Why Study Hypertension? Heart failure Heart attack Stroke Kidney failure Vision deterioration.

Why Study Hypertension?

• Heart failure

• Heart attack

• Stroke

• Kidney failure

• Vision deterioration

US National Center for Health Statistics

• Diseases of the Heart

• Malignant Neoplasms

• Cerebrovascular Diseases

Review Article in Lancet 2001

• Heart Disease

• Stroke (regardless of income)

How to label hypertension

• JNC 7 (Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure)

• <120/80

• Prehypertension 120-130/80-89

• Hypertension Stage 1 140-159/90-99

• Hypertension Stage 2 >160/>100

Practical note on variability:

time of dayrecent salt ingestion

alcoholexercisestresscoffee

mechanics of measure

Dr Saguils’ Answer:

• Multiple measurements

• Vary the time of day

• Vary the place

• Bring the cuff into the office with records

Those “unfortunate”

• Family hx• Smokers• Sedentary• Overweight or obese• African-americans• >35• Alcohol users• Salt users• “Certain prescriptions”

-Family History

• Inherited via genetic history

• Male (not all the time)

• Morphology (not all the time)

• Eating habits during early years

-Smokers

• Nicotine effects (high dosing)

• Irritating effects of smoke/reaction

• Carcinogenic effects/reaction

• Addictive cocktail (ammonia/arsenic)

-sedentary lifestyle

• Poor endurance

• Endocrine urge to store calories

• Poor perfusion to end organs

-Weight issues

• Fat and cholesterol content in blood vessel

• Extra weight to contend with during adl

-age and race

• Stress of life (60hrs)

• Deterioration of protective effects of liver

• Accumulation of abuse or neglect

• Historical tendancy

-ingested

• Alcohol destructive effects to liver

• Destructive effects to endothelial lining

• Osmotic changes caused by salt to kidney

-medicines

• Ephedra(ma huang), meridia

• pseudoephedrine

• Bextra, celebrex –cox2

• Motrin, naprosyn -nsaids

• Steroids

• Estrogen

• Imitrex

What to watch for:

• Vision changes

• Headache

• Chest pain/arm pain

• Difficulty breathing

• Irregular heart beat

• Blood in urine

• Fatigue or confusion

How to treat

• Conservative-if time warrants

• Aggressive-before any further damage or death

conservative

• Stress reduction (work change)• Weight loss• Breathing• Low salt diet (DASH or DASH 2)• Stress management (meditation,tai chi, yoga)• Kava kava• Reishi• Hawthorne berry• garlic

aggressive

• All conservative measures

• Medicines either outpx or ICU

Medicines

• ACE inhibitors, ARBS

• Betablockers

• Alpha blockers

• Calcium channel blockers

• Diuretics

Dr Saguils’ Answer

• Get stable and safe

• Back to conservative

• Work change

• Diet change (antiinflammatory diet)

• Supplement use

• Eastern exercise

• Family involvement

Hypercholesterolemia

• Hyperlipidemia

• Hypertriglyceridemia

• Hyperlipoproteinemia

• Elevated cholesterol

Cholesterol is good!

• But only in small amounts

• Needed for maintaining cell walls

• Hormone building block

• Vitamin D

• Bile for digestion

Too much cholesterol:

• Leads to deposition in blood vessels….

• Fatty plaque build up

• Narrowing of the artery

• Inflammatory reaction to plaque

• Ulceration

• Clot formation

• Plaque rupture

• Clot embolism

• Stroke or infarction

At risk?

• Family hx

• Smoking

• Sedentary lifestyle

• Age

• Menopause

• Over weight or obese

Measurements

• Lipoproteins measured in mg/dl:

• Total cholesterol 180-200

• LDL 80-100

• HDL 40-70

• Triglycerides 110-150

Cardiology testing:

• Berkley testing

• Stress testing

• Ultrafast CT scanning

• Carotid ultrasounding

• Echocardiogram

• Angiogram

Practical note on testing:

• Make sure a true fast was performed

• If unsure, repeat

• Dr Saguils’ Answer to initial results:

“you have 3 months”

Conservative Tx:

• Stress reduction• Weight control, appetite control• Antiinflammatory diet• No smoking• No alcohol• Nutrition support• Exercise• Herbal supplements

Cholesterol intake

• The American Heart Association recommends that you limit your average daily cholesterol intake to less than 300 milligrams. If you have heart disease, limit your daily intake to less than 200 milligrams.

