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Heart-health Self-management Course

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Class goals:

Understand hypertension and its relation to heart-health.
Learn how to manage and control blood pressure.
Develop personalized strategies for success.

Schedule overview.
Icebreaker instructions.

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Let’s Begin Our Journey

“The best compliment I have ever received (from a parent, teacher, friend, enemy, or a stranger).”

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Citation: Chapter 5 Epidemiology, Pathophysiology, and Treatment of Hypertension, Fuster V, Narula J, Vaishnava P, Leon MB, Callans DJ, Rumsfeld JS, Poppas A. Fuster and Hurst's The Heart, 15e; 2022. Available at: https://accessmedicine.mhmedical.com/content.aspx?sectionid=265678811&bookid=3134 Accessed: January 22, 2025

Risk of death from ischemic heart disease and stroke increases in a log-linear manner with both systolic and diastolic blood pressure. Reproduced with permission from Lewington S, Clarke R, Qizilbash N, et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002 Dec 14;360(9349):1903-1913.�

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Citation: Chapter 5 Epidemiology, Pathophysiology, and Treatment of Hypertension, Fuster V, Narula J, Vaishnava P, Leon MB, Callans DJ, Rumsfeld JS, Poppas A. Fuster and Hurst's The Heart, 15e; 2022. Available at: https://accessmedicine.mhmedical.com/content.aspx?sectionid=265678811&bookid=3134 Accessed: January 22, 2025

Relationship between cardiac output, peripheral blood flow regulation, and venous return.�

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Citation: Chapter 5 Epidemiology, Pathophysiology, and Treatment of Hypertension, Fuster V, Narula J, Vaishnava P, Leon MB, Callans DJ, Rumsfeld JS, Poppas A. Fuster and Hurst's The Heart, 15e; 2022. Available at: https://accessmedicine.mhmedical.com/content.aspx?sectionid=265678811&bookid=3134 Accessed: January 22, 2025

Population-attributable fraction (percentages) for 14 potentially modifiable risk factors for CVD (cardiovascular death, myocardial infarction, stroke, and heart failure) and mortality from 155,722 participants from the PURE prospective cohort study. Data from Yusuf S, Joseph P, Rangarajan S, et al. Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE): a prospective cohort study. Lancet. 2020 Mar 7;395(10226):795-808.�

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Citation: Chapter 5 Epidemiology, Pathophysiology, and Treatment of Hypertension, Fuster V, Narula J, Vaishnava P, Leon MB, Callans DJ, Rumsfeld JS, Poppas A. Fuster and Hurst's The Heart, 15e; 2022. Available at: https://accessmedicine.mhmedical.com/content.aspx?sectionid=265678811&bookid=3134 Accessed: January 22, 2025

Many factors affect BP control. These include patient level (blue sphere), provider level (green sphere), and health-care system level factors (orange sphere), which intersect and overlap.�

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Understanding Blood Pressure

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"Understanding Blood Pressure"

Content:

Definition of blood pressure.
Difference between systolic and diastolic pressures.
Normal, elevated, and high blood pressure ranges (with visual chart).
Importance of maintaining healthy blood pressure.

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Definition of blood pressure

Blood pressure is the force of your blood pushing against the walls of your blood vessels.

High blood pressure is also known as hypertension.

It happens when the force of your blood pushing against the walls of your blood vessels is too high.

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Difference between systolic and diastolic pressures.

Your blood pressure is recorded as two numbers:

Systolic blood pressure is the first number. It measures the pressure your blood is pushing against your artery walls when the heart beats.

Diastolic blood pressure is the second number. It measures the pressure your blood is pushing against your artery walls while the heart muscle rests between beats.

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Normal, elevated, and high blood pressure ranges

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Importance of maintaining healthy blood pressure.

