This document provides guidelines for the treatment of hypertension. It discusses the definition and classification of hypertension according to the JNC 7 report. Evaluation of patients involves measuring blood pressure accurately, assessing risk factors, checking for target organ damage, and identifying secondary causes. Treatment goals depend on patient population, with the general goal being under 140/90 mmHg. Initial drug therapy involves thiazide diuretics, ACE inhibitors, ARBs, or CCBs. Lifestyle modifications including salt restriction, moderation of alcohol, regular exercise, weight control, and smoking cessation are also recommended.
Telmisartan is an angiotensin receptor blocker (ARB) that is described as the "master sartan" due to several unique properties. It has a high trough-to-peak ratio, ensuring round-the-clock blood pressure control. It also has protective effects on target organs by reducing early morning blood pressure spikes. Additionally, telmisartan has beneficial effects beyond blood pressure lowering, such as reducing endothelial dysfunction through partial PPAR-gamma activation. These factors make telmisartan effective at preventing cardiovascular events like heart attacks and strokes.
This document discusses asthma-COPD overlap syndrome (ACOS). It defines asthma and COPD, noting their differences and similarities. Both are chronic inflammatory airway diseases but COPD is characterized by persistent airflow limitation and progressive lung function decline while asthma is often reversible. The document then discusses clinical features that can help distinguish asthma from COPD. It notes that some patients have features of both diseases, termed ACOS. Spirometry, biomarkers, imaging and response to treatment are discussed to help identify ACOS. The inflammatory patterns in asthma and COPD are compared, showing that eosinophilic inflammation is more prominent in asthma while neutrophilic inflammation dominates in COPD.
This document defines and classifies heart failure, discusses its epidemiology, risk factors, pathophysiology, clinical features, diagnosis, and management. Heart failure is defined as a condition where the heart cannot pump enough blood to meet the body's needs. It classifies heart failure based on ejection fraction, location in the heart, and cardiac output. Treatment involves managing risk factors, treating the underlying cause, and medications like diuretics, ACE inhibitors, beta blockers, and aldosterone antagonists.
This document provides an outline and overview of hypertension and hypertensive emergencies. It discusses the definition, pathophysiology, evaluation, treatment and management of hypertension as well as specific topics like pediatric, renal and pregnancy-related hypertension. Evaluation involves assessing for secondary causes and end-organ damage to the brain, eyes, heart and kidneys. Treatment goals are to lower blood pressure in a controlled manner to prevent adverse events while preserving organ function. Both oral and intravenous antihypertensive medications are discussed.
Resistant hypertension is defined as uncontrolled hypertension despite treatment with at least 3 antihypertensive drugs. It is increasingly common in clinical practice. The document outlines its definition, epidemiology, pathogenesis, diagnosis, and management approaches including lifestyle modifications, identifying and treating secondary causes, additional drug therapies, and device-based interventions.
Hypertension is defined as blood pressure above 140/90 mmHg. The document outlines classifications of hypertension and discusses essential vs secondary causes. Target organ damage from hypertension can include heart, brain, eyes and kidney effects. Lifestyle modifications like diet, exercise and limiting alcohol/sodium can help control blood pressure. Medications recommended as first-line include ACE inhibitors, ARBs, calcium channel blockers or thiazide diuretics depending on age. Treatment goals are under 140/90 mmHg with stricter goals for diabetics or those with kidney disease. Multiple drug classes may be needed and lifestyle changes should continue throughout management.
Combination Therapy In Hypertension - Dr Vivek Baliga PresentationDr Vivek Baliga
Dr Vivek Baliga of Baliga Diagnostics, Bangalore, discusses the common combination therapies used in the management of hypertension in clinical practice.
Telmisartan is an angiotensin receptor blocker (ARB) that is described as the "master sartan" due to several unique properties. It has a high trough-to-peak ratio, ensuring round-the-clock blood pressure control. It also has protective effects on target organs by reducing early morning blood pressure spikes. Additionally, telmisartan has beneficial effects beyond blood pressure lowering, such as reducing endothelial dysfunction through partial PPAR-gamma activation. These factors make telmisartan effective at preventing cardiovascular events like heart attacks and strokes.
This document discusses asthma-COPD overlap syndrome (ACOS). It defines asthma and COPD, noting their differences and similarities. Both are chronic inflammatory airway diseases but COPD is characterized by persistent airflow limitation and progressive lung function decline while asthma is often reversible. The document then discusses clinical features that can help distinguish asthma from COPD. It notes that some patients have features of both diseases, termed ACOS. Spirometry, biomarkers, imaging and response to treatment are discussed to help identify ACOS. The inflammatory patterns in asthma and COPD are compared, showing that eosinophilic inflammation is more prominent in asthma while neutrophilic inflammation dominates in COPD.
This document defines and classifies heart failure, discusses its epidemiology, risk factors, pathophysiology, clinical features, diagnosis, and management. Heart failure is defined as a condition where the heart cannot pump enough blood to meet the body's needs. It classifies heart failure based on ejection fraction, location in the heart, and cardiac output. Treatment involves managing risk factors, treating the underlying cause, and medications like diuretics, ACE inhibitors, beta blockers, and aldosterone antagonists.
This document provides an outline and overview of hypertension and hypertensive emergencies. It discusses the definition, pathophysiology, evaluation, treatment and management of hypertension as well as specific topics like pediatric, renal and pregnancy-related hypertension. Evaluation involves assessing for secondary causes and end-organ damage to the brain, eyes, heart and kidneys. Treatment goals are to lower blood pressure in a controlled manner to prevent adverse events while preserving organ function. Both oral and intravenous antihypertensive medications are discussed.
