Dr. Anil Ballani
M.D.
Consultant Physician
Hinduja Hospital
HYPERTENSION
Hypertension – Silent Killer
• Silent killer because it produces no symptoms till late stages
• Major misconception that w...
3
HYPERTENSION
The Truth is
It is only a marker of the bigger problem
Hypertension is a multi-organ systemic disease
What ...
4
How to be wise in HT?
The Truth is
To consider Hypertension as an isolated disease
Hypertension, DM, Dyslipidemia, Obesi...
5
Treatment Goal
The Truth is
Keep B.P. < 140/90 mm Hg in each patient
This may be revised to 120/80 may be ? 110/70
MRFIT...
6
Definitions
As per JNC VII and ISH (WHO) 2004
1. What is normal B.P ?
Normal SBP < 120 and DBP < 80
2. What is pre hyper...
7
Definitions
1. What is stage 1 HT ?
2. What is stage 2 HT ?
Stage 1 SBP 140 to 159
DBP 90 to 99
Stage 2 SBP 160 and more...
8
JNC VII Classification
CategoryCategory SBP (mm Hg)SBP (mm Hg) DBP (mm Hg)DBP (mm Hg)
Normal < 120 < 80
Pre – hypertensi...
9
Definitions
Are the values same for Diabetics , CKD?
No, for DM, IHD and CKD the criteria
are more stringent
The cut off...
10
Rule of Halves
What is this rule of halves in HT ?
• For every 800 adults in the community
• 400 are HT (either ↑ SBP o...
11
Normotensives (78%)
Hypertensives
(22%)
Under control (40%)
(7.5% of the total
hypertensives)
Uncontrolled
hypertension...
12
Isolated Systolic Hypertension
1. What is ISH ? –
2. What percentage of 65+ aged have ISH ?
3. Which is more harmful – ...
13
Isolated Systolic Hypertension
1. What is ISH ? –
SBP 140+ , DBP < 90
1. What percentage of 65+ aged have ISH ?
More th...
14
For adequate control of B.P.
Do you think we can control most of the
patients of hypertension with –
One drug
Two drugs...
TODAY’S PARADIGM
Gone are the days of monotherapy
It is the era of combination therapy
Why is it so?
15
Dr.Sarma@works
16
Global Risk Profile and HT
25)
17
Diseases Attributable to Hypertension
Hypertension
Heart failure
Stroke
Coronary heart disease
Myocardial infarction
Le...
18
Target Organ Damage (TOD)
• Heart
Left ventricular hypertrophy (LVH)
Angina or prior myocardial infarction (CHD)
Prior ...
19
Target Organ Damage - Assessment
Routine Tests
• Electrocardiogram, Echocardiography (desirable)
• Urinalysis for prote...
Ambulatory Blood Pressure Monitoring - ABPM
20
1. 24 hour B.P monitoring (every 15 minutes)
2. Today - 24 hour B.P. contro...
21
What is MOST essential ??
 Not that ‘my drug is superior to yours’
 Not that ‘this trial is better than that’
 Nor ‘...
So, What is new in Hypertension ?
1. High B.P recorded is only a clinical marker disease
2. HT is a multi-organ disease, o...
23 Dr.Sarma@works
Dr.Sarma@works
24
25
Lifestyle Modification
Modification Approximate BP reduction
(range)
Weight reduction 5–20 mm/10 kg wt loss
Adopt DASH ...
DASH
26
Dietary Approach to Stop Hypertension
1.Eating more fruits, vegetables, high fiber diet and low fat
dairy foods
2....
27
Hypertension – Why Combinations ?
 If goal BP is not achieved by a single drug in full dose
 Then adding another agen...
Thank You!!
For any query, write us
on-
info@hindujahospital.com
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Webinar on Hypertension- The Silent Killer : Hinduja Hospital

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Hypertension is a condition in which the force of blood against artery walls is high enough to cause health complications.

The more blood the heart pumps and the narrower the arteries, the higher the blood pressure.

Many a times, you can have hypertension for years without any symptoms. If the blood pressure is uncontrolled, it increases the risk of serious health problems, including heart attack and stroke.
Fortunately, hypertension can be easily detected. And if diagnosed, you can work with your doctor to control it.

To know more, read on Hypertension by our Consultant Internal Medicine, Dr. Anil Ballani.