Maintaining healthy blood pressure is crucial for overall well-being and can help prevent a variety of serious health problems. Here are some key reasons why it’s important:

Heart Health: Blood pressure that's too high or too low can put a strain on your heart, leading to conditions like coronary artery disease, heart attack, or heart failure.
Stroke Prevention: High blood pressure is a leading cause of strokes. By keeping your blood pressure within a healthy range, you reduce your risk of having a stroke.
Kidney Health: Your kidneys filter waste from your blood, and consistent high blood pressure can damage this process, potentially leading to chronic kidney disease or kidney failure.
Eye Health: Hypertension can cause damage to the blood vessels in the eyes, leading to retinopathy and even vision loss.
Overall Circulation: Proper blood pressure ensures that all your body’s organs get the right amount of oxygen and nutrients delivered through the bloodstream.

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Types of Hypertension

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"Primary vs. Secondary Hypertension"

Feature	Primary (Essential) Hypertension	Secondary Hypertension
Cause	Unknown; related to genetic and lifestyle factors	Caused by an underlying medical condition such as kidney disease, hormonal imbalances, certain medications, etc.
Prevalence	90-95% of hypertension cases	5-10% of hypertension cases
Onset	Develops gradually over many years	Sudden onset, often causing higher blood pressure
Risk Factors	Family history, age, gender (more common in men), race, obesity, physical inactivity, poor diet (high in salt), excessive alcohol consumption	Dependent on the underlying condition (e.g., kidney disease, hormonal disorders, medications)

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Feature	Primary (Essential) Hypertension	Secondary Hypertension
Management	Lifestyle changes (diet, exercise), medications	Focuses on treating the underlying condition, alongside lifestyle changes and medications
Symptoms	Often asymptomatic, discovered during routine checkups	Symptoms related to the underlying condition; sudden high blood pressure
Complications	Long-term organ damage (heart, kidneys, eyes), increased risk of heart attack, stroke	Complications related to the underlying cause and untreated high blood pressure

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Risk Factors for

Hypertension

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Complications of

Hypertension

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Blood pressure Medications

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Citation: Chapter 5 Epidemiology, Pathophysiology, and Treatment of Hypertension, Fuster V, Narula J, Vaishnava P, Leon MB, Callans DJ, Rumsfeld JS, Poppas A. Fuster and Hurst's The Heart, 15e; 2022. Available at: https://accessmedicine.mhmedical.com/content.aspx?sectionid=265678811&bookid=3134 Accessed: January 22, 2025

Management by BP category and ASCVD. ASCVD risk estimated using the PCE calculator. Adults with hypertension and either diabetes mellitus, CKD, or age ≥65 years can be assumed to be at high risk for CVD.�

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In adults with no compelling indication

The following four drug classes have been shown to be effective for prevention of CVD compared to placebo: (1) diuretics (especially the long-acting, thiazide-like diuretic chlorthalidone);
(2) calcium channel blockers (CCBs), especially dihydropyridine CCB; (3) ACE inhibitors; and
(4) ARBs.

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Combinations

Combinations should be based on the use of agents with complementary mechanisms of action. Taking a diuretic or CCB with an ACE inbibitor or ARB represents an effective two-drug combination.

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Triple Therapy

Triple therapy can be accomplished by combining a diuretic with a CCB and either an ACEI or ARB.

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If Triple Therapy is Not Sufficient

Substitution of a longer-acting diuretic in place of a shorter-acting agent or addition of spironolactone, an alpha-receptor blocker, or a b-blocker may prove to be effective. Lack of BP control with use of three or more antihypertensive agents at full doses merits a diagnosis of apparent resistant hypertension.

