DrRic The Moorings Lecture on Hypertension (slide share edition)

Taking the Hype out of

Hypertension

We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

Enrique Saguil, M.D.

My Doctor: Listens to my concerns Cares what I have to say Doesn’t Keep Me Waiting Gives Me Options

We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

First Health Associates

2010 S. Arlington Heights RdLL Suites

Arlington Heights, IL

The First Health Approach

We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.

Your Community of Care

Ric Saguil, MDJason Gruss, MDTom Jordan, RD

Katrina Christie, LCPCJennifer Green, NDJoe Musolino, DCAmy Iaquinta, DCNick Nowicki, DC

Emery Paredes, PTCourtney Day, EPYu Zhu, MD China

Mike Blumberg, LCPC

You

Begin with going back

Back to basics -Anatomy -Physiology -Pathology

The Pump

The Pump (deconstructed)

The delicate balance in push and receive:

The heart pushes

The receptors receive

Receptors are ultrafast in response!

For some reason, the blood

vessels are not responding

The Bed

Your other sphincter muscles!

Blood flows by osmosis also

The Delicate Organs

Damages – eye(slow)

Damages – brain(sudden)

Damages – kidney(chronic)

Damages – blood vessels(chronic but sudden)

Damages – heart(slow)

Damages – fingers(subtle)

No one is safe

Universal sign – Levine Sign

Sometimes obvious

Chris Farley

Sometimes “silent”

Billy Mays

Sometimes too late

Disease or Symptom?

• Lets first classify what Hypertension is (High Blood Pressure)…..

Who makes the guidelines?

• US Department of Health and Human Services (gov)• NIH National Institute of Health (gov)

• National Heart Lung and Blood Institute (gov) 1972

• Expert Panel to write guidelines (unpaid NHLBI panel) +Internal review panel considers conflict of interest +Methodologist hired to graph Clinical practice guidelines created for px and clinician to develop diagnostic and treatment modalities

Currently there are guidelines for:

• Asthma• High cholesterol • Overweight and Obesity• Von Willebrand’s Disease• High Blood Pressure

High Blood Pressure Guidelines

• High Blood Pressure in Children and Adolescents

• High Blood Pressure Guildelines (JNC7) 2003

How long has the JNC been?

• 1997 JNC6• 1992 JNC5• 1988 JNC4• 1984 JNC3• 1980 JNC2• 1976 JNC1

JNC 6

…….the introduction of new combination antihypertensive medications and new angiotensin II receptor blockers….

oh yeah!!

The JNC 7

• The 7TH Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure

(Evidence based medicine and consensus to make recommendations to clinicians)(Mission to create awareness, prevention,

treatment and control of hypertension)

Success?

• According to the National Health and Nutrition Examination Survey (NHANES) II -1976 to 80 and

III –1988 to 91 …..awareness went from 51-73%

…age adjusted mortality rate from stroke and CHD decreased

CDC

JNC 6

• Optimal BP <120 s <80 d• Normal BP <130 s <85 d• High NL 130-139 85-89

• Hypertension: Stage 1 140-159 90-99 Stage 2 160-179 100-109 Stage 3 >180 >110

JNC 7

• Created because of 1. Publication of many new hypertension observational studies and clinical trials 2. Need for a new, clear and concise guideline that would be useful for clinicians 3. Need to simplify the classification of blood pressure 4. Clear recognition that the JNC reports were not being used for their maximum benefit(the unpublished NHNESP 1999-2000 study showed increase in awareness from 68-70 only) Claud Lenfant, MD Director NHLBI

New “stuff”

• ABPM – ambulatory blood pressure monitoring for white coat hypertension and effective drug therapy

• White Coat Hypertension mentioned again• Initiation of dual therapy from the start of dx

http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf

Drug treatment (when not at goal <140/90 or <130/80 with DM or Chronic Renal Disease)

• Stage 1 140-159 or 90-99 single med• Stage 2 >160 or >100 dual med• With compelling indications: Heart Failure Post Myocardial Infarction Diabetes Chronic Renal Disease Recurrent Stroke Prevention

Lifestyle changes determine how long the future will last

• Weight reduction• Adopt DASH eating plan• Dietary sodium restriction• Physical activity• Moderation of alcohol consumption

Weight Reduction

• Maintain normal body weight BMI of 18.5-24.9 kg/m2 http://www.nhlbisupport.com/bmi/

5-20mmHg per 10 kg wt loss

Body Mass Index

DASH diet

• Consume a diet rich in fruits, vegetables and low fat dairy products with reduced content of saturated and total fats

8-14 mmHg

DASH

• Dietary Approaches to Stop Hypertension

Their findings showed that blood pressures were reduced with an eating plan that is low in saturated fat, cholesterol, and total fat and that emphasizes fruits, vegetables, and fat-free or low-fat milk and milk products.This eating plan—known as the DASH eating plan—also includes whole grain products, fish, poultry, and nuts. It is reduced in lean red meat, sweets, added sugars, and sugar-containing beverages compared to the typical American diet.

