Hypertension is highly prevalent in the elderly population. The risk of hypertension increases dramatically with age, with over 90% of people over 70 having hypertension. In the elderly, hypertension is characterized by an elevated systolic blood pressure with a normal or low diastolic blood pressure due to arterial stiffening caused by reduced elasticity of arteries with age. Multiple changes occur in the arteries with aging that result in increased systolic blood pressure and decreased diastolic blood pressure. Hypertension is the most important modifiable risk factor for cardiovascular disease in the elderly. Lifestyle modifications and medication are effective for treating hypertension in the elderly, with the goal of reducing blood pressure and cardiovascular risk.
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.
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.
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.
2017 ACC AHA guidelines on management of systemic hypertensionVasif Mayan
1. The 2017 ACC/AHA Guideline provides recommendations for the prevention, detection, evaluation, and management of high blood pressure in adults. It establishes new categories and stages of hypertension based on levels of systolic and diastolic blood pressure.
2. The guideline recommends treatment thresholds and medication options for various populations and medical conditions, including for pregnant women, those with heart and kidney conditions, and after stroke or surgery. It provides guidance on screening and managing secondary hypertension.
3. Nonpharmacological interventions like weight control, dietary changes, and physical activity are recommended initially or alongside drug therapy depending on the severity of a patient's high blood pressure. The choice of drugs depends on individual patient factors and conditions
This document provides guidelines for managing hypertension in elderly patients and those with renal impairment. It defines hypertension and classifications of blood pressure. For the elderly, hypertension is often salt-sensitive due to reduced ability to excrete salt and declining kidney function. Treatment goals for the elderly should be below 140/90 mmHg if possible, starting with low doses and monitoring for hypotension. For those with renal impairment, the goal is below 130/80 mmHg to prevent further kidney and heart damage. Careful medication management is needed due to declining organ function.
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.
Diabetes and heart two sides of the same coinSunil Wadhwa
This ppt presented in a CME of doctors in March 2017 discusses-if all Diabetics should be treated aggressively for prevention of coronary artery disease & SHOULD IT BE PRESUMED AS IF THEY ARE ALREADY PATIENTS OF CAD?
This presentation is updated till March 2017
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.
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.
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.
2017 ACC AHA guidelines on management of systemic hypertensionVasif Mayan
1. The 2017 ACC/AHA Guideline provides recommendations for the prevention, detection, evaluation, and management of high blood pressure in adults. It establishes new categories and stages of hypertension based on levels of systolic and diastolic blood pressure.
2. The guideline recommends treatment thresholds and medication options for various populations and medical conditions, including for pregnant women, those with heart and kidney conditions, and after stroke or surgery. It provides guidance on screening and managing secondary hypertension.
3. Nonpharmacological interventions like weight control, dietary changes, and physical activity are recommended initially or alongside drug therapy depending on the severity of a patient's high blood pressure. The choice of drugs depends on individual patient factors and conditions
This document provides guidelines for managing hypertension in elderly patients and those with renal impairment. It defines hypertension and classifications of blood pressure. For the elderly, hypertension is often salt-sensitive due to reduced ability to excrete salt and declining kidney function. Treatment goals for the elderly should be below 140/90 mmHg if possible, starting with low doses and monitoring for hypotension. For those with renal impairment, the goal is below 130/80 mmHg to prevent further kidney and heart damage. Careful medication management is needed due to declining organ function.
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.
Diabetes and heart two sides of the same coinSunil Wadhwa
This ppt presented in a CME of doctors in March 2017 discusses-if all Diabetics should be treated aggressively for prevention of coronary artery disease & SHOULD IT BE PRESUMED AS IF THEY ARE ALREADY PATIENTS OF CAD?
This presentation is updated till March 2017
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
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.
This document provides guidelines for the management of hypertension including:
1. Definitions of hypertension based on different blood pressure measurement methods and thresholds from recent guidelines.
2. Treatment goals for higher-risk and lower-risk populations.
3. Causes and complications of hypertension like left ventricular hypertrophy, heart failure, stroke, myocardial infarction, and renal failure.
4. Classes of antihypertensive agents used for treatment including thiazide diuretics, ACE inhibitors, ARBs, calcium channel blockers, and beta blockers.
