Hypertension IDiagnosis, causes
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Mean systolic and diastolic blood pressure by age for men and women
Hypertension 19952
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Definition of hypertension
• „There is no dividing line. The relationship between arterial pressure and mortality is quantitative; the higher the pressure, the worse the prognosis.” (Pickering, 1972)
• The operational definition of hypertension is the level at which the benefit …of action exceed those of inaction.” (Rose, 1980)
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Definition of hypertension
• Gauss distribution • No dividing line
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Incidence of hypertension
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Natural course of hypertension
Arteriosclerosis Vasc. dementia
Why is dangerous?
• Complications of hypertension– Cardiac (hypertrphy, failure, infarction)– Cerebral (ischemia, thrombosis, hemorrhage)– Renal (nephrosclerosis, failure)– Large vessel (aneurysm, dissection)– Atherosclerosis
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2007 ESH/ESC(WHO 1999)
Systolic BP
Diastolic BP
JNC VII (2003)
Optimal <120 <80 Normal
Normal 120-129 80-84 Prehypertension
High normal 130-139 85-89
Mild HT (1) 140-159 90-99 HT stage I.
Moderate HT (2) 160-179 100-109
Severe HT (3) >180 >110 HT stage II.
Isolated systolic HT
>140 <90
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Frequency of various diagnoses in hypertensive subjects
Diagnosis Prevalence in population
Prevalence in special ward
Primary hypertension 92-94 65-85
Secunder HT
- renoparenchymal 2-3 4-5
- renovascular 1-2 4-16
-primary aldosteronism 0.3 0.5-12
- Cushing’s sy < 0.1 0.2
-Pheochromocytoma < 0.1 0.2
- Drug induced 0.5-1 1-2
- OSAS n.k. 15-20%
- Thyreoid gl. n.k. n.k.
OSACONTROL
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Cushing syndrome
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Hypertension IIFocus on therapy
Tibor Kovacs MD
2nd Dept. of Internal Medicine
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Alternative blood pressure measurements
ABPM• Much data• Data about the night
BP• Diurnal rythm• Avoid white coat
effect
Home BPM• Improve the patient
compliance• Avoid white coat
effect
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Ambulatory blood pressure monitor (ABPM)
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Recommended Lifestyle Modifications and Their Individual Effects on Blood Pressure
Chobanian AV, et al. JAMA. 2003;289:2560-2572;Blumenthal JA, et al. Arch Intern Med. 2000;160:1947-1958.
Modifications* RecommendationApproximate SBP Reduction
Reduce weight Maintain normal body weight
(BMI of 18.524.9 kg/m2)320 mm Hg
Adopt DASH dietRich in fruit, vegetables, and
low-fat dairy; reduced saturated and total fat content
814 mm Hg
Reduce dietary sodium
<100 mmol (2.4 g)/day 28 mm Hg
Increase physical activity
Aerobic activity >30 min/day most days of the week
49 mm Hg
Moderate alcohol consumption
Men: ≤ 2 drinks/dayWomen: ≤ 1 drink/day
24 mm Hg
*Combining 2 or more of these modifications may or may not have an additive effect on blood pressure reduction.
SBP = systolic blood pressure; BMI = body mass index; DASH = Dietary Approaches to Stop Hypertension
Advantage and disadvantage of the antihypertensive drugsDrug group Indication Possibble
indicationCompelling contraindication
Possibble contraindication
Diuretics HF, elderly, syst. HT, black
Diabetic Gout MS,IGT, Dyslipid. Pregnancy
Beta-blocker Angina, p-AMI, tachyarrh
HF, Pregnancy, Diabetic, Glaucoma
Asthma, COPD, A-V block
PAD, MS, IGT, Sport
ACE-inhib HF, p-AMI, Diabetic, LV dysf., MS, AF, NP
CV prevention, atherosclerosis
Pregnancy, K↑, bilat. ren. a. sten
Dry cough, aortastenosis
ARB Dry cough due ACEI,see : ACEI
CV prevention? Pregnancy, K↑, bilat. ren. a. sten
Stenotic aortic valve
DRI ? ? Pregnancy, K↑, bilat. ren. a. sten
Ca-CB Angina, elderly syst. HT, LV hypertr., black
Diabetic, PAD, Pregnancy, atherosclerosis
A-V block , HF
Alpha-B Prostate hyperplasia IGT, Dyslipidaemia, sexual. dysf.
monotherapy Orthostatic hypotension, HF
27HF-Heart failure, MS- Metabolic sy. IGT- Impaired glucose tolerance AF- atrial fibrillationPAD – peripheral artery disease, NP – nephropathy/proteinuria LV-left ventricular
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Initiation of antihypertensive treatment
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Hypertension in emergency
• Hypertensive urgency BP > 230/130 mmHg without symptoms of
target organ damage • Hypertensive emergencyBP elevation with serious target organ
damageEg. Encephalopathy, acute heart failure,
acute coronaria sy, aortic dissection – acute BP lowering therapy needed
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Therapy of hypertensive urgency and emergency
• Nitroglycerin (sublingual or iv.)• ACEI (captopril, enalapril p.o.)• Urapidil i.v.• Short acting nifedipine (CI: angina, AMI)
• Labetalol• Clonidin• Sodium nitroprussid• In special cases: loop diuretics
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Thank you for your attention!
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METABOLIC SYNDROME
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Conditions favouring use of some antihypertensive drugs versus others I.
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Conditions favouring use of some antihypertensive drugs versus others II.
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