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HYPERTENSION
Hypertension ,[object Object],[object Object],[object Object],[object Object]
Hypertension: The Silent Killer Facts & Figures ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prevalence Prevalence on hypertension by age  Age % Hypertension 18~29 4 30~39 11 40~49 21 50~59 44 60~69 54 70~79 64 80 + 65
Causes of Hypertension ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hypertension - Guidelines ,[object Object],CATEGORY SBP  mm Hg   DBP  mm Hg Normal <120 & <80 Prehypertension 120-139 or 80-89 Stage-I 140-159 or 90-99 Stage-II >160 or >100
VARIOUS TERMS & DEFINITIONS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Chronic Complications End / Target organ damage Organ  Condition  Symptoms, signs/events Heart  LVH, CAD Angina / MI Artery  Atherosclerosis  CAD/CVD/PAD Aneurysm Stroke Kidney  Nephropathy  Microalbuminuria  Eye (retina) Retinopathy  Blurring of vision Brain  CVD TIA/Stroke
Prevalence of Cardiovascular Disease ,[object Object],10 20 30 40 50 60 High  BP CAD CHF  Stroke Other 50,000,000 12,200,000 4,600,000 4,400,000 2,800,000 Prevalence (millions) BP=blood pressure, CAD=coronary artery disease, CHF=congestive heart failure (24%) American Heart Association® . 2000 Heart and Stroke Statistical Update. 1999
Hypertension Risk Factors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hypertension : Symptoms  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hypertension - Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hypertension - Management Pharmacological management   Category  Drugs  Diuretics  Hydrochlorothiazide, Indapamide ACE-Is Enalapril, Perindopril  ARBs Olmesartan, Valsartan, Losartan Beta blockers  Nebivolol, Atenolol Alpha blockers Terazosin, Prazosin CCB Amlodipine, Diltiazem
Hypertension - Management ,[object Object],[object Object],[object Object],[object Object],[object Object]
Ideal  Antihypertensive  Drug ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The correct Approach to Hypertension
JNC 7 Algorithm
Anti Hypertensive drug classes The A, B, C, D  approach
Anti Hypertensive Drug Classes ,[object Object],[object Object],[object Object],[object Object],[object Object]
AB/CD Rule – HT Treatment  AGE Younger (< 55) ACEi, Beta-blocker Ca++-blocker, Diuretic) (AB/CD = Dickerson et al. Lancet 353:2008-11;1999 Older (> 55) ACEi / ARB BB A + B A + B + D Diuretic CCB D + C + A D + C I II III III II I Resistant HT / Intolerance Add / substitute alpha blocker Re-consider 2 0  causes    trial of spironolactone IV: V:
Drugs for Compelling Indications
DIURETICS ,[object Object],[object Object],[object Object],[object Object],Reduce BP
DIURETICS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
BETA  BLOCKERS ,[object Object],[object Object],[object Object],[object Object],Reduce BP
BETA  BLOCKERS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],ALPHA  BLOCKER Mechanism of action:
ALPHA  BLOCKER ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CALCIUM  CHANNEL  BLOCKERS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CALCIUM CHANNEL  BLOCKERS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ACE - INHIBITORS ,[object Object],[object Object],[object Object],[object Object]
ACE - INHIBITORS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ANGIOTENSIN-II RECEPTOR INHIBITOR ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Follow-up and Monitoring ,[object Object],[object Object],[object Object],[object Object],[object Object]
New Features and Key Messages ,[object Object],[object Object],[object Object],[object Object]
New Features and Key Messages ,[object Object],[object Object],[object Object],[object Object]
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Hypertension

  • 2.
  • 3.
  • 4. Prevalence Prevalence on hypertension by age Age % Hypertension 18~29 4 30~39 11 40~49 21 50~59 44 60~69 54 70~79 64 80 + 65
  • 5.
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  • 8. Chronic Complications End / Target organ damage Organ Condition Symptoms, signs/events Heart LVH, CAD Angina / MI Artery Atherosclerosis CAD/CVD/PAD Aneurysm Stroke Kidney Nephropathy Microalbuminuria Eye (retina) Retinopathy Blurring of vision Brain CVD TIA/Stroke
  • 9.
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  • 13. Hypertension - Management Pharmacological management Category Drugs Diuretics Hydrochlorothiazide, Indapamide ACE-Is Enalapril, Perindopril ARBs Olmesartan, Valsartan, Losartan Beta blockers Nebivolol, Atenolol Alpha blockers Terazosin, Prazosin CCB Amlodipine, Diltiazem
  • 14.
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  • 16. The correct Approach to Hypertension
  • 18. Anti Hypertensive drug classes The A, B, C, D approach
  • 19.
  • 20. AB/CD Rule – HT Treatment AGE Younger (< 55) ACEi, Beta-blocker Ca++-blocker, Diuretic) (AB/CD = Dickerson et al. Lancet 353:2008-11;1999 Older (> 55) ACEi / ARB BB A + B A + B + D Diuretic CCB D + C + A D + C I II III III II I Resistant HT / Intolerance Add / substitute alpha blocker Re-consider 2 0 causes  trial of spironolactone IV: V:
  • 21. Drugs for Compelling Indications
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Editor's Notes

  1. 2 nd most common reason for visit All family physicians should be experts at HTN.