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Hypertension
Each time the heart beats
(about 60-70 times a minute at
rest), it pumps out blood into
the arteries.
What Is Blood Pressure?
Your blood pressure is at its
highest when the heart beats,
pumping the blood.
When the heart is at
rest, between beats,
your blood pressure
falls.
Your blood pressure is always given as these two numbers with one above
or before the other.
This is called SYSTOLIC pressure.
120/
80
This is called DIASTOLIC pressure.
Bottom number
Category
Systolic
(Top Number)
Diastolic
(Bottom Number)
Normal Less than 120 Less than 80
What Is Normal Blood Pressure?
“Normal” blood pressure is when both numbers
are lower than 120/80.
If your blood pressure is in the prehypertensive range:
It means that you don’t have high blood pressure now, but you are likely to
develop it in the future.
Unless you take ACTION to prevent it!
“Prehypertension”
Prehypertension 120-139 80-89
Medical Education & Information – for all Media, all Disciplines, from all over the World
Powered by
2013 ESH/ESC Guidelines for the management of arterial hypertension
The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) - J Hypertension 2013;31:1281-1357
Definitions and classification of office BP levels (mmHg)*
Category Systolic Diastolic
Optimal <120 and <80
Normal 120–129 and/or 80–84
High normal 130–139 and/or 85–89
Grade 1 hypertension 140–159 and/or 90–99
Grade 2 hypertension 160–179 and/or 100–109
Grade 3 hypertension ≥180 and/or ≥110
Isolated systolic hypertension ≥140 and <90
* The blood pressure (BP) category is defined by the highest level of BP, whether systolic or diastolic. Isolated systolic hypertension should be
graded 1, 2, or 3 according to systolic BP values in the ranges indicated.
Hypertension:
SBP >140 mmHg ± DBP >90 mmHg
What Is High Blood Pressure?
A blood pressure of 140/90is considered high blood pressure.
High Blood Pressure Systolic Diastolic
Stage 1 140-159 90-99
Stage 2 160 or higher 100 or higher
“Hypertension”
Kieran McGlade Nov 2001 Department of General Practice QUB
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
• Conn’s syndrome (hyperaldosteronism)
• Acromegaly and hypothyroidism
– Coarctation of the aorta
– Iatrogenic
• Hormonal / oral contraceptive
• NSAIDs
• Renovascular disease is a progressive condition that causes
narrowing or blockage of the renal arteries or veins. These
are the blood vessels that take blood to and from the
kidneys. It's the general term used for three disorders:
renal artery occlusion, renal vein thrombosis, and renal
atheroembolism.
• Phaeochomocytoma is a small vascular tumor of the
adrenal medulla, causing irregular secretion of epinephrine
and norepinephrine, leading to attacks of raised blood
pressure, palpitations, and headache.
• Cusings syndrome is a metabolic disorder caused by
overproduction of corticosteroid hormones by the adrenal
cortex and often involving obesity and high blood pressure.
Coarctation of the aorta
• Coarctation
Hypertension:
Predisposing factors
• Advancing Age
• Sex (men and postmenopausal women)
• Family history of cardiovascular disease
• Sedentary life style & psycho-social stress
• Smoking ,High cholesterol diet, Low fruit
consumption
• Obesity & wt. gain
• Co-existing disorders such as diabetes,
and hyperlipidaemia
• High intake of alcohol
Haemodynamic Pattern
in Hypertension
Young :  BP = CO X TPR
Elderly :  BP =  CO X   TPR
What can high blood pressure do to your body?
Heart Attack
High blood pressure is a
major risk factor for heart
attack. The arteries bring
oxygen-carrying blood to the
heart muscle. If the heart
cannot get enough oxygen,
chest pain, can occur. If the
flow of blood is blocked, a
heart attack results.
Blindness
High blood pressure can eventually
cause blood vessels in the eye to
burst or bleed. Vision may become
blurred or otherwise impaired and
can result in blindness.
Kidney disease
Kidneys act as filters to rid the
body of waste. High blood
pressure can narrow and
thicken the blood vessels of
the kidneys. The kidneys
filter less fluid and waste
builds up in the blood. The
kidneys may fail altogether.
