7 A Toolkit for Health Care Professionals Unmet Needs in Hypertension Causes and Risk Factors Many of the common risk factors associated with high BP can be modified, including: Cigarette smoking/tobacco smoke exposure1-2.4 synopsis Diabetes Excessive alcohol consumption1-5.2.5 Hyperlipidemia Obstructive sleep apnea1-5.4.4 Overweight/obesity1-5.2.1 Physical inactivity/poor physical fitness1-5.2.4 Unhealthy diet1-2.4, 5.2 People with high BP may also have diabetes mellitus and dyslipidemia, including high levels of low-density lipoprotein (LDL) cholesterol or hypercholesterolemia, elevated triglycerides and low levels of high-density lipoprotein (HDL) cholesterol.1-2.4 There are complex and interdependent relationships between hypertension and other modifiable risk factors for CVD. Multiple risk factors share mechanisms of action and pathophysiology. Treating some risk factors may reduce BP through shared pathology, and reducing the global risk factor burden may reduce CVD risk. Common hypertension comorbidities include stroke, HF and chronic kidney diseases (CKD), which may both contribute to and be caused by elevated BP.1.9 Measurement and Diagnosis Obtaining accurate BP readings is a critical step in identifying hypertension. The AHA suggests following a checklist of straightforward practices prior to and during all in-office BP measurements.1-Table 8 • Instruct the patient to avoid smoking, caffeine and exercise at least 30 minutes before measurement. The patient should also have an empty bladder. • Confirm that the instrument is validated and properly calibrated. • Advise the patient to sit and relax, with feet on the floor and back supported for at least five minutes before the reading and to remain still and silent during the reading. • Support the patient’s limb that is used to measure BP and confirm that the BP cuff is positioned at heart level. Be sure to use the correct cuff size and do not take measurements over clothes. • At the patient’s initial visit, measure BP in both arms and use the higher reading. To minimize error, obtain two to three measurements taken on two to three separate occasions, one to two minutes apart, to get an accurate BP estimate. • Provide the patient with their SBP and DBP reading(s) both verbally and in writing.
RkJQdWJsaXNoZXIy MjI2NjI=