2. INTRODUCTION
EPIDEMIOLOGY
RISK FACTORS
CAUSES
TYPES OF HYPERTENSION
MANAGEMENT:
Among young, elderly and pregnant women and
diabetes
DIAGNOSIS
TREATMENT
PREVENTION
3. Hypertension is defined by :
The Seventh report of the Joint National
Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood
Pressure(JNC 7) a systolic blood pressure
(SBP) >130mmHg and diastolic blood
pressure (DBP)> 89mmHg at rest.
4. Table : Provides a classification of BP for adults 18 years
Note : Pre-hypertension is not a disease category, rather high
risk
5. Hypertensive urgency: Severely elevated
BP(SBP >220 and DBP>120) without signs and
symptoms of acute end organ damage
Hypertensive emergency: Severely elevated
BP(SBP >220 and DBP>120) with symptoms of
acute end organ damage (the system most
affected are cardiovascular ,Renovascular and
cerebrovascular)
6. Accelerated hypertension is a recent
significant increase over baseline BP that is
assoc/with target organ damage.
This is usually seen as vascular damage on
funduscopic exam, such as flame-shaped
hemorrhages or soft exudates, but without
papilledema.
Flame shaped
7. Malignant hypertension : is a syndrome of high
BP( SBP> 180 and DBP > 120mmHg) and
Papilledema on fundoscopy (retinopathy ) must be
present.
Papilledema
8. Resistant hypertension : is an uncontrolled
HTN despite the use of three anti-
hypertensives (ACEi/ARB + CCB or
BB)including diuretics eg: furosemide
9. Worldwide prevalence estimates for hypertension may be
as much as 1 billion individuals.
~ 7.1 million deaths per year may be attributable to
hypertension
Suboptimal BP ( > 115mmHg Systolic BP) is the number
one attributable risk factor for death throughout the world.
WHO reports: that suboptimal BP is responsible for 62% of
cerebrovascular disease and 49% of ischemic heart disease
(IHD), with little variation by sex.
Within the last two decades, better Rx of HTN has been
ass/with a considerable reduction in the hospital case-
fatality rate for heart failure (HF)
*WHO 2014 guideline
10. Causes/risk factors of HTN
Non modifiable
Age
Gender /sex
Genetic
Modifiable causes
Overweight BMI>
30kg/m2
Salt intake
Junk foods
Alcohol & tobacco
use
Physical inactivity
Other secondary causes of HTN are :
Chronic kidney disease
Coarctation of the aorta
Cushing’s syndrome and other
glucocorticoid excess states
including chronic steroid therapy
Obstructive uropathy
Pheochromocytoma
Primary aldosteronism and other
mineralocorticoid excess states
Renovascular hypertension
Sleep apnoea
Thyroid or parathyroid disease
11. Barriers to prevention include
cultural norms
insufficient attention to health education by health care
practitioners
lack of access to places to engage in physical activity;
larger servings of food in restaurants
lack of availability of healthy food choices in many
schools, worksites, and restaurants
lack of exercise programs in schools;
large amounts of sodium added to foods by the food
industry and restaurants;
The higher cost of food products that are lower in sodium
and calories
12.
13. History and physical examination
BP measurement using standard sized cuff
cholesterol and blood sugar levels
Rule out underlying disease:
CVD
DM
THYROID
GENETIC DISEASE e.g. Coarctation of aorta
14.
15. The Rx goal for individuals with:
In Pre-hypertension - lower BP to normal levels with lifestyle
changes and prevention
In Hypertensive and no other compelling conditions BP goal is
<140/90 mmHg
In hypertensive and diabetes or renal disease, the BP goal is
<130/80 mmHg
It has been estimated that for every 5mmHg reduction
of SBP in the population would result in:
14 % overall reduction in mortality due to stroke,
9% reduction in mortality due to CHD, and
7% decrease in all-cause mortality
* The Seventh/eight Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood
Pressure
18. Therapy begins with lifestyle modification, and
if BP goal is not achieved
Thiazide-type diuretics should be used as
initial therapy* for most patients, either alone or
in combination with one of the (ACEIs, ARBs,
BBs, CCBs) or when a diuretic cannot be used
or when a compelling indication is present that
requires the use of a specific drug
When BP is >20 mmHg above systolic goal or
10mmHg above diastolic goal, consideration
should be given to initiate therapy with 2drugs,
either as separate prescriptions or in fixed-dose
combinations.
19.
20. JNC 8 2014 target BP treatment
recommendations
In Nonblack patients with HTN, initial Rx can be a
thiazide-type diuretic, CCB, ACE inhibitor, or
ARB
while
In the general Black population, initial therapy
should be a thiazide-type diuretic or CCB
and
In patients >18 years with CKD, initial or add-on
therapy should be an ACE inhibitor or ARB,
regardless of race or diabetes status with the target
21.
22. Choose ONE of these medications based on underlying cause
and check BP before / after every dose.
IV LABETOLOL: preferred in aortic dissection. Avoid in CCF,
asthma and bradycardia.
Dose: Give 15mg over 2 minutes. Repeat every 10 minutes if needed
(max total dose = 300mg).
If giving infusion, start at 1 mg/min (mix 100mg in 100ml NS, then
give 1 drop every 3 seconds). Titrate
upward to a maximum of 4 to 5 mg/min if needed.
SODIUM NITROPRUSSIDE preferred in CCF. Avoid in renal
failure and pregnancy.
IV / IM HYDRALAZINE: preferred in pre-eclampsia /
eclampsia.
Dose: give 5mg, repeat every 30 minutes if needed (max total dose =
300mg per day).
23. Community service organizations can promote
the prevention of hypertension by providing
culturally sensitive educational messages and
lifestyle support services and by establishing
cardiovascular risk factor screening and
referral programs