Case Control Study on High blood pressure

EUNICE DUNU

CHETAN JOSHI

ABDUL MANAF IDDI

FRANK ANYAN

HOSTOS COMMUNITY COLLEGE

Professor D’Agostino

FALL 2011eunice

INTRODUCTION

High blood pressure is the force of pressure against the artery walls as it circulates through the body.

Blood pressure normally rises and fall through out the day but can cause health problem if it stays high for a long time.

When blood pressure rises the risk of heart disease and stroke

which is the 1st and 3rd leading cause of death in the US.

31.3% of Americans has high blood pressure

In 2010 high blood pressure will cost the us $76.6 billion in health care services ,medication and missed days of work.

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INTRODUCTION

Blood pressure has a lot of risk factors that

involves age Race Family history or hereditary Being overweight or obesity Not being physically active Tobacco use Too much sodium intake Too little vitamin D in a diet Stress Drinking too much alcohol and certainly chronic conditions

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WHAT IS HIGH BLOOD PRESSURE

Blood pressure is measured as systolic and diastolic pressures.

"Systolic" refers to blood pressure when the heart beats while pumping blood.

"Diastolic" refers to blood pressure when the heart is at rest between beats.

often written with the systolic number above or before the diastolic number, such as 120/80

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MECHANISM OF HYPERTENSION

Pressure is generated when the heart contracts against the resistance of the blood vessels

Systematic hypertension results from an increase in systematic vascular resistance(SVR) with normal cardiac output(CO)

In young patients with borderline hypertension, increased CO may be only hemodynamic disturbance. CO ‘normalizes’ with time and SVR increases to sustain hypertension

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CHART SHOWING BLOOD PRESSURE RANGE

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SYMPTOMS

What Are the Signs and Symptoms of High Blood Pressure?

High blood pressure (HBP) itself usually has no signs or symptoms. Rarely, headaches may occur.

You can have HBP for years without knowing it. During this time, the condition can damage your heart, blood vessels, kidneys, and other parts of your body.

Some people only learn that they have HBP after the damage has caused problems, such as coronary heart disease, stroke, or kidney failure.

Knowing your blood pressure numbers is important, even when you're feeling fine. If your blood pressure is normal, you can work with your health care team to keep it up

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TREATMENT lifestyle changes and Medicines.

Goals of Treatment goal for most adults is to get and keep blood

pressure below 140/90 mmHg. For adults who have diabetes or chronic kidney disease, the goal is to get and keep blood pressure below 130/80 mmHg.

Lifestyle Changes Healthy lifestyle habits- These habits include: Following a healthy diet Being physically active Maintaining a healthy weight Quitting smoking Managing your stress

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RISK FACTOR 1 : OBESITY MECHANISM: Obesity is strongly linked to hypertension. Central and peripheral abnormalities in

obese people explain development of high arterial pressure

Obesity linked to endothelial dysfunction Kidney functional abnormalities in obese

people

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RISK FACTOR 2: ALCOHOL

Some people have mutation on a gene which affect their body’s

ability to eliminate alcohol. Alcohol is initially metabolized to an

intermediate compound,Acetaldehyde, which is further metabolized and

then eliminate the body. The major enzyme responsible for this

elimination isAlcoholdehydrohenase2(ALDH2). In some people, a genetic mutation leads toan inability to metabolize Acetaldehyde and

causes accumulation ofAcetaldehyde after alcohol intake, which

increases blood pressure.Chetan

RISK FACTOR 3: DIET.

MECHANISM: Research in Britain concluded that life style

and diet determine blood pressure more than genetics.

Sample collected from participants found link between hypertension and diet.

Participant who had high blood pressure had high level of amino acid alanine that is abundant in animal products.

We need to keep our gut healthy in order to maintain a healthy blood pressure.

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Risk factor 4: high salt intake

Mechanism: Too much salt or high sodium intake can cause

your body to retain fluid which increases high blood pressure. Excessive salt keeps the circulatory volume higher than it should be, exerting excess fluid pressure on blood vessel walls.