Resistant hypertension is defined as uncontrolled hypertension despite treatment with at least 3 antihypertensive drugs. It is increasingly common in clinical practice. The document outlines its definition, epidemiology, pathogenesis, diagnosis, and management approaches including lifestyle modifications, identifying and treating secondary causes, additional drug therapies, and device-based interventions.
Hypertension is defined as blood pressure above 140/90 mmHg. The document outlines classifications of hypertension and discusses essential vs secondary causes. Target organ damage from hypertension can include heart, brain, eyes and kidney effects. Lifestyle modifications like diet, exercise and limiting alcohol/sodium can help control blood pressure. Medications recommended as first-line include ACE inhibitors, ARBs, calcium channel blockers or thiazide diuretics depending on age. Treatment goals are under 140/90 mmHg with stricter goals for diabetics or those with kidney disease. Multiple drug classes may be needed and lifestyle changes should continue throughout management.
Combination Therapy In Hypertension - Dr Vivek Baliga PresentationDr Vivek Baliga
Dr Vivek Baliga of Baliga Diagnostics, Bangalore, discusses the common combination therapies used in the management of hypertension in clinical practice.
Telmisartan is a new angiotensin receptor blocker (ARB) that has several potential advantages over other ARBs. It has the strongest binding affinity to the AT1 receptor compared to other ARBs. This may provide stronger and longer-lasting blood pressure lowering effects. Telmisartan also has partial agonist effects on peroxisome proliferator-activated receptor gamma, which can improve insulin resistance and exert anti-inflammatory and anti-proliferative effects in the vasculature. Studies in animals and cells suggest Telmisartan may have insulin sensitizing effects and protect against diabetic complications by blocking upregulation of VEGF and AGE-RAGE protein expression in the retina. While more randomized clinical trials
A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle. The most common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck or jaw
1) Pulmonary hypertension (PH) is defined as elevated pulmonary artery pressure, while pulmonary arterial hypertension (PAH) is a subtype caused by constriction and remodeling of small pulmonary arteries.
2) PAH is a progressive disease that involves proliferation of cells in the pulmonary arteries leading to increased pulmonary vascular resistance and right heart failure if left untreated.
3) The document reviews classification of PH, diagnostic testing and evaluation algorithms, goals of treatment, and approved therapies for PAH.
Current management of hypertension DR. ANKIT JAIN AIIMSAnkit Jain
This document summarizes current management of hypertension. It begins by stating the high worldwide prevalence of hypertension and its attributable risk for death. It then discusses definitions and classifications of hypertension according to guidelines. Target blood pressure goals for optimal management are outlined, along with evaluating for target organ damage. The importance of lifestyle modifications and pharmacological therapy to reduce cardiovascular events is emphasized.
The document discusses hypertension, including its definition, prevalence, risk factors, categories, and guidelines for assessment and treatment. Some key points:
- Hypertension is defined as BP ≥140/90 mmHg. It affects over 1 billion people globally with a prevalence of 30-45% in adults.
- Common risk factors include diabetes, dyslipidemia, obesity, and chronic kidney disease.
- Categories range from normal BP to grade 3 hypertension based on systolic and diastolic BP levels.
- Risk assessment uses the SCORE system to estimate 10-year fatal CVD risk based on factors like age and cholesterol.
- Out-of-office BP measurements via home monitoring or amb
Hypertension: New Concepts, Guidelines, and Clinical Management Hypertensio...MedicineAndFamily
This document summarizes guidelines for diagnosing and treating hypertension. It discusses the prevalence of hypertension and cardiovascular disease in the US population. It reviews risk factors for hypertension and cardiovascular events. It also summarizes findings from clinical trials demonstrating the benefits of treating hypertension, including reduced risks of stroke, heart failure, and myocardial infarction. Thiazide diuretics are recommended as first-line treatment based on their effectiveness and lower costs.
SGLT2I The paradigm change in diabetes managementPraveen Nagula
Just like ARNI, SGLT2I have changed the face of diabetes management and they have a good profile in multimodality management because of pleiotropic effects
Resistant hypertension is defined as uncontrolled blood pressure despite treatment with three or more antihypertensive medications, including a diuretic. Pseudo-resistant hypertension accounts for around 50% of cases due to issues like inaccurate measurements, poor medication adherence, and inadequate treatment regimens. Ambulatory blood pressure monitoring is important for accurately diagnosing and managing resistant hypertension. Treatment involves optimizing medication regimens with medications like chlorthalidone, spiranolactone, and amiloride-hydrochlorothiazide combinations, and considering interventions for refractory cases involving more than five medications.
Heart failure is a complex clinical syndrome that results from any structural or functional impairment of the heart that limits its ability to fill with or eject blood. The pathophysiology involves neurohormonal activation of the sympathetic nervous system and renin-angiotensin-aldosterone system. Pharmacological treatment focuses on blocking these neurohormonal mechanisms, reducing preload and afterload, and increasing contractility. The goals of therapy are to improve quality of life, relieve symptoms, prevent hospitalizations, and slow disease progression.
This document discusses heparin-induced thrombocytopenia (HIT). HIT is an immune-mediated reaction to heparin that results in platelet activation and thrombocytopenia. It can lead to thrombotic complications in 20-50% of patients. The document reviews the pathophysiology of HIT, defines its criteria, discusses diagnostic assays and algorithms, and outlines treatment and management approaches including alternative anticoagulants like lepirudin, argatroban, and danaparoid. Early recognition and treatment are important to prevent life-threatening thrombotic events associated with HIT.