5. Specific definitions and management recommendations for hypertension in pregnancy and its complications.
1) The document discusses lipid abnormalities seen in patients with insulin resistance and diabetes, including elevated triglycerides, reduced HDL, and small dense LDL particles.
2) It explains the effects of insulin resistance on lipid metabolism in the liver and fat cells, increasing VLDL production and free fatty acid release from fat cells.
3) Lifestyle modifications and drug therapies are recommended to target specific lipid abnormalities, with statins as first choice for lowering LDL, niacin for raising HDL, and fibrates for lowering triglycerides.
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
- The patient is a 50-year-old male smoker with hypertension for 6 years. His lipid profile shows a total cholesterol of 210 mg/dL, triglycerides of 180 mg/dL, LDL of 119 mg/dL, and HDL of 30 mg/dL.
- According to guidelines, he is at high cardiovascular risk due to smoking, hypertension, and lipid levels. Egypt is also considered a very high risk country.
- The appropriate measures for this high risk patient include lifestyle modifications plus high-intensity statin therapy, with an LDL cholesterol goal of less than 70 mg/dL. Monitoring is also needed.
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.
What’s new in Lipidology, Lessons from “recent guidelines“Arindam Pande
1. The 2018 ACC/AHA cholesterol guidelines provide 10 key take-home messages focusing on lifestyle management, statin therapy for various risk groups, and risk assessment approaches.
2. The guidelines emphasize lifestyle therapy and statins for secondary prevention, with an LDL-C goal of 70 mg/dL for very high risk patients to consider adding nonstatins.
3. They provide guidance on statin use for various primary prevention groups based on risk levels and discussion, including an expanded definition of intermediate risk factors.
This document discusses the evaluation and management of hypertension. It covers definitions of hypertension, reasons for treating it due to health risks like stroke and heart disease. It discusses causes like behaviors and genetics. It outlines diagnosing hypertension through various blood pressure measurements and assessing cardiovascular risk. Treatment involves lifestyle changes and medication, with goals of controlling blood pressure to reduce health risks. It addresses treatment-resistant cases and improving medication adherence.
This document provides an overview of the management of dyslipidemia. It discusses lipoprotein classification and composition. It also outlines the non-pharmacological and pharmacological treatment approaches for different dyslipidemia scenarios, including various drug classes like statins, PCSK9 inhibitors, fibrates and their effects. It discusses treatment approaches for different patient groups such as those with cardiovascular disease, diabetes, chronic kidney disease, inflammatory conditions and others. The guidelines for screening and management of dyslipidemia in various clinical situations are summarized.
1. The document discusses the effects of fasting during Ramadan for people with cardiovascular diseases such as coronary heart disease, hypertension, and heart failure.
2. It provides general advice for fasting and lists people who should not fast due to health reasons.
3. The document concludes by stating that Ramadan can be an opportunity for people to improve their overall health through weight loss, better diet, and stopping smoking.
Trajectories of lipids profile and incident cvd riskPraveen Nagula
The document discusses lipids and cardiovascular disease risk. It describes how the phenotype of acute coronary syndrome patients has changed from thin anxious executives to overweight sedentary individuals with diabetes or metabolic syndrome. Various lipid biomarkers are examined, including LDL, HDL, triglycerides, apoB, apoA-1, and Lp(a). Studies found these biomarkers provide better prediction of cardiovascular risk than LDL alone. Advanced lipid testing is recommended to better assess risk and treatment effectiveness beyond conventional lipids. Biomarkers like non-HDL-C, apoB, and Lp(a) show promise but more research is needed to understand their clinical utility.
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.
Device therapy for heart failure monitoring and managementDIPAK PATADE
1) Device therapy such as ICDs and CRT play an important role in managing advanced heart failure by treating life-threatening arrhythmias and improving morbidity and survival.
2) Clinical trials such as MUSTIC, MIRACLE, and CARE-HF demonstrated that CRT improves symptoms, exercise capacity, quality of life and reduces mortality in patients with heart failure and ventricular dyssynchrony.
3) The COMPANION trial showed that CRT with or without an ICD provided greater benefits than medical therapy alone in reducing the risk of all-cause mortality and hospitalizations.
1. The document discusses hypertension and the need for combination therapy to control blood pressure as most patients require two or more medications.
