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Mental Health Issues associated with
HBP and CVD
Dr. Dawn-Elise Snipes

Objectives
~ Define and examine the prevalence of HBP and CVD
~ Explore the impact of HBP and CVD on mental health
~ Identify strategies to improve wellness while living with HBP/CVD

Definition and Prevalence
~ High Blood Pressure
~ Definition: HBP defined as a systolic blood pressure greater than 130 mm Hg or a diastolic blood pressure greater than 80 mm Hg
~ Prevalence: 45% of adults
~ High Blood Pressure
~ Risk Factors:
~ Obesity (78% in men and 65% in women) which results in include altered hemodynamics, impaired sodium homeostasis, renal dysfunction, autonomic nervous system imbalance, endocrine alterations, oxidative stress and inflammation, and vascular injury
~ Excess sodium: Salt sensitivity is when an increase in sodium disproportionately increases BP
~ Insufficient Omega-3s, potassium, calcium, magnesium
~ Low physical activity
~ Sleep apnea (secondary hypertension)
~ Immune reactivity cause hypertension in autoimmune diseases
~ Caffeine less than 600mg/day often irrelevant in those without sensitivities
~ Mental Stress

Definition and Prevalence
~ Cardiovascular Disease
~ Definition: CVDs are a group of disorders of the heart and blood vessels and include coronary heart disease, cerebrovascular disease, rheumatic heart disease and other conditions.
~ Four out of 5 CVD deaths are due to heart attacks and strokes
~ Prevalence
~ About 655,000 Americans die from heart disease each year
~ In 2021, an estimated 608,570 people will die of cancer
~ 528,603 Americans had died of the coronavirus in one year, according to Johns Hopkins University data
~ Risk Factors: HBP, High LDL cholesterol, obesity, unhealthy diet, smoking and heavy alcohol use (5oz wine/12 oz beer x8/wk).

Impact of HBP and CVD
~ Physical Consequences
~ Heart attacks
~ Strokes (which can lead to dementia and physical dysfunction)
~ Kidney Disease
~ Sexual dysfunction: ED and reduced libido
~ Peripheral Artery Disease leading to pain and excessive fatigue
~ Increases in LDL accumulations
~ HBP and CVD Med Side effects
~ Balance and coordination difficulties
~ Fatigue
~ Headache
~ Increased risk of sleep apnea with SSRIs/benzos and antihypertensives
~ Statins interact with antidepressants improving mood response

Impact of HBP and CVD
~ Affective and Cognitive Consequences
~ Pre-existing, consequences of diagnosis or clinical event
~ Anger/Grief/Depression: Hypertension causes low-grade, chronic inflammation which can negatively affect your mental health, interfering with mood-regulating chemicals
~ Anxiety
~ Fatigue
~ PTSD
~ Vascular Dementia

Impact of HBP and CVD
~ Relational Consequences of HBP/CVD
~ Initial increase in anxiety and depression which may abate over time esp. with health education and treatment compliance
~ Changes in leisure activities and family responsibilities resulting in a grieving process
~ Dad should not push mow the lawn
~ Medications cause fatigue making it difficult to walk 18 holes of golf

Interventions
~ The foundation for a healthy blood pressure consists of a healthy diet, adequate exercise, mental and environmental stress reduction.
~ Trait mindfulness may have protective effect on BP when caregivers face high levels of stress
~ Hardiness & Resilience (commitment, control, and challenge) decreases the effect of stressful life events mediating the development of illness symptoms
~ DBT: Distress tolerance, dialectics
~ ACT: Living in the AND
~ CBT: FCP
~ Maintaining hope and positivity, versus managing worries, fears and anxieties was predominant

Interventions
~ Yoga and meditation: Autonomic cardiovascular control is impaired in hypertension, leading to an increase in the sympathetic influences to the heart and peripheral vessels.
~ Improvement in family relationships and reduction in interpersonal stress
~ Reduction in environmental stress triggers and vulnerabilities
~ Adjustment and motivational enhancement for new eating and activity patterns

Summary
~ Hypertension and cardiovascular disease can both be aggravated by and cause the development of depression, anxiety, anger, grief, and even PTSD if there is a life-threatening episode
~ HBP and CVD are largely preventable and/or treatable
~ Roles of the Counselor/Social Worker
~ Address grief and health anxiety in pt and family with hardiness, mindfulness, meditation, yoga, optimism and cognitive restructuring
~ Improve health literacy and motivation for treatment compliance
~ Encourage self-advocacy regarding medication/treatment side effects

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