“practical update on hypertension”

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“Practical Update on Hypertension”

Dr. Babu Shersad, MD, MACP (USA)Specialist Internal Medicine & Nephrologist

Date: 5th December 2006Venue : Renaissance Hotel

Time : 12:30 PM


Contents: What is Hypertension? Classification of Hypertension. Detection. Evaluation. Treatment. The JNC Algorithm. Hypertension in Diabetes. Resistant Hypertension.


What is Hypertension?Pre Hypertension: blood pressure 120/80 mmHg to 139/89 mmHg not a disease category

Hypertension: blood pressure of 140/90 mmHg or above The diagnosis of hypertension should be made only after noting a mean elevation on

three readings 6 hours apart


Classification of Hypertension


Detection of HypertensionA. Symptoms of Hypertension No symptoms Non-specific symptoms Headache Morning headache Tinnitus Dizziness Confusion Sleepiness Vision problems Angina Difficulty breathing Irregular heartbeat Blood in the urine Epistaxis Many symptoms occur from complications of hypertension


Contd.

B. Signs of Hypertension

Vital Signs - Elevated blood pressure, bradycardia, bounding pulse Skin - Flushed, diaphoresis, pallor Cardio-Vascular - Distended neck veins, extremity edema, pulmonary edema Neurologic - Decreased level of consciousness, impaired movement, symmetry

of face and extremities, seizures, unequal pupils


Evaluation of HypertensionThree main objectives:1. To asses lifestyle and other cardiovascular risk or

concomitant disorders that may affect prognosis and guide treatment.

2. To reveal identifiable causes of BP 3. To asses the presence or absence of target organ

damage and CVD


Identifiable causes of hypertension Sleep apnea Drug induced or related disease Primary aldosteronism Chronic kidney disease Reno-vascular diseases Chronic steroid therapy Cushing’s syndrome Pheochromocytoma Coarctation of aorta


Physical Evaluation Appropriate BP measurement With verification in the contra-lateral arm Examination of optic fundi BMI Auscultation of carotid, abdominal and

femoral bruits Examination of heart, lungs and kidneys Seek abnormal aortic pulse Examination of edema and abnormal pulses in

the lower extreme ties Neurological examination


Laboratory tests and diagnosticsThese are a must (Rule of 9) ECG Urine analysis Blood glucose (9 to 12 hr fasting) Hematocrit Serum potassium Serum creatinine Serum calcium Lipid profile (LDL & HDL with triglycerides) (9 to 12 hr fasting) Albumin creatinine ratio


Treatment of hypertension1. Non pharmacological management:Life Style changes: reducing salt intake: reduce dietary sodium intake to no more than 100 m mol per

day (2.4gm sodium of 6 gm sodium chloride) reducing fat intake losing weight : maintain normal body weight (BMI 18.5-24.5 kg/meter square) getting regular exercise : 30 minutes of daily aerobic exercise quitting smoking : strictly reducing alcohol consumption : not more than 2 drinks / day for men and 1 drink per

day for women managing stress DASH Diet: Dietary Approaches to Stop Hypertension - low in saturated fat,

cholesterol, and total fat, and that emphasizes fruits, vegetables, and low fat dairy foods, whole grain products, fish, poultry, and nuts


2. Pharmacological management of Hypertension

diuretics beta-blockers calcium channel blockers angiotensin converting enzyme inhibitors (ACE inhibitors) alpha-blockers alpha-beta blockers vasodilators peripheral acting adrenergic antagonists centrally acting agonists


Hypertension in Diabetes

Diabetes considerably increases the risk of cardiovascular disease if hypertension is also present, so the targets for blood pressure control in diabetes are tighter.

For people who don't have diabetes, the treatment goals for blood pressure– 140 / 85 mmHg

For people with diabetes, the goals are: if proteinuria is less than 1 gm/24 hrs. – 130 / 80 mmHg if proteinuria is greater than 1 gm/24 hrs. – 125 / 75 mmHg


What is resistant hypertension?

“Failure to reach goal BP in patients who are adhering to full doses of

an appropriate three drug regimen that includes a diuretic ”

Note: This is very common and less tried by clinicians and paramedics.


At the Clinician’s consulting room: Doctor: I have some bad news and some very bad news.

Patient: Well, might as well give me the bad news first.Doctor: The lab called with your test results. They said you have 24 hours to live.Patient: 24 HOURS! That's terrible! WHAT could be WORSE? What's the very bad news?Doctor: I've been trying to reach you since yesterday.

“ I Hope that I conveyed the message” – Dr. Babu Shersad

All references from: Joint National Committee’s 7 th Report

“practical update on hypertension”

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