Tag: high blood pressure

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Hypertension

HTN: Background

Definition: Hypertension is sustained elevation of resting systolic BP, diastolic BP, or both.

Primary HTN: HTN with no known cause

o Prevalence: 85-95% of cases

Secondary HTN: HTN with an identified cause

o Causes include: primary aldosteronism (most common), renal parenchymal disease (e.g., pyelonephritis), hyperthyroidism, excessive alcohol intake, use of oral contraceptives

 

Classifying HTN:

1. Per JNC 8 Guidelines:

 

What is “Blood Pressure”:

BLOOD

PRESSURE= cardiac output X peripheral resistance.

**cardiac output=heart rate X stroke volume

 

Definitions:

Blood Pressure: a measure of the force being exerted on the walls of arteries as blood is pumped out of the heart

▪ Cardiac Output: the amount of blood pumped out of the left ventricle in one minute

• Heart Rate: the number of times the heart beats per minute (bpm)

• Stroke Volume: the quantity of blood pumped out of the left ventricle with every heart beat

▪ Peripheral Resistance: the resistance of the arteries to blood flow. As arteries constrict, resistance increases. As arteries dilate, resistance decreases.

Measuring blood pressure:

▪ Tools: sphygmomanometer (inflatable cuff & pressure gauge) and stethoscope

▪ Position:

• Place the cuff on bare upper arm with the “artery mark” positioned directly over the brachial artery. The bottom edge of the cuff should be positioned approximately one inch above the antecubital fold.

• To verify a correct fit of the cuff, check that the “Index Line” falls between the two range lines.

• Arm should be fully supported on a flat surface at heart level. Patient’s back should be supported and legs should be uncrossed and placed flat on the ground. Patient should relax comfortably for five minutes prior to the measurement being taken.

▪ Technique:

• Inflate Cuff: Close the valve and inflate the cuff quickly. Palpate the radial artery while inflating the cuff, and inflate cuff 20-30mmHg above the point at which the radial pulse disappears. Inflated cuff occludes the brachial artery, blocking flow of blood to the arm below the cuff.

o Position chestpiece of stethoscope in antecubital space below cuff, distal to the brachium. Do not place underneath the cuff.

• Deflate Cuff: open the valve to deflate cuff gradually at rate of 2-3mmHg per second. Once first and last Korotkoff sounds are heard, open valve fully to release any remaining air in the cuff and remove it.

▪ Korotkoff Sounds:

• First sound: systolic blood pressure – the force the heart has to pump against to get the blood to flow around the body

• Second sound: diastolic blood pressure – the pressure in the arteries as the heart relaxes

Complications of HTN:

Early in HTN: No pathologic changes

Severe/prolonged HTN: damage to target organs (primarily cardiovascular system, brain, and Kidneys), increasing risk of:

  • Coronary artery disease
  • Myocardial infarction
  • Heart failure
  • Stroke
  • Renal failure
  • Death

 

Signs/symptoms: often asymptomatic until later in disease (complications to other organs)

Early signs of HTN:

  • 4th heart sound
  • Retinal changes
  • S/sx of complicated HTN:
  • Dizziness
  • Flushed face
  • Headache
  • Fatigue
  • Nervousness

 

Risk Factors for Developing HTN

Modifiable Risk Factors

Unmodifiable Risk Factors

Overweight or obese

Sedentary lifestyle

Tobacco use

Unhealthy diet (high in sodium, low in potassium, low in vitamin D)

Excessive alcohol usage

Stress

Sleep apnea

Diabetes

Age

  • 45-65 years old: men > women
  • > 65 years old: women > men

Race: AA > Caucasian

Family History

 

References:

1. http://www.merckmanuals.com/professional/cardiovascular-disorders/hypertension/overview-of-hypertension

2. https://www.omicsonline.org/open-access/hypertension-pathophysiology-and-treatment-2155-9562-5-1000250.php?aid=35433

3. https://www.medscape.com/viewarticle/888560

4. http://www.acc.org/latest-in-cardiology/articles/2017/11/08/11/47/mon-5pm-bp-guideline-aha-2017

5. https://www.ptdirect.com/training-design/anatomy-and-physiology/cardiac-output-and-blood-pressure

6. http://pie.med.utoronto.ca/CA/CA_content/CA_cardiacPhys_peripheralResistance.html

7. https://www.adctoday.com/learning-center/about-sphygmomanometers/how-take-blood-pressure

8. https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-causes/syc-20373410

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Why Lose weight?

Why do we want to lose weight? Aren’t we all a little more cheerful when we have a little weight? What is the harm in not being super skinny?  Is it just social pressure and social conventions that say we should be a certain size?

A new study suggests that previous studies have under estimated the harmful effects of carrying extra weight. The new study, conducted by researchers from the University of Bristol in the United Kingdom, attempted to find a link between Body Mass Index (BMI) and risk of death.

