DOCSLIB.ORG

Hypertension in Emergency Medicine

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Hypertension in Emergency Medicine Doctor, Michael Jay Bresler, M.D The Patient’s Blood Pressure is Elevated! Page 1.. • 64 year old female you’ve diagnosed with acute bronchitis Hypertension in • Initial BP = 250/130 • On no meds Emergency Medicine • No history of hypertension • Feels fine except for cough MICHAEL JAY BRESLER, MD, FACEP • Ready for discharge: BP = 210/110 Clinical Professor Division of Emergency Medicine “Hey Doc, whadya want to give her?” Stanford University School of Medicine • 64 year old female you’ve diagnosed • 64 year old male complaining of severe with acute bronchitis chest pain for 3 hours • Initial BP = 250/130 • Initial BP = 230/120 • On no meds • EKG normal • No history of hypertension • Widened mediastinum on CXR • Feels fine except for cough • Repeat BP = 170/90 • Ready for discharge: BP = 250/140 • “Doc, they’re ready in CT.” “Hey Doc, whadya want to give her?” “Hey Doc, whadya want to give him?” Agenda for Our Discussion Questions to be addressed • General Considerations In the Emergency Department • Blood Pressure Readings in the ED • When should HBP be treated ? • Pathophysiology • When should HBP not be treated ? • Pharmacologic Treatment Modalities • When should outpatient therapy be • Specific Emergencies Requiring BP started? Reduction in the ED • What agents should we use? • Post ED Therapy • For what conditions? • Summary - Hypertension in the ED 1 Doctor, Michael Jay Bresler, M.D The Patient’s Blood Pressure is Elevated! Page 2.. • I will use primarily generic names • But I will also include on the slides the brand names since these are most commonly used in the real world - I have no financial relationship where we practice • When there are several brand names I with any drug company will try to include them all • I have no idea which companies make which drugs What is Normal Blood Pressure ?? Prehypertension General 130-139/80-90 Considerations • Compared with normal BP – Double the risk for developing hypertension. • Lifestyle & diet intervention warranted Joint National Committee on Hypertension,2003 Incidence of Hypertension in U.S.A. Scope of the Problem • > 140/90 (HTN) • Normotensive people at age 55 have a – 27% of adults 90% lifetime risk of developing HTN (Ref: Vasan) • > 130/90 (pre HTN + HTN) • Between age 40-70, the risk of – 60% of adults! cardiovascular disease doubles for every – 88% > 60 years old (independent variables) – 40% ages 18-39 !! – 20 mm Hg systolic above 115 Wang Arch Intern Med 2004 – 10 mm Hg diastolic above 70 »Lewington Lancet 2002 2 Doctor, Michael Jay Bresler, M.D The Patient’s Blood Pressure is Elevated! Page 3.. Should BP Rise with Age? BP and Gender • Estrogens protect NO !! • After menopause, women catch up with men and eventually surpass In societies with natural diet, less salt, and less obesity, more exercise the men – BP does not rise with age (in blood pressure that is….) • Diet is a particular problem - – We love our unhealthy diet! BP and Ethnicity High Blood Pressure Readings in • Incidence of HTN – 1.5 - 2 x more common in Blacks the Emergency Department • 1 in 3 African Americans • 1 in 4-5 Caucasian and Hispanic Americans • ? Asians • African Americans – HTN begins earlier – More end organ damage –ACEI’s & ARB’s less effective Is that reading real? Question • Asymptomatic E.D. patients with BP >140/90 – BP at home bid – > 1/2 continued >140/90 – Most of rest continued at pre-hypertensive level Are ED BP readings – Independent of pain or anxiety in E.D. accurate & reliable for » Tanabe Ann Emerg Med 2008 screening asymptomatic • E.D. patients with BP >140/90 followed in clinic patients for HTN? – 54% continued >140/90 » Cline Acad Emerg Med 2000 3 Doctor, Michael Jay Bresler, M.D The Patient’s Blood Pressure is Elevated! Page 4.. ACEP Clinical Policy Question • Level B Recommendation –If SBP persistently > 140 or Do asymptomatic –If DPB persistently > 90 patients with elevated BP Refer for follow up of possible HTN benefit from rapid and BP management lowering of their BP? Ann Emerg Med. 2006;47:237-249 ACEP Clinical Policy • Level B Recommendation HBP in the ED – Initiating Tx in the ED is not necessary if F/U is available • Most useful terminology – Rapid lowering of BP is not necessary – Hypertensive Emergency and may be harmful – Hypertensive Urgency – When Tx is initiated, BP should be – Elevated Blood Pressure lowered gradually and should not be expected to be normalized during the ED visit Why is this the most useful classification? Ann Emerg Med. 2006;47:237-249 HBP in the ED Hypertensive Emergency • Hypertensive Emergency • By definition – Treated in ED with IV meds – Evidence of acute end organ damage • Hypertensive Urgency – Usually brain, heart, or kidney – May be treated in ED - oral meds OK • Definition implies that organ dysfunction – Usually give prescription is caused by acute HPB, rather than • Elevated Blood Pressure vice versa – Not treated in ED • Systolic usually > 220 – May or may not give prescription – We should refer for further evaluation • Diastolic usually > 130 4 Doctor, Michael Jay Bresler, M.D The Patient’s Blood Pressure is Elevated! Page 5.. Hypertensive “Urgency” Hypertensive Urgency • Major elevation of BP • Treatment may be administered in the (roughly in range of >220/>120) but ED if BP remains very elevated – Without evidence of acute organ – Controversial failure – Trend toward not treating in the ED – No acute symptoms directly • Outpatient treatment should generally attributable to elevated BP be initiated, however • Basic studies may be indicated Diagnostic Studies in the ED • Incidental finding of moderate HBP – ED workup not necessarily indicated -> refer • If initiating outpatient treatment Pathophysiology – Basic studies in ED may be considered – CBC, lytes, renal, glucose, UA, EKG of Hypertension • If ED treatment required – Basic studies usually indicated • If hypertensive emergency - basic plus – Studies specific to disorder (CT, etc.) Regulation of Blood Pressure Inherent stiffness of arterial wall A Balance Between Cardiovascular risk factors lead to: • Replacement of elastin in arterial walls by collagen and fibrous tissue-> • Inherent stiffness of the arterial wall – Decreased compliance • Vasodilation – Increased resistance • Vasoconstriction • Endothelial dysfunction 5 Doctor, Michael Jay Bresler, M.D The Patient’s Blood Pressure is Elevated! Page 6.. Pathophysiology Acute Regulation of BP BP --> Endothelial wall stretch/stress • Vasodilation – Beta-2 adrenergic innervation Endothelial Dysfunction – Nitric oxide c-AMP • Vasoconstriction Capillary permeability – Alpha-1 adrenergic innervation Depletion of NO – Circulating catecholamines Inflammation – Angiotensin II Renin-Angiotensin-Aldosterone Renin-Angiotensin-Aldosterone Angiotensin II Angiotensinogen • Powerful vasoconstrictor Renin • Release of aldosterone Angiotensin I • Inflammatory response • Hypertrophy of smooth muscle cells ACE • Decreased nitric oxide -> Angiotensin II further vasoconstriction Autoregulation and Hypertensive Crisis Organ-specific autoregulation Auto-Regulation and • Normally maintains capillary pressure Hypertensive Crisis & flow within an acceptable range – Increased systemic BP -> vasoconstriction – Decreased systemic BP -> vasodilation 6 Doctor, Michael Jay Bresler, M.D The Patient’s Blood Pressure is Elevated! Page 7.. Autoregulation of Cerebral Blood Flow Cerebral Autoregulation, Hypertension, and Excessive Correction • Cerebral arterial resistance varies directly Hypertensive with BP to maintain cerebral perfusion within Person acceptable limits • “Set point” rises with chronic HBP • Rapid ED reduction of BP may drop CPF below adequate level Normotensive • Lower BP gently, Person • And usually never < 110 diastolic – Except • with aortic dissection Mean Arterial Pressure Adapted from Elliott:Crit Care Clin 2001;17:435 Autoregulation and Hypertensive Crisis Pharmacologic Treatment Hypertensive crisis Modalities Autoregulation fails -> Endothelial dysfunction • Capillary permeability & edema • Inflammatory response • Prothrombotic response • Decreased nitric oxide Cell necrosis • Release of vasoconstrictors Pharmacologic Treatment Modalities • Parenteral Vasodilators • Beta Blockers • Calcium Channel Blockers • Angiotensin Converting Enzyme Parenteral Inhibitors • Angiotensin II Receptor Blockers Vasodilators • Direct Renin Inhibitors • Diuretics • Others 7 Doctor, Michael Jay Bresler, M.D The Patient’s Blood Pressure is Elevated! Page 8.. Parenteral Vasodilators Parenteral Vasodilators Nitroprusside (Nipride™, Nitropress™) Nitroprusside • Arterial > venodilator • Potential problems • Advantages – Unstable