2. It highlights that the combination of telmisartan and amlodipine is preferred in Pakistan due to their complementary mechanisms that minimize side effects and provide synergistic blood pressure lowering effects.
3. Telmisartan has advantages over other ARBs like a longer half-life and higher tissue distribution that provide sustained blood pressure control, especially during early morning hours when cardiovascular events are more common.
HYPERTENSION introduction, recommendations for accurate measurements of BP, evaluation of patient with hypertension, management of patient with hypertension, resistant hypertension, hypertensive crisis, hypertensive emergencies
1. Advise lifestyle modifications like a heart-healthy diet, exercise, weight control, and smoking cessation.
2. Reassess risk factors and calculate 10-year ASCVD risk in 5 years.
3. Consider a moderate-intensity statin if additional risk factors emerge or 10-year risk reaches 7.5% at the next assessment.
The SPRINT trial studied over 9,000 patients at high risk for cardiovascular events to compare intensive blood pressure control (target <120 mm Hg systolic) to standard control (target <140 mm Hg). It found that intensive control significantly reduced rates of fatal and nonfatal heart attacks, heart failure, and death from any cause. However, intensive control also increased some adverse effects like acute kidney injury and hypotension. Overall, the trial demonstrated benefits of very tight blood pressure control for high-risk patients without diabetes.
Mr. AMF 62 years presented with central chest pain on exertion for last 4 monthsHypertension(BP-220/120 mmHg) for last 4 years, taking 4 anti hypertensives.Diabetes for last 5 years (HbA1c-9.3%).Smoking for 8 years.Dyslipedemic for 3 years. H/o 5 times hospital admissions due to heart failure in last 3 years.ECG-Anterior wall ischemiaEF-58%During careful clinical exam- renal bruit on left side.Coronary angiogram done and revealed DVD. Renal angiogram showed significant left renal artery stenosis. Coronary angioplasty and left renal artery angioplasty done.
Mr AMF now have no chest pain on exertion after 3 months of coronary angioplasty.
Now BP is controlled (130/85 mm Hg), taking B blockers and ARB due to intolerance of ACE inhibitors.
No hospital admission during this period.
Diabetes and serum lipids are controlled.
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
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.
This document provides guidelines for the management of hypertension including:
1. Definitions of hypertension based on different blood pressure measurement methods and thresholds from recent guidelines.
2. Treatment goals for higher-risk and lower-risk populations.
3. Causes and complications of hypertension like left ventricular hypertrophy, heart failure, stroke, myocardial infarction, and renal failure.
4. Classes of antihypertensive agents used for treatment including thiazide diuretics, ACE inhibitors, ARBs, calcium channel blockers, and beta blockers.
5. Specific definitions and management recommendations for hypertension in pregnancy and its complications.
1) The document discusses lipid abnormalities seen in patients with insulin resistance and diabetes, including elevated triglycerides, reduced HDL, and small dense LDL particles.
2) It explains the effects of insulin resistance on lipid metabolism in the liver and fat cells, increasing VLDL production and free fatty acid release from fat cells.
3) Lifestyle modifications and drug therapies are recommended to target specific lipid abnormalities, with statins as first choice for lowering LDL, niacin for raising HDL, and fibrates for lowering triglycerides.
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
- The patient is a 50-year-old male smoker with hypertension for 6 years. His lipid profile shows a total cholesterol of 210 mg/dL, triglycerides of 180 mg/dL, LDL of 119 mg/dL, and HDL of 30 mg/dL.
- According to guidelines, he is at high cardiovascular risk due to smoking, hypertension, and lipid levels. Egypt is also considered a very high risk country.
- The appropriate measures for this high risk patient include lifestyle modifications plus high-intensity statin therapy, with an LDL cholesterol goal of less than 70 mg/dL. Monitoring is also needed.
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.
What’s new in Lipidology, Lessons from “recent guidelines“Arindam Pande
1. The 2018 ACC/AHA cholesterol guidelines provide 10 key take-home messages focusing on lifestyle management, statin therapy for various risk groups, and risk assessment approaches.
2. The guidelines emphasize lifestyle therapy and statins for secondary prevention, with an LDL-C goal of 70 mg/dL for very high risk patients to consider adding nonstatins.
