International Society of Hypertension 2020 guidlines

JAFAR ALSAID M.B.ChB. MD. FASN. FACP.
Chair of the Middle East and North Africa Advisory Group. ISH
Nephrology Consultant. Ochsner Health System. USA
Nephrology and Internal Medicine Consultant. Bahrain
jafaralsaid@gmail.com
2020 INTERNATIONAL SOCIETY OF HYPERTESION
GLOBAL HYPERTENSION PRACTICE GUIDLINES.
Jafar Alsaid. M.B.ChB. MD. FASN. FACP IRAQI HYPERTENSION
CONFERENCE NOV. 2021
1

2

Introduction
Hypertension
• Leading cause of death.
• 10.4 million death annually.
• Affect 1.39 Billion people.
• More in the low-income countries.
Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, Chen J, He J. Global disparities of hypertension prevalence
and control: a systematic analysis of population-based studies from 90 countries. Circulation. 2016;134:441–450.
3

Awareness
67%
38%
High Income Low and Middle Income
Beaney T, Burrell LM, Castillo RR, Charchar FJ, Cro S, Damasceno A, Kruger R, Nilsson PM, Prabhakaran D, Ramirez AJ, et al,
MMM Investigators. May Measurement Month 2018: a pragmatic global screening campaign to raise awareness of blood
pressure by the International Society of Hypertension. Eur Heart J. 2019;40:2006–2017.
4

INTERNATIONAL SOCIETY OF HYPERTENSION
HYPERTENSION GLOBAL AWARENESS CAMPAGN
MAY MEASUREMENT MONTH INITIATIVE
MMM
Beaney T, Schutte AE, Tomaszewski M, Ariti C, Burrell LM, Castillo RR, Charchar FJ, Damasceno A, Kruger R, Lackland DT,
et al. May Measurement Month 2017: an analysis of blood pressure screening results worldwide. Lancet Glob Health.
2018;6:e736-e743.
5

Worldwide Practice Guidelines
•High Income.
•Middle Income.
•Low income.
ESSENTIAL
OPTIMAL
6

Obstacles for Low-income countries:
• No regional guidelines.
• Lack of data in low-income countries.
• Availability of multiple guidelines.
• Difficulties in following high income countries guidelines.
• Guidelines generated reflect the best practice for that
population.
• Lack of trained health facilities.
• Low access to basic BP devices.
Poulter NR, Castillo R, Charchar FJ, Schlaich MP, Schutte AE, Tomaszewski M, Touyz RM, Wang JG. Are the American Heart
Association/ American College of Cardiology high blood pressure guidelines fit for global purpose?: Thoughts from the
International Society of Hypertension. Hypertension. 2018;72:260–262.
7

HYPERTENSION DEFINITION
8

Criteria for Hypertension Based on Office, Ambulatory
(ABPM)& Home Blood Pressure (HBPM) Measurement
9

Classification of Hypertension Based on Office
Blood Pressure (BP) Measurement
10

Measuring BP:
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Points to consider on Measuring BP
• Repeat the reading.
• Both arms are checked. >10mmHg is significant.
• Standing BP. In Orthostatic symptoms.
• BP Cuff size.
• Unattended Office BP.
• Out of office BP measurements.
13

White Coat & Masked Hypertension
White Coat Masked
% 10-30 10-15
Clinic/Hospital Elevated Normal
Out of office BP Normal Elevated
CV risk Moderate Like HTN
Diagnosis ABPM/Home
Management Lifestyle Lifestyle + Med.
Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, et
al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the Management Of Arterial
Hypertension of the European Society of Cardiology and the
14

Diagnosis
•History.
•CV risk factors.
•Physical Exam.
•Labs.
•Specific investigation.
15

CV risk factors with HTN
• DM 15-20%.
• Elevated LDL and Triglyce. 30%.
• Over wt. 40%.
• Hyperuricemia. 25%
• Metabolic syndrome. 40%
• Unhealthy lifestyle.
• Family history.
• Age/Gender/Race.
• Chronic Inflammation.
Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of
population health data. Lancet. 2006;367:1747–1757.
Neaton JD, Wentworth D. Serum cholesterol, blood pressure, cigarette smoking, and death from coronary heart disease. Overall findings
and differences by age for 316,099 white men. Multiple Risk Factor Intervention Trial Research Group. Arch Intern Med. 1992;152:56–64
16

Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, et al.
2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the Management Of Arterial
Hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens. 2018;36:1953–2041.
17

Hypertension
Mediated
Organ
Damage
Brain: Stroke, Microinfarct, Bleed or
Atrophy.
Heart: LVH. Diastolic or systolic dysfunction.
Kidney: Proteinuria or decreased eGFR.
Vascular system: Central or Peripheral.
Eye: Retinal changes. Papilledema.
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Basic Hypertensive Modifiable Organ Damage
Required Tests.
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Specific Investigations
• ECHO.
• Carotid Ultrasound.
• Fundoscopy.
• Kidney and adrenal imaging.
• Brain MRI/CT.
• Hormonal assay.
• Uric Acid.
• Liver function test.
• Ankle Brachial index.
20

Medications
Affecting BP
Medications Increase Syst./Dias.
NSAID. 3/1 mmHg.
Oral Contraceptives. 6/3 mmHg.
Antidepressants. 2/1 mmHg.
Daily Acetaminophen 34% increase HTN
incident.
21

Other
Medications
Affecting BP.
Steroids.
Anti Retroviral.
Sympathomimetics.
Erythropoietin Stim.
Antimigraine.
Calcineurin inh.
Antiangiogenisis and Kinase inh.
11 Beta OH steroid dehydrogenase.
Herbal: Alcohol, Ginseng high dose, Liquirice.
22

Blood
Pressure
Variations
With Stress.
Lack of Sleep.
Pain.
Substance abuse.
Seasonal.
Altitude.
23

HTN stage
CV risk
factors
Socioeco.
status
Lifestyle
Medical
History
Target
Organ
Damage
Management
24

Lifestyle
Modifications
Salt intake. 2-4 gm/day.
Healthy diet.
Healthy drinks.
Wt. Reduction.
Smoke Cessation.
Limiting Alcohol.
Regular Exercise.
Control stress.
Get Proper sleep.
Control Pain.
25

Pharmacological
Treatment
26

Target Office BP Treatment
27

Ideal Characteristics of Drug Treatment
28

ISH Core Drug Therapy
29

Adherence
to
Medication
30

Other
Aspects
Common Comorbidity.
Pregnancy.
HTN Crisis.
Secondary HTN.
Summary Diagrams.
31

Educate, discuss and communicate
with your patient
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International Society of Hypertension 2020 guidlines

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