Hypertension

KIN 121 Section: 005 Group #1

Darnell Taylor, Leah Jacobs, Aaron Hanchett, Nicole Coblentz,
KathyJo Buiteweg

Overview

Hypertension Basics
Effects of Hypertension
Causes/Influences
Demographics of Hypertension
Genetic influences
Research studies (4):
Controlled trial of Aerobic Exercise in Hypertension
Overweight, Ethnicity, and the Prevalence of Hypertension is School-Aged Children
Effects on Telomerase Gene Expression in African American Hypertensive
Patients
Predictors of Sedentary Behavior in the Elderly with Hypertension
Prevention/Treatment
Conclusion

Introduction to Hypertension

What is Hypertension?
High Blood Pressure
Occurs when the force of blood pumping through your arteries is too strong
What happens each time your heart beats with hypertension?
Each time your heart beats, blood is pushed through arteries to the rest of your
body
When blood is pushed harder against artery walls, blood pressure increases
When is your blood pressure usually high?
Depends on time of day
Typically higher in the morning when you first wake up
Under high amounts of stress
Exercise

Types of Hypertension
Essential Hypertension or Primary Hypertension

This type of hypertension is diagnosed after the doctor notices high blood pressure for 3 or more
visits and rules out all other causes of hypertension.
95% of all Hypertension victims
The cause of this type of hypertension is unknown.
Although the cause is unknown, research has shown that alcohol, hereditary, obesity, diet, and
smoking all play a role in essential hypertension.
Symptoms may not be present, but one may experience dizziness, headaches, tiredness, or even
nose bleeds.

Secondary Hypertension

The most common cause of secondary hypertension is an abnormality in the arteries

supplying the kidneys with blood.
Some other causes include: an airway obstruction during sleep or diseases that affect the
adrenal glands, thyroid disease, hormone abnormalities, and over the counter drugs like
ibuprofen or pseudoephedrine.
If the cause is found, the hypertension can be controlled.

Types of Hypertension Continued.

Isolated Systolic Hypertension

Systolic pressure rises above 140 mmHg but diastolic remains near the normal range of 80 mmHg.
This type of hypertension is most common in adults over the age of 65.
The cause of this form of hypertension is due to the loss of artery elasticity.
Systolic blood pressure is more important when it comes to risk of cardiovascular disease of an older
adult.

Malignant Hypertension

only occurs in about 1% of the hypertension population

Common in younger adults, African-American men, and women with pregnancy toxemia.
Malignant Hypertension occurs when blood pressure rises extremely quick
Symptoms include blurred vision, headaches, numbness in arms or legs, chest pain, and confusion
Very serious condition that should be treated in hospital

Systolic vs Diastolic

Systolic:

The top number in the blood pressure

reading

Measures the pressure in the arteries

when the heart beats (when the heart

muscle contracts)
Normal reading: < 120 mm Hg

Diastolic:
The bottom number in the blood
pressure reading

Measures the pressure in the arteries

between heartbeats (when the heart
muscle is resting between beats and
refilling with blood)

What Can Cause Hypertension?

Changes in the environment

Kidney fluid and salt balances

the sympathetic nervous system has important functions in blood pressure regulation, including heart rate,
blood pressure, and breathing rate
imbalances in this system may cause high blood pressure, still being researched

Blood vessel structure and function

Imbalances in this kidney function can expand blood volumes, which can cause high blood pressure

Sympathetic nervous system activity

unhealthy lifestyle habits

excessive sodium intake, excessive alcohol intake, sedentary/inactive lifestyle

overweight/obesity

small and large arteries may stiffen

Medicines

happens because medicines can change the way your body controls fluid and salt balances, cause your blood
vessels to constrict
prescription medicines such as asthma or hormone therapies (ex: birth control)

Effects of Hypertension

Hypertension damages the cells of the arteries inner lining which causes the
artery walls to thicken and become stiff (atherosclerosis)[4]
This can occur anywhere throughout the body and block blood flow to the
heart, kidneys, brain, and periphery blood vessels as well. [4]
The damage in these places can cause: Angina (chest pain), heart attack,
heart failure, kidney failure, Stroke, Peripheral artery disease, eye damage,
aneurysms[4]

