AE3 wk 4 notes.docx - A&E III WEEK 4 VASCULAR DISORDERS 10 OCTOBER 2019 HYPERTENSION Important Facts Some disparities 1 Incidence highest among

AE3 wk 4 notes.docx - A&E III WEEK 4 VASCULAR DISORDERS 10...

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A&E III WEEK 4: VASCULAR DISORDERS 10 OCTOBER 2019 HYPERTENSION Important Facts - Some disparities: 1. Incidence highest among African-Americans 2. Incidence higher among men compared to women until age 45 3. Incidence higher among women compared to men after age 45 - 1 in every 3 Americans has hypertension (HTN) 1. 47% do not have it under control - Uncontrolled BP increases the risk of co-morbidities: 1. A 20 mm Hg (systolic)/10 mm Hg diastolic increase in BP doubles the risk of Cardiovascular Disease (CVD) 2017 Guidelines BP Category SBP DBP Normal <120 mm Hg and <80 mm Hg Elevated 120–129 mm Hg and <80 mm Hg Hypertension Stage 1 Stage 2 130–139 mm Hg ≥140 mm Hg or 80–89 mm Hg ≥90 mm Hg CARDIOVASCULAR DISEASE PROGRESSION Risk Factors - Essential/Primary HTN 1. Family history 2. African-American ethnicity 3. Hyperlipidemia 4. Smoking 5. > 60 years or post menopausal 6. Excess sodium and caffeine 7. Overweight/obese 8. Sedentary 9. Excessive alcohol intake 10. High intake of salt 11. Reduced intake of potassium, calcium, or magnesium 12. Stress - Secondary HTN 1. Renal disease 2. Primary aldosteronism Modifiable/ Non-modifiable risk factors HTN End Organ Damage Death
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3. Pheochromocytoma 4. Cushing’s syndrome 5. Brain tumors 6. Pregnancy 7. Medications: Estrogen Glucocorticoids Mineralocorticoids Sympathomimetics Erythropoietin Monoclonal antibodies Others? ATHEROSCLEROTIC CARDIOVASCULAR DISEASE (ASCVD): Risk Calculator Exemplar Risk Factors 55 Y/O African American Female 55 Y/O Non-Hispanic White Female Age 55 55 Gender F F Race AA NH W Total cholesterol (mg/dL) 210 210 HDL cholesterol (mg/dL) 44 44 Systolic BP 139 139 Diastolic BP 70 70 Treated for high BP N N DM Y Y Smoking N N Score: 10 years ASCVD Risk 12.8% 5.8% 2
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Consequences of High BP HTN: Collaborative Management - Sodium restriction - Optimal goal is <1500 mg/d, but aim for at least a 1000- mg/d reduction in most adults. - Weight reduction Best goal is ideal body weight. Expect about 1 mm Hg for every 1-kg reduction in body weight - Reduce alcohol intake - 1 drink per day for women and up to 2 drinks per day for men. - Exercise - see notes - Decrease stress levels - Avoid smoking WHO Exercise Guidelines: - Adults aged 18–64 should do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week or do at least 75 minutes of vigorous- intensity aerobic physical activity throughout the week or an equivalent combination of moderate- and vigorous-intensity activity. - Aerobic activity should be performed in bouts of at least 10 minutes duration. - For additional health benefits, adults should increase their moderate-intensity aerobic physical activity to 300 minutes per week, or engage in 150 minutes of vigorous-intensity aerobic physical activity per week, or an equivalent combination of moderate- and vigorous-intensity activity.
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  • Summer '17
  • Laurei Jeffers

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