HypertensionLecture 1High Blood Pressure•When resting blood pressure is _____________–either or both pressures are elevated•Damages vessels and organs•Increased risk for:–stroke (blood vessel [transporting blood and oxygen] in brain bursts, depriving brain of oxygen)–blood clots–atherosclerosis–kidney failure–heart failurePrevalence of high blood pressure in adults ≥20 years of age by age and sex (National Health and Nutrition Examination Survey: 2009–2012). Mozaffarian D et al. Circulation. 2015Copyright © American Heart Association, Inc. All rights reserved.Age-adjusted prevalence trends for high blood pressure in adults ≥20 years of age by race/ethnicity, sex, and survey (National Health and Nutrition Examination Survey: 1988–1994, 1999–2006, and 2007–2012). Go A S et al. Circulation. 2014;129:e28-e292Copyright © American Heart Association, Inc. All rights reserved.Mozaffarian D et al. Circulation. 2015Copyright © American Heart Association, Inc. All rights reserved.Silent Killer•70% of people with hypertension are aware of it64-75% are being treated39-54% are controlled•Mortality from CAD, stroke increases almost linearlySBP >115 mm Hg; DBP >75 mm Hg•Mortality doubles for20-mm Hg rise in SBP, 10 mm Hg rise in DBP•Pressure in the arteries leading from the heart•Pressure difference between arteries and veins which causes blood flowBlood PressureHigh Blood Pressure: 4 major problems1. Kidney: Fluid and Salt balance•fluid retention, increased blood volume, increased pressure2. Renin-Angiotensin-Aldosterone System (RAAS)•Angiotensin: constricts blood vessels• Aldosterone: kidney fluid balance3. Sympathetic nervous system activity•Overactivity 4. Blood vessel structure and function•increased stiffness•decreased nitric oxide•increased vasoconstrictorsSystemic BPFigure 19.510Measuring Blood PressureKorotkoff Sounds24-hr BP monitoringAdvantages:1. May help determine accurate blood pressures over a day (vs. MD office)2. Can associate changes in BP with activities during the day3. Can evaluate sleeping BPDippers and Non-dippersnon-dipper <10% dropNocturnal Hypertension- related to higher mortality- related to end organ damageDefining high blood pressureCategory SBP DBPOptimal < 120 <80Normal 120-129 80-84High Normal 130-139 85-89Stage 1 hypertension 140-159 90-99Stage 2 hypertension 160-179 100-109Stage 3 hypertension >= 180 >= 110Primary (essential) Hypertension: no identifiable causeSecondary hypertension: sudden appearance of high blood pressureMedications, Adrenal gland tumors, Kidney problemsPREHYPERTENSIONHypertension Risk Factors1) Age2) Race3) Family History4) Overweight or Obesity5) Physical Inactivity 6) Sodium7) Low Potassium8) Low Vitamin D9) Alcohol use 10) StressComplications•MI•Stroke•Aneurysm•Heart failure•Kidney disease•Metabolic syndrome•Endothelial dysfunctionNormal sized and enlarged heart (from high blood pressure)Treatment of Hypertension MedicationsDiuretics (Thiazides)blood volumeBeta Blockersheart rateACE inhibitorsAngII blockersCalcium channel blockersvessel relaxationBP= Cardiac Output x vascular resistance(CO= HR x SV)Treatment of HypertensionLifestyleDiet (DASH = dietary approaches to stop hypertension)Exercise(150’/wk) Sodium Reduction (<1500mg/day)Weight loss (if BMI>25kg/m2)Smoking cessationLimit Alcohol(1/day W, 2/day M)1tsp salt = 2300mg sodiumPhysical Activity and HypertensionProspective/observational studiesHypertensionProspective/observational studies•Harvard Alumni (Paffenbarger)•Aerobics Longitudinal Study (ACLS)•Nurses Health Study (NHS)Paffenbarger et al. (1983) Study Design•6-10 yr follow-up of 14,998 male Harvard alumni•Follow-up started 16-50 yrs after entering college•Questionnaire assessed new diagnoses of hypertension•681 new cases of hypertension in the follow-up period•Physical activity calculated based on Paffenbarger questionnaireStudy Results1) No effect of # of stairs or blocks walked on the risk of developing hypertension2) No effect of light sports participation on risk of developing hypertension3) Those taking part in no vigorous sports were more likely to develop hypertension4) Those expending less than 2000 kcal/wk were 30% more likely to develop hypertensionAlumnus CharacteristicPrevalence ratio of characteristics in study population (%)Relative risk of hypertensionAttributable risk (%)CommunityLack of vigorous sports play65.0 1.52 25.3Body mass index of 36+ units36.3 1.43 13.5Body mass index gain since college of 5+ units40.8 1.44 15.2Parental history of hypertension38.8 1.91 26.3Relative and attributable risks of hypertension among Harvard male alumni in a 6 – 10-year follow-up (1962 or 1966 to 1972), by selected high-risk characteristicsAlumnus CharacteristicPrevalence ratio of characteristics in study population (%)Relative risk of hypertensionAttributable risk (%)CommunityLack of vigorous sports play65.0 1.52 25.3Body mass index of 36+ units36.3 1.43 13.5Body mass index gain since college of 5+ units40.8 1.44 15.2Parental history of hypertension38.8 1.91 26.3Relative and attributable risks of hypertension among Harvard male alumni in a 6 – 10-year follow-up (1962 or 1966 to 1972), by selected high-risk characteristicsAge-adjusted incidence rates and relative risks of HTN by paired combinations of vigorous sports participation and other characteristics of Harvard alumniStudy Summary•A number of risk factors predict who will subsequently develop hypertension–lack of vigorous activity, BMI, parent with HTN•Vigorous exercise is associated with lower risk for developing hypertension–Can help reduce incidence of HTN even with other high risk factors presentAerobics Center Longitudinal Study•ACLS (Chase, et al. Am J Hypertension. 2009)–16601 men aged 20-82–baseline BP <140/90–PA questionnaire–Fitness – time