to UV light-must be wrapped – Most commonly used agent in EM – Orthostatic hypotension - keep supine – Metabolized to cyanide/thiocyanate – Extremely effective – Toxic at higher dose – Very short half-life • Potentially toxic to fetus • Are there better agents ?? – Tissue necrosis if extravasation – Increases intracranial pressure Parenteral Vasodilators Parenteral Vasodilators • Fenoldopam (Corlopam™) Nitroglycerin • Newer IV alternative to nitroprusside – Peripheral dopamine (DA-1) receptor agonist • Venodilation > arterial dilation – Rapid onset & offset of action – Good for CHF & angina – Improves renal function ? – Not a good drug for hypertensive crisis – Less chance of overshoot vs. nitroprusside – No thiocyanate toxicity or light sensitivity Beta blockers •ß1 blockade Beta – Lusitropic • (decreased cardiac contractility) Blockers – Decrease renin – Decrease norepinephrine 8 Doctor, Michael Jay Bresler, M.D The
Load more

Recommended publications
  • The Association Between Blood Pressure Trajectories and Risk of Cardiovascular Diseases Among Non-Hypertensive Chinese Population: a Population-Based Cohort Study
    International Journal of Environmental Research and Public Health Article The Association between Blood Pressure Trajectories and Risk of Cardiovascular Diseases among Non-Hypertensive Chinese Population: A Population-Based Cohort Study Fang Li 1,2, Qian Lin 3 , Mingshu Li 3, Lizhang Chen 1,2,*,† and Yingjun Li 4,*,† 1 Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410078, China; [email protected] 2 Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha 410078, China 3 Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, Changsha 410078, China; [email protected] (Q.L.); [email protected] (M.L.) 4 Department of Epidemiology and Health Statistics, School of Public Health, Hangzhou Medical College, Hangzhou 310053, China * Correspondence: [email protected] (L.C.); [email protected] (Y.L.); Tel.: +86-0731-8883-6996 (L.C.); +86-0571-8769-2815 (Y.L.) † These authors contributed equally to this work and should be considered co-correspondence authors. Abstract: Although previous studies have discussed the association between trajectories of blood pressure (BP) and risk of cardiovascular diseases (CVDs), the association among the non-hypertensive Citation: Li, F.; Lin, Q.; Li, M.; Chen, general population of youth and middle age has not been elucidated. We used the growth mixture L.; Li, Y. The Association between model to explore the trajectories of BP among the non-hypertensive Chinese population and applied Blood Pressure Trajectories and Risk Cox regression to evaluate the association between trajectories of BP and the risk of stroke or of Cardiovascular Diseases among myocardial infarction (MI).
    [Show full text]
  • High Blood Pressure
    KNOW THE FACTS ABOUT High Blood Pressure What is high blood pressure? What are the signs and symptoms? Blood pressure is the force of blood High blood pressure usually has no against your artery walls as it circulates warning signs or symptoms, so many through your body. Blood pressure people don’t realize they have it. That’s normally rises and falls throughout the why it’s important to visit your doctor day, but it can cause health problems if regularly. Be sure to talk with your it stays high for a long time. High blood doctor about having your blood pressure pressure can lead to heart disease and checked. stroke—leading causes of death in the United States.1 How is high blood pressure diagnosed? Your doctor measures your blood Are you at risk? pressure by wrapping an inflatable cuff One in three American adults has high with a pressure gauge around your blood pressure—that’s an estimated arm to squeeze the blood vessels. Then 67 million people.2 Anyone, including he or she listens to your pulse with a children, can develop it. stethoscope while releasing air from the cuff. The gauge measures the pressure in Several factors that are beyond your the blood vessels when the heart beats control can increase your risk for high (systolic) and when it rests (diastolic). blood pressure. These include your age, sex, and race or ethnicity. But you can work to reduce your risk by How is it treated? eating a healthy diet, maintaining a If you have high blood pressure, your healthy weight, not smoking, and being doctor may prescribe medication to treat physically active.