Other studies have also suggested that even a small amount of weight gain in healthy, young individuals is associated with worsening heart function, posing a greater risk for future heart failure. People who were not obese at baseline and gained weight had a greater negative impact on their cardiac structure and function than people who were obese already.

What are the benefits of losing weight?

1.      Feeling better:

·         Having more energy

·         Sleeping better and waking up feeling rested and in a good mood

·         Having fewer aches and pains

·         Improved ability to move and get around

·         Finding it easier to breathe

·         Improved immune system (ability to fight off illness)

2.      Reduce risk of diseases like diabetes, heart disease, stroke, weight related cancers

·         Asthma

·         Arthritis

·         Deformity of the lower legs (Blount’s disease)

·         Sleep apnoea (a person temporarily stops breathing during sleep)

·         High blood pressure

·         Fatty liver

·         Polycystic ovary syndrome (PCOS) where cysts form in the ovaries

·         Menstrual (period) problems

·         Insulin resistance meaning that the body becomes resistant to insulin, the hormone that controls the amount of sugar in the blood.

·         Type 2 diabetes

The Best way to lose weight is through lifestyle changes (healthy diet) and exercise. The endocrine Society came out with clinical practice guidelines in 2015 for the use of medications in weight loss. Use of approved weight-loss medications is endorsed for people with a body mass index (BMI) of 30 kg/m2 and above or at least 27 kg/m2 with one or more comorbidities.  Yet many of the drugs are not being used because not everyone is convinced of the safety of these medications. The newer drugs to the market are bupropion/naltrexone (Contrave, Orexigen Therapeutics) and liraglutide(Saxenda, Novo Nordisk) for weight loss. These new comers join  controlled-release phentermine and topiramate (Qsymia, Vivus), and lorcaserin (Belviq, Arena Pharmaceuticals) and over the counter orlistat (Alli, GlaxoSmithKline).  Another consideration is that weight loss medications are usually not cover by insurances and can be quite expensive.

Is always best to speak to your Primary Care Doctor before embarking in any diet or exercise changes

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Happy New Year

New year, new you! With the start of a new year we all feel like it is the start of a new you, that is why we make resolutions for the new year. Having had to deal with the illness of a family member and having to make tough decisions like palliative care; it has become increasingly clear to me that we have a finite amount of time and we should make the most out of it. Since we are here for a set amount of time, it should be clear that we should take care of our bodies so that we may have longer healthier life and enjoy more the world out there. As humans we are not perfect, and we can always improve, personally, health wise and improve relationships with family. Like many of you I find myself needing to lose weight and start exercising more. I will start an exercise program and eat healthier.

The first step is setting health goals that are realistic and obtainable, choose one to two goals instead of having too many which will make it hard to keep track of them, and break the larger goals into smaller steps that will be easier to do.  If loosing weight is one of your goals, you want to make sure to do it the right way and stay away from gimmicks. One way to lose weight is adjusting your calorie intake, this new online tool can help you figure out how to adjust your calorie intake.  Small changes can add up and make a big difference, so start small with changes you know you can stick with.

Don’t forget exercise as it is one of the best things you can do to keep you healthy and loose weight. Logging what you eat can help you see how much you are eating and keep track of calories. There are many apps for your smart phone that you can use. There are also apps that can help you exercise such as the 7-minute workout. Writing down goals and letting your friends and family know can help you stay on track. Lastly, don’t for get to schedule time for exercise, if can’t do it daily start with three days per week. What ever your goals, the most important thing is to get started.

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Chronic Disease and the Holidays

Chronic disease — defined as illnesses lasting more than three months, being persistent or recurrent, having a significant health impact, and typically being incurable. So, with holidays like Christmas and Hanukkah at hand, there is always a temptation to abandon healthful living routines.  Eating too much, not getting enough exercise, staying up late, worrying about family members getting along — all these things can make you feel worse.

Patients with diabetes, heart conditions, or epilepsy, for example, must take care of yourself or the disease gets worse. With autoimmune diseases, such as MS, fibromyalgia, or lupus, your symptoms will get worse but not the disease itself.

Holidays bring out all the physical and social concerns around chronic diseases. The demands and expectations around holidays can “out” people whose conditions were hardly noticeable. During the year, they spend so much of their energy working and handling the daily chores of living that they have little time left for socializing. Come the holidays, they’re expected to show up and contribute.

Many chronic illnesses, such as diabetes, depression, arthritis, fibromyalgia, etc., are not noticeable. “People go to work or volunteer or shuttle kids to school. Most of the time, they don’t look sick. When illness flares up, their pain is invisible. Or they have bone-numbing fatigue, so bad that they can’t take a shower and go to the store in the same day. There’s a cultural misperception that says you’re not sick unless you look sick. They need to make their illness visible by talking about it.”

An article in Arthritis Today offers three tips for managing holiday stress:

Daily rest and relaxation. Don’t get stuck in a never-ending to-do list. Do a crossword puzzle or take a walk or a nap. The mental and physical break will rejuvenate you.

