2. LEARNING OBJECTIVES
What is hypertension?
What is normal BP?
Prevalence of hypertension.
Causes of hypertension.
Risk factors.
Regulation of BP.
Measurement of BP.
Treatment of hypertension.
3. DEFINITION
High blood pressure (hypertension) is a common condition in which the
long-term force of the blood against your artery walls is high enough that
it may eventually cause health problems, such as heart disease.
4. NORMAL BP
Normal blood pressure for most adults is defined as a systolic pressure of
less than 120 and a diastolic pressure of less than 80.
5. HYPERTENSIVE BP
Hypertension is diagnosed when systolic BP is 140 mm Hg or diastolic BP
is greater than 90 mm Hg on repeated examination.
Systolic BP is important and is basis for diagnosis in most patients.
For those age greater than 80 systolic BP is up to 150 mm Hg is now
regarded acceptable.
6. A WORLD EPIDEMIC
Nearly 1 billion hypertensive in world.
Hypertension is poorly cvontrolled with less than 25% controlled in
developed countries and less 10% in developing countries.
Hypertension is responsible for 3 million annual deaths.
May 14th is world hypertension day.
8. RISK FACTOR
Family history of cardiovascular
disease.
Psycho-social stress.
Smoking,high cholestrol diet,low
fruit consumption.
High intake of alcohol.
Co-existing disorders such as
diabetes and hyperlipidaemia.
Obesity and weight gain.
10. CAUSES OF HYPERTENSION
Renal
Endocrine
Miscellaneous
Unknown
CLINICAL MANIFESTATIONS
Asymptomatic in majority of patients can remain undetected for many
years.
Headache may occur when SBP rise above 200 mm Hg or when BP is
rapidly elevated.
12. COMPLICATIONS OF
HYPERTENSION
Hypertension itself isn’t life threatening but it can lead to
certain complications which can be life threatening.
Uncontrolled high blood pressure can lead to complications
including:
Heart attack or stroke
Aneurysm
Heart failure
Weakened and narrowed blood vessels in your kidneys
Thickened, narrowed or torn blood vessels in the eyes
Metabolic syndrome
Trouble with memory or understanding
Dementia
16. 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.
17. MEASURING OF BP
There are three types of blood pressure measuring devices:
1. Mercury sphygmanometer
2. Aneroid sphygmanometer
3. Digital sphygmanometer
21. MEASURING OF BP
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 two measurement.
22. MEASURING OF BP
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
23. MEASURING OF BP
Ambulatory BP Monitoring - information about BP during daily activities
and sleep.
Correlates better than office measurements with target-organ injury.
24. 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
25. MONITORING OF BP
Is of two types
1. Out of office Blood Pressure Monitoring
2. Office Blood Pressure Monitoring
29. AMBULATORY BP
MONITORING
Ambulatory blood pressure
monitoring allows your blood
pressure (BP) readings to be
recorded over a 24-hour period,
whether you're awake or asleep.
30. HYPERTENSION EVEN TODAY IS A
TRIPLE PARADOX WHICH IS:
Easy to diagnose OFTEN remains undetected.
Simple to treat OFTEN remain untreated.
Despite availability of potent drugs, treatment all to OFTEN is undetected.
32. OVERVIEW OF TREATMENT
Goals of therapy
Lifestyle modification
Pharmacologic treatment
Algorithm for treatment of hypertension
Follow up and monitoring
33. GOALS OF THERAPY
Reduce Cardiac and renal morbidity and mortality.
Primary focus should be on achieving of primary systolic BP.
Treat to BP <140/90 mmHg or BP <130/80 mmHg in patients with
diabetes or chronic kidney disease
34. LIFESTYLE MODIFICATIONS 1
Losing weight if you are overweight or obese
Quitting smoking. Tobacco damages the walls of your blood vessels and
hardens your arteries. Both need to be in good shape while you control
your blood pressure.
Following the DASH eating plan, which stands for Dietary Approaches to
Stop Hypertension. It focuses on vegetables, fruits, whole grains fish,
poultry, nuts, and beans. High-potassium foods, like avocados, bananas,
dried fruits, tomatoes, and black beans, get a big thumbs-up. This plan
keeps sugary drinks, sweets, and high-fat meats and dairy products at a
minimum.
35. LIFESTYLE MODIFICATIONS 2
Reducing the amount of sodium in your diet to less than 1,500 milligrams
a day if you have high blood pressure; healthy adults should try to limit
their sodium intake to no more than 2,300 milligrams a day (about 1
teaspoon of salt). Many processed foods have a lot of salt in them. For
instance, soups, condiments, and tomato sauce can have as much as 75%
of the total amount of salt you need each day. Read food labels carefully
(salt is listed as sodium), and don't sprinkle more on when you cook or
before you eat. Instead, use spices and herbs to flavor your food.
36. LIFESTYLE MODIFICATIONS 3
Keeping a healthy weight for your age and height is key. If you're
overweight or have obesity, you can lower your blood pressure by losing
just 5 pounds.
Limiting alcohol to two drinks a day for men, one drink a day for women.
One drink is an ounce of alcohol, 5 ounces of wine, or 12 ounces of beer.
Reducing stress. Think about stressful areas of your life and take steps to
change them. Consider talking to a counselor, learning meditation or
anger-control techniques, or getting regular massages.
44. CAUSES OF RESISTANT
HYPERTENSION
Improper BP measurement
Excess sodium intake
Inadequate diuretic therapy
Medication
Inadequate doses
Drug actions and interactions (e.g., (NSAIDs), illicit drugs, sympathomimetics, OCP)
Over-the-counter drugs and some herbal supplements
Excess alcohol intake
Identifiable causes of HTN
45. TRATMENT OF RESISTANT
HYPERTENSION
Limiting salt and alcohol.
Limiting use of NSAIDs for pain relief (acetaminophen can be used
instead).
Doing at least 30 minutes a day of aerobic activity several days a week.
Treating sleep apnea with continuous positive airway pressure.
46. CONCLUSION
Hypertension is a major cause of morbidity and mortality, and needs to be treated
It is an extremely common condition; however it is still under-diagnosed and
undertreated
Hypertension is easy to diagnose and easy to treat
Aim of the management is to save the target organ from the deleterious effect
Besides pharmacology we have other choices and one has to be acquainted with
that choice
Life style modification should always be encouraged in all Hypertensive patients