    [Show full text]
  • Lifetime Risk of Stroke and Impact of Hypertension: Estimates from the Adult Health Study in Hiroshima and Nagasaki
    Hypertension Research (2011) 34, 649–654 & 2011 The Japanese Society of Hypertension All rights reserved 0916-9636/11 $32.00 www.nature.com/hr ORIGINAL ARTICLE Lifetime risk of stroke and impact of hypertension: estimates from the adult health study in Hiroshima and Nagasaki Ikuno Takahashi1,4, Susan M Geyer2,6, Nobuo Nishi3,7, Tomohiko Ohshita4, Tetsuya Takahashi4, Masazumi Akahoshi1, Saeko Fujiwara1, Kazunori Kodama5 and Masayasu Matsumoto4 Very few reports have been published on lifetime risk (LTR) of stroke by blood pressure (BP) group. This study included participants in the Radiation Effects Research Foundation Adult Health Study who have been followed up by biennial health examinations since 1958. We calculated the LTR of stroke for various BP-based groups among 7847 subjects who had not been diagnosed with stroke before the index age of 55 years using cumulative incidence analysis adjusting for competing risks. By 2003, 868 subjects had suffered stroke (512 (58.9%) were women and 542 (62.4%) experienced ischemic stroke). BP was a significant factor in determining risk of stroke for men and women, with distributions of cumulative risk for stroke significantly different across BP groups. The LTR of all-stroke for normotension (systolic BP/diastolic BP o120/80 mm Hg), prehypertension (120–139/80–89 mm Hg), stage1 hypertension (140–159/90–99 mm Hg) and stage 2 hypertension (4160/100 mm Hg) were 13.8–16.9–25.8–25.8% in men and 16.0–19.9–24.0–30.5% in women, respectively (Po0.001 among BP groups in both sexes). The estimates did not differ significantly (P¼0.16) between normotensive and prehypertensive subjects.
    [Show full text]
  • The Multiple Lifestyle Modification for Patients With
    Open Access Protocol BMJ Open: first published as 10.1136/bmjopen-2014-004920 on 14 August 2014. Downloaded from The multiple lifestyle modification for patients with prehypertension and hypertension patients: a systematic review protocol Juan Li,1 Hui Zheng,1 Huai-bin Du,2 Xiao-ping Tian,2 Yi-jing Jiang,3 Shao-lan Zhang,4 Yu Kang,5 Xiang Li,2 Jie Chen,1 Chao Lu,1 Zhen-hong Lai,1 Fan-rong Liang1 To cite: Li J, Zheng H, ABSTRACT et al Strengths and limitations of this study Du H-bin, . The multiple Introduction: The objective of this systematic review lifestyle modification for is to investigate the effectiveness, efficacy and safety ▪ patients with prehypertension To the best of our knowledge, this is the first of multiple concomitant lifestyle modification and hypertension patients: a systematic review to investigate the effectiveness, systematic review protocol. therapies for patients with hypertension or efficacy and safety of multiple lifestyle changes BMJ Open 2014;4:e004920. prehypertension. for patients with hypertension. doi:10.1136/bmjopen-2014- Methods and analysis: Electronic searches will be ▪ The results of this systematic review can provide 004920 performed in the Cochrane Library, OVID, EMBASE, clinicians with useful clinical information to etc, along with manual searches in the reference lists guide their patient care and increase the under- ▸ Prepublication history for of relevant papers found during electronic search. We standing of lifestyle modifications, as well as this paper is available online. will identify eligible randomised controlled trials motivate patients with hypertension to adopt and To view these files please utilising multiple lifestyle modifications to lower blood maintain multiple lifestyle changes.