Hypertension is common in diabetics, affecting 20-60% of those with diabetes. It is the leading cause of morbidity and mortality worldwide. While only 25% of hypertensive patients have adequate blood pressure control, tight control of both blood pressure and glucose levels can significantly reduce cardiovascular and mortality risks for diabetics. Hypertension and diabetes frequently occur together due to their shared risk factors and pathophysiology, with each condition increasing the risks associated with the other. Proper management of both is important for preventing diabetes and hypertension-related complications.
1) Ambulatory blood pressure monitoring (ABPM) provides accurate blood pressure measurements over 24 hours and can detect differences between daytime and nighttime blood pressure that are important for diagnosing and treating hypertension.
2) ABPM was initially developed in the 1960s and has advantages over clinic blood pressure measurements in predicting health outcomes.
3) ABPM involves using an automated cuff to measure blood pressure at regular intervals over 24 hours while patients go about their daily activities. This provides definitions for diagnosing white coat, masked, and other types of hypertension.
This document provides information on the diagnosis and management of hypertension. It defines hypertension as blood pressure greater than 140/90 mmHg. It describes the types and causes of hypertension, including essential (95% of cases, no identifiable cause) and secondary (underlying cause such as renal or endocrine issues). Target organ damage from uncontrolled hypertension includes effects on the heart, brain, kidneys, and retina. Lifestyle modifications and medication are used to treat hypertension with the goals of reducing blood pressure below 140/90 mmHg to prevent cardiovascular events. Common classes of antihypertensive medications discussed include diuretics, beta-blockers, ACE inhibitors, calcium channel blockers, and angiotensin receptor blockers.
This document discusses resistant hypertension. It defines resistant hypertension as blood pressure that remains above goal despite concurrent use of three antihypertensive agents of different classes, including a diuretic. It notes that resistant hypertension affects 10-20% of hypertensive patients and is associated with increased risk of cardiovascular events. The document outlines various causes of resistant hypertension including primary factors, secondary causes like obstructive sleep apnea and primary aldosteronism, and lifestyle and medication factors that can contribute. It provides guidance on evaluating and managing patients with resistant hypertension through lifestyle changes, medication optimization, and consideration of device therapies if needed.
This document discusses updates in venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE). It describes the risk factors, signs, symptoms, and diagnostic testing for VTE including ultrasonography, CT pulmonary angiography (CTPA), ventilation-perfusion (V/Q) scanning, and magnetic resonance imaging (MRI). It also discusses specific considerations for diagnosing PE during pregnancy.
This document discusses the classification, symptoms, and treatment of heart failure. It begins by classifying heart failure based on its onset (acute or chronic), which side of the heart is affected (left or right), and its severity according to the New York Heart Association stages. The main symptoms of heart failure are then described using the mnemonic "FACES" (fatigue, activities limited, chest congestion, edema, shortness of breath). The document goes on to outline pharmacological treatments including ACE inhibitors, beta blockers, spironolactone, diuretics, and digoxin. Non-pharmacological interventions like diet, exercise, and cardiac rehabilitation are also mentioned.
The document discusses hypertension in several special situations. It describes how hypertension commonly co-exists with conditions like diabetes, cerebrovascular disease, renal disease, and congestive heart failure. It provides guidelines on evaluating and managing blood pressure in these situations. For example, it recommends that antihypertensive therapy aims to reduce stroke risk in cerebrovascular disease and slow renal disease progression when hypertension is present with renal problems. The document also examines hypertension among different demographic groups like women, pregnant women, and the elderly.
#flozins
🫀DAPA 🆚placebo in HFpEF
Now we have a positive trial!
⬇️18% in CV☠️ death or
worsening HF among LVEF>40%
⬇️ 21%heart failure
💥Results same for LVEF> 60% 🆚LVEF<60%
The JNC 8 guideline provides evidence-based recommendations for treating hypertension. It focuses on three key questions: 1) what BP thresholds should initiate treatment, 2) what treatment goals are appropriate, and 3) which drug classes are most effective and safe. Major recommendations include treating those over 60 to a goal of <150/90 mmHg, initiating treatment in others at 140/90 mmHg, and using thiazide diuretics, ACE inhibitors, ARBs, or CCBs as initial treatment. The guideline aims to simplify prior recommendations and focus on outcomes from randomized controlled trials.
Hypertension; Basics- Recommendations - Special SituationsRajat Biswas
Hypertension is a major global health problem affecting over 1 billion people worldwide. The document discusses hypertension guidelines including the JNC 8 guideline which recommends treating to a blood pressure goal of less than 150/90 mmHg for those aged 60 and older and less than 140/90 mmHg for those under 60. It provides recommendations on initial treatment options and adding additional drugs. The document also discusses special situations and management of hypertension in various comorbid conditions. Hypertensive emergencies require rapid parenteral treatment in a hospital to reduce blood pressure in a controlled manner to prevent end organ damage.
Telmisartan is a new angiotensin receptor blocker (ARB) that has several potential advantages over other ARBs. It has the strongest binding affinity to the AT1 receptor compared to other ARBs. This may provide stronger and longer-lasting blood pressure lowering effects. Telmisartan also has partial agonist effects on peroxisome proliferator-activated receptor gamma, which can improve insulin resistance and exert anti-inflammatory and anti-proliferative effects in the vasculature. Studies in animals and cells suggest Telmisartan may have insulin sensitizing effects and protect against diabetic complications by blocking upregulation of VEGF and AGE-RAGE protein expression in the retina. While more randomized clinical trials
A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle. The most common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck or jaw
1) Pulmonary hypertension (PH) is defined as elevated pulmonary artery pressure, while pulmonary arterial hypertension (PAH) is a subtype caused by constriction and remodeling of small pulmonary arteries.