3. They provide guidance on statin use for various primary prevention groups based on risk levels and discussion, including an expanded definition of intermediate risk factors.
This document discusses the evaluation and management of hypertension. It covers definitions of hypertension, reasons for treating it due to health risks like stroke and heart disease. It discusses causes like behaviors and genetics. It outlines diagnosing hypertension through various blood pressure measurements and assessing cardiovascular risk. Treatment involves lifestyle changes and medication, with goals of controlling blood pressure to reduce health risks. It addresses treatment-resistant cases and improving medication adherence.
This document provides an overview of the management of dyslipidemia. It discusses lipoprotein classification and composition. It also outlines the non-pharmacological and pharmacological treatment approaches for different dyslipidemia scenarios, including various drug classes like statins, PCSK9 inhibitors, fibrates and their effects. It discusses treatment approaches for different patient groups such as those with cardiovascular disease, diabetes, chronic kidney disease, inflammatory conditions and others. The guidelines for screening and management of dyslipidemia in various clinical situations are summarized.
1. The document discusses the effects of fasting during Ramadan for people with cardiovascular diseases such as coronary heart disease, hypertension, and heart failure.
2. It provides general advice for fasting and lists people who should not fast due to health reasons.
3. The document concludes by stating that Ramadan can be an opportunity for people to improve their overall health through weight loss, better diet, and stopping smoking.
Trajectories of lipids profile and incident cvd riskPraveen Nagula
The document discusses lipids and cardiovascular disease risk. It describes how the phenotype of acute coronary syndrome patients has changed from thin anxious executives to overweight sedentary individuals with diabetes or metabolic syndrome. Various lipid biomarkers are examined, including LDL, HDL, triglycerides, apoB, apoA-1, and Lp(a). Studies found these biomarkers provide better prediction of cardiovascular risk than LDL alone. Advanced lipid testing is recommended to better assess risk and treatment effectiveness beyond conventional lipids. Biomarkers like non-HDL-C, apoB, and Lp(a) show promise but more research is needed to understand their clinical utility.
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.
Device therapy for heart failure monitoring and managementDIPAK PATADE
1) Device therapy such as ICDs and CRT play an important role in managing advanced heart failure by treating life-threatening arrhythmias and improving morbidity and survival.
2) Clinical trials such as MUSTIC, MIRACLE, and CARE-HF demonstrated that CRT improves symptoms, exercise capacity, quality of life and reduces mortality in patients with heart failure and ventricular dyssynchrony.
3) The COMPANION trial showed that CRT with or without an ICD provided greater benefits than medical therapy alone in reducing the risk of all-cause mortality and hospitalizations.
1. The document discusses hypertension and the need for combination therapy to control blood pressure as most patients require two or more medications.
2. It highlights that the combination of telmisartan and amlodipine is preferred in Pakistan due to their complementary mechanisms that minimize side effects and provide synergistic blood pressure lowering effects.
3. Telmisartan has advantages over other ARBs like a longer half-life and higher tissue distribution that provide sustained blood pressure control, especially during early morning hours when cardiovascular events are more common.
HYPERTENSION introduction, recommendations for accurate measurements of BP, evaluation of patient with hypertension, management of patient with hypertension, resistant hypertension, hypertensive crisis, hypertensive emergencies
1. Advise lifestyle modifications like a heart-healthy diet, exercise, weight control, and smoking cessation.
2. Reassess risk factors and calculate 10-year ASCVD risk in 5 years.
3. Consider a moderate-intensity statin if additional risk factors emerge or 10-year risk reaches 7.5% at the next assessment.
The SPRINT trial studied over 9,000 patients at high risk for cardiovascular events to compare intensive blood pressure control (target <120 mm Hg systolic) to standard control (target <140 mm Hg). It found that intensive control significantly reduced rates of fatal and nonfatal heart attacks, heart failure, and death from any cause. However, intensive control also increased some adverse effects like acute kidney injury and hypotension. Overall, the trial demonstrated benefits of very tight blood pressure control for high-risk patients without diabetes.