1st DASH diet trial

• 459 people with BP’s 160/80-95• 3 groups -average American diet -average American diet with fruits and vegetables -DASH diet

• Blood pressure reductions in two weeks with F&V / DASH (note all diets were with 3000mg sodium restriction per day)

The four hospitals

• Brigham and Women’s Hospital, Boston• Duke Hypertension Center and the Sarah Stedman

Nutrition and Metabolism Center, Durham• Johns Hopkins Medical Institutions, Baltimore• Pennington Biomedical Research Center, Baton

Rouge

http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf

• http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf

The Mediterranean Diet

• Grains• Healthy oils/fat• Fruits• Veggies!!!!!!• Not so much processed meat• More fish

The Anti-inflammatory Diet

• Grains• Healthy oils/fats• Fruits• Veggies!!!• (Legumes)• Not so much processed meat/more whole foods• More fish• Less dairy• Whole soy• Green tea

Dietary sodium restriction• Reduce dietary sodium intake to no more than

100mmol per day (2.4 gm sodium or 6gm sodium choloride)

2-8mmHg

Is there an alternative? Yes? …and it doesn’t have to taste like cardboard

Spice, herbs nutritional yeast!!!

Is it worth changing your world?

• HAL study-europe study with 320,000 people age 70-90y/o for 10 years with decrease occurrence of heart disease morbidity, mortality

• NIH-AARP study 20,000 with 50-70 y/o with decrease in all cause mortality (including cancer)

Reference books for the:Mediterranean Diet

• The Mediterranean Diet Cook Book Nancy Jenkins

• Eat Drink and Weigh Less Walter Willet

Books on the concept of food for health:

• What is the color of your diet?

• Omnivore’s Dilemma

Documentaries on food industry:

• Food Inc.

• The Killer at Large

• The Hidden Epidemic

Physical Activity• Engage in regular aerobic physical such as

brisk walking (at least 30 min per day most days of the week)

4-9mmHg

Moderate consumption of alcohol

• Limit consumption to no more than 2 drinks per day in most men and to no more than 1 drink per day in women and lighter weight persons

2-4mmHg

The Saguil Approach

• Know the JNC7 guidelines• Behavioral support/ spirituality/ grounding• Think plant based diet, the color of your diet• The anti-inflammatory diet, animal protein if there’s

room• Movement that suits you but think dual purpose, run

to compete, climb to get into nature, yoga for spirituality and breath, tai chi for self defense and TCM healing

• Utilize the insurance but be truthful

In a nutshell…

• Review numbers• Compile risk factors• Ambulatory blood pressure monitoring at

walmart, jewel, target or dominics and record.• See with abpm record in 3 months • Soft suggestion of lifestyle change• Keep safe with meds until 6-12 months (noting all the side effects) • Hard referral to special forces……

One size does not fit all

• Primary care eval risk factor stratification• Physical therapy eval to introduce movement• Exercise eval to drive motivation• Dietary eval diet diary and education• Naturopathic eval herbal supplemment power! (still with plans to get off)• Behavior health eval to prepare for withdrawal• Specialist eval to prepare for surgery• Physical med eval to assess injury/limitation (Ortho, Sports Med, PMR, Chiro, PT, Massage, Reflex, Reiki….)

My lifestyle changes:

Find a Heart friendly exercise activity!

Stress reduction - meditation

Relaxation induction

• The Relaxation Response – Herb Benson blood pressure heart rate respiratory rate temperature

All dropped – with “distractions”

You are what you eat!

Preventive Medicine Research Institute

• Approved by medicare for an 18 week program as of summer 2010

Criteria: acute MI within 12 months

bypass surgery stable angina heart valve replacement or repair ptca plasty or stenting heart or heart lung transplant

http://www.pmri.org/certified_programs.html

Yoga, diet education, group therapy

All paid for by your tax dollars and

Medicare!! It only took 16 years!

Knowledge is power

…It’s our responsibility to share this power.

Americans are leading the world!

(into oblivion)

Weapons of mass destruction

QUESTIONS?

COMMENTS?CONCERNS?

The Hype has been taken out ofHypertension

2010 South Arlington Heights RoadArlington Heights, IL

Phone: 847-593-3330www.FirstHealthAssociates.com