2) PAH is a progressive disease that involves proliferation of cells in the pulmonary arteries leading to increased pulmonary vascular resistance and right heart failure if left untreated.
3) The document reviews classification of PH, diagnostic testing and evaluation algorithms, goals of treatment, and approved therapies for PAH.
Current management of hypertension DR. ANKIT JAIN AIIMSAnkit Jain
This document summarizes current management of hypertension. It begins by stating the high worldwide prevalence of hypertension and its attributable risk for death. It then discusses definitions and classifications of hypertension according to guidelines. Target blood pressure goals for optimal management are outlined, along with evaluating for target organ damage. The importance of lifestyle modifications and pharmacological therapy to reduce cardiovascular events is emphasized.
The document discusses hypertension, including its definition, prevalence, risk factors, categories, and guidelines for assessment and treatment. Some key points:
- Hypertension is defined as BP ≥140/90 mmHg. It affects over 1 billion people globally with a prevalence of 30-45% in adults.
- Common risk factors include diabetes, dyslipidemia, obesity, and chronic kidney disease.
- Categories range from normal BP to grade 3 hypertension based on systolic and diastolic BP levels.
- Risk assessment uses the SCORE system to estimate 10-year fatal CVD risk based on factors like age and cholesterol.
- Out-of-office BP measurements via home monitoring or amb
Hypertension: New Concepts, Guidelines, and Clinical Management Hypertensio...MedicineAndFamily
This document summarizes guidelines for diagnosing and treating hypertension. It discusses the prevalence of hypertension and cardiovascular disease in the US population. It reviews risk factors for hypertension and cardiovascular events. It also summarizes findings from clinical trials demonstrating the benefits of treating hypertension, including reduced risks of stroke, heart failure, and myocardial infarction. Thiazide diuretics are recommended as first-line treatment based on their effectiveness and lower costs.
SGLT2I The paradigm change in diabetes managementPraveen Nagula
Just like ARNI, SGLT2I have changed the face of diabetes management and they have a good profile in multimodality management because of pleiotropic effects
Resistant hypertension is defined as uncontrolled blood pressure despite treatment with three or more antihypertensive medications, including a diuretic. Pseudo-resistant hypertension accounts for around 50% of cases due to issues like inaccurate measurements, poor medication adherence, and inadequate treatment regimens. Ambulatory blood pressure monitoring is important for accurately diagnosing and managing resistant hypertension. Treatment involves optimizing medication regimens with medications like chlorthalidone, spiranolactone, and amiloride-hydrochlorothiazide combinations, and considering interventions for refractory cases involving more than five medications.
Heart failure is a complex clinical syndrome that results from any structural or functional impairment of the heart that limits its ability to fill with or eject blood. The pathophysiology involves neurohormonal activation of the sympathetic nervous system and renin-angiotensin-aldosterone system. Pharmacological treatment focuses on blocking these neurohormonal mechanisms, reducing preload and afterload, and increasing contractility. The goals of therapy are to improve quality of life, relieve symptoms, prevent hospitalizations, and slow disease progression.
This document discusses heparin-induced thrombocytopenia (HIT). HIT is an immune-mediated reaction to heparin that results in platelet activation and thrombocytopenia. It can lead to thrombotic complications in 20-50% of patients. The document reviews the pathophysiology of HIT, defines its criteria, discusses diagnostic assays and algorithms, and outlines treatment and management approaches including alternative anticoagulants like lepirudin, argatroban, and danaparoid. Early recognition and treatment are important to prevent life-threatening thrombotic events associated with HIT.
Hypertension is common in diabetics, affecting 20-60% of those with diabetes. It is the leading cause of morbidity and mortality worldwide. While only 25% of hypertensive patients have adequate blood pressure control, tight control of both blood pressure and glucose levels can significantly reduce cardiovascular and mortality risks for diabetics. Hypertension and diabetes frequently occur together due to their shared risk factors and pathophysiology, with each condition increasing the risks associated with the other. Proper management of both is important for preventing diabetes and hypertension-related complications.
1) Ambulatory blood pressure monitoring (ABPM) provides accurate blood pressure measurements over 24 hours and can detect differences between daytime and nighttime blood pressure that are important for diagnosing and treating hypertension.
2) ABPM was initially developed in the 1960s and has advantages over clinic blood pressure measurements in predicting health outcomes.
3) ABPM involves using an automated cuff to measure blood pressure at regular intervals over 24 hours while patients go about their daily activities. This provides definitions for diagnosing white coat, masked, and other types of hypertension.
This document provides information on the diagnosis and management of hypertension. It defines hypertension as blood pressure greater than 140/90 mmHg. It describes the types and causes of hypertension, including essential (95% of cases, no identifiable cause) and secondary (underlying cause such as renal or endocrine issues). Target organ damage from uncontrolled hypertension includes effects on the heart, brain, kidneys, and retina. Lifestyle modifications and medication are used to treat hypertension with the goals of reducing blood pressure below 140/90 mmHg to prevent cardiovascular events. Common classes of antihypertensive medications discussed include diuretics, beta-blockers, ACE inhibitors, calcium channel blockers, and angiotensin receptor blockers.