Risks of Hypertension

Hypertension is a genetic disorder that is caused by interplay between several

risk genes and environmental factors
Determinants of human heredity of Hypertension

Heritability is often between 30-60%

Hypertension is known to commonly be a heterogeneous phenotype trait
Still being researched

If left untreated, hypertension can cause serious health risks such as heart
attacks, stroke, kidney damage, and even an enlarged heart

Genetic Influences on Hypertension

How to find genes containing hypertension

Identify genes underlying blood pressure variation

Studies show that twins are more commonly known to have hypertension

more in identical twins than non-identical twins

Single genes containing hypertension in the body can cause large effects on
blood pressure and they show up in forms of what is called rare Mendelian
forms of high and low blood pressure

Mendelian Forms of Blood Pressure

Molecular studies have identified 8 genes that have mutated and cause
Mendelian forms of hypertension and 9 genes that mutate that cause a
Mendelian form in humans.
The mutated gene products in in every case of a gene mutation in mendelian
form all act in the same physiologic pathway in the kidney which alters the net
renal salt reabsorption in the body.

Pulmonary Arterial Hypertension (PAH) and How it can Affect

You
Put into four functional classes on how PAH can affect you
1.

2.

3.

4.

Class 1: Physical activity isnt limited to person with PAH

a. Person can still do regular activity without the effects of feeling woozy/dizzy, w/o feeling short
of breath, without feeling tired, or having chest pain.
Class 2: Physical activity becomes slightly limited
a.
Said person can comfortably rest, regular activities begin to cause dizziness and /or fainting,
shortness of breath, and chest pains during physical activity
Class 3: Greater limitation of physical activity
a. Still comfortable when at rest but activity becomes very limited, at this point very little activity
causes person to feel dizzy with shortness of breath along with feeling tired and chest pains.
Class 4: Unable to do any type of physical activity without feeling discomfort
a. Shortness of breath and a feeling of being tired may occur even if said person is at a resting
state and physical activity increases discomfort

Demographics of Hypertension

In the U.S., about 77.9 million adults have high blood pressure
thats 1 of every 3 adults
Data from NHANES 2007-2010 shows that of those with high blood pressure
81.5% are aware they have it
74.9% are under current treatment
52.5% have it controlled
47.5% do not have it controlled

Demographics of Hypertension

Among adults 20 and older in the U.S., the following have high blood pressure

For non-Hispanic whites:

33.4% of men
30.7% of women
For non-Hispanic blacks:
42.6% of men
47.0% of women
For Mexican Americans:
30.1% of men
28.8% of women

Alarming Facts of Hypertension

In 2009 high blood pressure was listed on death certificates as the primary
cause of death of 61,762 Americans
In 2009 high blood pressure was listed as a primary or contributing cause of
death in about 348,102 Americans
In 2009 the overall death rate from high blood pressure was 18.5 per 100,000

17.0 for white males

14.4 for white females
51.6 for black males
38.3 for black females

High blood pressure costs the nation $46 billion each year. This total includes
the cost of health care services, medications to treat high blood pressure, and
missed days of work

Study #1: Controlled Trial of Aerobic Exercise in

Hypertension

Method

27 Sedentary men, aged 18-60 years old. They had to have a diastolic pressure of 90-104mm
Hg.

They were excluded from the experiment if they were on any hypertension medication or
if they were striving to lose weight.

They were also excluded if they had any other diseases such as diabetes, or if they had
an irregular ECG [5]

They then measured several different factors that attribute to health such as body fat percent
and waist circumference prior to the study.

Subjects were then randomly assigned to either the control exercise group, or the aerobic
exercise group. Each program was for 30 minutes, four days a week for 10 weeks total.
Participants had to maintain their HR at 65-80% of max HR
Resting BP was taken before every workout session[5]

Study #1: Controlled Trial of Aerobic Exercise in

Hypertension

Results:

Aerobic exercise: Before the program, the average BP was 136.6/94.8 mmHg. After the 10
week program, the average BP dropped to 130.1/85.2 mmHg.

