1	High Blood Pressure Clayton Area Rescue Mick Stewart, NREMT-P
2	American Heart Association www.americanheart.org 1-800-AHA-USA-1 American Heart Association National Center 7272 Greenville Avenue Dallas, TX 75231 www.startwithyourheart.com (not affiliated with AHA)
3	What is Blood Pressure? When the heart beats, it pumps blood to the arteries and creates pressure in them. If you're healthy, your arteries are muscular and elastic. Blood pressure rises with each heartbeat and falls when your heart relaxes between beats. Changes from minute to minute
4	Why Have a Blood Pressure? Without circulating blood, vital organs can't get the oxygen and nutrients that they need to work.
5	By the Numbers Systolic top number when the heart is contracting <120mm hg Diastolic bottom number when the heart is resting <80mm hg
6	Good, Bad and Ugly Good - < 120/80 mm hg - Normal Bad - Between 120-139/80-89 mm hg - Prehypertensive Ugly – Above 140/90 mm hg - Hypertensive - Stage 1: 140-159/90-99 mm hg - Stage 2: >159/>99 mm hg
7	Statistics High blood pressure (hypertension; HTN) killed 49,707 Americans in 2002. As many as 65 million Americans age 6 and older have high blood pressure. Nearly one in three U.S. adults has HTN. More than 40 percent of African Americans have high blood pressure. Thirty percent of people with high blood pressure don't know they have it.
8	Causes 90–95 percent of the cases of HTN isn't known Primary HTN 5-10 percent caused by: Secondary HTN Kidney abnormality A structural abnormality of the aorta (large blood vessel leaving the heart) existing since birth Narrowing of certain arteries
9	Who Is at Risk of Developing HTN Controllable factors Obesity — Body mass index (BMI) of 30.0 or higher Eating too much salt — A high sodium intake increases BP in some people. Drinking too much alcohol — Heavy and regular use of alcohol can increase BP dramatically. Lack of physical activity — Inactive lifestyle makes it easier to become overweight and increases the chance of HTN. Stress — Often mentioned as a risk factor, but stress levels are hard to measure, and responses to stress vary from person to person.
10	Who Is at Risk of Developing HTN Uncontrollable factors Race — African Americans develop high blood pressure more often than Caucasians, and it tends to occur earlier and be more severe. Heredity — If your parents or other close blood relatives have high blood pressure, you're more likely to develop it. Age — In general, the older you get, the greater your chance of developing HTN. Men - between age 35 and 55. Women - after menopause.
11	HTN Signs/Symptoms None Many people have this disease for years without knowing it – “silent killer” Exception - hypertensive crisis A single high reading doesn't mean you have high blood pressure, but it's a sign that you need to watch your blood pressure carefully. White coat syndrome - BP goes up when you are being evaluated by a doctor
12	Why Should We Care?
13	Blood Vessel Injury / Disease Atherosclerosis – disease in which fatty plaques develop on inner walls of blood vessels, eventually causing obstruction (thrombus) Arteriosclerosis – thickening and loss of elasticity of blood vessels; “hardening of the arteries” Aneurysm - dilation of a blood vessel (similar to a balloon) that poses a risk for rupture, clotting, or dissecting
14	Stroke Blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot, or bursts Cerebral vascular accident – CVA - stroke Transient ischemic attack – TIA – mini stroke May cause: Paralysis or loss of motor control Loss of memory Loss of speech or vision Death
15	Stroke High blood pressure is the single most important risk factor for stroke. Adults 40 - 89 years of age - the risk of death begins to rise at blood pressures as low as 115/75 mmhg Risk doubles for each increase of 20 mmhg systolic or 10 mmhg diastolic Lowering BP to acceptable levels reduces incidence of stroke 30-40%
16	Heart Attack Myocardial infarction Blood supply to part of the heart muscle itself -- the myocardium -- is severely reduced or stopped May cause death of heart tissue May cause death of patient
17	Heart Attack
18	Heart Attack Adults 40 – 89 years of age - the risk of death begins to rise at blood pressures as low as 115/75 mmhg Risk doubles for each increase of 20 mmhg systolic or 10 mmhg diastolic Lowering BP to acceptable levels reduces incidence of heart attack 20-25%
19	Heart Failure Sounds like the heart is no longer working at all Actually, heart isn’t pumping as well as it should be Can’t supply the cells with enough oxygen- and nutrient-rich blood Causes fatigue and shortness of breath
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21	Heart Failure HTN causes the heart to pump harder than normal to keep the blood circulating HTN increases a person's risk of developing heart failure by two to three times Lowering BP to acceptable levels reduces incidence of heart failure by more than 50%
22	Kidney Failure Main function of kidneys is to eliminate excess fluid and waste material from your blood In kidney failure, the kidneys lose their filtering ability, and dangerous levels of fluid and waste accumulate in your body HTN and diabetes are most common cause of kidney failure
23	Kidney Failure
24	Kidney Failure 20 million adult Americans have chronic kidney disease Another 20 million at risk of developing it Few signs/symptoms early on Usually don’t appear until irreversible damage is done
25	Hypertensive Crisis Sudden worsening of chronic hypertension Many times patients have suddenly stopped taking their blood pressure medicines Other causes include: Drugs (cocaine, amphetamines) Acute heart failure Pregnancy-induced hypertension (eclampsia or toxemia of pregnancy) Acute kidney infection or abnormal kidney function Dissecting thoracic aortic aneurysm Intracranial event
26	Hypertensive Crisis Signs and symptoms Markedly elevated blood pressure. Systolic pressure greater than 250 mm Hg Diastolic pressure greater than 120 mm Hg Severe headache or dizziness Decreased level of responsiveness Visual disturbances Nausea or vomiting Chest pain, shortness of breath Nosebleed (epistaxis)
27	Hypertensive Crisis What to do: Remain calm CALL 911 Sit or lie down, but keep head elevated
28	What Can You Do To Lower Blood Pressure? Know what your BP level is, and what it should be. Talk to your doctor about your BP. -Take medications as prescribed -Lifestyle changes -Weight loss -Daily physical activity -Healthy diet -Limit salt intake -Limit alcohol
29	American Heart Association www.americanheart.org 1-800-AHA-USA-1 American Heart Association National Center 7272 Greenville Avenue Dallas, TX 75231 www.startwithyourheart.com (not affiliated with AHA)