All recent guidelines on hypertension

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GUIDELINES
ON
TREATING
HYPERTENSION
Dr.O.THASNEEM ARA
PG 1ST YEAR,INTERNAL MEDICINE,
DCMS.

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INTRODUCTION
 Hypertension is a common lifestyle disorder.
 Very strong risk factor for cardiovascular diseases.
 Increases 2 fold risk for CVD Such as coronary artery
disease,congestive heart failure,ischemic or
haemorrhagic stroke,renal failure and peripheral
arterial disease.
 Usually other risk factors such as diabetes and
dyslipidemia commonly a/w hypertension.

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EPIDEMIOLOGY
 Hypertension is a global disease.
 Prevalence increases with growing age
- 15 to 20% in early age to
75 to 80% in individuals above 70 yrs of age.
 Over two decades,In urban areas,6.1% to 36% in men and
2% to 39.4% in women.
In rural areas,3% to 36% in men,
5.8% to 37.2% in women
 Recent surveys reported higher prevalence in urban population.

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PREDISPOSING FACTORS
 Strong familial and genetic predisposition.
 Studies revealed that 20 to 60% of essential hypertension
is inherited.
 Remaining is due to acquired or environmental factors.

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CONTINUED.,
 Sex:-In adults, men>women
In middle aged, women=men.
In later life, women>men.
 Weight:-1mm Hg rise in SBP for every 1.25 kg
wt gain.
 Abdominal obesity of 80 cm in men and 90 cm
in men a/w increased risk of hypertension.

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CONTINUED.,
 SALT:-those who consume 3gm 0r less per day found to
have lower BP.
- 100 mg lower salt intake resulted in decrease in BP by
9mm of hg.
 ALCOHOL:-5 to 30 % of all hypertension.
 PHYSICAL ACTIVITY :-Sedentary life style contribute to
20 to 50 % of increased risk of hypertension.
 Smoking and tobacco has been reported to cause sharp
rise in BP.

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DEFINITION

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PREHYPERTENSION
 Continuous relationship between level of bp and risk of its
complication.
 Individuals with Bp of prehypertension are not the one for
drug therapy.
 These are the one who needs life style modifications.
 Moreover individuals with prehypertensive levels of Bp who
also have DM and kidney disease should be considered for
appropriate drug therapy if life style trial fails.

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CONTINUED.,
 Prehypertensive individuals carry twice the
risk of developing hypertension compared to
normotensives.
 Prehypertension associated mortality and
morbidity far exceeds that of hypertension.

16. z PHYSIOLOGICAL DIP
 Usually Normotensive Individuals And Hypertensive
individuals have a physiological Dip In Bp at Night time.
 Those who don’t have this physiological dip found to have
prognosis.
 Another important parameter i.e morning surge of BP
 Those pts who have higher morning surge of BP are more
likely to develop CVDs.
 Hypertensive individuals found to have 2 times risk of CVD,4
times risk of CHF and 7 times increased risk of STROKE.

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Corresponding Values of SBP/DBP for Clinic,
HBPM, Daytime, Nighttime, and 24-Hour ABPM
Measurements
Clinic HBPM Daytime
ABPM
Nighttime
ABPM
24-Hour
ABPM
120/80 120/80 120/80 100/65 115/75
130/80 130/80 130/80 110/65 125/75
140/90 135/85 135/85 120/70 130/80
160/100 145/90 145/90 140/85 145/90

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PATHOPHYSIOLOGY

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AHA GUIDELINES

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Detection of White Coat Hypertension or Masked
Hypertension in Patients Not on Drug Therapy
Daytime ABPM
or HBPM
BP <130/80 mm Hg
Yes
White Coat Hypertension
 Lifestyle modification
 Annual ABPM or HBPM
to detect progression
(Class IIa)
No No
Daytime ABPM
or HBPM
BP ≥130/80 mm Hg
Yes
Office BP: ≥130/80 mm Hg but <160/100 mm Hg
after 3 mo trial of lifestyle modification and
suspected white coat hypertension
Office BP: 120–129/<80 mm Hg
after 3 mo trial of lifestyle modification and
suspected masked hypertension
Hypertension
Continue lifestyle modification
and start antihypertensive drug
therapy
(Class IIa)
Elevated BP
 Lifestyle modification
 Annual ABPM or ABPM
to detect masked
hypertension or progression
(Class IIa)
Masked Hypertension
Continue lifestyle modification
and start antihypertensive drug
therapy
(Class IIa)

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Detection of
White Coat
Effect or
Masked
Uncontrolled
Hypertensio
n in Patients
on Drug
Therapy
Office BP
≥5–10 mm Hg
above goal on
≥3 agents
Continue titrating
therapy
Yes
Screening
not necessary
(No Benefit)
Screen for
white coat effect with
HBPM
(Class IIb)
White coat effect:
Confirm with ABPM
(Class IIa)
No
Yes
HBPM BP
at goal
No
Increased
CVD risk or
target organ
damage
Continue current
therapy
Yes
Screening
not necessary
(No Benefit)
Screen for
masked uncontrolled
hypertension with HBPM
(Class IIb)
Masked uncontrolled
hypertension:
Intensify therapy
(Class IIb)
No
Yes
HBPM BP
above goal
No
Yes No
Detection of white coat effect or masked uncontrolled
hypertension in patients on drug therapy
Office BP
at goal
ABPM BP
above goal

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NICE GUIDELINES

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THANK YOU …,