DrRic The Moorings Lecture on Hypertension (slide share edition)
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Lecture given on the basics of hypertension and what to expect if you are diagnosed with it.
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DrRic The Moorings Lecture on Hypertension (slide share edition)
- 1. Taking the Hype out of Hypertension Enrique Saguil, M.D. We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.
- 3. Cares what I have to say
- 4. Doesn’t Keep Me Waiting
- 5. Gives Me OptionsWe didn’t invent the practice of medicine…. we’re just changing the way it’s provided.
- 6. The First Health Approach We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.
- 7. Your Community of Care Ric Saguil, MD Jason Gruss, MD Tom Jordan, RD Katrina Christie, LCPC Jennifer Green, ND Joe Musolino, DC Amy Iaquinta, DC Nick Nowicki, DC Emery Paredes, PT Courtney Day, EP Yu Zhu, MD China Mike Blumberg, LCPC You
- 8. Begin with going back Back to basics -Anatomy -Physiology -Pathology
- 9. The Pump
- 11. The delicate balance in push and receive: The receptors receive The heart pushes
- 12. Receptors are ultrafast in response! For some reason, the blood vessels are not responding
- 13. The Bed
- 14. Your other sphincter muscles!
- 15. Blood flows by osmosis also
- 20. Damages – blood vessels(chronic but sudden)
- 23. No one is safe
- 24. Universal sign – Levine Sign
- 25. Sometimes obvious Chris Farley
- 26. Sometimes “silent” Billy Mays
- 28. Disease or Symptom? Lets first classify what Hypertension is (High Blood Pressure)…..
- 29. Who makes the guidelines? US Department of Health and Human Services (gov) NIH National Institute of Health (gov) National Heart Lung and Blood Institute (gov) 1972 Expert Panel to write guidelines (unpaid NHLBI panel) +Internal review panel considers conflict of interest +Methodologist hired to graph Clinical practice guidelines created for px and clinician to develop diagnostic and treatment modalities
- 30. Currently there are guidelines for: Asthma High cholesterol Overweight and Obesity Von Willebrand’s Disease High Blood Pressure
- 31. High Blood Pressure Guidelines High Blood Pressure in Children and Adolescents High Blood Pressure Guildelines (JNC7) 2003
- 32. How long has the JNC been? 1997 JNC6 1992 JNC5 1988 JNC4 1984 JNC3 1980 JNC2 1976 JNC1
- 33. JNC 6 …….the introduction of new combination antihypertensive medications and new angiotensin II receptor blockers…. oh yeah!!
- 34. The JNC 7 The 7TH Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure (Evidence based medicine and consensus to make recommendations to clinicians) (Mission to create awareness, prevention, treatment and control of hypertension)
- 35. Success? According to the National Health and Nutrition Examination Survey (NHANES) II -1976 to 80 and III –1988 to 91 …..awareness went from 51-73% …age adjusted mortality rate from stroke and CHD decreased CDC
- 36. JNC 6 Optimal BP <120 s <80 d Normal BP <130 s <85 d High NL 130-139 85-89 Hypertension: Stage 1 140-159 90-99 Stage 2 160-179 100-109 Stage 3 >180 >110
- 37. JNC 7 Created because of 1. Publication of many new hypertension observational studies and clinical trials 2. Need for a new, clear and concise guideline that would be useful for clinicians 3. Need to simplify the classification of blood pressure 4. Clear recognition that the JNC reports were not being used for their maximum benefit (the unpublished NHNESP 1999-2000 study showed increase in awareness from 68-70 only) ClaudLenfant, MD Director NHLBI
- 38. New “stuff” ABPM – ambulatory blood pressure monitoring for white coat hypertension and effective drug therapy White Coat Hypertension mentioned again Initiation of dual therapy from the start of dx http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf
- 39. Drug treatment (when not at goal <140/90 or <130/80 with DM or Chronic Renal Disease) Stage 1 140-159 or 90-99 single med Stage 2 >160 or >100 dual med With compelling indications: Heart Failure Post Myocardial Infarction Diabetes Chronic Renal Disease Recurrent Stroke Prevention
- 40. Lifestyle changes determine how long the future will last Weight reduction Adopt DASH eating plan Dietary sodium restriction Physical activity Moderation of alcohol consumption
- 41. Weight Reduction Maintain normal body weight BMI of 18.5-24.9 kg/m2 http://www.nhlbisupport.com/bmi/ 5-20mmHg per 10 kg wt loss
- 42. Body Mass Index
- 43. DASH diet Consume a diet rich in fruits, vegetables and low fat dairy products with reduced content of saturated and total fats 8-14 mmHg
- 44. DASH Dietary Approaches to Stop Hypertension Their findings showed that blood pressures were reduced with an eating plan that is low in saturated fat, cholesterol, and total fat and that emphasizes fruits, vegetables, and fat-free or low-fat milk and milk products. This eating plan—known as the DASH eating plan—also includes whole grain products, fish, poultry, andnuts. It is reduced in lean red meat, sweets, added sugars, and sugar-containing beverages compared to the typical American diet.
