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Hypertension &
Management
Dr Sheikh Muhammad Huzaifa
When ever you think of Hypertension which
comes first in your mind ?
Overview
• High blood píessuíe, also called hypeítension,
is blood pĂ­essuĂ­e that is higheĂ­ than noĂ­mal.
YouĂ­ blood pĂ­essuĂ­e changes thĂ­oughout the
day based on youĂ­ activities. Having blood
pĂ­essuĂ­e measuĂ­es consistently above noĂ­mal
may Ă­esult in a diagnosis of high blood
pĂ­essuĂ­e (oĂ­ hypeĂ­tension).
Working Definition By (WHO)
• Hypertension ̶ or elevated blood pressure ̶ is
a serious medical condition that significantly
increases the risks of heart, brain, kidney and
other diseases.
• Epidemiology : An estimated 1.28 billion adults
aged 30-79 years worldwide have hypertension,
most (two-thirds) living in low- and middle-
income countries
Types of Hypertension
• There are 2 Types
• 1.Primary
•2 Secondary
Primary
• 1.No underlying Cause
• 2.90% world Population
• 3.>25 Years
Types of Hypertension
Secondary
1.Renal : CKD, APKD, Nephritic syndrome, etc…
2.Congenital : Coarctation of Aorta
3.Endocrinal : Acromegaly, Phechromocytoma, DM,
Cushing, Conn syndrome (Hyperaldosteronism)
4.Drugs : OCPs, cocaine, NSAIDs
5.Obstetrical : Pre-eclampsia, etc….
Why Hypertension is knownas “Silent Killer”?
Classification
• Recommendationsregardingclassificationfor
Blood pressure and targetblood pressure differ
betweenclinicalpracticeguidelines.
• Guidelineswe used in this slides are :
• 1.British Hypertension society(B.H.S)
• 2.8thJoint National Committee(J.N.C)
• 3. International societyof Hypertension(I.S.H)
• 4.AmericanHeartAssociation(A.H.A)
Life style Modification
• 1.DASH Diet : Diet Rich in Fruits, Vegetables and
whole grains, Low saturated Fat and Trans Fat
Reduces BP approx 11 mmHg
• 2.Decrease sodium Intake <1500 mg Reduces BP
Approx 5-6 mmHg
• 3.Decrease Alcohol and Quit Smoking
• 4.Daily Excersice (Brisk walks 30 min) Minimum 3
Times/wk and (Leslie walk on YouTube)
Principle Of Treatment
• 1.Start an Appropriate Drug according to Age in
Lowest possible dose, Follow up every 2 weeks
• 2.Tritrate it upward slowly if needed
• 3.Failure of 1 Anti-Hypertensive (Max Dose) to
achieve Target BP Indications of Next step is to
add on 2nd drug
• 4. Failure of 3 Anti-Hypertensive in its Max dose
to Achieve Target BP is Known as Resistant HTN
Anti-Hypertensive Treat For Co-Morbidities
• 1.D.M : ACEI
• 2.CHF : ACEI, BB, Spiranolactone
• 3.IHD : ACEI , BB
• 4.Hyperthyrodism : BB
• 5.Migraine : BB, CCB
• 6.B.P.H : Alpha Blockers
• 7.Osteoporosis : Thiazide Diuretics
• 8.Pre-Operative HTN : BB
• 9.Dyslipisemia : Alpha Blockers
• 10.Renal Insufficiency : ACEI
• 11.(P.I.H) : Alpha Methyl Dopa
Contraindications
• 1.DM don’t give (B.B Mask Features of
Hypoglycemia )
• 2. Renal Artery stenosis don’t give ACEI
• 3.Depression don’t giveAlpha methyl Dopa
• 4.Chronic Renal Failure don’t give
Spiranolactone
• 5.Bronchospasm don’t give B.B
Thanks ....Any Questions ?

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Hypertension Management

  • 2. When ever you think of Hypertension which comes first in your mind ?
  • 3. Overview • High blood pĂ­essuĂ­e, also called hypeĂ­tension, is blood pĂ­essuĂ­e that is higheĂ­ than noĂ­mal. YouĂ­ blood pĂ­essuĂ­e changes thĂ­oughout the day based on youĂ­ activities. Having blood pĂ­essuĂ­e measuĂ­es consistently above noĂ­mal may Ă­esult in a diagnosis of high blood pĂ­essuĂ­e (oĂ­ hypeĂ­tension).
  • 4. Working Definition By (WHO) • Hypertension ̶ or elevated blood pressure ̶ is a serious medical condition that significantly increases the risks of heart, brain, kidney and other diseases. • Epidemiology : An estimated 1.28 billion adults aged 30-79 years worldwide have hypertension, most (two-thirds) living in low- and middle- income countries
  • 5. Types of Hypertension • There are 2 Types • 1.Primary •2 Secondary Primary • 1.No underlying Cause • 2.90% world Population • 3.>25 Years
  • 6. Types of Hypertension Secondary 1.Renal : CKD, APKD, Nephritic syndrome, etc… 2.Congenital : Coarctation of Aorta 3.Endocrinal : Acromegaly, Phechromocytoma, DM, Cushing, Conn syndrome (Hyperaldosteronism) 4.Drugs : OCPs, cocaine, NSAIDs 5.Obstetrical : Pre-eclampsia, etc….
  • 7.
  • 8. Why Hypertension is knownas “Silent Killer”?
  • 9. Classification • Recommendationsregardingclassificationfor Blood pressure and targetblood pressure differ betweenclinicalpracticeguidelines. • Guidelineswe used in this slides are : • 1.British Hypertension society(B.H.S) • 2.8thJoint National Committee(J.N.C) • 3. International societyof Hypertension(I.S.H) • 4.AmericanHeartAssociation(A.H.A)
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  • 14. Life style Modification • 1.DASH Diet : Diet Rich in Fruits, Vegetables and whole grains, Low saturated Fat and Trans Fat Reduces BP approx 11 mmHg • 2.Decrease sodium Intake <1500 mg Reduces BP Approx 5-6 mmHg • 3.Decrease Alcohol and Quit Smoking • 4.Daily Excersice (Brisk walks 30 min) Minimum 3 Times/wk and (Leslie walk on YouTube)
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  • 17. Principle Of Treatment • 1.Start an Appropriate Drug according to Age in Lowest possible dose, Follow up every 2 weeks • 2.Tritrate it upward slowly if needed • 3.Failure of 1 Anti-Hypertensive (Max Dose) to achieve Target BP Indications of Next step is to add on 2nd drug • 4. Failure of 3 Anti-Hypertensive in its Max dose to Achieve Target BP is Known as Resistant HTN
  • 18. Anti-Hypertensive Treat For Co-Morbidities • 1.D.M : ACEI • 2.CHF : ACEI, BB, Spiranolactone • 3.IHD : ACEI , BB • 4.Hyperthyrodism : BB • 5.Migraine : BB, CCB • 6.B.P.H : Alpha Blockers • 7.Osteoporosis : Thiazide Diuretics • 8.Pre-Operative HTN : BB • 9.Dyslipisemia : Alpha Blockers • 10.Renal Insufficiency : ACEI • 11.(P.I.H) : Alpha Methyl Dopa
  • 19. Contraindications • 1.DM don’t give (B.B Mask Features of Hypoglycemia ) • 2. Renal Artery stenosis don’t give ACEI • 3.Depression don’t giveAlpha methyl Dopa • 4.Chronic Renal Failure don’t give Spiranolactone • 5.Bronchospasm don’t give B.B
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