These walls react to these stress by thickening and narrowing. Leaving less space for the fluid already cramped in the blood compartment raising resistance and requiring high pressure to move blood to the organs.

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RISK FACTOR 1A: OBESITY

MECHANISM: Many medical studies have shown that

obesity presented an increase in the cardiac output and the blood volume, and in the arterial resistance.

obesity induces a high secretion of insulin in trying to decrease the excessive sugar concentration in the blood.

Moreover, the insulin, secreted by the pancreas, is responsible for many modifications in the body:

It induces a thickening of the vessels which is responsible for an increase in their rigidity, thus increasing the blood pressure;

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RISK FACTOR 1A CONTINUATION

It increases the cardiac output, because the secretion of adrenalin is increased;

It induces the reabsorption of water and salt by the kidney, which increases the blood volume and thus increases the blood pressure;

Moreover, obesity is responsible for an over-sensitiveness to sodium, which is known to increase the rigidity of the peripheral arteries.

After some time, the obese subject will develop a natural resistance to the insulin which will lead his body to synthetize more insulin, thus generating a rise in the blood pressure by the way of the mechanisms described above.

LITERATURE REVIEW: OBESITY High Rate of Obesity-Associated

Hypertension among Primary Schoolchildren in Sudan (Zeena, S., et al)

304 students were randomly selected and questionnaires regarding child’s age, gender and health condition sent to parents

Questions about prior diagnosis of, diabetes or heart disease asked about blood relations.

CONCLUSION: hypertension among schoolchildren was more linked to obesity than family history

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LITERATURE REVIEW: OBESITY

Prevalence of Hypertension in the Paediatric Population in coastal south India ( Veena, G., et al)

3067 students between ages 5-16 yrs studied

BMI was taken along with blood pressure measurements using auscultatory method.

Using WHO charts, prevalence of obese children was determined.

CONCLUSION: higher BMI is associated with hypertension

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LITERATURE REVIEW: ALCOHOL

Chronic Ethanol ingestion induce aortic inflammation/oxidative endothelial injury and hypertension (Husain, K., et. Al.)

The author investigate the relationship of chronic ethanol induced inflammation leading to vascular endothelial injury and elevation of blood pressure in rats divided in to two groups. They gave them5%sucrose20%ethnol orally for12 weeks. The mean arterial blood pressure was recorded every week.

The result shows that the mean BP was significantly elevated 12 week after ethanol ingestion and it was related to increased aortic inflammation.

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LITERATURE REVIEW: ALCOHOL

Alcohol and Hypertension : Gender differences in dose- response relationships determined through systematic review and meta analyses, (Taylor, B., et. Al.)

A computer assisted search was completed for 10 data base, followed by relevant articles from Japan Korea and United States. A linear dose response relationship studied in men and women by increasing alcohol from 50g per day to 100g per day.

The risk for Hypertension increases linearly with alcohol consumption.

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LITERATURE REVIEW: DIET

Dietary Approaches to stop hypertension- sodium study (DASH) Diet: Applicability and acceptability to a UK population (K. E . Harnden et. al.)

14 healthy subjects followed the adapted Dash diet for 30 days. Dietary intake was assessed by 5-days food diaries completed before and towards the end of the study.

The DASH style diet was well accepted and was associated with a decrease in blood pressure .

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LITERATURE REVIEW: DIET

D-limonene attenuates blood pressure and improves the lipid and antioxidant status in high fat diet and L-NAME treated rats.( J. V. Antony et al).

N- nitro-L-arginine methyl ester (L-NAME) and d-limonene were purchased from sigma chemical Co.(st.louis,Mo,USA).

This compound would be predicted to produce substantially change the circulatory lipids and antioxidant as well as decreased blood pressure.

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LITERATURE REVIEW: HIGH SALT INTAKE

High salt intake elevated blood pressure but not change circadian blood pressure rhythm in otsuka long –tokushima fatty (olety) rat

Mika Matsumoto, Takeshi Tsujino, Yoshiro Naito,et.

