Hypertension: Dr. Lucia Mazur-Nicorici Md. PHD
Hypertension: Dr. Lucia Mazur-Nicorici Md. PHD
Hypertension: Dr. Lucia Mazur-Nicorici Md. PHD
Definition
High risk hypertensive patient means
hypertensive patient with evidence of
atherosclerosis (coronary, cerebral or peripheral)
Or one or more atherosclerotic risk factors
Or with target organ damage
(cardiac, renal, eye or cerebral affection)
Epidemiology
The prevalence of hypertension worldwide is
estimated approximately 1 million individuals
mortality is about 7.1 million decese/an.
According to WHO hypertension is the leading
cause of mortality consequences worldwide.
Although hypertension is more common in
developed countries (37.3%) compared with those
in developing countries (22.9%), hypertensive
largest number in absolute terms the latter is found
in.
Stage 1
Stage 2
Stage 3
ISP
Systolic
< 120
120-129
130-140
140-159
160-179
>180
>140
and
and/or
and/or
and/or
and/or
and/or
and
Diastolic
< 80
80-84
85-89
90-99
100-109
> 110
< 90
Aetiology of Hypertension
Primary 90-95% of cases also termed essential of idiopathic
Secondary about 5% of cases
Renal or renovascular disease
Endocrine disease
Phaeochomocytoma
Cusings syndrome
Conns syndrome
Acromegaly and hypothyroidism
Benefits of lowering BP
Average percent reduction
Stroke incidence
35-40%
Myocardial infarction
20-25%
Heart failure
50%
HOT
Hypertension
Optimal
Treatment
H O T Findings
Lowest incidence of major CV events
occurred at a mean achieved DBP of 83
mmHg. This target (compared to mean
achieved of 105 mmHg was associated with
a 30% reduction in main CV events.
In diabetes Diastolic< or = 80mmhg 51 %
lower risk compared to 90 mmHg
Stages
Tailored Approach
CONTRAINDICATIONS
CLASSSOFDRUG
COMPELLING
POSSIBLE
POSSIBLE
COMPELLING
-blockers
Prostatism
Dyslipidaemia
PosturalHypotension
Unrinaryincontinence
Angiotensinconvertingenzyme(ACE)inhibitors
Heartfailure
Leftventriculardysfunction
Chronicrenaldisease*
TypeIIdiabeticnephropathy
Renalimpairment*
Peripheralvasculardisease
Pregnancy
Renovasculardisease
AngiotensinIIreceptorantagonists
CoughinducedbyACEinhibitor
Heartfailure
Intoleranceofotherantihypertensivedrugs
Peripheralvasculardisease
Pregnancy
Renovasculardisease
blockers
Myocardialinfarction
Heartfailure
Angina
Heartfailure
Dyslipidaemia
Peripheralvasculardisease
AsthmaorCOPD
Heartblock
Calciumantagonists(dihydropyridine)
Isolatedsystolichypertension(ISH)inelderlypatients
Angina
Elderlypatients
Calciumantagonists(ratelimiting)
Angina
Myocardialinfarction
Combinationwithblockade
Heartblock
Heartfailure
Thiazides
ElderlypatientsincludingISH
Dyslipidaemia
Gout
*ACEinhibitorsmaybebeneficialinchronicrenalfailurebutshouldbeusedwithcaution.Closesupervisionandspecialistadviceareneededwhenthereisestablishedand
significantrenalimpairment
CautionwithACEinhibitorsandangiotensinIIreceptorantagonistsinperipheralvasculardiseasebecauseofassociationwithrenovasculardisease.
IfACEinhibitorindicated
-blockersmayworsenheartfailure,butinspecialisthandsmaybeusedtotreatheartfailure
Therapeutic targets
MeasuredinclinicMeandaytimeABPM
orhomemeasurement
BloodPressureNodiabetesDiabetesNodiabetesDiabetes
Optimal<140/85<140/80 <130/80<130/75
AuditStandard<150/90<140/85<140/85<140/80
TheauditstandardreflectstheminimumrecommendedlevelsofBPcontrol.Despitebestpractice,itmaynotbe
achievableinsometreatedhypertensivepatients.
NB:Bothsystolicanddiastolictargetsshouldbereached
BritishHypertensionSocietyGuidelines
Logical Combinations
Diuretic
-blocker
CCB
Diuretic
blocker
ACEinhibitor
CCB
-
*
-
ACE
inhibitor
blocker
-blocker
* Verapamil+beta-blocker=absolutecontra-indication
Follow-up
ForpatientswithBPstabilisedbymanagement,
followupshouldnormallybethreemonthly(interval
shouldnotexceed6months),atwhichthefollowing
shouldbeassessedbyatrainednurse:
*MeasurementofBPandweight
*Reinforcementofnon-pharmacologicaladvice
*Generalhealthanddrugside-effects
*Testurineforproteinuria(annually)
RECOMMENDATIONS
Practical Points