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HTN among USA adults:
HTN among USA adults:
- Nearly 1 out of 2 (45% or 116 million) has HTN
- 35% (92.1 million) do not have it under control
- 13% (33.6 million) who are already treated with medication may need dosage increased or prescribed additional medications
- 13% (34.1 million) are untreated
Risk factors for HTN:
HTN among USA adults:
- Advanced age
- African-American ethnicity
- Alcohol, excessive
- Chronic diseases (diabetes, chronic kidney disease, high cholesterol)
- Genetic predisposition
- High fat, high sodium diet
- Male
- Sedentary lifestyle
- Tobacco use
HTN increases risk of:
HTN increases risk of:
- Heart Failure
- Myocardial Infarction (MI)
- Stroke (CVA)
- Aneurysm
- Death (Fryar et al, 2012)
"THE SILENT KILLER"
MEDICATIONS FOR HTN & patient compliance
Types of Anti-HTN Medications
Diuretics - Beta Blockers - Calcium channel blockers - Angiotensin covering enzyme inhibitors - Angiotensin II receptor blockers (Oparil et al, 2018)
Diuretics - 'Water Pills"
They help the kidneys release more sodium into the urine, which removes more water from the blood and decreases the amount of fluid flowing through the veins and arteries, which reduces blood pressure. Examples:
- Aldactone (spironolactone)
- Bumex (bumetanide)
- Demadex (torsemide)
- Esidrix (hydrochlorothiazide)
- Lasix (furosemide)
- Zaroxolyn (metolazone)
Beta Blockers
They block the effects of adrenaline (a hormone that triggers fight-or-flight response when stressed), which reduces HR and stroke volume so the heart does not have work as hard. They also relax blood vessels (so blood flows better). It may be combined with other anti-HTN meds.
Examples:
- Acebutolol(Sectral)
- Atenolol(Tenormin)
- Betaxolol(Kerlone)
- Bisoprolol(Zebeta, Ziac)
- Carteolol(Cartrol)
- Carvedilol(Coreg)
- Labetalol(Normodyne, Trandate)
- Metoprolol(Lopressor, Toprol-XL)
- Nadolol(Corgard)
- Nebivolol(Bystolic)
- Penbutolol(Levatol)
- Pindolol(Visken)
- Propanolol(Inderal)
- Sotalol(Betapace)
- Timolol(Blocadren)
Calcium Channel Blockers
They relax the muscles that control the arteries. Vasodilator test required and first doses in the hospital to ensure safe dose is determined.
Examples:
Angiotensin Covering Enzyme (ACE) Inhibitors
They cause the relaxation of blood vessels and a decrease in blood volume, which lead to lower BP and decreased oxygen demand from the heart. They are used to treat HTN and heart failure.
Examples:
Angiotensin II Receptor Blockers (ARBs)
Often used when patients are intolerant of the adverse effects produced by ACE inhibitors.
Examples:
Importance of Compliance
Are they taking their anti-HTN medication as prescribed? If not, tell them to follow the instructions of their MD (e.g., can just read the bottle)
Medication should keep BP WNL
Is BP still too high and/or is it ever too low? If not WNL, notify MD
Adverse side effects?
Are they have any adverse effects from the medication? Obtain details and report to MD
Teaching patients about their Anti-Htn medications
Importance of Compliance
Are they taking their anti-HTN medication as prescribed? If not, tell them to follow the instructions of their MD (e.g., can just read the bottle)
Medication should keep BP WNL
Is BP still too high and/or is it ever too low? If not WNL, notify MD
Adverse side effects?
Are they have any adverse effects from the medication? Obtain details and report to MD
DASH DIET
Rich in fruits, vegetables, and low in salt. It also includes mostly whole grains, lean meats, fish, poultry, nuts, and beans
Guidelines:
- ~ 55% carbs, ~ 18% protein
- No more than 27% total fat, 6% saturated fat, and 150 mg cholesterol
- No more than 1500 mg sodium for those who are middle-aged and older, African Americans, or have HTN
Compared to a control group, the DASH diet reduced systolic BP by 3.2 mm Hg and diastolic BP by 2.5 mm Hg (in those with HTN
One study found (compared to a control group) the DASH diet reduced systolic BP by 5.2 mm Hg and diastolic BP by 2.6 mm Hg (in those with HTN
nutrition - Whole-Food, Plant-Based Diet (WFPBD)
Only unprocessed foods from the plant kingdom - no processed foods from the plant kingdom (e.g. French fries) and no foods from the animal kingdom.
Vegetarians (those who eat a plant-based diet) - and especially those who eat only the WFPB diet - have lower blood pressure