Prioritize. Decide how much shopping, cooking, or partying you can do and stick to it. Ask for help.

Volunteer. Take toys to the Marine Toys-for-Tots Foundation, take food to homebound seniors through Meals on Wheels, or provide goods and services for Hurricane victims. It will boost your spirit and remind you what the holidays are about.

The holidays can be hard on everyone but more so to patients with chronic diseases. Family members and in general people need to be more accommodating to those who have chronic illnesses.

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Is Eating Vegan Healthy?

A few years ago, one of my patients asked me if I knew anything about Forks over knives. She reported she saw a cardiologist to get cleared for surgery, he told her he would not clear her but encouraged her to see the documentary Forks over Knives and to follow the diet. The patient was very stressing over the fact she could not get the surgery, she told me that the cardiologist encouraged her to eat a vegan diet. Vegans abstain from eating any animal products while vegetarians do not eat animal meat but still eat eggs, cheese, milk.  The Forks over Knife documentary and book explores the claim that all deteriorating diseases can be control, even reverse by not eating animal based and processed foods.

Most people become vegan to avoid animal cruelty products and wanting to be healthier. But is a vegan diet Healthy? Around 2.5 percent of people in the United States (U.S.) are vegans, according to a 2016 poll. Here are some facts about the vegan diet:

The vegan diet contains only plant-based foods. All protein, vitamins, and minerals must come from non-animal sources, so food choice and preparation are important. Tofu, tempeh, and mushrooms are three of the many alternatives than can provide the nutrients found in meat. A vegan diet can help to protect bone and heart health, and lower the risk of cancer.  Supplements are recommended to replace levels of certain nutrients abundant in meat, such as vitamin B12.

Animal fats have been linked to various cancers, diabetes, rheumatoid arthritis, hypertension, heart disease, and a range of illnesses and conditions. Animal sources are likely to account for 13 of the top 15 sources of cholesterol-raising fats in the U.S.  Not eating meat reduces the overall risk of mortality.

The following are likely to be in short supply on a vegan diet, but alternatives are available.

  • Vitamin B12: Vitamin-B12 fortified plant foods, such as fortified soy, seaweed, cereals, and nutritional yeast can supplement intake.
  • Iron: Dried beans and dark leafy greens may be better sources of iron than meat on a per-calorie basis. Using a cast-iron skillet to prepare a meal is a good way to absorb more iron into the food.
  • Calcium: Eat more tofu, tahini, and green, leafy vegetables.
  • Vitamin D: Regularly consuming more vitamin-D fortified foods and spending time in the sun can boost vitamin D levels.
  • Omega-3 fatty acids such as DHA and ALA: Omega-3 fatty acids, such as fish oil, are vital for cardiovascular health, eye function, and brain function. Though EPA, another type of omega-3, can’t be obtained with a vegan diet, ALA and DHA can be found in ground flaxseed, walnuts, canola oil, soy products, and hemp beverages.
  • Zinc: Whole grains, legumes, and soy products are rich in zinc.

My patient followed the diet and lost around 20 lbs., reported feeling better, got off most of her medications and could get her surgery. The patient was not able to stick with the diet for more than 18 months, and has since started to eat meat again. While eating vegan can be healthy, making sure to get vitamin B12, iron, calcium, vitamin D, omega 3 acids and zinc; is important.

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Setting Health Goals

We all set goals for work, for education, for careers and for life in general. What about setting goals for your health? How many times have you wanted to diet, exercise only to say “I will do it tomorrow, I will start my diet tomorrow or I will start exercise tomorrow”.  For patients with chronic diseases such as diabetes, high blood pressure, cholesterol, COPD, etc. postponing those goals can bring bad consequences.

Setting goals is the start of the road to better health. Do you keep your promises? Goals are a type of promise that you make to yourself. Honor your commitments, especially those made to yourself.  For each goals, smaller steps can be set so as not to get over whelmed.  Set SMART goals:

S: Specific

Be specific, don’t just say I will exercise starting tomorrow. State how much and what types of exercise you will do. Example: I will start exercising tomorrow, I will start walking 30 minutes three days per week on Mondays, Wednesdays and Fridays in the morning.

M:Measurable

Have a way to measure your progress. if you are trying to loose weight for example; weigh your self daily or at the end of every week.  If you are going to start walking measure how far you walk for 30 minutes or how fast.

A:Attainable

Your goals should be meaningful to you, they  should specific to you and they should be goals that you really want to achieve.

R:Realistic

Your goals should not be impossible but goals you will be able to work toward.  Loosing 20 lbs in one month is probably not realistic. Create a plan and commit to it.

T:Time sensitive

Set a time in which you will accomplish your goals. Saying “I will work three times a week for 30 minutes” is good but not as good as saying “I will walk three times a week for 30 minutes per week and will walk 3 miles in 30 minutes by the end of three months”.

Writing down your goals, making a very specific plan and sharing it with friends or love ones can increase the odds that you will stick to your goals. Commit to your self and improve your health today.