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  • Slide 5 Studies show that a multitude of diseases are attributable to hypertension. They include: • Heart failure • Coronary heart disease • Myocardial infarction • Left ventricular hypertrophy and failure • Aortic aneurysm • Peripheral vascular disease • Retinopathy • Hypertensive encephalopathy • Chronic kidney failure • Cerebral hemorrhage • Stroke With so many diseases linked to hypertension, prompt and effective treatments have the potential to reduce many complications. Dustan HP, et al. Arch Intern Med 1996; 156:1926-1935.
  • Webinar on Hypertension- The Silent Killer : Hinduja Hospital

    1. 1. Dr. Anil Ballani M.D. Consultant Physician Hinduja Hospital HYPERTENSION
    2. 2. Hypertension – Silent Killer • Silent killer because it produces no symptoms till late stages • Major misconception that with hypertension patient should have headache, giddiness, etc., • Most of these symptoms come up only when the B.P. reaches above 180 mm Hg • The incidence of Hypertension in community is almost 30-40% • As age increases the incidence of hypertension also increases exponentially 2
    3. 3. 3 HYPERTENSION The Truth is It is only a marker of the bigger problem Hypertension is a multi-organ systemic disease What we record as B.P. The Problem is Hypertension is asymptomatic in 85% of cases
    4. 4. 4 How to be wise in HT? The Truth is To consider Hypertension as an isolated disease Hypertension, DM, Dyslipidemia, Obesity often coexist They are the 4 pallbearers to the grave of CHD, CVD For all of them Primary and secondary prevention by TLC is the answer Afflicted with one, must be screened for all other thieves It is wrong
    5. 5. 5 Treatment Goal The Truth is Keep B.P. < 140/90 mm Hg in each patient This may be revised to 120/80 may be ? 110/70 MRFIT’s cut off values are 115/75 mm Hg It is essential to keep the B.P at or below the goal But, It also matters how the goal B.P. is achieved ! Goal BP
    6. 6. 6 Definitions As per JNC VII and ISH (WHO) 2004 1. What is normal B.P ? Normal SBP < 120 and DBP < 80 2. What is pre hypertension ? Pre HT SBP 120 to 139 mm Hg DBP 80 to 99 mm Hg
    7. 7. 7 Definitions 1. What is stage 1 HT ? 2. What is stage 2 HT ? Stage 1 SBP 140 to 159 DBP 90 to 99 Stage 2 SBP 160 and more DBP 100 and more
    8. 8. 8 JNC VII Classification CategoryCategory SBP (mm Hg)SBP (mm Hg) DBP (mm Hg)DBP (mm Hg) Normal < 120 < 80 Pre – hypertension 120-139 80-90 Hypertension Stage 1 140 – 159 90 – 99 Stage 2 160 and above 100 and above
    9. 9. 9 Definitions Are the values same for Diabetics , CKD? No, for DM, IHD and CKD the criteria are more stringent The cut off values are 10 mm lower Stage 1 SBP 130 to 149 DBP 80 to 89 Stage 2 SBP 150 and more DBP 90 and more
    10. 10. 10 Rule of Halves What is this rule of halves in HT ? • For every 800 adults in the community • 400 are HT (either ↑ SBP or ↑ DBP or both) • Of them only 200 are diagnosed HT • Of them only 100 are started on treatment • Of them only 50 are on correct drug • Of them in only 25 the goal B.P. is attained • Means 25 ÷ 400 = 6% only have goal BP
    11. 11. 11 Normotensives (78%) Hypertensives (22%) Under control (40%) (7.5% of the total hypertensives) Uncontrolled hypertension (60%) Diagnosed HT Under treatment (50%) Undiagnosed HT How many are really Dx. and Rx.ed ?? 37% 63% Un Rx. HT A study from Europe on 23,339 patients
    12. 12. 12 Isolated Systolic Hypertension 1. What is ISH ? – 2. What percentage of 65+ aged have ISH ? 3. Which is more harmful – ↑ SBP or DBP ? 4. Why is ISH important ?
    13. 13. 13 Isolated Systolic Hypertension 1. What is ISH ? – SBP 140+ , DBP < 90 1. What percentage of 65+ aged have ISH ? More than 90% 1. Which is more harmful – ↑ SBP or DBP ? Of course ↑ SBP 1. Why is ISH important ? Because of ↑↑ CVA and CHD mortality