This document discusses resistant hypertension. It defines resistant hypertension as blood pressure that remains above goal despite concurrent use of three antihypertensive agents of different classes, including a diuretic. It notes that resistant hypertension affects 10-20% of hypertensive patients and is associated with increased risk of cardiovascular events. The document outlines various causes of resistant hypertension including primary factors, secondary causes like obstructive sleep apnea and primary aldosteronism, and lifestyle and medication factors that can contribute. It provides guidance on evaluating and managing patients with resistant hypertension through lifestyle changes, medication optimization, and consideration of device therapies if needed.
This document discusses updates in venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE). It describes the risk factors, signs, symptoms, and diagnostic testing for VTE including ultrasonography, CT pulmonary angiography (CTPA), ventilation-perfusion (V/Q) scanning, and magnetic resonance imaging (MRI). It also discusses specific considerations for diagnosing PE during pregnancy.
This document discusses the classification, symptoms, and treatment of heart failure. It begins by classifying heart failure based on its onset (acute or chronic), which side of the heart is affected (left or right), and its severity according to the New York Heart Association stages. The main symptoms of heart failure are then described using the mnemonic "FACES" (fatigue, activities limited, chest congestion, edema, shortness of breath). The document goes on to outline pharmacological treatments including ACE inhibitors, beta blockers, spironolactone, diuretics, and digoxin. Non-pharmacological interventions like diet, exercise, and cardiac rehabilitation are also mentioned.
The document discusses hypertension in several special situations. It describes how hypertension commonly co-exists with conditions like diabetes, cerebrovascular disease, renal disease, and congestive heart failure. It provides guidelines on evaluating and managing blood pressure in these situations. For example, it recommends that antihypertensive therapy aims to reduce stroke risk in cerebrovascular disease and slow renal disease progression when hypertension is present with renal problems. The document also examines hypertension among different demographic groups like women, pregnant women, and the elderly.
#flozins
🫀DAPA 🆚placebo in HFpEF
Now we have a positive trial!
⬇️18% in CV☠️ death or
worsening HF among LVEF>40%
⬇️ 21%heart failure
💥Results same for LVEF> 60% 🆚LVEF<60%
The JNC 8 guideline provides evidence-based recommendations for treating hypertension. It focuses on three key questions: 1) what BP thresholds should initiate treatment, 2) what treatment goals are appropriate, and 3) which drug classes are most effective and safe. Major recommendations include treating those over 60 to a goal of <150/90 mmHg, initiating treatment in others at 140/90 mmHg, and using thiazide diuretics, ACE inhibitors, ARBs, or CCBs as initial treatment. The guideline aims to simplify prior recommendations and focus on outcomes from randomized controlled trials.
Hypertension; Basics- Recommendations - Special SituationsRajat Biswas
Hypertension is a major global health problem affecting over 1 billion people worldwide. The document discusses hypertension guidelines including the JNC 8 guideline which recommends treating to a blood pressure goal of less than 150/90 mmHg for those aged 60 and older and less than 140/90 mmHg for those under 60. It provides recommendations on initial treatment options and adding additional drugs. The document also discusses special situations and management of hypertension in various comorbid conditions. Hypertensive emergencies require rapid parenteral treatment in a hospital to reduce blood pressure in a controlled manner to prevent end organ damage.
This document discusses guidelines for the treatment of hypertension from multiple organizations and studies. It provides recommendations for treatment thresholds, goals, and initial drug choices. For the case patient, a 58-year-old African American woman with diabetes and dyslipidemia, the guidelines recommend a goal blood pressure of <140/90 mmHg and initial drug treatment with a thiazide diuretic or calcium channel blocker. Lifestyle modifications including dietary changes, exercise, weight control, and limiting alcohol and salt are also emphasized.
This document summarizes guidelines from the Eighth Joint National Committee (JNC 8) on the prevention, detection, evaluation, and treatment of high blood pressure. It provides recommendations on when to initiate pharmacologic treatment based on age, race, presence of diabetes or chronic kidney disease. It recommends treating to a blood pressure goal of less than 150/90 mmHg for those aged 60 or older, and less than 140/90 mmHg for others. It also provides guidance on first-line antihypertensive drug classes based on patient characteristics.
This document provides information about hypertension including its definition, types, causes, risk factors, diagnosis, treatment, goals of therapy, and lifestyle modifications. It defines hypertension as blood pressure higher than 140/90 mmHg and describes the classification of blood pressure readings. The treatment section discusses lifestyle changes and various classes of antihypertensive medications used to treat hypertension.
Hypertension is defined as blood pressure over 140/90 mmHg or taking medication for it. It can be essential or secondary hypertension. Treatment involves lifestyle modifications like weight loss, exercise, and diet changes as well as medications. Goals of treatment are to lower blood pressure to under 140/90 mmHg or 130/80 mmHg for those with diabetes or kidney disease to prevent heart disease and stroke. Treatment begins with lifestyle changes and may involve one or more classes of blood pressure medications including diuretics, ACE inhibitors, calcium channel blockers, beta blockers, and ARBs.
Hypertension is defined as blood pressure above 140/90 mmHg or taking antihypertensive medication. It can be essential or secondary hypertension. Treatment involves lifestyle modifications like weight loss, exercise, and diet changes as well as pharmacologic treatments. Drug therapy aims to reduce blood pressure below 140/90 mmHg or 130/80 mmHg for those with diabetes or kidney disease to decrease risk of heart disease and stroke. Treatment involves diuretics, ACE inhibitors, calcium channel blockers, beta blockers, and other drugs depending on individual factors. Goals are to control blood pressure and reduce target organ damage through lifestyle and medical treatment.