Mr. AMF 62 years presented with central chest pain on exertion for last 4 monthsHypertension(BP-220/120 mmHg) for last 4 years, taking 4 anti hypertensives.Diabetes for last 5 years (HbA1c-9.3%).Smoking for 8 years.Dyslipedemic for 3 years. H/o 5 times hospital admissions due to heart failure in last 3 years.ECG-Anterior wall ischemiaEF-58%During careful clinical exam- renal bruit on left side.Coronary angiogram done and revealed DVD. Renal angiogram showed significant left renal artery stenosis. Coronary angioplasty and left renal artery angioplasty done.
Mr AMF now have no chest pain on exertion after 3 months of coronary angioplasty.
Now BP is controlled (130/85 mm Hg), taking B blockers and ARB due to intolerance of ACE inhibitors.
No hospital admission during this period.
Diabetes and serum lipids are controlled.
Hypertensive nephropathy is kidney damage caused by long-standing high blood pressure. It involves thickening of the walls of small arteries in the kidneys which reduces blood flow and causes scarring. Risk factors include a family history of high blood pressure, older age, unhealthy habits like smoking, and illnesses like diabetes. Symptoms include high blood pressure, swelling, fatigue, breathing difficulties, and changes in urination. Treatment focuses on controlling blood pressure through lifestyle changes and medications like ACE inhibitors, ARBs, calcium channel blockers, and diuretics. If kidney function declines significantly, dialysis or kidney transplantation may be required.
This document discusses hypertension, also known as high blood pressure. It begins by defining hypertension and noting that it is a major global health issue, including in Bangladesh where approximately 20-40% of adults suffer from it. The document then covers classifications of hypertension, potential causes including lifestyle and genetic factors, common complications affecting organs like the brain, eyes, heart and kidneys, diagnostic evaluations, and management through lifestyle modifications and pharmacological therapies like diuretics and beta blockers. The goal of treatment is to control blood pressure and prevent complications.
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.
Recent guidelines classify hypertension into four stages based on increasing levels of systolic and diastolic blood pressure. Hypertension increases risks for cardiovascular and kidney diseases, and adequate control can reduce risks by 20-50%. Primary hypertension is usually essential and related to multiple genetic and lifestyle factors in 95% of cases. Treatment involves lifestyle changes, medication, and interventional procedures for resistant cases. Goals are to control blood pressure and reduce long-term health risks.
This document discusses hypertension (high blood pressure) and its management through diet and lifestyle changes or medications. It defines hypertension and classifies it by severity. It describes secondary causes of hypertension like kidney disease or tumors and essential (primary) hypertension which is idiopathic. Uncontrolled hypertension can damage organs over time. Management includes weight loss, reducing sodium intake, increasing potassium/calcium/magnesium, reducing alcohol and managing stress. For mild cases, lifestyle changes may control blood pressure but medications are often needed if goals are not met. Early treatment can reduce heart disease and stroke risks.
This document provides information about hypertension management through a series of questions and presentations. It begins with 3 multiple choice questions about hypertension management goals, recommended first-line drugs, and blood pressure staging. The subsequent presentations define blood pressure, discuss white coat hypertension, screening recommendations, hypertension classification, etiology, duration and incidence. It also covers hypertension evaluation, secondary causes, treatment approaches including lifestyle modifications and pharmacotherapy, special patient considerations, and resistant hypertension.
Management of Hypertension in Diabetic Patients with Chronic Kidney Disease: ...O. E.Nyandi PhD
South Pacific Medical Education Conference Presentation byDr Osborne E Nyandiva on Conference Presentation : Management of Hypertension in Diabetic Patients with Chronic Kidney Disease: A pathologist perspective view in SAMOA and NEW ZEALAND
Diabetes is associated with markedly increased cardiovascular risk, a risk compounded with imposition of chronic kidney disease (CKD). More than 80% of people with diabetes and CKD have hypertension, and many have an obliterated nocturnal blood pressure “dip,” the normal physiological drop in blood pressure during sleep. Appropriate blood pressure measurement is the Achilles heel of hypertension management, especially in diabetic kidney disease (DKD). The prevalence of kidney disease and diabetes is increasing among the people of the Pacific with an unknown proportion having metabolic syndrome. The preponderance of those with diabetic kidney disease (DKD) will not progress to kidney failure, but rather will succumb to cardiovascular disease (CVD).
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.
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.
