hypertension- management
TRANSCRIPT
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HYPERTENSION
AND ITS MANAGEMENT
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O HYPERTENSION IS A CHRONIC MEDICAL CONDITION IN WHICH THE BLOOD PRESSURE IN THE ARTERIES IS ELEVATED
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STAGING OF HYPERTENSION
CATEGORY SYSTOLIC BP DIASTOLIC BP
NORMAL < 120 <80PREHYPERTENSION 120-139
OR80-90
STAGE 1 HYPERTENSION 140-159 OR
90-99
STAGE 2 HYPERTENSION >= 160 OR
>= 100
JNC 7 CLASSIFICATION
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O ISOLATED SYSTOLIC HYPERTENSION- SYSTOLIC PRESSURE OF 140 mmHg OR MORE AND A DIATOLIC PRESSURE OF LESS THAN 90 mmHg.
O WHITE COAT HYPERTENSION-
PHENOMENON IN WHICH A PATIENT EXHIBIT A BLOOD PRESSURE LEVEL ABOVE THE NORMAL RANGE IN CLINICAL SETTINGS BUT NOT SO IN OTHER SETTINGS.
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CLASSIFICATION OF HYPERTENSION
ESSENTIALHYPERTENSION(90%)
SECONDARY HYPERTENSION(10%)
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CAUSES OF SECONDARY HYPERTENSION (10%)
O CHRONIC KIDNEY DISEASEO SLEEP APNEAO PHEOCHROMOCYTOMAO COARCTATION OF THE AORTAO PREGNANCYO ALCOHOL ADDICTIONO THYROID DYSFUNCTION
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RISK FACTORS
NON-MODIFIABLE RISK FACTORS
• AGE• SEX• GENETIC FACTORS• ETHNICITY
MODIFIABLE RISK FACTORS
• OBESITY• SALT INTAKE• SATURATED FAT• DIETARY FIBRE• ALCOHOL• PHYSICAL ACTIVITY• ENVIRONMENTAL STRESS• SOCIO-ECONOMIC STATUS• HEART RATE
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RULE OF HALVES
1. WHOLE COMMUNITY2. NORMOTENSIVE SUBJECTS3. HYPERTENSIVE SUBJECTS4. UNDIAGNOSED HYPERTENSION5. DIAGNOSED HYPERTENSION6. DIAGNOSED BUT UNTREATED7. DIAGNOSED AND TREATED8. INADEQUATELY TREATED9. ADEQUATELY TREATED
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TRACKING OF BLOOD PRESSURE
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HYPERTENSIVE URGENCY
O SEVERE HEADACHEO SHORTNESS OF BREATHO NOSEBLEEDSO SEVERE ANXIETY
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HYPERTENSIVE EMERGENCYO STROKEO LOSS OF CONSCIOUSNESSO MEMORY LOSSO HEART ATTACKO LOSS OF KIDNEY FUNCTIONO DAMAGE TO EYES AND KIDNEYSO AORTIC DISSECTIONO PULMONARY EDEMA
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PREVENTION OF HYPERTENSION
PRIMARY PREVENTION SECONDARY PREVENTION• POPULATION STRATEGY• HIGH-RISK STRATEGY
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PRIMARY PREVENTIONO ALL MEASURES TO REDUCE THE
INCIDENCE OF DISEASE IN A POPULATION BY REDUCING THE RISK OF ONSET
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POPULATION STRATEGYO NUTRITIONO WEIGHT REDUCTIONO EXERCISE PROMOTIONO BEHAVIOURAL CHANGESO HEALTH EDUCATIONO SELF-CARE
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HIGH-RISK STRATEGYO AIM IS TO PREVENT THE ATTAINMENT
OF LEVELS OF BLOOD PRESSURE AT WHICH THE INSTITUTION OF TREATMENT WOULD BE CONSIDERED