- 45. 1st DASH diet trial 459 people with BP’s 160/80-95 3 groups -average American diet -average American diet with fruits and vegetables -DASH diet Blood pressure reductions in two weeks with F&V / DASH (note all diets were with 3000mg sodium restriction per day)
- 46. The four hospitals Brigham and Women’s Hospital, Boston Duke Hypertension Center and the Sarah Stedman Nutrition and Metabolism Center, Durham Johns Hopkins Medical Institutions, Baltimore Pennington Biomedical Research Center, Baton Rouge http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf
- 48. The Mediterranean Diet Grains Healthy oils/fat Fruits Veggies!!!!!! Not so much processed meat More fish
- 49. The Anti-inflammatory Diet Grains Healthy oils/fats Fruits Veggies!!! (Legumes) Not so much processed meat/more whole foods More fish Less dairy Whole soy Green tea
- 50. Dietary sodium restriction Reduce dietary sodium intake to no more than 100mmol per day (2.4 gm sodium or 6gm sodium choloride) 2-8mmHg
- 51. Is there an alternative? Yes? …and it doesn’t have to taste like cardboard Spice, herbs nutritional yeast!!!
- 52. Is it worth changing your world? HAL study-europe study with 320,000 people age 70-90y/o for 10 years with decrease occurrence of heart disease morbidity, mortality NIH-AARP study 20,000 with 50-70 y/o with decrease in all cause mortality (including cancer)
- 53. Reference books for the:Mediterranean Diet The Mediterranean Diet Cook Book Nancy Jenkins Eat Drink and Weigh Less Walter Willet
- 54. Books on the concept of food for health: What is the color of your diet? Omnivore’s Dilemma
- 55. Documentaries on food industry: Food Inc. The Killer at Large The Hidden Epidemic
- 56. Physical Activity Engage in regular aerobic physical such as brisk walking (at least 30 min per day most days of the week) 4-9mmHg
- 57. Moderate consumption of alcohol Limit consumption to no more than 2 drinks per day in most men and to no more than 1 drink per day in women and lighter weight persons 2-4mmHg
- 58. The Saguil Approach Know the JNC7 guidelines Behavioral support/ spirituality/ grounding Think plant based diet, the color of your diet The anti-inflammatory diet, animal protein if there’s room Movement that suits you but think dual purpose, run to compete, climb to get into nature, yoga for spirituality and breath, tai chi for self defense and TCM healing Utilize the insurance but be truthful
- 59. In a nutshell… Review numbers Compile risk factors Ambulatory blood pressure monitoring at walmart, jewel, target or dominics and record. See with abpm record in 3 months Soft suggestion of lifestyle change Keep safe with meds until 6-12 months (noting all the side effects) Hard referral to special forces……
- 60. One size does not fit all Primary care eval risk factor stratification Physical therapy eval to introduce movement Exercise eval to drive motivation Dietary eval diet diary and education Naturopathic eval herbal supplemment power! (still with plans to get off) Behavior health eval to prepare for withdrawal Specialist eval to prepare for surgery Physical med eval to assess injury/limitation (Ortho, Sports Med, PMR, Chiro, PT, Massage, Reflex, Reiki….)