Methods Two different species of rat was housed in

individual cages and was given the same rat food and water to drink for sometime and then separated one group diet to high salt drinking water and maintain the standard food and drink for the other group.

Conclusion; From the study it was founded that the group

that was given high salt water and food has elevation in blood pressure than the other group which was fed with regular food and water.

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LITERATURE REVIEW; OBESITY

Should obesity be blamed for the high prevalence rates of hypertension in the black south African women (Schutte, A. E., et. al.)

102 African women and 115 Caucasian women were matched for age, weight and body mass index.

correlation between obesity and cardiovascular risk markers were compared between the ethnic groups

Comparism between low and high BP groups were also made for each ethnic group.

Conclusion: it was founded that although urban African women have higher BP than Caucasians, their obesity levels are weakly related to traditional cardiovascular risk factors compared to Caucasian women.

The results however suggested a link with insulin resistance.

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HYPOTHESIS Diet, obesity, alcohol and high salt

intake are risk factors for hypertension. Mechanisms Summarized:

Diet - lifestyle and diet directly linked to hypertension

Obesity - high central and peripheral abnormalities

Alcohol - the body eliminates alcohol differently depending on the individual

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BIBLIOGRAPHY

salman, zeena, gregory kirk, and mark DeBoer. "High Rate of Obesity-Associated Hypertension among Primary Schoolchildren in Sudan." international journal of hypertension. 2011. (2011): 5. Print.

kamath, veena, prassana parthage, asha kamath, and anuja balakrishnan. "Prevalence of hypertension in the paediatric population in Coastal South India." australian medical journal. (2010): 695-698. Print.

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BIBLIOGRAPHY

Taylor Benjamin, Hyacinth Irving , Dolly Baliunas , Michael Roerecke, Jayadeep Patra, and Satya Mohapatra. "Alcohol and Hyper-tension: gender differences in dose-response relationships determined through systematic review and meta-analysis." Addiction . 104. (1981-1990): n. page. Print.

Husain, Karim, Leon Ferder, Firais A Ansari , and Jainarine Lalla. "Chronic ethanol ingestion induces aortic inflammation/oxidative endothelial injury and hypertension in rats." Human and experimental Toxicology 30(8)930-939 Author(S). (2010): n. page. Print.

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BIBLIOGRAPHY

Santiago, Jesudoss, Jayaraman Jayachitra, Madhavan Shenbangam, and Namasivayam Nalini. "d-limonene attenuates blood pressure and improves the lipid andantioxidant status in high fat and L-NAME treated rats.." 2. (2010): 752-758. Print

Elliott, Charlene D. "Sweet and salty: nutritional content and analysis of and toddler." journal of public health advance access published.. (2010): 1-8. Print.

Frank

BIBLIOGRAPHY "High blood pressure (hypertension)." Mayo

Clinic. Mayo Foundation for Medical Education and Research (MFMER). , 03/22/2011. Web. 24 Oct 2011. <http://www.mayoclinic.com/health/high-blood-pressure/DS00100>.

"High Blood Pressure ." 1.CDC. Health, United States, 2008. Hyattsville, MD: National Center for Health Statistics; 2008.. (July 7 2011): n. page. Print. <cdcinfo@cdc.gov>.

"What Is High Blood Pressure." National Heart, Lung, and Blood Institute. ( April 01, 2011 ): n. page. Print. <http://www.nhlbi.nih.gov/health/health-topics/topics/hbp/names.html>. eunice1

BIBLIOGRAPHY

AE shutte, HW Huisman, JM Van Rooyen, R shutte, M Reimann JH De Ridder, A VAN der Merwe,PEH Schwarz and NT Malan ‘’should obesity be blamed for the high prevalence rates of hypertension in black south African women?’’(2008 22,528-536)

Mika matsumoto, Tekeshi Tsujimo,Yoshiro Naito, Tsuyotsi Sakoda, Mitsumasa Ohyanagi,et.al ‘’(high salt intake elevated blood pressure but not changed circadian blood pressure rythym in Otsuka Long-Evans tokushima fatty (OLETF) Rat 31;271-280,2009)’’

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