Hypertension guidelines have been updated with several key changes:
1. The definition of hypertension is now lower at 130/80 mmHg or higher which means more people will be classified as hypertensive.
2. The term "prehypertension" has been eliminated and replaced with "elevated blood pressure" for readings of 120-129/80 mmHg or lower.
3. More emphasis is placed on accurately measuring blood pressure at home or with ambulatory monitoring to detect white coat hypertension or masked uncontrolled hypertension.
4. Treatment goals for blood pressure are now lower, especially for those with cardiovascular disease.
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.
The document outlines a presentation on hypertension and hypertensive disorders for allied health workers. It begins with an introduction and outline covering hypertension and hypertensive disorders of pregnancy. The outline discusses risk factors and diagnosis of hypertension, as well as management of hypertensive crisis. Guidelines for diagnosing and treating hypertension from sources like the 2020 Philippine CPG are also summarized.
This document provides an overview of essential hypertension including its definition, classifications, causes, detection, importance, prevention, management, goals of treatment, classes of drugs and their side effects, and specific management for patients with ischemic heart disease or diabetes. Essential hypertension is high blood pressure where secondary causes are not identified, accounts for 95% of hypertension cases, and needs to be further classified. Lifestyle modifications and pharmacologic treatments can help control blood pressure to reduce health risks.
Hypertension is a major public health concern affecting over 1 billion people worldwide. It is a leading cause of death and its prevalence is increasing. The document discusses guidelines for defining and classifying hypertension from organizations like JNC and WHO. It also summarizes lifestyle modifications and pharmacological treatments recommended for managing hypertension, including initial drug classes like ACE inhibitors, ARBs, calcium channel blockers, and thiazides. The guidelines emphasize starting with one drug and titrating dosage before adding additional medications to control blood pressure.
The document summarizes guidelines from the International Society of Hypertension (ISH), World Health Organization (WHO), American College of Cardiology/American Heart Association (ACC/AHA), and European Society of Cardiology/European Society of Hypertension (ESC/ESH) on the diagnosis and treatment of hypertension. It compares the guidelines on prevalence of hypertension, treatment thresholds and targets, drug choice and sequencing, and targets for specific patient groups. While the guidelines have some differences, they also have many similarities, including treatment targets of under 140/90 mmHg for most patients and under 130/80 mmHg for high-risk groups.
This lecture presents the 1-Updated recommendations regarding definition and proper diagnosis of HTN. 2-Updated guidelines for threshold of BP to start treatment and targets of treatment. 3- Updated recommendations on CV risk assessment and management. 4-Hypertension and comorbidities: updated guidelines
1) For stroke prevention, intensive blood pressure lowering is recommended, with the lower the better. The target is below 115/75 mmHg for those under 60 and below 140/90 mmHg for those over 60.
2) In patients with acute ischemic stroke, it is unnecessary to lower blood pressure in the first 7 days unless systolic blood pressure is over 220 mmHg.
3) In intracerebral hemorrhage patients, the target systolic blood pressure is below 140 mmHg. More aggressive lowering to 120 mmHg is not necessary.
Hypertension, or high blood pressure, is a global health problem that affects nearly 1 billion people worldwide. It is poorly controlled, with less than 25% of cases controlled in developed countries and less than 10% in developing countries. If left untreated, hypertension can lead to heart attacks, heart failure, strokes and kidney disease.
The goals of hypertension treatment are to reduce cardiovascular and renal morbidity and mortality by achieving blood pressure targets. Lifestyle modifications such as weight loss, following a diet low in sodium and high in fruits/vegetables, engaging in physical activity, and quitting smoking can help lower blood pressure. When lifestyle changes are not enough, antihypertensive medications including diuretics, ACE inhibitors,
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.
The document outlines a presentation on hypertension and hypertensive disorders for allied health workers. It begins with an introduction and outline covering hypertension and hypertensive disorders of pregnancy. The outline discusses risk factors and diagnosis of hypertension, as well as management of hypertensive crisis. Guidelines for diagnosing and treating hypertension from sources like the 2020 Philippine CPG are also summarized.
This document provides an overview of essential hypertension including its definition, classifications, causes, detection, importance, prevention, management, goals of treatment, classes of drugs and their side effects, and specific management for patients with ischemic heart disease or diabetes. Essential hypertension is high blood pressure where secondary causes are not identified, accounts for 95% of hypertension cases, and needs to be further classified. Lifestyle modifications and pharmacologic treatments can help control blood pressure to reduce health risks.
Hypertension is a major public health concern affecting over 1 billion people worldwide. It is a leading cause of death and its prevalence is increasing. The document discusses guidelines for defining and classifying hypertension from organizations like JNC and WHO. It also summarizes lifestyle modifications and pharmacological treatments recommended for managing hypertension, including initial drug classes like ACE inhibitors, ARBs, calcium channel blockers, and thiazides. The guidelines emphasize starting with one drug and titrating dosage before adding additional medications to control blood pressure.
The document summarizes guidelines from the International Society of Hypertension (ISH), World Health Organization (WHO), American College of Cardiology/American Heart Association (ACC/AHA), and European Society of Cardiology/European Society of Hypertension (ESC/ESH) on the diagnosis and treatment of hypertension. It compares the guidelines on prevalence of hypertension, treatment thresholds and targets, drug choice and sequencing, and targets for specific patient groups. While the guidelines have some differences, they also have many similarities, including treatment targets of under 140/90 mmHg for most patients and under 130/80 mmHg for high-risk groups.
This lecture presents the 1-Updated recommendations regarding definition and proper diagnosis of HTN. 2-Updated guidelines for threshold of BP to start treatment and targets of treatment. 3- Updated recommendations on CV risk assessment and management. 4-Hypertension and comorbidities: updated guidelines
1) For stroke prevention, intensive blood pressure lowering is recommended, with the lower the better. The target is below 115/75 mmHg for those under 60 and below 140/90 mmHg for those over 60.
2) In patients with acute ischemic stroke, it is unnecessary to lower blood pressure in the first 7 days unless systolic blood pressure is over 220 mmHg.
3) In intracerebral hemorrhage patients, the target systolic blood pressure is below 140 mmHg. More aggressive lowering to 120 mmHg is not necessary.
Hypertension, or high blood pressure, is a global health problem that affects nearly 1 billion people worldwide. It is poorly controlled, with less than 25% of cases controlled in developed countries and less than 10% in developing countries. If left untreated, hypertension can lead to heart attacks, heart failure, strokes and kidney disease.
The goals of hypertension treatment are to reduce cardiovascular and renal morbidity and mortality by achieving blood pressure targets. Lifestyle modifications such as weight loss, following a diet low in sodium and high in fruits/vegetables, engaging in physical activity, and quitting smoking can help lower blood pressure. When lifestyle changes are not enough, antihypertensive medications including diuretics, ACE inhibitors,
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.