Saturated fats

• Reduce saturated fat. The richest sources of saturated fat (fat that is usually solid at room temperature) in the diet are red meat and dairy foods. Substitute soy protein for animal protein, and use low- or non-fat dairy products.

Trans fats

• Avoid trans-fat. Stay away from items that list "partially hydrogenated oil" on the label, especially snack foods. Try baked or air-popped versions instead.

Antioxidants

• Drink green tea daily. The antioxidants in green tea help lower cholesterol and prevent the cholesterol in your blood from oxidizing.

• Multivitamins

High fiber

• Eat plenty of soluble fiber. It has a powerful cholesterol-lowering effect. The best sources are beans and lentils, apples, citrus fruits, oats, barley, peas, carrots and freshly ground flaxseed.

Exercise!

• Exercise increases HDL cholesterol in some people. Even moderate-intensity activities, if done daily, can help control weight, diabetes, and high blood pressure -- all risk factors for heart disease.

Herbal supplements:

• Omega 3 fish oils

• Low omega 6

• Garlic

• Co Q10

• Red yeast rice

• Liver cleanse

• Colon cleanse (if symptomatic)

Red Yeast Rice

• Red rice yeast (Monascus purpureus) has a long history of use in China as a food coloring and healthful ingredient. It provides a source of naturally occurring statins, and because it delivers a mix of statins rather than a single molecule, it is much less likely to cause the side effects of the pharmaceutical versions.

• Red yeast rice extract -cholestin

Omega 3

• Omega-3 fatty acids can lower triglyceride levels, increase HDL cholesterol, help minimize inflammation and blood clotting, and keep blood vessels healthy.

• Deep cold water oily fish, supplement

Co Q10

• helps protect LDL cholesterol from oxidation, maintain healthy blood vessels, protect against clots and plaque rupture, and support optimal functioning of the heart muscle.  

• supplement

Garlic

• Hebrew University in Jerusalem-rats that got the 500-milligram daily dose of garlic were resistant to the cholesterol-raising effects of their diet. The 500-milligram dose of garlic was also associated with an increase in the time it would take for blood to clot.

• Supplement and diet

Medicines

• Statins

• Niacin

• Bile-acid resins

• Fibric acid derivatives

Statins

• Statins lower cholesterol and reduce the risk of heart attacks by blocking an enzyme that causes the liver to produce cholesterol. These drugs also have antioxidant and anti-inflammatory properties.

• Baycol, mevacor, provachol, lipitor

Niacin

• Nicotinic acid reduces the production of triglycerides and VLDL (very low-density lipoprotein, which is converted to LDL in the blood). This leads to decreased LDL ("bad") cholesterol, increased HDL ("good") cholesterol, and lowered triglycerides. Nicotinic acid raises HDL cholesterol more than other lipid-lowering medicines.

• Niaspan

Fibrates

• Fibrates reduce the production of triglycerides and can increase HDL cholesterol.

• Tricor

• lopid

Bile sequestrants

• These drugs work inside the intestine, where they bind to bile from the liver and prevent it from being reabsorbed into the circulatory system. Bile is made largely from cholesterol, so these drugs work by depleting the body's supply of cholesterol. The most common side effects are constipation, gas and upset stomach.

• Questran, welchol, cholestid

Dr Saguils’ Answer

• Get stable and safe

• Back to conservative

• Work change

• Diet change (antiinflammatory diet)

• Supplement use

• Eastern exercise

• Family involvement

If all else fails and Rx is the way:

• Watch anything that can hit the liver

• Do a liver cleanse 3-4 times a year with your herbalist

• See your doctor or cardiologist routinely

• Join a running club or go more aggressive eastern exercise

• See a nutritionist