Hypertension is defined as blood pressure above 140/90 mmHg or taking antihypertensive medication. It can be essential or secondary hypertension. Treatment involves lifestyle modifications like weight loss, exercise, and diet changes as well as pharmacologic treatments. Drug therapy aims to reduce blood pressure below 140/90 mmHg or 130/80 mmHg for those with diabetes or kidney disease to decrease risk of heart disease and stroke. Treatment involves diuretics, ACE inhibitors, calcium channel blockers, beta blockers, and other drugs depending on individual factors. Goals are to control blood pressure and reduce target organ damage through lifestyle and medical treatment.
Hypertension is defined as blood pressure over 140/90 mmHg or taking medication for it. The document discusses diagnosis and management of hypertension including lifestyle modifications like weight loss, exercise, and diet changes as well as drug therapies. Drug classes discussed are diuretics, beta-blockers, ACE inhibitors, calcium channel blockers, and ARBs. Treatment is aimed at reducing blood pressure below 140/90 mmHg or 130/80 for those with diabetes or kidney disease to decrease risk of heart disease, stroke, kidney disease and other complications. Selection of drug depends on individual patient factors and conditions.
1. Hypertension is defined as a systolic blood pressure of 160 mmHg or higher and/or a diastolic blood pressure of 95 mmHg or higher. It can be essential (95% of cases, no identifiable cause) or secondary (5% of cases, an underlying cause such as kidney, endocrine, or other diseases).
2. Risk factors for hypertension include increasing age, male sex, family history, sedentary lifestyle, smoking, diet high in salt and cholesterol, obesity, diabetes, and alcohol use. Target organ damage includes heart, brain, kidneys, and eyes.
3. Treatment involves lifestyle modifications like weight loss, exercise, diet changes, and limiting alcohol. Medic
The document discusses guidelines for the management of high blood pressure from JNC 8 (2014). It provides:
1) Recommendations on when to initiate pharmacologic treatment based on systolic and diastolic blood pressure thresholds for general populations aged 60 years and older, younger than 60 years, and those with chronic kidney disease or diabetes.
2) Recommendations on treatment goals for different populations.
3) Recommendations on initial drug treatment options based on population, including thiazide-type diuretics, calcium channel blockers, ACE inhibitors, and ARBs.
This document discusses the diagnosis and management of hypertension. It defines hypertension as blood pressure above 140/90 mmHg or being on antihypertensive medication. The main types are essential and secondary hypertension. Lifestyle modifications like weight loss, exercise, and diet changes can help control hypertension before starting medications. Common drug classes for treatment include diuretics, ACE inhibitors, calcium channel blockers, angiotensin receptor blockers, and beta blockers. The goals of treatment are to reduce target organ damage and cardiovascular risk by achieving a blood pressure under 140/90 mmHg or 130/80 mmHg for those with diabetes or chronic kidney disease.
Hypertension is defined as systolic blood pressure over 140 mmHg or diastolic over 90 mmHg. The document discusses the diagnosis, management, treatment, and goals of treating hypertension. Treatment involves lifestyle modifications like weight loss, reduced salt intake, exercise, as well as pharmacologic treatments including diuretics, ACE inhibitors, calcium channel blockers, and others. The goals of treatment are to reduce cardiovascular and renal morbidity and mortality by achieving a blood pressure under 140/90 mmHg or under 130/80 for those with diabetes or chronic kidney disease.
This document discusses the diagnosis and management of hypertension. It defines hypertension as blood pressure above 140/90 mmHg or being on antihypertensive medication. The main types are essential and secondary hypertension. Lifestyle modifications like weight loss, exercise, and diet changes can help control hypertension before starting medications. Common drug classes for treatment include diuretics, ACE inhibitors, calcium channel blockers, angiotensin receptor blockers, and beta blockers. The goals of treatment are to reduce target organ damage and cardiovascular risk by achieving a blood pressure under 140/90 mmHg or 130/80 mmHg for those with diabetes or chronic kidney disease.
Hypertension is defined as systolic blood pressure over 140 mmHg or diastolic over 90 mmHg. The document discusses the diagnosis, management, treatment, and goals of treating hypertension. Treatment involves lifestyle modifications like weight loss, reduced salt intake, exercise, as well as pharmacologic treatments including diuretics, ACE inhibitors, calcium channel blockers, and others. The goals of treatment are to reduce cardiovascular and renal morbidity and mortality by achieving a blood pressure under 140/90 mmHg or under 130/80 for those with diabetes or kidney disease.
Hypertension is defined as systolic blood pressure over 140 mmHg or diastolic over 90 mmHg. The document discusses the diagnosis, management, treatment, and goals of treating hypertension. Treatment involves lifestyle modifications like weight loss, reduced salt intake, exercise, as well as pharmacologic treatments including diuretics, ACE inhibitors, calcium channel blockers, and others. The goals of treatment are to reduce cardiac and renal morbidity and mortality by achieving a blood pressure under 140/90 mmHg or under 130/80 for those with diabetes or kidney disease.
Hypertension is defined as systolic blood pressure over 140 mmHg or diastolic over 90 mmHg. The document discusses the diagnosis, management, treatment, and goals of treating hypertension. Treatment involves lifestyle modifications like weight loss, reduced salt intake, exercise, as well as pharmacologic treatments including diuretics, ACE inhibitors, calcium channel blockers, and others. The goals of treatment are to reduce cardiovascular and renal morbidity and mortality by achieving a blood pressure under 140/90 mmHg or under 130/80 for those with diabetes or chronic kidney disease.