Secondary hypertension - Etiopathogenesis, Clinical features, Advances in Man...Chetan Ganteppanavar
Secondary hypertension can be caused by renal or endocrine disorders. Renal causes include renal parenchymal diseases like glomerulonephritis which account for 2-5% of secondary hypertension cases. Renovascular hypertension from atherosclerosis or fibromuscular dysplasia is responsible for 1-3% of cases. Primary aldosteronism is an uncommon but important endocrine cause that can present with hypokalemic hypertension and is diagnosed through elevated aldosterone to renin ratio and saline suppression testing. Imaging and adrenal vein sampling are used to determine unilateral vs bilateral disease.
Management of hypertensive condition in 2020 according to AHA/ASA guidelines. We will discuss the presentation, clinical assessment, investigations, and management of hypertension along with major randomized controlled trials and guidelines.
Essential hypertension management and treatmentFabio Grubba
This document discusses hypertension (high blood pressure), including its classification, causes, symptoms, diagnosis, and treatment. It defines the different stages of hypertension according to blood pressure readings. Lifestyle modifications are recommended initially, including diet changes and exercise. If lifestyle changes do not control blood pressure, medications such as diuretics, beta-blockers, calcium channel blockers, ACE inhibitors, and other drug classes may be used. The goal of treatment is to prevent complications in target organs like the heart, brain, and kidneys by maintaining a blood pressure below 140/90 mmHg.
SGLT2 inhibitors in Heart failure: A prized addition to HF treatment optionsahvc0858
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Chan Wan Xian
Cardiologist, Echocardiologist
Heart Failure Intensivist
Asian Heart & Vascular Centre
www.ahvc.com.sg
This document provides guidelines for the assessment and management of dyslipidemia from several major organizations. It discusses risk assessment tools for cardiovascular disease from ATP III, ADA, ACC/AHA, and QRISK2. It also compares statin intensity categories between NICE and ACC/AHA guidelines. The document recommends lifestyle modification as first-line treatment and the use of high-intensity statins for primary and secondary prevention of CVD according to the guidelines of NICE, ADA, and ACC/AHA.
Study material for Doctor of pharmacy and other medical students. Hypertension is a condition in which the force of the blood against the artery walls is too high. Approximately one billion adults or ~22% of the population of the world have hypertension. It is slightly more frequent in men, in those of low socioeconomic status, and prevalence increases with age. So it is more important to manage it as early, this includes Pharmacological as well as Non-pharmacological Management.
One high reading does not mean you have high blood pressure. It is necessary to measure your blood pressure at different times, while you are resting comfortably for at least five minutes. To make the diagnosis of hypertension, at least three readings that are elevated are usually required
Hypertension, its causes, types and managementAbu Bakar
This document discusses hypertension (high blood pressure). It defines hypertension and provides normal and elevated blood pressure readings. It describes the types and causes of primary and secondary hypertension. It discusses the risk factors, mechanisms, diagnosis, clinical presentation, complications and treatment of hypertension, including lifestyle modifications and medication options. The overall goal of treatment is to reduce blood pressure levels to lower the risks of complications like stroke, heart disease and kidney failure.
2018 ESC/ESH Guidelines for the management of arterial hypertensionJulfikar Saif
This document provides guidelines for the management of arterial hypertension from the 2018 ESC/ESH Guideline. Some of the key changes from the previous 2013 guidelines include lowering the target systolic blood pressure to under 140 mmHg for all patients and under 130 mmHg if tolerated. For patients over 65 years old, the target is 130-139 mmHg. The diastolic target is lowered to under 80 mmHg for all patients regardless of risk factors. The guidelines also provide recommendations on confirming a diagnosis of hypertension, investigating secondary causes, assessing risk factors, monitoring blood pressure, and initiating treatment.
Hypertension, or high blood pressure, is one of the most common diseases worldwide. It is a major risk factor for heart disease and stroke. The document discusses the definition, classification, evaluation, causes, treatment, and prevention of hypertension. Prevention strategies recommended by WHO include reducing salt intake, maintaining a healthy weight, regular exercise, stress reduction, not smoking, and modifying lifestyle behaviors. Treatment aims to lower blood pressure below 140/90 mmHg through lifestyle changes and lifelong medication if needed.
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.
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 discusses the measurement of blood pressure. It outlines the correct procedures for measuring blood pressure, including using properly calibrated machines, appropriate cuff sizes, and positioning the patient correctly. It describes the historical development of blood pressure measurement techniques from the 1700s to present. It also discusses auscultatory and oscillometric methods, defining key terms like systolic, diastolic, and mean arterial pressure. Accurate measurement of blood pressure is essential for diagnosing and managing hypertension.
This document discusses the management of hypertensive emergencies in children. It defines hypertension and hypertensive crises, and outlines the urgency vs emergency distinction. It describes the prevalence of hypertension in children, potential causes, pathophysiology, and complications involving end organ damage if left untreated. Initial diagnostic approach involves assessing for end organ injury and its severity, with the immediate goal of therapy being to decrease blood pressure quickly in emergency situations.
The document outlines guidelines for the management of arterial hypertension from the 2018 ESC/ESH conference. It discusses definitions of hypertension, recommendations for blood pressure measurement, classifications of hypertension, screening and diagnosis, assessment of hypertension-mediated organ damage, and initiation of blood pressure-lowering treatment. Key points include defining hypertension as a blood pressure over 140/90 mmHg, outlining options for office and out-of-office blood pressure measurement, stratifying cardiovascular risk, and recommending prompt initiation of treatment for grade 2 or 3 hypertension or grade 1 hypertension with high risk or organ damage.
The 2017 ACC/AHA guidelines provide an updated classification of blood pressure levels and recommendations for diagnosing and treating hypertension. Key points include:
1) The guidelines lower the thresholds for elevated blood pressure and define prehypertension as 120-139/80-89 mmHg and stage 1 hypertension as 140-159/90-99 mmHg.
2) Both higher systolic and diastolic blood pressure are associated with increased risk of cardiovascular disease.
3) Lifestyle modifications like weight loss, reduced sodium intake, and increased physical activity can significantly reduce blood pressure, especially in patients with hypertension.
4) Target blood pressure levels for treatment depend on patient risk factors and comorbidities, but
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.
Secondary hypertension - Etiopathogenesis, Clinical features, Advances in Man...Chetan Ganteppanavar
Secondary hypertension can be caused by renal or endocrine disorders. Renal causes include renal parenchymal diseases like glomerulonephritis which account for 2-5% of secondary hypertension cases. Renovascular hypertension from atherosclerosis or fibromuscular dysplasia is responsible for 1-3% of cases. Primary aldosteronism is an uncommon but important endocrine cause that can present with hypokalemic hypertension and is diagnosed through elevated aldosterone to renin ratio and saline suppression testing. Imaging and adrenal vein sampling are used to determine unilateral vs bilateral disease.
Management of hypertensive condition in 2020 according to AHA/ASA guidelines. We will discuss the presentation, clinical assessment, investigations, and management of hypertension along with major randomized controlled trials and guidelines.
Essential hypertension management and treatmentFabio Grubba
This document discusses hypertension (high blood pressure), including its classification, causes, symptoms, diagnosis, and treatment. It defines the different stages of hypertension according to blood pressure readings. Lifestyle modifications are recommended initially, including diet changes and exercise. If lifestyle changes do not control blood pressure, medications such as diuretics, beta-blockers, calcium channel blockers, ACE inhibitors, and other drug classes may be used. The goal of treatment is to prevent complications in target organs like the heart, brain, and kidneys by maintaining a blood pressure below 140/90 mmHg.