Control exercise: Before the program, the average BP was 134.9/93.7 mmHg. After the
program, the average BP increased to 135.8/94.4.[5]

Conclusion:
This randomized controlled trial provides evidence for the independent BP low
aerobic exercise in unmedicated mildly hypertensive men.[5]

Study #2: Overweight, Ethnicity, and the Prevalence of

Hypertension is School-Aged Children

Objectives: To describe the current prevalence of pediatric hypertension and

the relationships between gender, ethnicity, weight, and blood pressure.
Methods: 5102 school children were asked to fill out a survey that asked
about their height, weight, age, gender and ethnicity. BMI was then calculated.
They were considered overweight if their BMI was >95 percentile. Their blood
pressure was then measured, and if they were in the children had a blood
pressure in the 95th percentile or higher, they underwent three screenings for
blood pressure.

Study #2: Overweight, Ethnicity, and the Prevalence of

Hypertension is School-Aged Children

Results:

Ethnicity distribution:
White: 44%
Hispanic: 25%
African American: 22%
Asian: 7%
Overweight prevalence was about 20% overall

Elevated blood pressure was the highest among Hispanics at 25% and lowest am

at 14%

Ethnic differences in the prevalence of hypertension were not significant after co

overweight
The prevalence of hypertension increased progressively as the BMI percentile increased

After adjustment for gender, ethnicity, weight, and age, the relative risk of hypert
significant for gender and weight.

Conclusion: If there is an increase in the prevalence of overweight and hypertension,

mostly among ethnic minority children.

Study #3 Effects on Telomerase Gene Expression

in African American Hypertensive Patients

Method

48 African American men and women with stage 1 hypertension participated in this study
voluntary

These participants either participated in a stress reduction with Transcendental

Meditation technique and a basic education course

Transcendental Meditation is a form of mantra meditation where you sit and close
your eyes for 15-20 minutes and think of clear and happy thoughts and illusions
Or the participants participated in an extensive health education program
Both were for a period of 16 weeks
Primary outcomes were telomerase gene expression and clinic blood pressure
Secondary outcomes included lifestyle-related factors

Telomerase gene expression is a complex protein added to the end of our DNA strands that
has an antiaging and anticancer functions

Study #3 Effects on Telomerase Gene Expression

in African American Hypertensive Patients

Results:

Data was analyzed for within-group and between-group changes

Both groups of participants showed increases in the telomerase gene expression, however,
there was no statistically significant difference between the two groups

Both groups of participants showed reductions in systolic blood pressure but again there was
no statistically significance difference between the two groups

There was a greater number of changes in lifestyle behaviors noted for the extensive health
education group

Study #3 Effects on Telomerase Gene Expression

in African American Hypertensive Patients
Conclusion

Both stress reduction and health education programs demonstrate increased telomerase gene
expression and reduction in blood pressure

The association between increased telomerase gene expression and reduced blood pressure
suggest that telomerase gene expression may be
a biomarker for reduced blood pressure

Or a mechanism where stress reduction and lifestyle modification reduces blood

pressure

Study #4 Predictors of Sedentary Behavior in

Elderly with Hypertension

Method:

306 hypertensive elderly subjects who visited three health centers were chosen

They would complete regular medical checkups and questionnaires on sedentary

behavior, physical activity, empowerment, perceived health, depression, self-efficacy for
physical activity, and social support for physical activity

Sedentary behavior refers to any waking activity characterized by an energy expenditure less
than 1.5 metabolic equivalents. So in general this means that any time a person is sitting or
lying down, they are engaging in sedentary behavior

Study #4 Predictors of Sedentary Behavior in

Elderly with Hypertension

Results:

The participants would spend an average of 8.6 hours a day in sedentary behavior

Analysis showed that sedentary behavior was significantly predicted by empowerment level,
perceived health, time since diagnosis of hypertension, physical activity, and depression.

Conclusion:

To reduce sedentary behavior in this population, future interventions should improve

empowerment and perceived health, increase their physical activity, alleviate depression, and
lower their blood pressure.

