a brief description of evidences in favour of recent hypertension guideline

1. Impact of
different
clinical trials on
recent
hypertension
guideline

2. Evolution of definition
of Hypertension

5. HYPERTENSION- New definition

7. What is NEW in this guideline
• New definition and classification
• Treatment started from stage 1 hypertension with clinical
CVD or 10 yrs risk of ASCVD more than 10%
• Self monitoring and ABPM
• Stage 2 hypertension requires 2 agent often
• Specific recommendation for specific population, blacks are
prone to hypertension often requires two agents

8. CONTD……
• More emphasis on CVD risk
• Focus on accurate measurements
• New targets for comorbidities
• Different follow up interval for different stages of
hypertension

9. Where from the evidences came!

12. Blood pressure-
lowering
treatment based
on cardiovascular
risk: a meta-
analysis of
individual patient
data
The Blood Pressure
Lowering
Treatment Trialists'
Collaboration
The LANCET
August 16, 2014
Sunderstrom et
al

13. initial treatment strategy for
hypertension should be the
patient's total CVD risk,
rather than his or her blood-
pressure (BP) levels alone

14. Non pharmacological intervention
• Weight loss
• Healthy diet
• Reduced sodium
• Enhanced potassium
• Improved physical activity
• Moderation in alcohol intake

15. A diet rich in fruits,
vegetables, and
low-fat dairy foods and
with reduced saturated and
total fat can substantially
lower blood pressure. This
diet offers an additional
nutritional approach to
preventing
and treating hypertension

16. Sodium Reduction and Weight
Loss in the Treatment of
Hypertension in Older Persons
A Randomized Controlled Trial
of Nonpharmacologic
Interventions in the Elderly
(TONE)
Paul K. Whelton et al
• Reduced sodium intake and
weight reduction were
associated with less
hypertension in follow up
visits and decreased
cardiovascular events
subsequently.
JAMA. 1998;279(11):839-846. doi:10.1001/jama.279.11.839

17. • Mean 24 hr ABPM more than 135/80 predicts hypertension
• Lowered mean BP in night means lowerered cardiovascular mortality
• Higher BP VARIABILITY and less pulse variabity means higher CV
MORTALITY
• HOME BP ABOVE 135/85 PREDICTS HYPERTENSION
• HOME systolic BP is better predictor than diastolic bp
• Greater home mean pulse rate is associated with higher CV mortality
• White coat hypertension predicts true hypertension 8 years later.
ABPM & Self monitoring:
OHASAMA study

18. One drug or two drugs to start with!
Recommen
dations
from JNC 7

19. Diuretics as preffered initial monotherapy –
ALLHAT Study
• No difference in primary CHD outcomes or mortality between
chlorthiazide, amlodipine or lisinopril
• Stroke incidence more with Lisinopril than chlorthalidone , primarily
in African American cohort
• Heart failure was greater with amlodipine and Lisinopril compared to
chlorthalidone both in African American and white patients

20. B blockers are no more first line
• LIFE study: CVD events were 13% lower in losartan group compared
to B blocker mainly due to reduction in stroke events but not due to
CHD EVENTS
• ASCOT BPLA: The amlodipine-based regimen prevented more
major cardiovascular events and induced less diabetes than the
atenolol-based regimen

21. Impact of SPRINT trial
• SPRINT provides evidences for intensive blood pressure lowering in
patients of 50 years or older and with high CVD risk( measured with
framinghum risk score)
• SPRINT provides additional evidences for automated or
semiautomated blood pressure monitoring
• SPRINT provides evidences for < 130/90 BP targets in CKD patients, As
stage 3 -4 CKD comprises around 28% of sprint population

22. CONTD…..
• SPRINT senior , a subgroup analysis of sprint study showed that
benefits of intensive treatment also maintained in age group above 75
years. Very frail elderly patients , hospitalised elderly patients or
patients with multiple comorbidities were excluded from these study
• SPRINT mind is another sub study which observes effect of intensive
control of BP and cognitive function

23. THANK YOU