    14. 14. 14 For adequate control of B.P. Do you think we can control most of the patients of hypertension with – One drug Two drugs Three drugs Can’t control In most of the patients of hypertension Two drugs are required for adequate control More so if the initial BP is 20/10 above the goal
    15. 15. TODAY’S PARADIGM Gone are the days of monotherapy It is the era of combination therapy Why is it so? 15
    16. 16. Dr.Sarma@works 16 Global Risk Profile and HT 25)
    17. 17. 17 Diseases Attributable to Hypertension Hypertension Heart failure Stroke Coronary heart disease Myocardial infarction Left ventricular hypertrophy Aortic aneurysm Retinopathy Peripheral vascular disease Hypertensive encephalopathy Chronic kidney failure Cerebral hemorrhage Adapted from: Arch Intern Med 1996; 156:1926-1935. All Vascular
    18. 18. 18 Target Organ Damage (TOD) • Heart Left ventricular hypertrophy (LVH) Angina or prior myocardial infarction (CHD) Prior Coronary revascularization PTCA or CABG Heart failure (Systolic / Diastolic dysfunction) • Brain CVA Stroke or Transient Ischemic Attack (TIA) • Kidney : Chronic kidney disease and CRF • Vessels : Peripheral arterial disease PVD • Eyes : Hypertensive Retinopathy
    19. 19. 19 Target Organ Damage - Assessment Routine Tests • Electrocardiogram, Echocardiography (desirable) • Urinalysis for proteinuria, Microalbuminuria • Blood glucose (F and PP), and Hematocrit • Serum Na and K, Creatinine or GFR, Calcium • Lipid Profile complete, Eye examination, ABI Optional tests • X-Ray Chest PA • 24 hr. urine albumin excretion or ACR • More extensive testing is not generally indicated
    20. 20. Ambulatory Blood Pressure Monitoring - ABPM 20 1. 24 hour B.P monitoring (every 15 minutes) 2. Today - 24 hour B.P. control is essential 3. Identifies dippers and non-dippers 4. Excludes white coat hypertension
    21. 21. 21 What is MOST essential ??  Not that ‘my drug is superior to yours’  Not that ‘this trial is better than that’  Nor ‘this combination is better than that’  But to get AS MANY PEOPLE as we can to goal SBP < 140 & DBP < 90  And prevent or halt TOD.  Of course, tailor the treatment as per individual patient’s co-morbidities.
    22. 22. So, What is new in Hypertension ? 1. High B.P recorded is only a clinical marker disease 2. HT is a multi-organ disease, often asymptomatic 3. Not to consider in isolation- Must look for ‘Co-Thieves’ 4. Today’s goal BP is 140/90 – It will sure be less tomorrow 5. It matters to attain goal; matters more how it is attained 6. In DM, CKD, IHD the cut off values are 10 mm less 7. Remember rule of ½ in HT– Adequate control only in 7% 22
    23. 23. 23 Dr.Sarma@works
    24. 24. Dr.Sarma@works 24
    25. 25. 25 Lifestyle Modification Modification Approximate BP reduction (range) Weight reduction 5–20 mm/10 kg wt loss Adopt DASH eating plan 8–14 mmHg Dietary sodium reduction 2–8 mmHg Physical activity 4–9 mmHg Abstinence from alcohol 2–4 mmHg All put together reduce BP by 20 to 55 mmHg
    26. 26. DASH 26 Dietary Approach to Stop Hypertension 1.Eating more fruits, vegetables, high fiber diet and low fat dairy foods 2.Reduce fried food, red meat, organ meat, sweets, direct sugars and bakery products 3.More whole grain products, fruits, nuts (almonds & walnuts) 4.Approximately 1 tsp. of salt/ day, which is 6gms or 2400mg of salt/ day
    27. 27. 27 Hypertension – Why Combinations ?  If goal BP is not achieved by a single drug in full dose  Then adding another agent will help achieve the goal BP  Two agents sometimes nullify each others side effects  Fixed dose combinations will reduce the no. of tablets  Once daily formulations are good for compliance  Sustained release or LA formulations for 24 h BP control  If three drugs can’t achieve goal BP – Resistant HT
    28. 28. Thank You!! For any query, write us on- info@hindujahospital.com

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