Management of Hypertension in Diabetic Patients with Chronic Kidney Disease: ...O. E.Nyandi PhD
Diabetes is associated with markedly increased cardiovascular risk, a risk compounded with imposition of chronic kidney disease (CKD). More than 80% of people with diabetes and CKD have hypertension, and many have an obliterated nocturnal blood pressure “dip,” the normal physiological drop in blood pressure during sleep. Appropriate blood pressure measurement is the Achilles heel of hypertension management, especially in diabetic kidney disease (DKD).
Hypertension, or high blood pressure, is a major global health issue. It is defined as a systolic blood pressure over 140 mmHg or a diastolic over 90 mmHg. Risk factors include age, family history, stress, obesity, alcohol, sodium intake and lack of exercise. Complications can include heart disease, stroke, kidney disease and eye damage if left untreated. Treatment involves lifestyle changes like diet, exercise and weight loss as well as medications that lower blood pressure such as diuretics, ACE inhibitors, calcium channel blockers and beta blockers. Nurses play an important role in educating patients about hypertension management.
This document discusses hypertension (high blood pressure) including its definition, causes, clinical presentation, assessment, and management. It notes that hypertension is defined as blood pressure above 140/90 mmHg and risks of cardiovascular disease double for every 20/10 mmHg rise. Common complications include stroke, myocardial infarction, heart failure, and renal failure. Treatment involves lifestyle modifications and medication, starting with ACE inhibitors, calcium channel blockers, or thiazides. The goals are to lower blood pressure and reduce cardiovascular risk based on individual patient factors.
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.
This document discusses hypertension (high blood pressure) including its causes, effects on the heart, treatment targets, and drug treatment options. It notes that primary hypertension accounts for 90-95% of cases and outlines trial findings showing benefits of tight blood pressure control, especially in patients with diabetes. Treatment involves lifestyle changes and medications, typically starting with diuretics, with the goal of controlling blood pressure to under 140/85 mmHg.
Hypertension is defined as high blood pressure with a systolic reading over 140 mmHg or diastolic over 90 mmHg. It can be caused by many factors like increased cardiac output, vasoconstriction, fluid volume, and activation of the renin-angiotensin system. Treatment involves lifestyle modifications like weight loss, reduced sodium intake, and exercise as well as drug therapy using diuretics, ACE inhibitors, calcium channel blockers, and beta blockers. Uncontrolled hypertension can damage organs and lead to complications like heart disease, stroke, and kidney disease so treatment aims to control blood pressure and reduce cardiovascular risk.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
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).
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
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2. DEFINATION
• Hypertension is defined as the presence of a
blood pressure elevation to a level that places
patients at increased risk for target organ
damage in several vascular beds including the
retina, brain , heart, kidneys and large conduit
arteries .
3. BLOOD PRESSURE CLASSIFICATIONS IN ADULTS
BLOOD PRESSURE
CATEGORY
SYSTOLIC (MMHG) DIASTOLIC (MMHG )
NORMAL <120 and <80
ELEVATED 120-129 And <80
HYPERTENSION
STAGE 1 130-139 OR 80-89
STAGE 2 >=140 OR >90
SOURCE , 2017 ACC/ AHA
4. • There is a dramatic increase in the
prevalence of hypertension with
aging ; by age 70 years, the majority
of people have hypertension .
5. EPIDEMIOLGY OF HYPERTENSION AND
AGING
• Without treatment , approximately 40% of adults
have hypertension
• HTN prevalence increases markedly with age
a) By 60 years ~ 65 % have HTN
b) By 70 years ~ 90 % have HTN ( ISH)
• In Framingham Study , HTN eventually developed in >
90% of people with normal BP at age of 55 years .
8. • In older adults , hypertension is
characterised by an elevated systolic
blood pressure with normal or low
diastolic BP , due to age associated
stiffening of the large arteries .
9. JOINT INFLUENCES OF SBP AND PULSE
PRESSURE ON CORONARY HEART DISEASE
Thus pulse pressure is the most important predictor of cardiovascular risk in the
elderly
10. PATHOPHYSIOLOGY OF HYPERTENSION IN THE
ELDERLY
• Multiple changes occur in arterial media with
aging , including reduced elastin content with
increase in non distensible collagen and calcium (
eg arterial stiffening )
• Age associated arterial stiffening results in a
gradual increase in systolic BP and a decrease in
diastolic BP
• Flow – mediated arterial dilation , primarily
mediated by endothelium derived nitric oxide,
declines markedly with aging
11. PATHOPHYSIOLOGY CONTINUES
The changes in the vessel wall results in increased
pulse wave velocity , early return of reflected waves
from the periphery and altered contour of the pulse
waveform .