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Citation: Chapter 5 Epidemiology, Pathophysiology, and Treatment of Hypertension, Fuster V, Narula J, Vaishnava P, Leon MB, Callans DJ, Rumsfeld JS, Poppas A. Fuster and Hurst's The Heart, 15e; 2022. Available at: https://accessmedicine.mhmedical.com/content.aspx?sectionid=265678811&bookid=3134 Accessed: January 22, 2025

Obesity shifts the frequency distribution of BP. Not all individuals who are obese have BPs in the hypertensive range; however, obesity raises BP above the baseline level for an individual. (eg, from point A to B). Conversely, weight loss lowers BP in individuals who are obese but considered to be normotensive (eg, from point B to A), as well as in those who are obese and hypertensive. Increasing duration of obesity exacerbates the obesity-induced shift of the BP frequency distribution to higher levels of BP.�

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Citation: Chapter 5 Epidemiology, Pathophysiology, and Treatment of Hypertension, Fuster V, Narula J, Vaishnava P, Leon MB, Callans DJ, Rumsfeld JS, Poppas A. Fuster and Hurst's The Heart, 15e; 2022. Available at: https://accessmedicine.mhmedical.com/content.aspx?sectionid=265678811&bookid=3134 Accessed: January 22, 2025

Time dependency of BP control mechanisms. Approximate maximum feedback gains of various BP control mechanisms at different time intervals after the onset of a disturbance to BP. Reproduced with permission from Hall JE, Hall ME. Guyton and Hall Textbook of Medical Physiology, 14th ed. Philadelphia, PA: Elsevier; 2021.�

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Citation: Chapter 5 Epidemiology, Pathophysiology, and Treatment of Hypertension, Fuster V, Narula J, Vaishnava P, Leon MB, Callans DJ, Rumsfeld JS, Poppas A. Fuster and Hurst's The Heart, 15e; 2022. Available at: https://accessmedicine.mhmedical.com/content.aspx?sectionid=265678811&bookid=3134 Accessed: January 22, 2025

Autoregulation of blood flow during acute changes in mean arterial pressure in people with normal BP (blue curve), with chronic hypertension (red curve), and with impaired ability to autoregulate blood flow (black curve). The dashed vertical lines indicate the approximate normal range of autoregulation in many tissues.�

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Citation: Chapter 42 Hypertension in High-Risk Populations, Lerma EV, Rosner MH, Perazella MA. CURRENT Diagnosis & Treatment: Nephrology & Hypertension, 2e; 2017. Available at: https://accessmedicine.mhmedical.com/content.aspx?sectionid=177430299&bookid=2287 Accessed: January 21, 2025

Total mortality by diastolic blood pressure among untreated and treated hypertensives. (From Boutitie F et al: J-shaped relationship between blood pressure and mortality in hypertensive patients: new insights from a meta-analysis of individual-patient data. Ann Intern Med 2002;136:438.)�

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Citation: Chapter 11 Antihypertensive Agents, Katzung BG, Vanderah TW. Basic & Clinical Pharmacology, 15e; 2021. Available at: https://accessmedicine.mhmedical.com/content.aspx?sectionid=250595338&bookid=2988 Accessed: January 21, 2025

Anatomic sites of blood pressure control.�

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Citation: Chapter 11 Antihypertensive Agents, Katzung BG, Vanderah TW. Basic & Clinical Pharmacology, 15e; 2021. Available at: https://accessmedicine.mhmedical.com/content.aspx?sectionid=250595338&bookid=2988 Accessed: January 21, 2025

Sites of action of the major classes of antihypertensive drugs.�

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Basic laboratory testing enables CVD risk profiling, provides a baseline prior to the use of medication, and facilitates the recognition of secondary causes of hypertension. Minimally, it should include obtaining fasting blood glucose, serum sodium and potassium, serum creatinine, and estimation of glomerular filtration rate (eGFR), lipid profile, serum calcium, thyroid-stimulating hormone (TSH), complete blood count, urinalysis, and a 12-lead electrocardiogram. Blood uric acid and urinary albumin-to-creatinine ratio readings may be warranted in the context of specific medication choices, and echocardiography can be used as a complement to or in place of electrocardiography as a sensitive method for assessing left ventricular hypertrophy and function.