Documente Academic
Documente Profesional
Documente Cultură
Hypertension
Other problems;
Difficult to achieve good control of BP especially in the older pts with comorbid disease. Requirement of multiple medications .
Increment of 20mmHg in SBP & 10 mmHg in DBP double the risk of both IHD & stroke . The risk CAD starts from BP > 120/80
Incidence
50% for persons above 50yr 80% > 80 yr
JNC 7 classification
Normal: < 120 SBP & < 80 DBP Prehypertension : 120 - 139 / 80-89 Stage 1 : 140-159 / 90-99 Stage 2 : > 160 / 100
Definitions
Essentional ( primary, idiopathic) hypertension; 90% of all cases Clusters in families & represents a collection of genetically based disease.
Secondary HTN ;
High BP caused by a specific , potentially curable disorder.
Hypertensive urgency : DBP > 120 mmHg. Hypertensive emergency : DBP >120 mmHg plus acute or ongoing end organ damage.
Initial evaluation should include; 1) accurate measurement of BP 2) assessment of end organ damage. 3) screening for secondary causes.
BP measurement
Diagnosis of HTN should be made when at least 2 separate readings obtained at least 1-2 weeks apart average > 140/90.
Off tobacco & caffeine for > 30 min. before BP measurement. Suitable cuff that encircle 80% of the arm. large cuff ---- false low reading small cuff ---- false high reading
Secondary HTN
Considered when ; onset of HTN < 20 yr or > 60yr refractory HTN worsening of previously controlled HTN. azotemia induced or worsened by ACEI or ARBs. recurrent flash pulmonary edema with normal LV function.
Secondary HTN
Renal causes; 90% of all secondary HTN. Endocrine; Drugs ; steroids, alcohol, OCP, NSAID, nasal decongestants, cyclosporine, erythropoietin ,.. Sleep apnea Coarctataion of aorta.
Weight reduction ( for each 1 kg wt loss, SBP & DBP decreased by 1.6 mmHg /1.3 mmHg )
Physical activity ( engagement in regular aerobic exercise such as brisk walking at least 30 min / day, most days of the week can reduce SBP 4-9 mmHg )
Na restriction to 2.4g daily reduce SBP by 2-8 mmHg. Adopting diet rich in fruits & vegetables & low in saturated fats can reduce SBP by 814 mmHg.
Goal of treatment
for most pts , goal BP is < 140 / 90 . For pts with DM or CKD , goal BP is <130/80
5 major classes have shown benefit outcome ; 1) thiazide- type diuretics 2) B-Blokers 3) Ca Channel Blokers 4) Angiotensin converting enzyme inhibitors (ACEI) 5) angiotesin receptor blokers (ARBs)
Comorbid conditions
In many pts , 2nd , 3rd & even 4th line drugs are needed in order to attain goal BP.
Thank you