    [Show full text]
  • Standard Nurse Protocol for Primary Hypertension
    STANDARD NURSE PROTOCOL FOR PRIMARY HYPERTENSION IN ADULTS THIS PAGE INTENTIONALLY LEFT BLANK Department of Public Health Nurse Protocols for Registered Professional Nurses 2015 2015 HYPERTENSION CLINICAL REVIEW TEAM Patricia Jones, RN William R. Grow, MD, FACP Chronic Disease Prevention Section District Health Director Department of Public Health South Health District Medical Consultant Natalie Keadle, RN, MSN Kelly Knight, RN, BSN Adult Health Coordinator Clinical Nursing Coordinator Northeast Health District South Central Health District Gina Richardson, RN Kimberley Hazelwood, Pharm D County Nurse Manager Director of Pharmacy Burke County Health Department Georgia Department of Public Health Tammy Burdeaux, RN, BSN, CRNI Greg French, RD, LD, CPT District Nursing and Clinical DeKalb County Board of Health Coordinator East Central Health District Gayathri Kumar, MD Medical Officer/Epidemiologist Lawton C. Davis, MD Georgia Department of Public Health District Health Director South Central Health District Stephen Goggans, MD, MPH District Health Director East Central Health District This protocol update was developed with funding through the Association of State and Territorial Health Officials Million Hearts Learning Collaborative from the Centers for Disease Control and Prevention. The clinical review team acknowledges the contributions to the protocol of Department of Public Health staff Jean O’Connor, JD, DrPH, Brittany Taylor, MPH, Kenneth Ray, MPH, Yvette Daniels, JD, and J. Patrick O’Neal, MD, MPH. Hypertension Department of Public
    [Show full text]
  • Prehypertension: Is It Relevant for Nephrologists?
    Special Feature Prehypertension: Is It Relevant for Nephrologists? Norman M. Kaplan Department of Internal Medicine, Division of Hypertension, University of Texas Southwestern Medical School, Dallas, Texas Prehypertension has been proposed as the diagnosis for the presence of blood pressures >120/80 mmHg but <140/90 mmHg. It covers more than 60 million people in the United States and nephrologists will increasingly be involved with them. This review describes its relevance to nephrologists. Clin J Am Soc Nephrol 4: 1381–1383, 2009. doi: 10.2215/CJN.02340409 ephrologists will rarely deal with patients who have experienced a two-fold increase in death from cardiovascular prehypertension (i.e., BP below hypertension [140/90 diseases. mmHg] but above ideal [120/80 mmHg]), which In addition to these mortality data, a number of studies of NϾ includes 60 million people in the United States (1). Because smaller populations have shown an increase in nonfatal target there are hardly enough nephrologists to care for the increasing organ damage (3). For the sake of brevity, emphasis is placed number of patients with chronic kidney disease, why should on those that relate to the kidneys: they be concerned about patients who do not yet have hyper- • Left ventricular hypertrophy (4) tension? • Coronary calcification (5) The reasons include the following: First, multiple data show • Reduced coronary flow reserve (6) that people with prehypertension often have subclinical target • Progression of coronary atherosclerosis (7) organ damage, including nephropathy. Second, the families of • Increases in ischemic coronary disease and stroke (8) patients with chronic kidney disease (CKD) harbor an in- • Poor cognitive function (9) creased prevalence of nephropathy, and they need early recog- • Retinal vascular changes (10) nition.