The net effect is an elevated SBP and augmentation
index .
DBP is also reduced due to reduced elastic recoil of stiff
arteries .
The changes in SBP and DBP are clearly responsible for
the increased afterload , wall tension of the left
ventricle, reduced coronary perfusion pressure ,
diastolic dysfunction and left atrial enlargement
12. PATHOPHYSIOLOGY CONTINUES………
• Neurohormonal profile of older hypertensive
adults characterized by increased plasma
norepinephrine , low renin , and low
aldosterone levels
• Many so called normal aging changes in
arterial structures and function are blunted /
absent in population not chronically exposed
to high sodium/high calorie diets, low physical
activity levels , and high rates of obesity
13. Hypertension as a Risk Factor in the
Elderly
• In older adults , Hypertension is the most
prevalent modifiable CV risk factor: antecedent
HTN is estimated in :
~ 70 % of patients with incident myocardial
infarction
~ 77 % of patients with incident strokes
~ 74 % with chronic Heart Failure
~ 90 % with acute aortic syndrome
~ 30 % to 40 % with atrial fibrillation
14. Hypertension continues….
• HTN is also a major risk factor for conditions
directly influencing CV risk in the elderly
a) Diabetes
b) Metabolic Syndrome
c) Chronic kidney disease
15. Failure to control BP with combination of 3 or
more drugs including diuretics with adequate
dose and duration
• Unsuspected secondary cause
• Poor adherance to therapeutic plan
• Failure to modify lifestyle
• Volume overload – inadequate diuretic therapy,
progressive renal failure, high sodium intake
• Whitecoat hypertension
• Small cuff on large arm
• Too early measure after nicotine or caffiene intake
Refractory Hypertension
Reason ?
16. Hypertensive crisis
• Hypertensive emergency – critical elevation of blood
pressure (SBP >=140mmhg & DBP >=90 mmhg) associated
with features of acute or ongoing TOD as evident clinically
or by laboratory findings( Acute LVF, ARF,Encepahopathy )
• Hypertensive urgency – DBP >= 120mmhg & No features
of TOD
• Accelerated hypertension- High BP (SBP>= 140mmhg &
DBP >= 90mmhg ) with vascular damage ( retinal
hemorrhages & Exudates )
• Malignant hypertension – High BP ( SBP>=140 mmhg &
DBP >=90MMHG) with features of papilledema
17. Steps in clinical evaluation of
hypertension
• Duration and severity of elevated BP
• History of prior medications and antihypertenssive
medication use
• Use of tobacco , alcohol
• Risk factors for CAD
• Family history of hypertension, Diabetes, CVD
• Psychosocial history ( presence of stress, insomnia )
• Dietary habbits, physical activity and weight changes in
the recent past
• Features of TOD
18. Some features suggestive of secondary
HTN should be specially looked for
• Abrupt onset of hypertension
• Sudden worsening of previously well
controlled BP
• Refractory hypertension
• Episodes of hypertensive criris
• Specific symptoms and signs related to the
cause of HTN ( eg , azotemia in renal
parenchymal disease )
19. Extent of Awareness, Treatment and Control of
High Blood Pressure by Age
BP Control Rates remain suboptimal in the elderly
20. Routine Tests recommended for the
initial evaluation of a hypertensive
patient
• Serum chemistry
• glucose
• potassium
• creatinine
• sodium
• Serum Total and HDL Cholesterol
• Urinalysis
• Electrocardiogram , CBC
21. Other investigations
• Chest radiography – cardiomegaly, heart failure, CoA
• Ambulatory BP recording – to assess border line or
whitecoat HTN
• Echocardiogram – to detect or quantify LVH
• Renal ultrasound – to detect possible renal disease
• Renal angiography – to detect or confirm presence of
renal artery stenosis
• Urinary cortisol and dexamethasone suppression test – to
detect possible Cushing’s syndrome
• Plasma renin activity and aldosterone – to detect
possible primary aldosteronism
22. Lifestyle modifications that lower blood pressure
Primary lifestyle modification
Reduction of body weight (10 kg reduces BP ~ 10/8 mmHg)
Reduction in dietary salt consumption ( target 100 mmol/day, can
lower BP ~ 12/10 mmHg, but individual responses vary)
Increase physical activity to 30 – 45 mins, 4 times a week ( can lower
BP 8/4 mmHg and often helps control weight)