SGLT2 inhibitors in Heart failure: A prized addition to HF treatment optionsahvc0858
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Chan Wan Xian
Cardiologist, Echocardiologist
Heart Failure Intensivist
Asian Heart & Vascular Centre
www.ahvc.com.sg
This document provides guidelines for the assessment and management of dyslipidemia from several major organizations. It discusses risk assessment tools for cardiovascular disease from ATP III, ADA, ACC/AHA, and QRISK2. It also compares statin intensity categories between NICE and ACC/AHA guidelines. The document recommends lifestyle modification as first-line treatment and the use of high-intensity statins for primary and secondary prevention of CVD according to the guidelines of NICE, ADA, and ACC/AHA.
Study material for Doctor of pharmacy and other medical students. Hypertension is a condition in which the force of the blood against the artery walls is too high. Approximately one billion adults or ~22% of the population of the world have hypertension. It is slightly more frequent in men, in those of low socioeconomic status, and prevalence increases with age. So it is more important to manage it as early, this includes Pharmacological as well as Non-pharmacological Management.
One high reading does not mean you have high blood pressure. It is necessary to measure your blood pressure at different times, while you are resting comfortably for at least five minutes. To make the diagnosis of hypertension, at least three readings that are elevated are usually required
Hypertension, its causes, types and managementAbu Bakar
This document discusses hypertension (high blood pressure). It defines hypertension and provides normal and elevated blood pressure readings. It describes the types and causes of primary and secondary hypertension. It discusses the risk factors, mechanisms, diagnosis, clinical presentation, complications and treatment of hypertension, including lifestyle modifications and medication options. The overall goal of treatment is to reduce blood pressure levels to lower the risks of complications like stroke, heart disease and kidney failure.
2018 ESC/ESH Guidelines for the management of arterial hypertensionJulfikar Saif
This document provides guidelines for the management of arterial hypertension from the 2018 ESC/ESH Guideline. Some of the key changes from the previous 2013 guidelines include lowering the target systolic blood pressure to under 140 mmHg for all patients and under 130 mmHg if tolerated. For patients over 65 years old, the target is 130-139 mmHg. The diastolic target is lowered to under 80 mmHg for all patients regardless of risk factors. The guidelines also provide recommendations on confirming a diagnosis of hypertension, investigating secondary causes, assessing risk factors, monitoring blood pressure, and initiating treatment.
Hypertension, or high blood pressure, is one of the most common diseases worldwide. It is a major risk factor for heart disease and stroke. The document discusses the definition, classification, evaluation, causes, treatment, and prevention of hypertension. Prevention strategies recommended by WHO include reducing salt intake, maintaining a healthy weight, regular exercise, stress reduction, not smoking, and modifying lifestyle behaviors. Treatment aims to lower blood pressure below 140/90 mmHg through lifestyle changes and lifelong medication if needed.
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.
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 discusses the measurement of blood pressure. It outlines the correct procedures for measuring blood pressure, including using properly calibrated machines, appropriate cuff sizes, and positioning the patient correctly. It describes the historical development of blood pressure measurement techniques from the 1700s to present. It also discusses auscultatory and oscillometric methods, defining key terms like systolic, diastolic, and mean arterial pressure. Accurate measurement of blood pressure is essential for diagnosing and managing hypertension.
This document discusses the management of hypertensive emergencies in children. It defines hypertension and hypertensive crises, and outlines the urgency vs emergency distinction. It describes the prevalence of hypertension in children, potential causes, pathophysiology, and complications involving end organ damage if left untreated. Initial diagnostic approach involves assessing for end organ injury and its severity, with the immediate goal of therapy being to decrease blood pressure quickly in emergency situations.
The document outlines guidelines for the management of arterial hypertension from the 2018 ESC/ESH conference. It discusses definitions of hypertension, recommendations for blood pressure measurement, classifications of hypertension, screening and diagnosis, assessment of hypertension-mediated organ damage, and initiation of blood pressure-lowering treatment. Key points include defining hypertension as a blood pressure over 140/90 mmHg, outlining options for office and out-of-office blood pressure measurement, stratifying cardiovascular risk, and recommending prompt initiation of treatment for grade 2 or 3 hypertension or grade 1 hypertension with high risk or organ damage.
The 2017 ACC/AHA guidelines provide an updated classification of blood pressure levels and recommendations for diagnosing and treating hypertension. Key points include:
1) The guidelines lower the thresholds for elevated blood pressure and define prehypertension as 120-139/80-89 mmHg and stage 1 hypertension as 140-159/90-99 mmHg.
2) Both higher systolic and diastolic blood pressure are associated with increased risk of cardiovascular disease.
3) Lifestyle modifications like weight loss, reduced sodium intake, and increased physical activity can significantly reduce blood pressure, especially in patients with hypertension.
4) Target blood pressure levels for treatment depend on patient risk factors and comorbidities, but
Dt benh THA và chien luoc phoi hop thuoc nham dat muc tieu dt - Cn cac khuye...thito6
The document discusses guidelines and strategies for treating hypertension, including:
1) 2017 guidelines from Canada, the US, Europe, and the American Society of Hypertension recommend initiating treatment with two drugs if blood pressure is more than 20 mmHg systolic or 10 mmHg diastolic above target to improve control.
2) Combination therapy using two first-line drug classes is recommended, such as a thiazide diuretic with an ACE inhibitor, ARB, CCB, or beta-blocker.
3) For patients with diabetes and hypertension, the target blood pressure is below 130/80 mmHg, and more than three drugs may be needed to achieve control.
The document discusses guidelines and strategies for treating hypertension from various medical organizations. It provides recommendations on initiating treatment with single-drug monotherapy versus dual therapy, and optimal targets for blood pressure control in different patient populations such as those with diabetes or heart disease. Combination drug treatments are recommended to help achieve blood pressure control, including common effective combinations such as ACE inhibitors with diuretics, ARBs with diuretics, or ACE inhibitors with calcium channel blockers.
New 2017 aha acc hypertension guidelinesgisa_legal
The new Hypertension Guideline lowers the threshold for diagnosing hypertension from 140/90 mm Hg to 130/80 mm Hg. This means nearly half of American adults now have hypertension based on the new definition. The guideline provides new treatment recommendations including lifestyle changes and BP-lowering medications. It also emphasizes accurate BP measurement and self-monitoring by patients at home.
Untreated high blood pressure can lead to serious health complications. The 2017 guidelines from the American College of Cardiology and American Heart Association recommend evaluating and diagnosing hypertension based on multiple blood pressure readings on separate occasions. Once diagnosed, lifestyle changes and medication are recommended for management. First-line drug options include thiazide diuretics, calcium channel blockers, ACE inhibitors, and ARBs. The guidelines aim to help prevent disability and death from hypertension-related conditions like heart disease and stroke.