    [Show full text]
  • Hypertension and Prehypertension Definition/Cut-Off Value
    05/2019 345 Hypertension and Prehypertension Definition/Cut-off Value Hypertension is defined as high blood pressure which may eventually cause health problems and includes chronic hypertension during pregnancy, preeclampsia, eclampsia, chronic hypertension with superimposed preeclampsia, and gestational hypertension (1, 2, 3). Prehypertension is defined as being at high risk for developing hypertension, based on blood pressure levels. Presence of condition diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. See Clarification for more information about self-reporting a diagnosis. Participant Category and Priority Level Category Priority Pregnant Women I Breastfeeding Women I Non-Breastfeeding Women III, IV, V or VI Infants I Children III Justification Hypertension (HTN), commonly referred to as high blood pressure, occurs when the force of blood against artery walls is high enough that it may eventually cause health problems. Hypertension is measured in terms of both systolic blood pressure (pressure in blood vessels when the heart contracts) and diastolic blood pressure (pressure in blood vessels when the heart rests between contractions). Two main factors in the body increase levels of blood pressure – a higher volume of blood being pumped by the heart and narrower arteries. Untreated HTN leads to many degenerative diseases, including congestive heart failure, end-stage renal disease, and peripheral vascular disease. People with HTN
    [Show full text]
  • JNC 7 Express the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure
    National High Blood Pressure Education Program JNC 7 Express The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Heart, Lung, and Blood Institute JNC 7 Express The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure This work was supported entirely by the National Heart, Lung, and Blood Institute. The Executive Committee, writing teams, and reviewers served as volunteers without remuneration. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Heart, Lung, and Blood Institute National High Blood Pressure Education Program NIH Publication No. 03-5233 December 2003 Chair Aram V. Chobanian, M.D. (Boston University Medical Center, Boston, MA) Executive Committee George L. Bakris, M.D. (Rush Presbyterian-St. Luke’s Medical Center, Chicago, IL); Henry R. Black, M.D. (Rush Presbyterian-St. Luke’s Medical Center, Chicago, IL); William C. Cushman, M.D. (Veterans Affairs Medical Center, Memphis, TN); Lee A. Green, M.D., M.P.H. (University of Michigan, Ann Arbor, MI); Joseph L. Izzo, Jr., M.D. (State University of New York at Buffalo School of Medicine, Buffalo, NY); Daniel W. Jones, M.D. (University of Mississippi Medical Center, Jackson, MS); Barry J. Materson, M.D., M.B.A. (University of Miami, Miami, FL); Suzanne Oparil, M.D. (University of Alabama at Birmingham, Birmingham, AL); Jackson T. Wright, Jr., M.D., Ph.D. (Case Western Reserve University, Cleveland, OH) Executive Secretary Edward J.
    [Show full text]
  • A Study of Left Ventricular Diastolic Dysfunction in Prehypertensive Middle Aged Indiviuais
    Original Research Article http://doi.org/10.18231/j.pjms.2020.005 A study of left ventricular diastolic dysfunction in prehypertensive middle aged indiviuais P. Venkatesh1, S. Vithiavathi2, Gerard Joseph Devadassou3* 1Post Graduate, 2Professor and HOD, 3Assistant Professor, Dept. of General Medicine, Aarupadai Veedu Medical College and Hospital, Pondicherry, India *Corresponding Author: Gerard Joseph Devadassou Email: [email protected] Abstract Prehypertension is associated with excessive morbidity and mortality due to Cardiovascular diseases (CVD). Our study emphasizes the need of early diagnosis of left ventricular diastolic dysfunction in prehypertension patients and to perform echocardiogram in prehypertension middle aged patients. Materials and Methods: Its hospital based cross sectional study done on 50 samples all middle aged patients of both sexes with prehypertension in the age group of 45-64years. Results: The mean E value was found to be 69.78+4.83, mean value of A was 68.88+5.71 and mean value of E/A 1.01+.0.15. About 17(34%) had normal diastolic function E/A Ratio between 1.0-1.5 and 33 (66%) had impaired relaxation grade 1. There is no significant difference between the smokers and non – smokers, likewise for obese and non -obese patients. Conclusion: We conclude that even non obese patients and non- smokers has significant diastolic dysfunction, so prehypertension is risk factor for diastolic dysfunction. Keywords: Prehypertension, Diastolic dysfunction, Echocardiogram, Cardiovascular disease. Introduction Medical College and Hospital, for the period 4 months from Hypertension (HT) is a major global public health burden, December 2018 to March 2019. and it is an important risk factor for cerebrovascular accident.