- 62. Find aHeart friendly exercise activity!
- 63. Stress reduction - meditation
- 64. Relaxation induction The Relaxation Response – Herb Benson blood pressure heart rate respiratory rate temperature All dropped – with “distractions”
- 65. You are what you eat!
- 66. Preventive Medicine Research Institute Approved by medicare for an 18 week program as of summer 2010 Criteria: acute MI within 12 months bypass surgery stable angina heart valve replacement or repair ptcaplasty or stenting heart or heart lung transplant http://www.pmri.org/certified_programs.html Yoga, diet education, group therapy All paid for by your tax dollars and Medicare!! It only took 16 years!
- 67. Knowledge is power …It’s our responsibility to share this power.
- 68. Americans are leading the world! (into oblivion)
- 69. Weapons of mass destruction
- 70. QUESTIONS? The Hype has been taken out ofHypertension COMMENTS? CONCERNS? 2010 South Arlington Heights Road Arlington Heights, IL Phone: 847-593-3330www.FirstHealthAssociates.com
Hinweis der Redaktion
- Just to understand better, let me show you how things work in the body
- Blood flows in and out of chambers with the force of muscle contraction
- Muscle fibers of the heart are broken down into tow simple filaments that slide and lock onto each other via calcium attraction- its called a sliding filament theory…..its fantasticThese green molecules called myosin are in a cocked or unwound spring phase without energy, they become electrically attracted to connect spots on the coiled protein-actin. The only way to expose the connect spots is to bath the pink area with calcium. When calcium is present and the “spring” then contracts. When energy or atp is produced by the mitochondria (powerhouse) the spring releases and cocks up again gets ready to pull the fiber along again. The process repeats until one fiber has slid down the entire length of the other fiber causing complete contraction of the entire muscle. Then calcium is taken away and the entire fiber complex relaxes back to startin length. This is important to know because when the calcium “bathing the acting” part is slowed down or limited, contraction is also limited. The theory of a calcium channel blocker pill
- The body is a great instrument with very good feedback systems in place to regulate how hard the pump pushes. Barorecptors are found in the aorta and carotid located behind the sternum and in the neck. When the tissue here gets stretched or manipulated ( like tickling your side) electric impulses are sent to the brain and the brain suddenly says drop the pressure in the body by opening all the flood gates and emptying the lake-so bp drops suddenlyIn addition, the brain says slow down the heart rate fast and the pace of contraction is really slowed almost to a resting or sleeping state
- In wrestling, it is called the “sleeper hold” or a choke, if tight enough, the heart will slow and bp will drop putting your opponent to “sleep”In the er the first and most primitive manuver to slow a fast heart rate is carotid massage, even before the iv lines get put in or medicine gets placed under the toungue
- this is the vascular bed, not like the bed you sleep on but more like a flower bed, vast and when spread out flat=enormous one persons bed spread flat is almost the sqaure footage of a football fieldBlood vessels always travel in pairs…where there is an artery, there will be a vein right next to it. When oxygenated blood leaves the heart, it pumps to the very end of the artery then into the bed and out to the tissue….
- Here is a pic of the very end of the artery where capillaries connect out and reach through the tissue to the veins. Remember around the arterys are circular muscles that when contracted, tighten like a blood pressure cuff. When the circular smooth muscle tightens it collapses the size of the artery and narrows the diameter/lumen. This can turn your high flow hose to just a drizzle. These circular muscles are also in the areas where the blood vessels enter into the capillary bed, they are called sphincters. When sphincters are tight, no flow occurs, when loose all the beds are flooded with blood. As I mentioned, this bed is the size of a football field, if I flood a football field it will take a lot of my blood to do so, of 6liters, my pressure will drop. This is what beta blockers can do (they also have another function to slow the rate of the pump but more later…)
- Venules can open up and the “empty space” will pull the blood from the artery to the vein. So another method of dropping blood pressure is by having all the veins relax and open to encourage the blood to flow. The problem is if the vein is blocked or congested, blood wont flow and tissue can suffer and become ischemic (slow death), like a swollen leg or edema turning blue or purple
- Bmi is important, it has been determined to be an ideal weight at which the human body will function best in all its systems