The document summarizes key points from the 2017 ACC/AHA hypertension clinical practice guidelines. It outlines a new blood pressure classification system with lower targets for managing hypertension. It emphasizes accurate blood pressure measurement, lifestyle modifications like weight loss and reducing sodium intake, and initial treatment with thiazide diuretics, calcium channel blockers, or ACE inhibitors/ARBs. The guidelines recommend developing a specific care plan to achieve and sustain blood pressure control through reducing cardiovascular risk factors and social determinants of health.
- Hypertension is defined as systolic blood pressure over 140 mmHg or diastolic over 90 mmHg. Options for blood pressure measurement include office, ambulatory, and home monitoring.
- Ambulatory blood pressure monitoring provides advantages like identifying white-coat hypertension but is more expensive. Home blood pressure monitoring is cheaper but lacks nocturnal readings.
- Uncontrolled hypertension despite three or more antihypertensive classes at maximum dose is defined as resistant hypertension. Causes include non-adherence, secondary causes, and volume overload.
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
This document summarizes guidelines for the diagnosis and management of hypertension. It defines hypertension and outlines methods for blood pressure measurement, including office, ambulatory, and home monitoring. It discusses various hypertension guidelines and the changes in definitions. It also covers hypertensive crises, resistant hypertension, treatment goals, lifestyle modifications, and classes of antihypertensive medications.
Ten commandments of the 2018 esc guidelines on hypertension in adultsDavid Arias
The document summarizes key points from the 2018 European Guidelines for the treatment of hypertension. It defines hypertension as a systolic BP of 140 mmHg or higher and/or a diastolic BP of 90 mmHg or higher. It recommends screening all adults for high BP at least every 5 years. It advises initiating drug treatment for adults under 80 with grade 1 hypertension if lifestyle changes do not control their BP and immediately for those with higher grades of hypertension or who are high risk. It provides targets for lowering BP through lifestyle changes and medications.
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 provides information and guidelines about assessing and managing blood pressure to prevent strokes. It discusses objectives, hypertension overview, blood pressure targets, blood pressure measurement techniques, recommendations for proper measurement, interpreting readings, and managing hypertension. The key goals are to measure blood pressure at least annually for stroke prevention, treat to a target of under 130/80 mmHg for patients with diabetes or kidney disease, and initiate treatment before hospital discharge after a stroke or TIA.
This document discusses updates to NICE guidelines for managing hypertension. Key changes include recommendations for using ambulatory or home blood pressure monitoring to confirm diagnoses, treating stage 1 hypertension only for those over age 80 or with other risk factors, aiming for lower blood pressure targets, and considering new drug classes like direct renin inhibitors or higher diuretic doses for resistant hypertension. The guidelines emphasize shared decision making and culturally appropriate care and communication.
This document provides guidelines for measuring, diagnosing, evaluating, and managing hypertension from the Department of Cardiology at Yangon General Hospital. It discusses proper techniques for measuring blood pressure, classifications of blood pressure levels, confirming a diagnosis of hypertension using ambulatory or home blood pressure monitoring, evaluating patients for target organ damage and cardiovascular risk factors, initial drug choices, lifestyle modifications, and managing special cases of hypertension. Resistant hypertension is addressed, defining it and outlining steps to identify and address contributing factors.
Management of hypertension problems in gpAmir Mahmoud
This document discusses the management of two patients. For the first patient, a 47-year-old man with diabetes and hypertension, the goal blood pressure is less than 140/90 mmHg. ACE inhibitors are recommended due to their benefits for patients with diabetes. For the second patient, a 56-year-old woman with uncontrolled hypertension, the doctor's approach will focus on lifestyle modifications and optimizing her medication regimen given her multiple comorbidities.
1) The document compares the 2017 guidelines for hypertension from Hypertension Canada and the American Heart Association/American College of Cardiology.
2) There are some differences in definitions of elevated blood pressure and hypertension thresholds. Hypertension Canada guidelines are more evidence-based while AHA/ACC guidelines are more pragmatic.
3) Both emphasize accurate blood pressure measurement and recommend similar non-pharmacological interventions like weight loss, diet changes, and increased physical activity. However, they differ on when to initiate drug therapy and targets for specific patient groups.
This document discusses diagnostic challenges and treatment dilemmas related to arterial hypertension. It covers topics such as accurate blood pressure measurement methods, diagnosing hypertension using out-of-office assessments like ambulatory blood pressure monitoring and home monitoring, assessing overall cardiovascular risk, evaluating for secondary causes of hypertension like renovascular disease and hyperaldosteronism, and the role of echocardiography in hypertension management.
Thrombotic microangiopathy and the kidney - Dr. Mohamed Mamdouh AbdAlBaryMNDU net
TTP is characterized by unusually large von Willebrand factor multimers and platelet-rich thrombi in capillaries and arterioles due to ADAMTS13 deficiency, while aHUS is typically caused by dysregulated complement activation on endothelial cells from genetic mutations or autoantibodies. TMA can be caused by a variety of conditions including infections, drugs, pregnancy, transplantation, and other diseases, with manifestations varying depending on the organs involved but commonly involving renal failure, neurological symptoms, and thrombocytopenia.
Hyperphosphatemia in CKD patients; The Magnitude of The Problem - Prof. Alaa ...MNDU net
Hyperphosphatemia in CKD patients; The Magnitude of The Problem
Prof. Alaa Sabry - Professor of Nephrology
Mansoura Nephrology and Dialysis Unit (MNDU) Course
Sample size and how to calculate it
- Why sample size is important
- Alpha and beta errors
- Main outcome and Effect size
- Practical examples using Means-Proportions-Correlation- Confidence Interval
Towards improving HD efficiency .. HD membranes update - prof. Hesham ElsayedMNDU net
1) The document discusses various methods for improving the efficiency of hemodialysis (HD), including updating HD membranes, improving dialysate quality, and optimizing HD dose prescription.
2) It notes that HD improvements involve addressing "three unknowns": solid knowns, known unknowns, and unknown unknowns related to outcomes like mortality and quality of life.
3) The document advocates for an integrated approach involving HD technique, membrane properties, and measures beyond KT/V to better understand and improve HD outcomes.
What are we missing in CKD-MBD management? - prof. Magdy El SharkawyMNDU net
This document discusses gaps in the current definitions and management of chronic kidney disease-mineral and bone disorder (CKD-MBD). It notes that while CKD-MBD is now defined more broadly than just renal osteodystrophy, clinical definitions are still lacking. Guidelines for phosphorus management need clarification on organic vs. inorganic phosphorus and dialysate calcium guidelines could be more precise. Role of magnesium and biomarkers like alkaline phosphatase are underexplored. PTH assays and their relationship to bone remodeling is also in need of better definition. Overall, this highlights several areas where CKD-MBD understanding and treatment could be improved.
Vascular access care .. nephrology perspective - Dr. Tamer El saidMNDU net
This document discusses vascular access care from a nephrology perspective. It begins by noting the increasing number of ESRD patients requiring hemodialysis and the need for adequate vascular access to deliver treatment. It then describes the common types of vascular access and emphasizes the importance of planning, assessment, and surveillance to promote access patency and prevent complications like stenosis and infection. The document provides guidelines for physical examination, ultrasound, angiography, and other testing to monitor access and identify issues requiring intervention. The goal is early detection and treatment of problems to maximize vascular access lifespan and function.