High blood pressure is the most important
risk factor for stroke. Very high pressure can
cause a break in a weakened blood vessel,
which then bleeds in the brain. This can
cause a stroke. If a blood clot blocks one of
the narrowed arteries, it can also cause a
stroke.
Stroke
As people get older, arteries
throughout the body
"harden," especially those in
the heart, brain, and
kidneys. High blood pressure
is associated with these
"stiffer" arteries. This, in
turn, causes the heart and
kidneys to work harder.
Arteries
Heart failure
The heart is unable to
pump enough blood to
supply the body's needs.
Diagnosis
Clinical manifestations
• No specific complains or manifestations other than
elevated systolic and/or diastolic BP (Silent Killer
)
• Morning occipital headache
• Dizziness
• Fatigue
• In severe hypertension, epistaxis or blurred vision
Self-Measurement of BP
 Provides information on:
1. Response to antihypertensive therapy
2. Improving adherence with therapy
3. Evaluating white-coat HTN
 Home measurement of >135/85 mmHg is generally
considered to be hypertensive.
 Home measurement devices should be checked
regularly.
Measuring
Blood Pressure
• Patient seated quietly for at least
5minutes in a chair, with feet on the
floor and arm supported at heart
level
•An appropriate-sized cuff (cuff bladder encircling at least
80% of the arm)
•At least 2 measurements
Continue…
• Systolic Blood Pressure is the point at which
the first of 2 or more sounds is heard
• Diastolic Blood Pressure is the point of
disappearance of the sounds (Korotkoff 5th)
Continue…
Measuring
Blood Pressure
• Ambulatory BP Monitoring - information about
BP during daily activities and sleep.
• Correlates better than office measurements
with target-organ injury.
Continue…
Measuring
Blood Pressure
Laboratory Tests
 Routine Tests
• Electrocardiogram
• Urinalysis
• Blood glucose,
• Serum potassium, creatinine, or the corresponding estimated GFR,
and calcium
• Lipid profile, after 9- to 12-hour fast, that includes high-density and
low-density lipoprotein cholesterol, and triglycerides
 Optional tests
• Measurement of urinary albumin excretion or albumin/creatinine
ratio
 More extensive testing for identifiable causes is not generally indicated
unless BP control is not achieved
How to treat ?
Treatment Overview
Goals of therapy
Lifestyle modification
Pharmacologic treatment
 Algorithm for treatment of hypertension
Follow up and monitoring
Goals of Therapy
Reduce Cardiac and renal morbidity and mortality.
Treat to BP <140/90 mmHg or BP <130/80 mmHg in
patients with diabetes or chronic kidney disease.
Non pharmacological
Treatment of hypertension
Avoid harmful habits ,smoking ,alcohal
Reduce salt and high fat diets
Loose weight , if obese
Regular exercise
DASH
diet
Life style modifications
• Lose weight, if overweight
• Increase physical activity
• Reduce salt intake
• Stop smoking
• Limit intake of foods rich in fats and
cholesterol
• increase consumption of fruits and
vegetables
• Limit alcohol intake
Lifestyle Modification
Modification Approximate SBP reduction
(range)
Weight reduction 5–20 mmHg / 10 kg weight loss
Adopt DASH eating
plan
8–14 mmHg
Dietary sodium
reduction
2–8 mmHg
Physical activity 4–9 mmHg
Moderation of alcohol
consumption
2–4 mmHg
Antihypertensive Drugs
Continue….
AT1 receptor
ARB
Drug therapy for hypertension
Class of drug Example Initiating dose Usualmaintenance
dose
Diuretics Hydrochlorothiazide 12.5 mg o.d. 12.5-25 mg o.d.
-blockers Atenolol 25-50 mg o.d. 50-100 mg o.d.
Calcium Amlodipine 2.5-5 mg o.d. 5-10 mg o.d.
channel
blockers
-blockers prazosin 2.5 mg o.d 2.5-10mg o.d.
