This document discusses hypertension (high blood pressure) including definitions, stages, measurement techniques, targets for treatment, and general management strategies. Some key points: - Hypertension is defined as a blood pressure level where treatment benefits outweigh risks based on clinical trials. The overall adult prevalence is 30-45%. - Stages of hypertension include normal, elevated, stage 1, and stage 2 based on systolic and diastolic blood pressure levels. Isolated systolic and diastolic hypertension are also discussed. - Lifestyle modifications like following a DASH diet, reducing salt and weight, exercising, and not smoking can help lower blood pressure. Various drug classes are also used to treat hypertension. - Treatment targets

1. Hypertension
Dr Md Mashiul Alam
MBBS MD
Assistant Professor of Cardiology

2. Blood pressure?
Lateral pressure exerted by blood column on vessel wall
BP = CO x TPR

5. Nomenclature of HTN
• Arterial Hypertension
• Pulmonary hypertension
• Portal Hypertension

6. Definition
‘Hypertension’ is defined as the level of BP at which the benefits of
treatment (either with lifestyle interventions or drugs) unequivocally
outweigh the risks of treatment, as documented by clinical trials
The overall prevalence of hypertension in adults is around 30 - 45%

7. Stages of HTN

8. Isolated systolic HTN
• Isolated Diastolic HTN
Isolated diastolic hypertension (IDH), defined as a diastolic blood
pressure (DBP) > 90 mmHg and a systolic blood pressure (SBP) < 140
mmHg, is a common situation in medical practice

9. Methods of pressure measurement
• Non invasive
Aneroid manometer
Mercury manometer
• Invasive (Most accurate)
CLINICALLY????

11. Measurement technique

14. Office vs Ambulatory Vs Home blood pressure

15. White coat HTN Vs Masked HTN

17. Targets of blood pressure
Age 65
Risk factors for cardiovascular disease/ other co morbidity
<130/80 <140/90

21. General Management of HTN

22. DASH diet

23. Dietary salt reduction
Weight reduction
Exercise
Alcohol reduction
Smoking caseation

24. Drugs for HTN

26. HTN in special situation

27. Ischemic heart disease
Target: SBP >120-130 mmHg 130-140 mmHg if age ≥65yrs
DBP >70-80 mmHg
Drug of choice: MI -BB, ACEi or ARB
Angina – BB/ CCB

28. Obstructive airway disease
Drug of Choice:
CCB, ACEi/ ARB
Caution: Diurectics and B1 selective BB (Bisoprolol, Atenolol,
Nebivolol)
Avoid: non selective BB

29. Stroke
Acute Hemorrhagic Stroke:
6 Hours
Do not lower if less than 220 mmHg
If ≥ 220 mmHg lower to 180 mmHg in acute condition (6 hours)
Acute ischemic stroke: 3 days
≥220 mmHg or 120 mmHg ---15% reduction in 24 hours
<180/105 mmHg if thrombolysis is given

30. TIA: Initiate antihypertensive and keep BP with in range
Target SBP : 120-130 mmHg
Drug of choice: ACEi/ARB with CCB or Thiazide like diurectics

31. Pregnancy
Initiation of anti HTN drug:
150 / 95 mmHg
140/90 mmHg if gestational HTN, pre existing HTN with gestational
HTN or features of organ damage
Drug of choice: Methyl dopa, CCB, labetalol
IV GTN if heart failure

32. Breast feeding women
Drug of choice:
Labetalol, Atenolol, Metoprolol
Enalapril/ Captopril
Nifedipine
Insufficient data on : ARB, other ACEi, Amlodipine
Avoid/caution: Diuretics, Methyldopa, alpha blocker, Clonidin

33. Chronic kidney disease
Target SBP: 130-140 mmHg
Drug: same as stroke

34. HTN with DM
Target BP: same as IHD
Drug: Same as Stroke

35. Complications of HTN
• Hypertensive heart failure
• Renal impairment
• Stroke
• Aortic dissection
• Encephalopathy

36. Hypertensive urgency and emergency
>180/110 mmHg without end organ damage = Urgency
>180/110 mmHg with end organ damage = emergency

37. Accelerated or malignant
HTN
Malignant HTN = >180/110 mmHg +
Papilledema +/- other end organ damage
Accelerated HTN = >180/110 mmHg + fundoscopic change without
papilledema

38. Hypertensive retinopathy

39. Hypertensive emergency
• Acute pulmonary edema
• Encephalopathy
• ACS
• Aortic dissection
• Eclampsia/ sever preeclampsia
• Malignant hypertension

41. Thank you