Hypertension guidelines ESH ESC 2013

12,580 views

Published on

Published in: Health & Medicine

Hypertension guidelines ESH ESC 2013

  1. 1. Hypertension Guidelines: ESH/ESC 2013 Dr. Akshay Mehta Nanavati Hospital Asian Heart Institute
  2. 2. Definitions and classification of office blood pressure 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
  3. 3. BP Goals • all be treated to <140/90 mm Hg • Except : diabetes (<85 mm Hg diastolic) • In patients near 80 years age, the systolic blood- pressure target should be 140 to 150 mm Hg, but physicians can go lower than 140 mm Hg if the patient is fit and healthy-mentally & physically
  4. 4. When measuring BP in the office, care should be taken:
  5. 5. Emphasis on ambulatory blood- pressure monitoring (ABPM). • It provides a large number of measurements outside the medical environment • More closely correlated to end-organ damage and cardiovascular events than office blood- pressure measurements
  6. 6. Home BP v/s Ambulatory BP Home BP • Multiple measurements over several days, or even longer periods • in the individual’s usual environment • notes day-to-day BP variability • cheaper • more widely available and • more easily repeatable. Ambulatory BP • BP data during routine, day-to- day activities and • during sleep • Waking surge • quantifies short-term BP variability • Correlation with symptoms • Most accurate
  7. 7. Definitions of hypertension by office and out-of-office blood pressure levels Category Systolic BP(mmHg) Diastolic BP (mmHg) Office BP >= 140 And/or >= 90 Ambulatory BP Daytime (or awake) >= 135 And/or >= 85 Nighttime (or asleep) > = 120 And/or >= 70 24 hour > = 130 And/or >= 80 Home BP >= 135 And/or > = 85
  8. 8. Life style changes Salt • A reduction to 5 g per day can decrease systolic blood pressure about 1 to 2 mm Hg in normotensive individuals and 4 to 5 mm Hg in hypertensive patients, he said. Wt loss • Losing about 5 kg can reduce systolic blood pressure by as much as 4 mm Hg, aerobic endurance training • can reduce systolic blood pressure 7 mm Hg
  9. 9. How long to continue lifestyle changes alone ? • For low/moderate-risk individuals a few months • For higher-risk patients, a few weeks
  10. 10. When to start drug Rx Consider BP level and correlate with overall risk: • cardiovascular risk factors • overt cardiovascular disease • asymptomatic organ damage • diabetes • chronic kidney disease.
  11. 11. Asymptomatic Target Organ Damage (TOD) √ √ Pulse pressure ( in the elderly) >= 60 mmHg Electrocardiograhic LVH( Sokolow-Lyon index > 3.5 mV; RaVL > 1.` mV; Cornell voltage duration product> 244 mV* ms), or Echocardiographic LVH [ LVM index: men > 115 g/m2; women > 95 g/m2 (BSA)]a Carotid wall thickening (IMT > 0.9 mm) or plaque Carotid- femoral PWV > 10 m/s Ankle- brachial index < 0.9 CKD with Egfr 30-60 ml/min/1.73 m2 (BSA) Microalbuminuria (30-300 mg/24 h), or albumin- creatinine ratio(30-300 mg/g; 3.4-34 mg/mmol) (preferentially on morning spot urine)
  12. 12. When to start drug Rx ? Correlate BP with Risk
  13. 13. When to start drug Rx ?
  14. 14. When to start drug Rx • HIGH N SBP 130-139 DBP 80-89…………TLC, No drugs • Grade III >180 >110 …..TLC +Immediate drugs
  15. 15. ………When to start drug Rx • Grade I 140-159 90-99 + no RF….. TLC for mths + RF ….. TLC for wks +CVD or TOD or D/CKD …….TLC + Drugs • Grade II 160-179 100-109 + 2 or more RF… TLC for weeks + CVD/TOD/D/CKD… TLC+Drugs
  16. 16. Combination Rx • For patients at high risk for cardiovascular events or those with a markedly high baseline blood pressure • In those at low or moderate risk for cardiovascular events or with mildly elevated blood pressure, a single starting agent is preferred. • For a high-risk individual, you can't play around with one drug after another, trying to control blood pressure
  17. 17. Dual renin-angiotensin system (RAS) blockade— ARBs, ACE inhibitors, and direct renin inhibitors • NO because of concerns of hyperkalemia, low blood pressure, and kidney failure. • risk of cancer that has recently been attached to ARBs has been disproven
  18. 18. Drugs to be preferred in specific conditions
  19. 19. Compelling and possible contra-indications to the use of antihypertensive drugs
  20. 20. Renal Denervation
  21. 21. Renal denervation- ESH/ECS 2013 • Simply labeled as "promising" therapy • Yet to establish safety and efficacy against the best possible drug regimens • Will it translate into reductions in cardiovascular morbidity and mortality ?
  22. 22. THANK YOU!!!

×