ACE- inhibitors ramipril 1.25-5 mg o.d. 5-20 mg o.d.
Angiotensin-II Losartan 25-50 mg o.d. 50-100 mg o.d.
receptor blockers

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Hypertension.pdf

  • 2. Each time the heart beats (about 60-70 times a minute at rest), it pumps out blood into the arteries. What Is Blood Pressure? Your blood pressure is at its highest when the heart beats, pumping the blood. When the heart is at rest, between beats, your blood pressure falls. Your blood pressure is always given as these two numbers with one above or before the other. This is called SYSTOLIC pressure. 120/ 80 This is called DIASTOLIC pressure. Bottom number
  • 3. Category Systolic (Top Number) Diastolic (Bottom Number) Normal Less than 120 Less than 80 What Is Normal Blood Pressure? “Normal” blood pressure is when both numbers are lower than 120/80.
  • 4. If your blood pressure is in the prehypertensive range: It means that you don’t have high blood pressure now, but you are likely to develop it in the future. Unless you take ACTION to prevent it! “Prehypertension” Prehypertension 120-139 80-89
  • 5. Medical Education & Information – for all Media, all Disciplines, from all over the World Powered by 2013 ESH/ESC Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) - J Hypertension 2013;31:1281-1357 Definitions and classification of office BP levels (mmHg)* Category Systolic Diastolic Optimal <120 and <80 Normal 120–129 and/or 80–84 High normal 130–139 and/or 85–89 Grade 1 hypertension 140–159 and/or 90–99 Grade 2 hypertension 160–179 and/or 100–109 Grade 3 hypertension ≥180 and/or ≥110 Isolated systolic hypertension ≥140 and <90 * The blood pressure (BP) category is defined by the highest level of BP, whether systolic or diastolic. Isolated systolic hypertension should be graded 1, 2, or 3 according to systolic BP values in the ranges indicated. Hypertension: SBP >140 mmHg ± DBP >90 mmHg
  • 6. What Is High Blood Pressure? A blood pressure of 140/90is considered high blood pressure. High Blood Pressure Systolic Diastolic Stage 1 140-159 90-99 Stage 2 160 or higher 100 or higher “Hypertension”
  • 7. Kieran McGlade Nov 2001 Department of General Practice QUB 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 • Conn’s syndrome (hyperaldosteronism) • Acromegaly and hypothyroidism – Coarctation of the aorta – Iatrogenic • Hormonal / oral contraceptive • NSAIDs
  • 8. • Renovascular disease is a progressive condition that causes narrowing or blockage of the renal arteries or veins. These are the blood vessels that take blood to and from the kidneys. It's the general term used for three disorders: renal artery occlusion, renal vein thrombosis, and renal atheroembolism. • Phaeochomocytoma is a small vascular tumor of the adrenal medulla, causing irregular secretion of epinephrine and norepinephrine, leading to attacks of raised blood pressure, palpitations, and headache. • Cusings syndrome is a metabolic disorder caused by overproduction of corticosteroid hormones by the adrenal cortex and often involving obesity and high blood pressure.
  • 9. Coarctation of the aorta • Coarctation
  • 10. Hypertension: Predisposing factors • Advancing Age • Sex (men and postmenopausal women) • Family history of cardiovascular disease • Sedentary life style & psycho-social stress • Smoking ,High cholesterol diet, Low fruit consumption • Obesity & wt. gain • Co-existing disorders such as diabetes, and hyperlipidaemia • High intake of alcohol
  • 11. Haemodynamic Pattern in Hypertension Young :  BP = CO X TPR Elderly :  BP =  CO X   TPR
  • 12. What can high blood pressure do to your body? Heart Attack High blood pressure is a major risk factor for heart attack. The arteries bring oxygen-carrying blood to the heart muscle. If the heart cannot get enough oxygen, chest pain, can occur. If the flow of blood is blocked, a heart attack results. Blindness High blood pressure can eventually cause blood vessels in the eye to burst or bleed. Vision may become blurred or otherwise impaired and can result in blindness. Kidney disease Kidneys act as filters to rid the body of waste. High blood pressure can narrow and thicken the blood vessels of the kidneys. The kidneys filter less fluid and waste builds up in the blood. The kidneys may fail altogether. High blood pressure is the most important risk factor for stroke. Very high pressure can cause a break in a weakened blood vessel, which then bleeds in the brain. This can cause a stroke. If a blood clot blocks one of the narrowed arteries, it can also cause a stroke. Stroke As people get older, arteries throughout the body "harden," especially those in the heart, brain, and kidneys. High blood pressure is associated with these "stiffer" arteries. This, in turn, causes the heart and kidneys to work harder. Arteries Heart failure The heart is unable to pump enough blood to supply the body's needs.