Treatment For hypertension

Medications:

Diuretics
Beta Blockers
Angiotensin II receptor blockers
Calcium channel blockers
Renin inhibitors
Vasodilators[4]

Prevention

Following healthy lifestyle habits

Limit sodium consumption

Check your blood pressure regularly

maintain a healthy weight

regular/daily physical activity
eating a healthy/balanced diet
eliminate smoking
limited alcohol consumption

children should have their blood pressure taken starting at 3 years old

Exercise regularly

Exercise Prescription for Hypertension: Aerobic

Exercise
Frequency: 7 days a week
7 days a week because Blood Pressure is lowered drastically for hours after a single exercise session.
Lowering Blood Pressure with aerobic exercise only a few days a week is not enough.

Intensity: moderate intensity

Below 70% of Heart Rate Reserve
Moderate intensity has been proven to lower Blood Pressure as well, if not better, than exercise at high
intensity.

Type: Cycling, Walking, or swimming.

Any aerobic exercise that is done at moderate intensity
Try to avoid running because the intensity may be too high.

Time: 30-60 minutes

Exercise Prescription for Hypertension:

Resistance Training.
Resistance training should be combined with an Aerobic exercise program.
Frequency: 3 days a week
Target all large muscle groups

Intensity: 30-60% of maximal effort

Type: weight lifting or resistance bands
Avoid isometric exercises

Time: 12-15 repetitions

Precautions and Tips for Exercising with

Hypertension
Do not exercise if resting systolic blood pressure is greater than 200 mm Hg or
diastolic is greater than 110 mm Hg.
Vigorous exercise such as rowing, sprinting, or heavy lifting is not ideal for
individuals that are hypertensive.
Some blood pressure medications may cause an impairment in temperature
regulation, so be careful when exercising in the heat.
Extend your cool down time by a few minutes, some blood pressure medications
may cause an abrupt drop in blood pressure if exercise is suddenly stopped.
Weight loss will help lower Blood Pressure.
When lifting avoid holding your breath. (Valsalva maneuver)

Video
https://www.youtube.com/watch?v=8TSSQbOTDHY
Exercise without increasing blood pressure!

Conclusion

Healthy, low sodium diet

Maintain healthy weight
Minimize stressors
Stop smoking
Decrease alcohol consumption
Prevention > treatment

Resources

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How PAH can affect you. (n.d.). Retrieved November 22, 2015, from http://opsumit.com/patient/how-pah-can-affect-you?
utm_source=google&utm_medium=cpc&utm_term=pulmonary arterial
hypertension&utm_campaign=PAHGeneral&gclid=CjwKEAjw8NaxBRDhiafRuvkpywSJAAxcl6flaDXIoU48inXjJPBVDGmRaJ8r4c21MKZ4qspU1EQKxoCrj3w_wcB [2]
How PAH can affect you. (n.d.). Retrieved November 22, 2015, from http://opsumit.com/patient/how-pah-can-affect-you?
utm_source=google&utm_medium=cpc&utm_term=pulmonary arterial hypertension&utm_campaign=PAH
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High blood pressure (hypertension). (n.d.). Retrieved November 12, 2015, from http://www.mayoclinic.org/diseases-conditions/high-bloodpressure/in-depth/high-blood-pressure/art-20045868 [6]
Hypertension: FastStats. (2015, May 14). Retrieved November 22, 2015, from http://www.cdc.gov/nchs/fastats/hypertension.htm [7]
Causes of High Blood Pressure. (n.d.). Retrieved November 22, 2015, from http://www.nhlbi.nih.gov/health/health-topics/topics/hbp/causes
[8]
http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/Understanding-Blood-PressureReadings_UCM_301764_Article.jsp#.VknW6n6rSM8 [9]
High Blood Pressure Facts. (2015, February 19). Retrieved November 23, 2015, from http://www.cdc.gov/bloodpressure/facts.htm [10]
Statistical Fact Sheet 2013 Update. (2013, May 1). Retrieved November 23, 2015, from https://www.heart.org/idc/groups/heartpublic/@wcm/@sop/@smd/documents/downloadable/ucm_319587.pdf [11]
Sorof, J., Lai, D., Turner, J., Poffenbarger, T., & Portman, R. (n.d.). Overweight, Ethnicity, and the Prevalence of Hypertension in SchoolAged Children. Retrieved November 23, 2015, from http://pediatrics.aappublications.org/content/113/3/475.short [12]
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