Similar to Guidelines for treatment of hypertension (20)
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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2. Overview
• Introduction
• JNC report on management of hypertension
Definition and classification
Patient evaluation
Hypertension management
• Summary
3. • Hypertension- characterised by a sustained elevation of arterial
blood pressure (BP) of more than 140/90 mm Hg
• Contributing factor to many cardiovascular disease and organ
damage including
myocardial infarction (MI)
stroke
heart failure
renal failure
retinopathy
leading cause of death
Introduction
4.
5. Introduction(Contd.)
• Although it is associated with high morbidity and mortality,
hypertension is a preventable and manageable disease
• Control of BP leads to
– Approximately 50% reduction in heart failure
– Approximately 40% reduction in stroke
– Approximately 20-25% reduction in MI
• Early diagnosis, lifestyle modifications and adherence to therapy
are the key for hypertension management
6. Guidelines for treatment of hypertension
• To assist the medical practitioners in making treatment decisions,
several health agencies have released guidelines for management of
hypertension
• Based on high quality research evidence and expert consensus
• Physician adherence to evidence based care results in achieving
adequate BP control among hypertensive patients.
• The most widely accepted are the JNC guidelines
7. • The US National Heart, Lung, and Blood Institute, (NHLBI)
administers the National High Blood Pressure Education Program
(NHBPEP) Coordinating Committee.
• NHBPEP issues guidelines and advisories to increase awareness,
prevention, treatment, and control of hypertension.
• The Joint National Committee (JNC) consists of a panel of experts
appointed by NHBPEP.
• The JNC panel prepares guidelines for hypertension based on
research evidence and expert consensus
• Latest report- JNC 8
JNC report on management of hypertension
8. Comparison of JNC 7 and JNC 8
Topic JNC 7 JNC 8
Methodology Nonsystematic literature
review and
Recommendations based on
consensus
Systematic review of RCT evidence
and recommendations by the
panel
Definitions Defined hypertension and
prehypertension
Definitions not addressed
Treatment
goals Separate treatment goals for
“uncomplicated” hypertension
and hypertension with
comorbid conditions
Similar treatment goals for all
hypertensive populations
except when evidence review
supports different goals in
subpopulation
9. Comparison of JNC 7 and JNC 8- contd.
Life style
recommendations
Recommendation based on
literature review and
expert opinion
endorsed the evidence
based recommendations of
the LifestyleWork Group
Drug therapy Recommended 5 classes to
be considered as initial
therapy (ACEI
or ARB, CCB, diuretics and
beta blockers)
Recommended selection
among 4 specific
medication classes (ACEI
or ARB, CCB or diuretics)
10. Definition and classification
JNC 7
Category Systolic and diastolic BP
Normal blood pressure 120 mm Hg and <80 mm Hg
Prehypertension 120-139 mm Hg and/or 80-89 mm Hg
Stage I hypertension 140-159 mm Hg and/or 90-99 mm Hg
Stage II hypertension 160 mm Hg and/or 100 mm Hg
12. Diagnosing BP
• When considering a diagnosis of hypertension, blood pressure has
to be measured in both arms.
• If the difference in readings between arms is more than 20 mmHg,
the measurement has to be repeated.
• If the difference in blood pressure between the arms persists in
the next measurement, subsequent measurements have to be
taken in the arm with the higher reading.
13. Diagnosing BP(Contd.)
• when blood pressure is 140/90 mmHg or higher, Ambulatory blood
pressure monitoring (AMPM) can be used to confirm the diagnosis
• In cases of intolerance to ABPM, home blood pressure monitoring
(HBPM) is a suitable alternative.
15. Evaluation of new hypertensive patient
• To assess lifestyle and identify other cardiovascular risk factors or
concomitant disorders that may affect prognosis and guide
treatment
• The major risk factors to be looked for are
Age (>55 year for men, >65 years for women)
Presence of obesity (BMI>30)
Diabetes mellitus
Cigarette smoking
Sedentary lifestyle
Dyslipidemia
Microalbuminuria
Family history of premature cardiovascular disease
(men <55 years or women 65 years).
16. Evaluation of new hypertensive patient (Contd.)
• To reveal identifiable causes of high BP (presence of secondary
hypertension) like
Chronic kidney disease,
Primary aldosteronism,
Renovascular disease,
Chronic steroid therapy and Cushing syndrome
Pheochromocytoma
Coarctation of the aorta
Thyroid or parathyroid disease
Sleep apnea
17. Evaluation of new hypertensive patient (Contd.)
• To assess the presence or absence of target organ damage and
CVD e.g.
Left ventricular hypertrophy
Angina or prior myocardial infarction
Prior coronary revascularization
Heart failure
Stroke or transient ischemic attack
Chronic kidney disease
Peripheral arterial disease
Retinopathy
19. General population < 60 years
• Initiate pharmacological treatment to lower BP of 140/90 mm Hg
or higher
• Treat to a goal BP of lower than 140/90 mm Hg.
