Khan Quiz - Opiates/Hypertension

What is normal blood pressure?

120/80

What is blood pressure?

The force exerted by blood against the walls of blood vessels - determined by the amount the HEART PUMPS and amount of RESISTANCE IN ARTERIES

What is hypertension?

Defined by having a blood pressure greater than 140/90 mmHg

What causes this higher blood pressure?

There is more blood the heart is pumping, but the arteries are too narrow

How much more likely are AA to have strokes than whites?

50%

Difference in stroke risks for AA vs. whites

AA are 2-3 times more likely to have a stroke than whites

What percentage of the US has high blood pressure?

55%

What percentage of stroke deaths are due to hypertension worldwide?

50-60% * female AA are at the greatest risk

How many deaths worldwide are due to hypertension?

12.8%

Causes of hypertension

1. Obesity

2. Stress

3. Smoking

4. High sodium intake

*all can trigger especially those w/ inherited tendencies

Symptoms of hypertension and dilemma

There are typically no symptoms of hypertension until a dangerous complication (ex. stroke) occurs

Results of hypertension

• Forces heart to work harder - can lead to heart attack

• Kidney failure by reducing blood flow to kidneys

• Arteriosclerosis (hardening of arteries)

High BP statistics in AA, whites, Asians, Hispanics

More common in AA (56%) as compared to whites (48%), Asians (46%), and Hispanics (39%)

How many US adults have high blood pressure?

Roughly 1/2, making the number around 120 million

Where are the highest death rates due to stroke in the US?

Southeast US (FL, GA, AL)

Oral contraceptive use and risks

Can increase the possibility for heart disease, especially in women over 35 y/o who are smokers

Adherence statistics in healthcare from patients

30-35% of patients completely comply to their physician’s recommendations, but 30-35% DO NOT AT ALL

Adherence and daily meds correlation

Decreases if 3+ meds are taken, and if prescribed 4+ times per day

What qualities cause a patient to adhere less?

Having chronic illness (ex. arthritis, mental disorders), elderly, young, being disadvantaged, hypochondriacs, risk-takers

What are the prevention/control methods for hypertension risks?

• Obesity control

• Reduced salt intake

• Lifetime of anti-hypertensive treatment in ESTABLISHED CASES

• More extensive screening for elevated blood pressure in employees

Women’s strokes in US statistic

Over ½ of strokes in the US are women, at 56%, with risk increasing after menopause

Women’s stroke death statistics in US

More women die in the US from strokes than men do; 60% of stroke deaths are women

Strokes during women’s reproductive years statistics

Women aged 35 y/o and younger are 44% more likely to have a stroke than men at the same age

Regardless of age… (BW vs WW)

BW are more likely to have strokes than WW

Lower BP reduces the risk of stroke and…

• accelerated brain aging

• mental decline

• impairment in judgment, thinking, memory, learning ability

______ is the largest major killer of people in the US, representing 1 in __ deaths

Coronary heart disease; 1 in 5 deaths

What is a stroke?

Brain damage from an interruption of the blood supply/flow to the brain

How many strokes and stroke deaths occur annually in the US?

795k strokes a year; 140k stroke deaths

Stroke and stroke death time statistics

A stroke occurs every 40 seconds; a stroke death every 4 minutes

Family history and stroke

If someone in your family has had a stroke, you are 2x as likely to have one as well

High BP and stroke

High BP is the most important contributor to stroke in both sexes; other risk factors include elevated cholesterol, diabetes, obesity — all of which should be treated earlier in life to avoid arterial blockage in the brain

Cigarettes and stroke risk

Major risk factor for both sexes, but female smokers are more likely to have a stroke than male smokers

Pregnancy and stroke

Blood clots more easily during these 9 months, somewhat increasing the BP of the woman

Birth control pills and stroke

Increases blood clot risk (especially if over 35 years old); newer/safer pills are only effective for those who are not already at an increased risk

Tamoxifen and stroke

Tamoxifen protects women who are at risk of breast cancer and increases their survivability, but INCREASES RISK OF STROKE

HRT and stroke

Postmenopausal women taking hormone replacement therapy for estrogen have an increased stroke, breast cancer, and heart attack risk

High WBC count and stroke

Silent inflammation in arteries when no infection is present in the body can lead to an increased vulnerability for a stroke

Elevated C-reactive protein (CRP) and stroke

The elevated levels of the protein reflect inflammation somewhere else in the body; treatments including STAINS are available, which also lower cholesterol

Plaque in carotid arteries and stroke

A whoosing sound from a stethoscope indicates the presence of plaques that can fragment and travel to the brain - causing a stroke

Self-protection: regular exercise

Sustained physical activity for 30-60 mins on most days reduces stroke

Self-protection: consuming the right foods

• Eat foods rich in beta-carotene (carrots, oranges, green vegetables)

• A serving of potassium (bananas, potatoes) can decrease stroke risk by 40%

Self-protection: aspirin in low dosages

40k women over 10 years have reported taking an aspirin every other day reduces the risk of stroke

Self-protection: alcohol in moderation

1-2 drinks a day reduces the risk of stroke, but over 4 drinks a day increases the risk of HEMORRHAGIC stroke

3 key points from stroke lecture

1. Population at increased risk of developing anemia is BLACKS

2. Type of cancer with cost-effective screening is CERVICAL

   1. Type of cancer with not cost-effective screening is LUNG and CORONARY HEART DISEASE

When is screening cost-effective?

• TB

• Iron deficiencies

  • Vision impairment

When is screening cost-ineffective?

• Lung cancer

• Heart disease

  • Hypertension

Tips for shaking salt

• No salted chips, pickles, lunch meat, canned foods

• Avoid processed foods

• Opt for low-sodium versions of foods

• More fruits and vegetables

• Unsalted nuts, seeds, dried vegetables

• Unsalted, low-sodium, fat-free soups and broths

• Don’t add salt to vegetables or buy canned vegetables with salt

• No salt during cooking or before tasting

• Spices and herbs to enhance flavor

  • Take salt shaker off the table

Aprocitentan (Tryvio)

Treatment for patients with RESISTANT hypertension; 1st new type in decades

Renal denervation

Minimally invasive procedure involving treating resistant hypertension by interrupting the nerves which control blood flow to the kidneys with a catheter

Study of e-cigs question; which of the following is NOT true?

Users have higher risks of diabetes than nonusers

Lifetime risk of neurological disorders for women

50% will develop some neurological disorder (stroke, dementia, Parkinson’s diseaes)

Is lower BP better in T2 diabetes and recent acute coronary syndrome (ACS)?

Answer choice C; lower for both

While NJ deaths from opiates remained flat during COVID…

Racial and ethnic disparities increased

Which group has highest rate of overdose deaths among all groups in NJ?

Black residents

Black residents change in death rates from opioids

Rose from 54.6 per 100k to 65.9 per 100k in 2021

Hispanic residents change in opioid deaths

24.6 per 100k to 25.9 per 100k

White residents change in opioid death

DECREASED from 37.7 per 100k to 34.9

From 2000 to 2018, the overdose death rate per 100k…

Increased 8 to 33%, a change of 341%

From 2000 to 2015, the jail population rate in NJ…

Changed from 272 to 253 per 100k, a change of -7%