Treatment Of HCV in CKD Patients - Prof. Hussein El-FishawyMNDU net
- Hepatitis C virus (HCV) infection affects an estimated 170-200 million people worldwide and is a major cause of liver disease.
- HCV infection is highly prevalent among patients with end-stage renal disease undergoing hemodialysis, ranging from 1-100% depending on geographic region.
- Chronic HCV infection increases mortality in hemodialysis patients, both from hepatic causes like liver cancer as well as extrahepatic causes such as cardiovascular disease. It is associated with higher mortality compared to HCV-negative patients.
Updates in management of membranous nephropathy - Dr. Mohammed Kamal NassarMNDU net
This document discusses updates in the management of membranous nephropathy (MN). It begins by reviewing the current status and pathogenesis of MN, noting it is a common cause of nephrotic syndrome. It then discusses progress made in understanding MN, including identifying podocyte antigens and autoantibodies associated with MN. Rituximab therapy is emerging as a promising new treatment approach, targeting B cells and plasma cells to provide disease-specific therapy. Ongoing clinical trials are further evaluating rituximab compared to conventional immunosuppressive regimens. The conclusion emphasizes that evaluation of autoantibody levels and proteinuria can guide tailored treatment protocols, moving away from nonspecific toxic therapies towards safer disease
Renal transplantation in patients with lupus nephritis - prof. Ayman Refaie MNDU net
This document discusses renal transplantation in patients with lupus nephritis. It begins with background on lupus nephritis as a cause of end-stage renal disease. It then covers the pre-transplant workup, including screening for cardiovascular disease, infections, and thrombophilia. The timing of transplantation is discussed, noting most centers recommend 3-6 months of dialysis. Recurrence of lupus nephritis after transplantation is evaluated, finding the rate is low at 2-9%. Outcomes are then reviewed, with graft and patient survival found to be similar to other causes of ESRD. In conclusion, kidney transplantation is a good option for lupus nephritis patients and offers better
This document contains a quiz with 10 multiple choice questions about various topics in nephrology and hypertension in pregnancy. For each question, the correct answer is identified and a brief explanation of the relevant concept is provided. The questions cover topics such as gestational hypertension, intradialytic phosphate kinetics, dialysis prescriptions in pregnancy, immunosuppressive drugs in pregnancy, membranous nephropathy, acute hypertension treatment in pregnancy, electrolyte abnormalities in acute myeloid leukemia, ANCA-associated vasculitis, factors associated with increased FGF23 in CKD, and the effects of estrogen on mesangial cells.
Obesity Related Glomerulopathy (ORG) - prof. Salem EldeebMNDU net
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2. Introduction
• This new hypertension guidelines summarizes key changes
and information from the 2017 Guideline for the Prevention,
Detection, Evaluation and Management of High Blood
Pressure in Adults.
• It focuses on recommendations and changes that are most
significant for the treatment of patients with hypertension.
3. Publication Information
2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/
NMA/PCNA Guideline for the Prevention, Detection, Evaluation,
and Management of High Blood Pressure in Adults
Published on November 13, 2017, available at: Hypertension
and Journal of the American College of Cardiology.
The full-text guidelines are also available on the following
websites: AHA (professional.heart.org) and ACC (www.acc.org)
4.
5. Applying Class of Recommendation and Level of Evidence to Clinical Strategies, Interventions, Treatments,
or Diagnostic Testing in Patient Care*
(Updated August 2015)
6. Hypertension is the Number One Risk Factor
for Global Mortality
World Health Organisation. Global atlas on cardiovascular disease prevention and control. 2011.
0 1000 2000 3000 4000 5000 6000 7000 8000
Attributable deaths due to selected risk factors (in thousands)
Indoor smoke from solid fuels
Childhood underweight
Alcohol use
Unsafe sex
High cholesterol
Overweight and obesity
Physical inactivity
High blood glucose
Tobacco
Raised blood pressure
About 15% of global
mortality can be
attributed to
hypertension
13. Categories of Bl.P in Adults
(based on an average of ≥2 careful readings obtained on ≥2 occasions).
BP Category SBP DBP
Normal <120 mm Hg and <80 mm Hg
Elevated 120–129 mm Hg and <80 mm Hg
Hypertension
Stage 1 130–139 mm Hg or 80–89 mm Hg
Stage 2 ≥140 mm Hg or ≥90 mm Hg
14. No Prehypertension
• The updated guideline eliminates the term prehypertension
• The term elevated BP is used for a SBP of 120 to 129 mm
Hg and a DBP of less than 80 mm Hg.
15. More Hypertension Patients
• The new definition of hypertension is lower (130/80 mm Hg),
• More people will be classified as having hypertension.
• Most new patients: lifestyle changes alone
16. Percentage of US adults with SBP of 130 to 139 mm Hg or DBP of 80 to 89 mm Hg
recommended for antihypertensive medication according to the 2017 ACC/AHA
guideline.
17. Prevalence of hypertension, recommendation for pharmacological antihypertensive
treatment, and blood pressure above goal among US adults according to the 2017
ACC/AHA and the JNC7 guidelines
21. Pharmacologic recommendations
BP-lowering medication is recommended for :
Stage 1 hypertension with clinical CVD or a 10-year risk of ASCVD >10%
Stage 2 hypertension : 2 BP-lowering medications + healthy lifestyle changes, (more aggressive
treatment )
Updated Recommendations for specific populations:
Black adults: more likely to have hypertension, higher morbidity and mortality
2 or more antihypertensive medications are recommended : Thiazide-type diuretics and/or CCB alone or
in multidrug regimens.
Patients with new or adjusted drug regimen : monthly follow up until their BP is under control.
22. Emphasis on Cardiovascular disease
Patients with clinical CVD and the ASCVD risk calculator:
Primary prevention of CVD:
• No history of CVD
• 10-year ASCVD risk < 10%
• BP > 140/90 mm Hg
Secondary prevention of recurrent CVD events:
• Clinical CVD
• BP > 130/80 mm Hg
• Primary prevention with 10-year ASCVD risk > 10%
23. CVD Risk Factors Common in Patients With Hypertension
Modifiable Risk Factors* Relatively Fixed Risk Factors†
Current cigarette smoking, secondhand
smoking
Diabetes mellitus
Dyslipidemia/hypercholesterolemia
Overweight/obesity
Physical inactivity/low fitness
Unhealthy diet
CKD
Family history
Increased age
Low socioeconomic/educational status
Male sex
Obstructive sleep apnea
Psychosocial stress
24. Focus on accurate measurements
• Instrument: properly calibrated.
• Basic processes for accurately measuring BP, (before and during measurements)
• Avoid smoking, caffeine, or exercise within 30 minutes before measurements;
• Empty his or her bladder; sit quietly for at least 5 minutes before measurements;
and remain still during measurements.
• Support the limb used to measure BP,
• BP cuff is at heart level
• Correct cuff size;
• Don’t take the measurement over clothes.
• Measure in both arms and use the higher reading;
• An average of 2 to 3 measurements taken on 2 to 3 separate occasions.
