diagnosis and management of hypertension..jnc 8 guidelines and 2017 AHA guidelines

1. Presented by:
Dr. Hirdesh Chawla
MD Medicine(KGMU)

2. DEFINITION
• Clinically defined as that level of blood
pressure at which institution of therapy
reduces blood pressure related morbidity and
mortality.

3. CLASSIFICATION
Blood pressure
classification
Systolic (mm Hg) Diastolic(mm Hg)
Normal <120 And <80
Prehypertension 120-139 Or 80-89
Stage I Hypertension 140-159 Or 90-99
Stage II Hypertension >=160 Or >=100
Isolated Systolic
Hypertension
>=140 And <90

5. INDIAN SCENARIO
• Prevalence is 25% in urban adults and 10-15%
in rural adults
• 25% of rural and 42% of urban indians are
aware of their hypertensive status.
• Only 25% rural and 38% of urban indians are
being treated for hypertension
• One tenth of rural and one fifth of urban
indians have their BP under control

6. TYPES
• ESSENTIAL HYPERTENSION
• 95% of the hypertensive patients.
• No underlying cause
• Complex interaction between multiple genetic
and enviornmental factors
• SECONDARY HYPERTENSION
• 5% of cases with underlying cause

7. CAUSES OF HYPERTENSION
• Obstructive Sleep Apnoea
• Drug induced or drug related
• Chronic kidney disease
• Primary aldosteronism
• Renovascular disease
• Phaeochromocytoma
• Coarctation of aorta
• Thyroid(Hypo and Hyper) or Parathyroid disease
• Cushing Syndrome
• Acromegaly
• Mineralocorticoid excess syndromes

9. RISK FACTORS
• Advancing age
• Sex(men and postmenopausal women)
• Family history of cardiovascular disease
• Sedentary lifestyle and pscyho social stress
• Smoking, high cholesterol diet,low fruit
consumption
• Obesity and weight gain
• High intake of alcohol

10. WHY TO TREAT
• Cerebrovascular disease- Ischemic stroke,
Cerebral hemorrhage, TIA
• Cardiovascular disease- ACS, Angina, Heart
failure
• Renal disease- Nephropathy, Chronic Kidney
Disease
• Peripheral Arterial disease
• Advanced retinopathy

11. TECHNIQUE OF MEASUREMENT OF
BLOOD PRESSURE
• In the office, BP should be measured atleast
twice after 5 minutes of rest, with patient seated
on chair,back supported,arm bare and at heart
level
• Large adut size cuff to be used in overweight
adults to avoid spurious high readings
• Tobacco and caffeine should be avoided for
atleast 30 minutes
• Ideally should be measured in both arms and
after 5 minutes of standing.

12. DIAGNOSIS
• If office BP is more than or equal to
140/90mm Hg, offer ABPM to confirm the
diagnosis.
• When using ABPM, ensure that at least two
measurements per hour are taken during
usual waking hours.
• Use the average of atleast 12 measurements
taken during waking hours to confirm the
diagnosis.

13. • When using Home BP monitoring(HBPM), ensure:
• For each BP recording, two consecutive measurements are
taken, atleast 1 min. apart and with person seated.
• Recorded twice daily, ideally in the morning and evening
• Continues for atleast 4 days and ideally 7 days
• Discard the measurement of first day and use average of all
the remaining values to confirm.

14. LABORATORY TESTS FOR PRIMARY
HYPERTENSION
• BASIC TESTING
• Fasting blood glucose
• Renal Function tests with eGFR
• CBC
• ECG
• Urinalysis
• Thyroid hormone analysis
• Lipid Profile
• Serum sodium, potassium,calcium
• Fundoscopic examination

15. • OPTIONAL TESTING
• Echocardiogram
• Urinary albumin to creatinine ratio
• Uric acid

16. WHITE COAT HYPERTENSION
• Elevated office BP but normal Home or ABPM
• Daytime BP is less than 135/85mm Hg and no
target organ damage despite consistently
elevated office readings

17. MASKED HYPERTENSION
• Patients in whom office readings
underestimate out of office blood pressure
because of sympathetic overactivity due to
daily life stress, tobacco abuse etc.

18. VARIANTS
• Hypertensive Urgency- BP must be reduced
within hours. Asymptomatic severe
hypertension(SBP>220 or DBP>125mm Hg)
• Hypertensive Emergency- Substantial
reduction required in an hour to avoid severe
morbidity and death. Target organ
complications with optic disc edema, new
retinal hemorrhages and exudates.

19. HYPERTENSIVE CRISIS
• AHA defines hypertensive emergency and
urgency as SBP>180 or DBP>120 with or without
target organ damage respectively.
• Target organ damage includes:
• CNS-Encephalopathy.IC infarct, IC
hemorrhage,subarachnoid hemorrhage
• CVS- ACS, Acute LVF, Aortic dissection
• Acute renal failure, retinopathy,eclampsia and
microangiopathic hemolytic anemia

23. MANAGEMENT OF
HYPERTENSION