    [Show full text]
  • High Blood Pressure Fact Sheet
    HIGH BLOOD PRESSURE (HYPERTENSION) IN NORTH CAROLINA Fact Sheet What is high blood pressure? Figure 1. Prevalence of modifiable risk factors • High blood pressure, also known as hypertension, is a disease that occurs for high blood pressure, North Carolina, 2015–2016 when blood pressure stays above normal for a long time. As a result, the walls of arteries get stretched beyond their healthy limit, and damage 66.9% occurs creating a variety of other health problems. 51.9% • Blood pressure is the force of blood pushing against the walls of the arteries, vessels that carry blood from the heart to other parts of the body. • Blood pressure is measured in millimeters of mercury (mmHg) using two numbers. The first/top number, systolic blood pressure, represents the 17.9% pressure in blood vessels when the heart contracts. The second/bottom 11.3% number, diastolic blood pressure, represents the pressure in blood vessels Overweight Did not meet Current Diabetes and Obese aerobic PA Smoker when the heart relaxes between beats. recommendations • Blood pressure normally rises and falls throughout the day based on the Data Source: North Carolina State Center for Health Statistics, kind of activity in which an individual is engaged. www.schs.state.nc.us/data/brfss/2016/nc/all/topics.htm (accessed 03/2018). • High blood pressure usually has no warning signs or symptoms, so many people do not know that they have it. The only way to know whether you have high blood pressure is to have your blood pressure accurately • Modifiable risk factors include unhealthy diet (eating foods high in sodium measured.
    [Show full text]
  • High Blood Pressure Is a Blood Pressure Reading of 140/90 Mmhg Or Higher
    What Is High Blood Pressure? High blood pressure is a blood pressure reading of 140/90 mmHg or higher. Both numbers are important. Nearly 1 in 3 American adults has high blood pressure. Once high blood pressure develops, it usually lasts a lifetime. The good news is that it can be treated and controlled. High blood pressure is called the silent killer because it usually has no symptoms. Some people may not find out they have it until they have trouble with their heart, brain, or kidneys. When high blood pressure is not found and treated, it can cause: • The heart to get larger, which may lead to heart failure. • Small bulges (aneurysms (AN-u-risms)) to form in blood vessels. Common locations are the main artery from the heart (aorta); arteries in the brain, legs, and intestines; and the artery leading to the spleen. • Blood vessels in the kidney to narrow, which may cause kidney failure. • Arteries throughout the body to "harden" faster, especially those in the heart, brain, kidneys, and legs. This can cause a heart attack, stroke, kidney failure, or amputation of part of the leg. • Blood vessels in the eyes to burst or bleed, which may cause vision changes and can result in blindness. What Is Blood Pressure? Blood is carried from the heart to all parts of your body in vessels called arteries. Blood pressure is the force of the blood pushing against the walls of the arteries. Each time the heart beats (about 60–70 times a minute at rest), it pumps out blood into the arteries.
    [Show full text]
  • Hypertensive Emergencies
    336 Medicine Update 57 Hypertensive Emergencies ATUL BHASIN, DG JAIN, RM CHHABRA, RK SINGAL ARTERIAL HYPERTENSION the risk of serious morbidity and death. Blood pressure is often severely raised, diastolic >130 mmHg but is Arterial Hypertension is a medical condition where always a poor correlation between pressure and end- the blood pressure is chronically elevated1. Persistent organ damage. Seriousness of hypertensive emergency hypertension is one of the risk factors for stroke, heart and approach to treatment is determined by end organ attack and heart failure, and is a leading cause of chronic damage. While at the same time hypertensive urgency renal failure. is characterized by a lack of end organ damage. Hyper- tensive emergencies are associated with the following: DEFINITION • Neurological deficits primarily presenting as TIA, Blood pressure is a continuous variable, and risks hypertensive encephalopathy, intracranial of various adverse outcomes rise with it. “Hypertension” hemorrhage and stroke. is usually diagnosed on finding blood pressure above • Cardiovascular complications such as pulmonary 140/90 mmHg measured on both arms on three edema, acute myocardial infarction, adrenergic crisis, occasions over a few weeks. Recently, the JNC VII (The dissecting aortic aneurysm, and eclampsia. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of • Renal complications as hematuria and progressive High Blood Pressure)2 has defined blood pressure over renal dysfunction. 120/80 mmHg and below 140/90 mmHg as “pre- In these conditions, the blood pressure (BP) should hypertension”. “Prehypertension is not a disease be lowered aggressively over minutes to hours. category. Rather, it is a designation chosen to identify individuals at high risk of developing hypertension (JNC Hypertensive Urgency VII).” Normal blood pressure is 120/80 mmHg.
    [Show full text]