25. Selection Criteria for BP Cuff Size for Measurement of BP in Adults
Arm Circumference Usual Cuff Size
22–26 cm Small adult
27–34 cm Adult
35–44 cm Large adult
45–52 cm Adult thigh
26. Checklist for Accurate Measurement of BP
Key Steps for Proper BP Measurements
Step 1: Properly prepare the patient.
Step 2: Use proper technique for BP measurements.
Step 3: Take the proper measurements needed for diagnosis and treatment of elevated
BP/hypertension.
Step 4: Properly document accurate BP readings.
Step 5: Average the readings.
Step 6: Provide BP readings to patient.
27. DIAGNOSIS
BP readings obtained during Office or Clinic visits could be
potentially misleading.
– BP variability is common.
– Diurnal variation.
– White-coat or masked hypertension.
28. Focus on self-monitoring
Office BPs
Ambulatory or home BPs:
• Patients monitor their own BP for diagnosis and treatment.
Precautions:
1. Use the same validated instrument,
2. Position themselves correctly,
3. Take at least 2 readings 1 minute apart each morning and evening
4. Weekly readings 2 weeks after treatment change and the week
before a clinic visit.
5. Record all readings accurately;
30. BP Patterns Based on Office and Out-of-Office Measurements
Office/Clinic/Healthcare
Setting
Home/Nonhealthcare/AB
PM Setting
Normotensive No hypertension No hypertension
Sustained
hypertension
Hypertension Hypertension
Masked
hypertension
No hypertension Hypertension
White coat
hypertension
Hypertension No hypertension
31. Detection of White Coat Hypertension or Masked Hypertension in Patients Not on
Drug Therapy
32. Detection of White Coat Effect or Masked Uncontrolled Hypertension in Patients on Drug Therapy
33. Best Proven Nonpharmacological Interventions for Prevention and Treatment of Hypertension
Nonpharmacological
Intervention
Dose Approximate Impact on SBP
Hypertension Normotension
Weight loss Weight/body fat Best goal is ideal body weight, but aim for at
least a 1-kg reduction in body weight for most
adults who are overweight. Expect about 1 mm
Hg for every 1-kg reduction in body weight.
-5 mm Hg -2/3 mm Hg
Healthy diet DASH dietary
pattern
Consume a diet rich in fruits, vegetables, whole
grains, and low-fat dairy products, with
reduced content of saturated and total fat.
-11 mm Hg -3 mm Hg
Reduced intake of
dietary sodium
Dietary sodium Optimal goal is <1500 mg/d, but aim for at
least a 1000-mg/d reduction in most adults.
-5/6 mm Hg -2/3 mm Hg
Enhanced intake of
dietary potassium
Dietary potassium Aim for 3500–5000 mg/d, preferably by
consumption of a diet rich in potassium.
-4/5 mm Hg -2 mm Hg
34. Best Proven Nonpharmacological Interventions for Prevention and Treatment of Hypertension*
(cont.)
Nonpharmacological
Intervention
Dose Approximate Impact on SBP
Hypertension Normotension
Physical
activity
Aerobic ● 90–150 min/wk
● 65%–75% heart rate reserve
-5/8 mm Hg -2/4 mm Hg
Dynamic resistance ● 90–150 min/wk
● 50%–80% 1 rep maximum
● 6 exercises, 3 sets/exercise, 10
repetitions/set
-4 mm Hg -2 mm Hg
Isometric resistance ● 4 × 2 min (hand grip), 1 min rest
between exercises, 30%–40% maximum
voluntary contraction, 3 sessions/wk
● 8–10 wk
-5 mm Hg -4 mm Hg
Moderation in
alcohol intake
Alcohol consumption In individuals who drink alcohol, reduce
alcohol† to:
● Men: ≤2 drinks daily
● Women: ≤1 drink daily
-4 mm Hg -3 mm
35. New targets for comorbidities
• Patients with clinical CVD and new stage 1 or stage 2
hypertension :
Target a BP <130/80 mm Hg (previously was <140/90 mm Hg)
• Different follow-up intervals based on the stage of hypertension,
type of medication, level of BP control, and target organ
damage.
37. Screening for Secondary Hypertension
New-onset or uncontrolled hypertension in adults
Referral not
necessary
(No Benefit)
Refer to clinician with
specific expertise
(Class IIb)
NoYes
Screening not
indicated
(No Benefit)
Screen for
secondary hypertension
(Class I)
(see Table 13)
Yes No
Positive
screening test
Conditions
• Drug-resistant/induced hypertension
• Abrupt onset of hypertension
• Onset of hypertension at <30 y
• Exacerbation of previously controlled hypertension
• Disproportionate TOD for degree of hypertension
• Accelerated/malignant hypertension
• Onset of diastolic hypertension in older adults (age ≥65 y)
• Unprovoked or excessive hypokalemia
38. Causes of Secondary Hypertension With Clinical Indications
Common causes
Renal parenchymal disease
Renovascular disease
Primary aldosteronism
Obstructive sleep apnea
Drug or alcohol induced
Uncommon causes
Pheochromocytoma/paraganglioma
Cushing’s syndrome
Hypothyroidism
Hyperthyroidism
Aortic coarctation (undiagnosed or repaired)
Primary hyperparathyroidism
Congenital adrenal hyperplasia
Mineralocorticoid excess syndromes other than primary aldosteronism
Acromegaly
39. Renal Artery Stenosis
COR LOE Recommendations for Renal Artery Stenosis
I A
Medical therapy is recommended for adults with atherosclerotic
renal artery stenosis.
IIb C-EO
In adults with renal artery stenosis for whom medical management
has failed (refractory hypertension, worsening renal function, and/or
intractable HF) and those with nonatherosclerotic disease, including
fibromuscular dysplasia, it may be reasonable to refer the patient for
consideration of revascularization (percutaneous renal artery
angioplasty and/or stent placement).
40. Patient Evaluation and History
Primary hypertension : requires treatment…………Features :
• Gradual increase with slow rate of rise in BP
• Lifestyle factors that favor higher BP
• Family history of hypertension
Secondary hypertension: modifiable causes need to be corrected before you diagnose hypertension….. Features:
• BP lability, episodic pallor, and dizziness (pheochromocytoma)
• Snoring, hypersomnolence (obstructive sleep apnea)
• Prostatism (chronic kidney disease)
• Muscle cramps, weakness (hypokalemia from primary or secondary aldosteronism)
• Weight loss, palpitations, heat intolerance (hyperthyroidism)
• Edema, fatigue, frequent urination (kidney disease or failure)
• History of coarctation repair
• Central obesity, facial rounding, easy bruisability (Cushing syndrome)
• Medication or substance use (eg, alcohol, nonsteroidal anti-inflammatory drugs, cocaine)
• Absence of family history of hypertension
41. Basic and Optional Laboratory Tests for Primary Hypertension
Basic testing Fasting blood glucose*
Complete blood count
Lipid profile
Serum creatinine with eGFR*
Serum sodium, potassium, calcium*
Thyroid-stimulating hormone
Urinalysis
Electrocardiogram
Optional testing Echocardiogram
Uric acid
Urinary albumin to creatinine ratio
42. Blood Pressure (BP) Thresholds and Recommendations for Treatment and Follow-Up
Normal BP
(BP <120/80
mm Hg)
Promote optimal
lifestyle habits
Elevated BP
(BP 120–129/<80
mm Hg)
Stage 1 hypertension
(BP 130–139/80-89
mm Hg)
Nonpharmacologic
therapy
(Class I)
Reassess in
3–6 mo
(Class I)
Nonpharmacologic
therapy and
BP-lowering medication
(Class I)
Reassess in
1 y
(Class IIa)
Clinical ASCVD
or estimated 10-y CVD risk
≥10%*
YesNo
Nonpharmacologic
therapy
(Class I)
BP thresholds and recommendations for treatment and follow-up
Nonpharmacologic therapy
and
BP-lowering medication†
(Class I)
Stage 2 hypertension
(BP ≥ 140/90 mm Hg)
43.