  • 14. Clinical manifestations • No specific complains or manifestations other than elevated systolic and/or diastolic BP (Silent Killer ) • Morning occipital headache • Dizziness • Fatigue • In severe hypertension, epistaxis or blurred vision
  • 15. Self-Measurement of BP  Provides information on: 1. Response to antihypertensive therapy 2. Improving adherence with therapy 3. Evaluating white-coat HTN  Home measurement of >135/85 mmHg is generally considered to be hypertensive.  Home measurement devices should be checked regularly.
  • 16. Measuring Blood Pressure • Patient seated quietly for at least 5minutes in a chair, with feet on the floor and arm supported at heart level •An appropriate-sized cuff (cuff bladder encircling at least 80% of the arm) •At least 2 measurements Continue…
  • 17. • Systolic Blood Pressure is the point at which the first of 2 or more sounds is heard • Diastolic Blood Pressure is the point of disappearance of the sounds (Korotkoff 5th) Continue… Measuring Blood Pressure
  • 18. • Ambulatory BP Monitoring - information about BP during daily activities and sleep. • Correlates better than office measurements with target-organ injury. Continue… Measuring Blood Pressure
  • 19. Laboratory Tests  Routine Tests • Electrocardiogram • Urinalysis • Blood glucose, • Serum potassium, creatinine, or the corresponding estimated GFR, and calcium • Lipid profile, after 9- to 12-hour fast, that includes high-density and low-density lipoprotein cholesterol, and triglycerides  Optional tests • Measurement of urinary albumin excretion or albumin/creatinine ratio  More extensive testing for identifiable causes is not generally indicated unless BP control is not achieved
  • 21. Treatment Overview Goals of therapy Lifestyle modification Pharmacologic treatment  Algorithm for treatment of hypertension Follow up and monitoring
  • 22. Goals of Therapy Reduce Cardiac and renal morbidity and mortality. Treat to BP <140/90 mmHg or BP <130/80 mmHg in patients with diabetes or chronic kidney disease.
  • 23. Non pharmacological Treatment of hypertension Avoid harmful habits ,smoking ,alcohal Reduce salt and high fat diets Loose weight , if obese Regular exercise DASH diet
  • 24. Life style modifications • Lose weight, if overweight • Increase physical activity • Reduce salt intake • Stop smoking • Limit intake of foods rich in fats and cholesterol • increase consumption of fruits and vegetables • Limit alcohol intake
  • 25. Lifestyle Modification Modification Approximate SBP reduction (range) Weight reduction 5–20 mmHg / 10 kg weight loss Adopt DASH eating plan 8–14 mmHg Dietary sodium reduction 2–8 mmHg Physical activity 4–9 mmHg Moderation of alcohol consumption 2–4 mmHg
  • 27. Drug therapy for hypertension Class of drug Example Initiating dose Usualmaintenance dose Diuretics Hydrochlorothiazide 12.5 mg o.d. 12.5-25 mg o.d. -blockers Atenolol 25-50 mg o.d. 50-100 mg o.d. Calcium Amlodipine 2.5-5 mg o.d. 5-10 mg o.d. channel blockers -blockers prazosin 2.5 mg o.d 2.5-10mg o.d. ACE- inhibitors ramipril 1.25-5 mg o.d. 5-20 mg o.d. Angiotensin-II Losartan 25-50 mg o.d. 50-100 mg o.d. receptor blockers
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