This document summarizes hypertension physiology, pathophysiology, and clinical management. It discusses the pathogenesis of primary hypertension including genetic and lifestyle factors. It also describes pathological changes in blood vessels and target organs. Symptoms, diagnosis, cardiovascular risk assessment, treatment goals, lifestyle modifications, and drug therapies are summarized. Treatment aims to reduce blood pressure below 140/90 mmHg or 130/80 mmHg for those with diabetes or kidney disease.

1. Hypertension Physiology, Pathophysiology and Clinical Managements Jun Tao

2. Stroke and Ischemic Heart Disease (IHD) Mortality Rate in Each Decade of Age, Versus Usual Systolic BP at the Start of that Decade Mortality* Usual SBP (mmHg) 50–59 y 60–69 y 70–79 y 80–89 y Stroke Age at risk 256 128 64 32 16 8 4 2 1 0 120 140 160 180 IHD Usual SBP (mmHg ) 50–59 y 60–69 y 70–79 y 80–89 y Age at risk 40–49 y 256 128 64 32 16 8 4 2 1 0 120 140 160 180 *Floating absolute risk and 95% CI Reproduced from The Lancet, 360, Lewington et al. pp. 1903–13 Copyright © 2002, with permission from Elsevier

6. Primary hypertension

26. Hpertrophy of left ventricle

34. 肾动脉硬化 肾动脉硬化 致密的肾盂 X 线影象

35. Malignant hypertension: Fibrinoid necrosis of damaged arteriole of kidney

52. Cardiovascular risk category of hypertension Blood pressure （ mmHg ） Grade 1(SBP 140 ～ 159 or DBP 90 ～ 99) Grade 2(SBP 160 ～ 179 or DBP 100 ～ 109) Grade 3(SBP ≥180 or DBP ≥110) No other risk factors Low-risk Medium-risk High-risk 1 ～ 2 risk factors Moderate-risk Medium-risk Very High-risk 3 or more risk factors ， or diabetes ， or target organ damage High-risk High-risk Very High-risk complications Very High-risk Very High-risk Very High-risk

59. Algorithm for Treatment of Hypertension Not at Goal Blood Pressure (<140/90 mmHg) (<130/80 mmHg for those with diabetes or chronic kidney disease) Initial Drug Choices Lifestyle Modifications Drug(s) for the compelling indications Other antihypertensive drugs (diuretics, ACEI, ARB, BB, CCB) as needed. With Compelling Indications Stage 2 Hypertension (SBP > 160 or DBP > 100 mmHg) 2-drug combination for most (usually thiazide-type diuretic and ACEI, or ARB, or BB, or CCB) Stage 1 Hypertension (SBP 140–159 or DBP 90–99 mmHg) Thiazide-type diuretics for most. May consider ACEI, ARB, BB, CCB, or combination. Without Compelling Indications Not at Goal Blood Pressure Optimize dosages or add additional drugs until goal blood pressure is achieved. Consider consultation with hypertension specialist.

69. Classification and Management of BP for adults *Treatment determined by highest BP category. † Initial combined therapy should be used cautiously in those at risk for orthostatic hypotension. ‡ Treat patients with chronic kidney disease or diabetes to BP goal of <130/80 mmHg. BP classification SBP* mmHg DBP* mmHg Lifestyle modification Initial drug therapy Without compelling indication With compelling indications Normal <120 and <80 Encourage Prehypertension 120–139 or 80–89 Yes No antihypertensive drug indicated. Drug(s) for compelling indications. ‡ Stage 1 Hypertension 140–159 or 90–99 Yes Thiazide-type diuretics for most. May consider ACEI, ARB, BB, CCB, or combination. Drug(s) for the compelling indications. ‡ Other antihypertensive drugs (diuretics, ACEI, ARB, BB, CCB) as needed. Stage 2 Hypertension > 160 or > 100 Yes Two-drug combination for most † (usually thiazide-type diuretic and ACEI or ARB or BB or CCB).

72. Other medications for hypertensive patients Primary prevention ( 1 ) Aspirin: use 75mg daily if patient is aged  50 years with blood pressure controlled to <150/90 mm Hg and either; target organ damage, diabetes mellitus, or 10 year risk of cardiovascular disease of  20% (measured by using the new Joint British Societies’ cardiovascular disease risk chart) ( 2 ) Statin: use sufficient doses to reach targets if patient is aged up to at least 80 years, with a 10 year risk of cardiovascular disease of  20% (measured by using the new Joint British Societies’ cardiovascular disease risk chart) and with total cholesterol concentration  3.5mmol/l ( 3 ) Vitamins—no benefit shown, do not prescribe

74. Targets for lipid lowering Ideal - TC<4.0mmol/l or LDL <2.0mmol/l or 25%  in TC or 30%  in LDL-C whichever is the greater ‘ Audit’ - TC <5.0mmol/l or LDL <3.0mmol/l or 25%  in TC or 30%  in LDL-C whichever is the greater Lipid targets

78. ESH - ESC Guidelines, J Hypertens 2008 -BP < 140/90 mmHg in all hypertensive patients < 130/80 mmHg in hypertensive patients with diabetes or renal disease -Control of all cardiovascular risk factors Goals of treatment

81. 谢谢！