Transcript Hypertension and High Cholesterol

Why Study Hypertension?
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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 day
recent salt ingestion
alcohol
exercise
stress
coffee
mechanics of measure
Dr Saguils’ Answer:
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Multiple measurements
Vary the time of day
Vary the place
Bring the cuff into the office with records
Those “unfortunate”
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Family hx
Smokers
Sedentary
Overweight or obese
African-americans
>35
Alcohol users
Salt users
“Certain prescriptions”
-Family History
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Inherited via genetic history
Male (not all the time)
Morphology (not all the time)
Eating habits during early years
-Smokers
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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
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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
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Ephedra(ma huang), meridia
pseudoephedrine
Bextra, celebrex –cox2
Motrin, naprosyn -nsaids
Steroids
Estrogen
Imitrex
What to watch for:
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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
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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
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ACE inhibitors, ARBS
Betablockers
Alpha blockers
Calcium channel blockers
Diuretics
Dr Saguils’ Answer
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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!
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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….
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Fatty plaque build up
Narrowing of the artery
Inflammatory reaction to plaque
Ulceration
Clot formation
Plaque rupture
Clot embolism
• Stroke or infarction
At risk?
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Family hx
Smoking
Sedentary lifestyle
Age
Menopause
Over weight or obese
Measurements
• Lipoproteins measured in mg/dl:
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Total cholesterol
LDL
HDL
Triglycerides
180-200
80-100
40-70
110-150
Cardiology testing:
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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:
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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:
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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
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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
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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