44. General Principles of Drug Therapy
COR LOE Recommendation for General Principle of Drug Therapy
III: Harm A
Simultaneous use of an ACE inhibitor, ARB, and/or renin inhibitor is potentially
harmful and is not recommended to treat adults with hypertension.
46. Follow-Up After Initial BP Evaluation
COR LOE Recommendations for Follow-Up After Initial BP Elevation
I B-R
Adults with an elevated BP or stage 1 hypertension who have an estimated 10-
year ASCVD risk less than 10% should be managed with nonpharmacological
therapy and have a repeat BP evaluation within 3 to 6 months.
I B-R
Adults with stage 1 hypertension who have an estimated 10-year ASCVD risk of
10% or higher should be managed initially with a combination of
nonpharmacological and antihypertensive drug therapy and have a repeat BP
evaluation in 1 month.
I B-R
Adults with stage 2 hypertension should be evaluated by or referred to a primary
care provider within 1 month of the initial diagnosis, have a combination of
nonpharmacological and antihypertensive drug therapy (with 2 agents of different
classes) initiated, and have a repeat BP evaluation in 1 month.
47. Follow-Up After Initial BP Evaluation (cont.)
COR LOE Recommendations for Follow-Up After Initial BP Elevation
I B-R
For adults with a very high average BP (e.g., SBP ≥180 mm Hg or DBP
≥110 mm Hg), evaluation followed by prompt antihypertensive drug
treatment is recommended.
IIa C-EO
For adults with a normal BP, repeat evaluation every year is reasonable.
49. Monitoring Strategies to Improve Control of BP in Patients on Drug Therapy for
High BP
COR LOE
Recommendation for Monitoring Strategies to Improve Control of
BP in Patients on Drug Therapy for High BP
I A
Follow-up and monitoring after initiation of drug therapy for hypertension
control should include: systematic strategies to help improve BP,
including use of HBPM, team-based care, and telehealth strategies.
51. Management of Hypertension in Patients With SIHD
Hypertension With SIHD
Reduce BP to <130/80 mm Hg with
GDMT beta blockers*, ACE inhibitor, or ARBs†
(Class I)
Add
dihydropyridine CCBs
if needed
(Class I)
Add
dihydropyridine CCBs,
thiazide-type diuretics,
and/or MRAs as needed
(Class I)
Angina
pectoris
No
BP goal not met
Yes
52. Heart Failure
COR LOE
Recommendation for Prevention of HF in Adults With
Hypertension
I
SBP:
B-R
In adults at increased risk of HF, the optimal BP in those with hypertension
should be less than 130/80 mm Hg.
DBP: C-
EO
COR LOE
Recommendations for Treatment of Hypertension
in Patients With HFrEF
I C-EO
Adults with HFrEF and hypertension should be prescribed
GDMT titrated to attain a BP of less than 130/80 mm Hg.
III: No
Benefit
B-R
Nondihydropyridine CCBs are not recommended in the
treatment of hypertension in adults with HFrEF.
53. Management of Hypertension in Patients With CKD
•*CKD stage 3 or higher or stage 1 or 2 with albuminuria
≥300 mg/d or ≥300 mg/g creatinine.
.
Treatment of hypertension in patients with CKD
Albuminuria
(≥300 mg/d or ≥300 mg/g
creatinine)
ACE inhibitor*
(Class IIa)
Yes
Usual “first-line”
medication choices
ACE inhibitor
(Class IIa)
ARB*
(Class IIb)
No
Yes
ACE inhibitor
intolerant
No
BP goal <130/80 mm Hg
(Class I)
54. Hypertension After Renal Transplantation
COR LOE
Recommendations for Treatment of Hypertension After Renal
Transplantation
IIa
SBP:
B-NR
After kidney transplantation, it is reasonable to treat patients with hypertension to
a BP goal of less than 130/80 mm Hg.
DBP:
C-EO
IIa B-R
After kidney transplantation, it is reasonable to treat patients with hypertension
with a calcium antagonist on the basis of improved GFR and kidney survival.
55. Management of Hypertension in Patients With Acute ICH
Acute (<6 h fromsymptom onset)
spontaneous ICH
SBP lowering to
<140mmHg
(Class III:Harm)
SBP lowering with
continuous IVinfusion and
close BP monitoring
(Class IIa)
SBP 150–220 mmHg SBP >220mmHg
56. Management of Hypertension in Patients With Acute Ischemic Stroke
Acute (<72 h from symptom onset) ischemic
stroke and elevated BP
Yes
Initiating or reinitiating treatment of
hypertension within the first 48-72
hours after an acute ischemic stroke is
ineffective to prevent death or
dependency
(Class III: No Benefit)
Lower SBP to <185 mm Hg and
DBP <110 mm Hg before
initiation of IV thrombolysis
(Class I)
Lower BP 15%
during first 24 h
(Class IIb)
Patient
qualifies for IV
thrombolysis
therapy
BP ≤220/110 mm Hg BP >220/110 mm Hg
For preexisting hypertension,
reinitiate antihypertensive drugs
after neurological stability
(Class IIa)
Maintain BP <180/105 mm Hg for
first 24 h after IV thrombosis
(Class I)
No
And
57. Management of Hypertension in Patients With a Previous History of Stroke (Secondary Stroke
Prevention)
Stroke ≥72 h from symptom onset and stable
neurological status or TIA
Initiate
antihypertensive
treatment
(Class I)
Restart
antihypertensive
treatment
(Class I)
Usefulness of starting
antihypertensive
treatment is not
well established
(Class IIb)
Previous
diagnosed or treated
hypertension
Established
SBP ≥140 mm Hg or
DBP ≥90 mm Hg
No
Aim for
BP <140/90 mm Hg
(Class IIb)
Established
SBP <140 mm Hg and
DBP <90 mm Hg
Aim for
BP <130/80 mm Hg
(Class IIb)
Yes
58. Diabetes Mellitus
COR LOE Recommendations for Treatment of Hypertension in Patients With DM
I
SBP:
B-RSR
Initiated treatment at a BP of 130/80 mm Hg or higher
Goal: Bl.P <130/80 mm Hg.
DBP: C-
EO
I ASR
all first-line classes of antihypertensive agents (i.e., diuretics, ACE inhibitors, ARBs,
and CCBs) are useful and effective.
