2. Introduction
• HTN. is silent killer , an asymptomatic chronic
disorder, that undetected and undertreated
,silently damages the blood vessels , heart ,
brain and kidneys. (Brounwald 2012 )
10. TOMHS
VA MONORx
CONVINCE
ALLHAT
ANBP2
LIFE
HAPPHY
MAPHY
INSIGHT
NORDIL
CAPPP
STOP-2
VALUE
ASCOT
ACCOMPLISH
Clinical Trials in Hypertension
HR Black, 2003.
1960s 1970s 1980s 1990-1995 1996-1999 2000 2001-2003 2004-2009
Should we treat
diastolic HBP?
What is the
best way to
treat HBP?
Should we treat
DBP in older
persons?
What is the
goal of
treatment?
Should we
treat ISH in
older
persons?
Can we
prevent
hypertension?
VA
Cooperative
Studies
MRC-1
ANHBP-1
EWPHE
MRC-2
STOP-1
SCOPE
HDFP HOT
UKPDS
Syst-Eur
Syst-China
SHEP TROPHY
11. 11
Globally Renowned HT Societies
1. JNC VIII – Joint National Committee on HT, USA
2. ISH – WHO International Society on HT
3. AHA – American Heart Association, USA
4. ACC – American College of Cardiologist
5. BHS – British Hypertension Society
6. NIHLB – National Inst. Heart Lung & Blood vessels
7. EHS – European Hypertension Society
8. CHS – Canadian Hypertension Society
9. NKF – National Kidney Foundation, USA
10.AKA – American Kidney Association, USA
11.GHA- Gulf heart association
12.SHA –Saudi Heart Association
13.EHS- Egyptian hypertension society
14.Etc.
12. Physicians’ Bias in HT
12
Isolated SHT is often dubbed as ‘aging factor’
To consider HT is only in the ‘ARM’ and not in the body
No concept of ‘pulse pressure’ – Not seeing the whole
Worry about side effects – Need to watch, not to worry
OK, some control is achieved – why attain goal BP ?
Not insisting on compliance with drugs & assessments
Pressure from patients – B.P. How much ? How much ?
Concentrating on the pill & not on the ill –TLC forgotten
13. 13
HYPERTENSION
The Truth is
It is only a marker of the bigger problem
Hypertension is a multi-organ systemic disease
What we record as B.P.
The Problem is
Hypertension is asymptomatic in 85% of cases
14. 14
How to be wise in HT?
The Truth is
To consider Hypertension as an isolated disease
Hypertension, DM, Dyslipidemia, Obesity often coexist
They are the 4 pallbearers to the grave of CHD, CVD
For all of them
Primary and secondary prevention by TLC is the answer
Afflicted with one, must be screened for all other thieves
It is wrong
15. Systemic Arterial Hypertension
JNC VII / WHO - IHS
BP > 140/90 mmHg
BP Continuous biological variable
No cut-off point of separation N vs H
High BP doubling the long term risk
21. a. Office measurement
b. Home measurement
c. Monitoring BP
To establish the diagnosis, measure BP accurately
22. To confirm hypertension & determine its level
Home readings correlate better with TOD
< office readings by 12/7 mmHg
Epidemiology is based on office readings
Not more than twice weekly
Periodical calibration at home
23. Careful & frequent measurements.
3 sets of 3 readings at intervals of 2 or more.
Average of multiple readings taken
Over 1-2 months
Office Measurement
54. BP Measurement Definitions
BP Measurement Definition
SBP First Korotkoff sound*
DBP Fifth Korotkoff sound*
Pulse pressure SBP minus DBP
Mean arterial pressure DBP plus one third pulse pressure†
Mid-BP Sum of SBP and DBP, divided by 2
*See Section 4 for a description of Korotkoff sounds.
†Calculation assumes normal heart rate .
BP indicates blood pressure; DBP, diastolic blood pressure; and SBP,
systolic blood pressure.
55. To confirm hypertension & determine its level
To establish the diagnosis measure BP accurately :
a. Office measurement
b. Home measurement
c. Ambulatory Monitoring BP