Increase consumption of fruits and vegetables (at least 4
servings/day, can lower BP 6/3 mmHg and often helps reduce salt
consumption)
Moderation of alcohol consumption (target 10 -20 g ethanol for
women, 20 – 30 g for men, can lower BP up to 8/4 mmHg in those
who have more than 5 drinks/ day)
Stress management (randomized clinical trials outside the workplace
have been unconvincing, but many psychologists still recommend
the approach despite a lack of detailed protocols that uniformely
lower BP)
23. Other lifestyle modifications that are routinely
recommended
• Tobacco avoidance (lowers cardiovascular risk
independently of any effect on BP)
• Fish consumption (improves lipid profiles and
cardiovascular risk more than expected if BP effects alone is
operative)
• Increasing dietary fibre (improves lipid profiles and cancer
risk independently of effect on BP)
• DASH (Dietry Approach to Stop Hypertension) Diet:-
• Potassium Rich fruits, Low salt and total fat, Increased
vegetable and fruits, and low Dairy Products.
24. Randomized Hypertension in the Very
Elderly Trail ( HYVET )
• In 3845 patients , > 80 years old with SBP>= 160
MMHG, AT 1.8 Year follow up, those randomized
to indapamide vs placebo had :
a) 30% non significant decrease in fatal/nonfatal
stroke
b) 39% significant decrease in fatal stroke
c) 21% significant decrease in all cause mortality
d) 23 % insignificant decrease in CV death
e) 64% significant decrease in heart failure
25. Pharmacological Management
It is based on the same principles as for younger
people with minor differences -
• The elderly have reduced body mass, reduced liver
and kidney mass. Absorption capacity is reduced
hence the pharmacokinetics of drugs are altered
• Some of the drugs commonly prescribed in the
elderly increases BP and interfere with
antihypertensive therapy. These are
corticosteroids, anabolic steroids, NSAIDS, and
erythropoietin
• All the drug classes have similar BP lowering
efficacy and CV risk reduction is largely due to BP
lowering and not due to any individual drug effect .
26. • If there are no compelling indications , start with a low
dose of any drug ( preferably a thiazide type diuretic ) .
Add a second drug if Goal BP is not achieved inspite of
maximally tolerated dose. Similarly , add a third drug
and assess for secondary hypertension if desired
response in not obtained .
• Thiazide type diuretics and dihydropyridine CCBs are
the most studied drugs in the geriatric population.
• In the presence of compelling indications, start with
drug class shown to have maximal benefit .
• Check regularly for compliance , postural hypotension
and side effects of drugs .
27. Key Message
1. Aging is associated with increased stiffness of vessels and
very high prevalence of hypertension. The prevalence is
also influneced by dietary factors( salt intake ) and other
poorly understood influences( hormonal influences )
2. All forms of hypertension are common in the elderly ;
though ISH is the commonest
3. There are no clear guidelines on different risk profile older
people, practical defination of hyperetnsion and goal BP
to be achived . Currently , 140/90mmhg is the diagnostic
threshold and also the goal BP for people in the age group
of 60-79 years of age . For octogenarians and beyond,
based on the data available, a diagnostic threshold of
160mmhg seems reasonable and a goal BP in the range of
140-145 mmhg is a reasonable target if tolerated well .
28. 4 In older people , there is no data to support the
lower BP targets in the presence of DIABETES ,
CKD &CVD
5 There is a need to identify which drugs are most
suitable and well tolerated by the elderly and
also most effective in reducing CV risk
6 Drug compliance is poor in this group because of
cost, cognitive impairment , multiple drug intake
for co-morbidities etc . Emphasis should be on
using low cost combinations
29. 7 Fundamental research should focus on
understanding the pathophysiology of
vascular stiffness to develop methods to
reverse and prevent it
8 There is a need to generate data on local
populations, specially in our country , in
different age sections within the elderly and
with different co-morbidities