IIb B-NR
ACE inhibitors or ARBs may be considered in the presence of albuminuria.
59. Benefits of ACE.I and ARBs
• Antiproteinuric effect (reduce SBP, intraglomerular capillary pressure
and proteinuria).
• Regression of left ventricular hypertrophy
• Improve symptoms and prolong survival in heart failure
• Reduce mortality after myocardial infarction.
• Better patient and graft survival at 10 years
• Prevent CNI-induced fibrosis
• Disrupt the production of angiotensin 1
• CNIs may increase angiotensin concentrations and increase the
number of angiotensin receptors contributing to HTN
60. Atrial Fibrillation
COR LOE Recommendation for Treatment of Hypertension in Patients With AF
IIa B-R
Treatment with ARB can be useful for prevention of recurrence of AF.
Valvular Heart Disease
COR LOE
Recommendations for Treatment of Hypertension in Patients With
Valvular Heart Disease
I B-NR
asymptomatic aortic stenosis: treat hypertension with pharmacotherapy, starting at a
low dose and gradually titrating upward as needed.
IIa C-LD
Chronic aortic insufficiency: treatment of systolic hypertension with agents that do not
slow the heart rate (i.e., avoid beta blockers) is reasonable.
61. Pregnancy
COR LOE
Recommendations for Treatment of Hypertension in
Pregnancy
I C-LD
Pregnant, or planning to become pregnant: shift to methyldopa,
nifedipine, and/or labetalol during pregnancy.
III:
Harm
C-LD
Women with hypertension who become pregnant should not be
treated with ACE inhibitors, ARBs, or direct renin inhibitors.
62. Age-Related Issues
COR LOE
Recommendations for Treatment of Hypertension in Older
Persons
I A
≥ 65 years of age and SBP >130 mm Hg: SBP treatment goal of < 130
mm Hg
IIa C-EO
≥ 65 years of age with hypertension, comorbidity and limited life
expectancy: clinical judgment, patient preference, and a team-based
approach to assess risk/benefit : need decisions regarding intensity of BP
lowering and choice of antihypertensive drugs.
64. Heart, Lung and Circulation(2016)
Resistant Hypertension:
Spironolactone Story
65. Diagnosis and Management of a Hypertensive Crisis
SBP >180 mm Hg and/or
DBP >120 mm Hg
Target organ damage new/
progressive/worsening
Reduce SBP to <140 mm Hg
during first h* and to <120 mm Hg
in aortic dissection†
(Class I)
Yes
Yes
Reduce BP by max 25% over first h†, then
to 160/100–110 mm Hg over next 2–6 h,
then to normal over next 24–48 h
(Class I)
No
Markedly elevated BP
Reinstitute/intensify oral
antihypertensive drug therapy
and arrange follow-up
Hypertensive
emergency
Admit to ICU
(Class I)
No
Conditions:
• Aortic dissection
• Severe preeclampsia or eclampsia
• Pheochromocytoma crisis
66. Patients Undergoing Surgical Procedures
COR LOE
Recommendations for Treatment of Hypertension in Patients
Undergoing Surgical Procedures
Preoperative
I B-NR
Major surgery & maintained on beta blockers chronically:
beta blockers should be continued.
IIa C-EO
Planned elective major surgery:
continue medical therapy for hypertension until surgery.
IIb B-NR
Major surgery:
discontinuation of ACE inhibitors or ARBs perioperatively may be considered.
67. Patients Undergoing Surgical Procedures (cont.)
COR LOE
Recommendations for Treatment of Hypertension in Patients
Undergoing Surgical Procedures
Preoperative
IIb C-LD
Planned elective major surgery and SBP >180 mm Hg or DBP > 110 mm
Hg, deferring surgery may be considered.
III:
Harm
B-NR
For patients undergoing surgery, abrupt preoperative discontinuation of
beta blockers or clonidine is potentially harmful.
III:
Harm
B-NR
Beta blockers should not be started on the day of surgery in beta blocker–
naïve patients.
Intraoperative
I C-EO
Patients with intraoperative hypertension:
IV medications until oral medications resumed.
68. Antihypertensive Medication Adherence Strategies
COR LOE
Recommendations for Antihypertensive Medication Adherence
Strategies
I B-R
In adults with hypertension, dosing of antihypertensive medication once daily
rather than multiple times daily is beneficial to improve adherence.
IIa B-NR
Use of combination pills rather than free individual components can be useful to
improve adherence to antihypertensive therapy.
69. • Compare intensive BP control (<130/80mmHg) with standard BP control (<140/90mmHg)
• on major renal outcomes in patients with CKD without diabetes.
• 9 trials with 8127 patients and a median follow-up of 3.3 years.
CONCLUSIONS:
Targeting BP below the current standard did not provide additional benefit for renal outcomes. However, nonblack patients
or those with higher levels of proteinuria might benefit from the intensive BP-lowering treatments.
JAMA Intern Med. doi:10.1001/jamainternmed.2017.0197
70. Comparison of JN7, JN8 and 2017 ACC/AHA
Circulation. 2018;137:109–118. DOI: 10.1161/CIRCULATIONAHA.117.032582
72. Am J Kidney Dis. 71(3): 352-361. Published 2018 March
Data for AKI resulting in or during hospitalization or emergency department visits were collected as part of the
serious adverse events reporting process of the Systolic Blood Pressure Intervention Trial (SPRINT).
There were 179 participants with AKI
events in the intensive arm and 109 in the standard arm
73. Conclusions
• Blood pressure control is important to decrease
complications, morbidity and mortality
• Control of Bl.P decrease CVD complications
• Good assessment and follow up are the keys to successful
Bl.P control
• Patient adherence to medications
74. BP Thresholds for and Goals of Pharmacological Therapy in Patients With Hypertension According
to Clinical Conditions
Clinical Condition(s)
BP Threshold,
mm Hg
BP Goal,
mm Hg
General
Clinical CVD or 10-year ASCVD risk ≥10% ≥130/80 <130/80
No clinical CVD and 10-year ASCVD risk <10% ≥140/90 <130/80
Older persons (≥65 years of age; noninstitutionalized, ambulatory,
community-living adults)
≥130 (SBP) <130 (SBP)
Specific comorbidities
Diabetes mellitus ≥130/80 <130/80
Chronic kidney disease ≥130/80 <130/80
Chronic kidney disease after renal transplantation ≥130/80 <130/80
Heart failure ≥130/80 <130/80
Stable ischemic heart disease ≥130/80 <130/80
Secondary stroke prevention ≥140/90 <130/80
Secondary stroke prevention (lacunar) ≥130/80 <130/80
Peripheral arterial disease ≥130/80 <130/80
75. Conclusions
• The recent ACC/AHA guidelines promote radical changes in the management of
hypertension.
• First, the change in the definition increased the proportion of hypertensive adults in US
from 32% to 46%.
• Second, the new blood pressure target of treatment is also accordingly lower.
• Third, use of antihypertensive drugs is to be guided by blood pressure as well as by the
presence of CVD, diabetes, or a more than 10% 10-year risk
• of developing CVD.
• Fourth, more emphasis on monitoring blood pressure at home and on team-based
systems for managing hypertension.