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SECONDARY PREVENTIONO EARLY CASE DETECTIONO TREATMENTO PATIENT COMPLIANCE
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MANAGEMENT OF HYPERTENSION
LIFE-STYLE MODIFICATION
PHARMACOLOGICAL MANAGEMENT
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LIFE-STYLE MODIFICATIONMODIFICATION APPRX SBP
REDUCTIONWEIGHT REDUCTION 5 - 20 mmHgADOPT DASH EATING PLAN 8 - 14 mmHgDIETARY SODIUM REDUCTION 2 - 8 mmHgPHYSICAL ACTIVITY 4 – 9 mmHgMODERATION OF ALCOHOL CONSUMPTION
2 - 4 mmHg
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O WEIGHT REDUCTION – ACC. TO JNC 7, 5-20 POINTS REDUCTION IN BP PER 10 KG WEIGHT LOSS
O DIETARY APPROACHES TO STOP HYPERTENSION –
DIET RICH IN FRUITS, VEGETABLES AND LOW-FAT DAIRY PRODUCTS.HIGH PROTEIN AND FIBRE
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O SALT REDUCTION-LESS THAN 2400 mg PER DAY
O PHYSICAL ACTIVITY-BRISK WALKING ATLEAST 30 MIN/MOST DAYS OF THE WEEK
O ALCHOL REDUCTION-NO MORE THAN 2 DRINKS/ DAY
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GOAL BLOOD PRESSURE
O < 140/90 mmHg FOR PATIENTS WITH HYPERTENSION
O <130/80 mmHg FOR PATIENTS WITH DIABETES OR CHRONIC KIDNEY DISEASE
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PATIENTS WITH HYPERTENSION ALREADY ON TREATMENT
IF SYSTOLIC BP < 140 mmHgAND DIASTOLIC BP <90mmHg
ADVISE TO CONTINUE SAME TREATMENT AND LSM COUNSELLING
IF SYSTOLIC BP >= 140 mmHgAND DIASTOLIC BP >=90mmHg
REGULAR FOLLOW-UP
FOLLOW THE SAME PROTOCOLOF NEWLY DETECTED HYPERTENSIVE PATIENTS TO ACHIEVE GOAL BLOOD PRESSURE
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NEWLY DETECTED STAGE I HYPERTENSION
ASSESS RISK FACTORSIF YES IF NO
LSM AND T.AMLODIPINE2.5 mg Hg
RECHECK BP AFTER 2 WEEKS
IF BP >= 140/90 mm Hg,INCREASE DOSE OF AMLO TO MAX- 10 mg/ DAY
LSM ONLY
RECHECK BP AFTER 2 WEEKS
IF BP >= 140/90 mm Hg,LSM WITH AMLODIPINE 2.5 mg/ day
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NEWLY DETECTED STAGE II HYPERTENSION
LSM AND T.AMLODIPINE 5 mg/day
RECHECK BP AFTER 2 WEEKS
IF BP >= 140/90 mmHg
INCREASE DOSE OF AMLODIPINE TO MAX- 10mg/ day
RECHECK BP AFTER 2 WEEKS
GOAL BP ACHIEVED GOAL BP NOT ACHIEVED
CONTINUE SAME ADD SECOND DRUG
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SECOND DRUGISOLATED HYPERTENSION NOT CONTROLLED WITH T.AMLO 10 MG/DAYADD T.HYDROTHIAZIDE 25 MG OD ORT.ENALAPRIL 2.5-20 MG PER DAY ORT.ATENOLOL 25-100 MG PER DAY
HYPERTENSION WITH DIABETESADD T.ENALAPRIL 2.5-20 MG PER DAY(if sr. creatinine is <2mg)
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SECOND DRUGHYPERTENSION WITH IHDADD T.ATENOLOL 25-100 MG PER DAYWITH T.ASPIRIN 75 MG OD ANDT.ISOSORBITRATE DINITRATE 5-10 MG TDS
HYPERTESION WITH CKDAVOID ENALAPRIL IF SR. CREATININE > 2 mgADD T.ATENOLOL 25-100 mg PER DAY(cautious use in PVD)
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SECOND DRUG
HYPERTENSION WITH BRONCHIAL ASTHMA OR COPDAVOID ATENOLOLT.ENALAPRIL 2.5-20 mg PER DAY (OR)T.HYDROCHLOROTHIAZIDE 25 mg OD
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