• Reduces cerebrovascular events, heart failure, and overall
mortality
20. General population < 60 years(Contd)
• HOT trial found no benefit in treating patients to a DBP goal of
either 80 mm Hg or lower or 85 mm Hg or lower compared
with 90 mm Hg
• No evidence for SBP threshold in this population group
• So recommendation from previous guidelines were followed
21. Elderly population(>60)
• Initiate at 150/90 mm Hg or higher
• Treat to a goal BP of less than 150/90 mm Hg
• Higher SBP due to progressive stiffening and non-compliance of
larger arteries
• Setting a goal SBP of lower than 140 mm Hg provided no
additional benefit compared with a higher SBP goal of 140 to 160
mm Hg or 140 to 149 mm Hg
• Treating to goal BP reduces stroke, heart failure, and coronary
heart disease
22. Population18 years or older
with CKD
• Initiate pharmacological treatment to lower BP at 140/90 mm Hg
or higher
• Treat to goal BP of lower than 140/90 mm Hg
• By further lowering BP, no improvement was observed in renal
damage progression
23. Population 18 years or older
with diabetes
• Initiate pharmacological treatment to lower BP at 140/90 mm Hg
or higher
• Treat to a goal BP of lower than 140/90 mm Hg
• The panel also recognizes that an SBP goal of lower than 130 mm
Hg is commonly recommended for adults with diabetes and
hypertension. However, this lower SBP goal is not supported by
any RCT showing important health outcomes
25. General nonblack population
• In general nonblack population, including those with diabetes,
initial antihypertensive treatment should include a thiazide-type
diuretic, CCB, ACEI, or ARB.
• Each of the 4 drugs yielded comparable effects on overall mortality
and cardiovascular, cerebrovascular, and kidney outcomes, with
one exception: heart failure.
• Initial treatment with a thiazide-type diuretic (chlorthalidone, and
indapamide) was more effective than other classes in improving
heart failure outcomes.
26. General nonblack population(Contd)
• β-blockers not recommended for the initial treatment of
hypertension
• Use of β-blockers resulted in a higher rate of cardiovascular death,
myocardial infarction and stroke compared to use of an ARB
27. General black population
• In the general black population, including those with diabetes, initial
antihypertensive treatment should include a thiazide-type diuretic
or CCB.
28. Summary of JNC 8 recommendations on BP goal
and drug usage
Population Goal BP, mm Hg Initial drug therapy
General ≥60 y <150/90 Nonblack: thiazide-type
diuretic, ACEI, ARB, or
CCB
Black: thiazide-type
diuretic or CCB
General <60 y <140/90
Diabetes <140/90 Thiazide-type diuretic,
ACEI, ARB, or CCB
CKD <140/90 ACEI or ARB
29. Drug dosing strategy
• The main objective of hypertension treatment is to attain and
maintain goal BP.
• If goal BP is not reached within a month of treatment, the dose of
the initial drug should be increased or a second drug should be
added.
• If goal BP cannot be reached with 2 drugs, a third drug should be
added and titrated.
30. Drug dosing strategy(Contd.)
• If goal BP cannot be reached using the recommended drugs
because of a contraindication or the need to use more than 3
drugs to reach goal BP, antihypertensive drugs from other classes
can be used
• Referral to a hypertension specialist may be indicated for patients
in whom goal BP cannot be attained using the above strategy
31. Lifestyle modifications
• Salt restriction
• Moderation of alcohol consumption
• High consumption of vegetables, fruits and low-fat and other
types of diet (DASH and Mediterranean diet)
• Weight reduction and maintenance
• Regular physical exercise
• Smoking cessation.
32. Salt restriction
• Causal relationship between salt intake and high BP
• Excessive salt consumption –risk factor for resistant hypertension
• Recommended intake- 5-6 g/ day
33. List of Sodium content of foods part of Indian diet
<25 mg Low 25–50 mg
Moderate
50–100 mg
Moderately High
>100 mg High
Amla
Bitter gourd
Brinjal
Cabbage
Lady finger
Cucumber
Peas
Onion
Potato
Tomato ripe
Ragi
Vermicelli
Wheat
Maida
Milk
Grapes
Papaya
Orange
Raisins
Broad beans
Carrots
Reddish white
Black gram dal
Green gram dal
Red gram dal
Lentil whole
Bengal gram whole
Banana
Pineapple
Apple
Mutton
Cauliflower
Fenugreek
Lettuce
Field beans
Beetroot
Water melon
Bengal gram dal
Red gram tender
Liver
Prawns
Beef
Chicken
Bacon
Egg
Lobster
34. List of foods to be avoided in hypertensives
Table salt
Mono sodium glutamate (Ajinomoto)
Baking powder
Sodium bicarbonate
Fried foods
Alcohol
Salt preserved foods
Pickles and canned foods
Ketchup and sauces
Prepared mixes
Ready to eat foods
Highly salted foods
Potato chips
Cheese
Peanut butter
Salted butter
Papads
Bakery products: Biscuits, cakes, breads
and pastries
35. Smoking cessation
• Smoking- major risk factor for atherosclerotic CVD
• Stimulates sympathetic nervous system at the central level and
at nerve endings
• A parallel change in plasma catecholamine and impairment of
baroreflex are also related to smoking
• So smoking cessation is one of the most effective lifestyle
modification for the prevention of CVDs
36. Follow up
• During initial stages- visit every 2-4 weeks
• If target BP reached- every 3-6 months
• If target BP maintained- gradual reduction of number and dosage
of drugs
• Check BP every 2 years
37. Adherence to treatment
• Patient education about treatment – important for adherence
• Provide information about benefits and possible side effects
• Provide details about self-help groups and forums
38. Summary
• Hypertension-major public health problem - contributing factor
for several cardiovascular, renal and other organ damage.
• Although hypertension is highly prevalent-preventable and
manageable.
• Various guidelines -to assist medical practitioners in making
treatment decisions.
• The most widely accepted guidelines is the JNC guidelines
39. Summary(Contd)
• JNC 8 offers clinicians an analysis of available information about BP
treatment thresholds, goals, and treatment strategies to achieve
those goals based on high quality research evidence from RCT.
• Guidelines-not a substitute for clinical judgment, and decisions
about care must carefully consider and incorporate the clinical
characteristics and circumstances of each individual patient