This document discusses hypertension, including its definition, staging, classification, causes, risk factors, prevention, and management. Some key points: - Hypertension is defined as elevated blood pressure over 140/90 mmHg. It is classified as essential (90% of cases) or secondary (10% due to identifiable causes like kidney disease). - Risk factors include non-modifiable factors like age as well as modifiable behaviors such as diet, physical activity, weight, and alcohol intake. - Prevention focuses on lifestyle modifications like diet, exercise, weight control to reduce risk, as well as early detection and treatment of elevated blood pressure. - Management involves lifestyle changes and may include pharmacological treatment starting with

1. HYPERTENSION
AND ITS MANAGEMENT

2. O HYPERTENSION IS A CHRONIC
MEDICAL CONDITION IN WHICH
THE BLOOD PRESSURE IN THE
ARTERIES IS ELEVATED

3. STAGING OF HYPERTENSION
CATEGORY SYSTOLIC BP DIASTOLIC BP
NORMAL < 120 <80
PREHYPERTENSION 120-139
OR
80-90
STAGE 1 HYPERTENSION 140-159
OR
90-99
STAGE 2 HYPERTENSION >= 160
OR
>= 100
JNC 7 CLASSIFICATION

4. O ISOLATED SYSTOLIC HYPERTENSION-
SYSTOLIC PRESSURE OF 140 mmHg
OR MORE AND A DIATOLIC PRESSURE
OF LESS THAN 90 mmHg.
O WHITE COAT HYPERTENSION-
PHENOMENON IN WHICH A PATIENT
EXHIBIT A BLOOD PRESSURE LEVEL
ABOVE THE NORMAL RANGE IN
CLINICAL SETTINGS BUT NOT SO IN
OTHER SETTINGS.

5. CLASSIFICATION OF
HYPERTENSION
ESSENTIAL
HYPERTENSION
(90%)
SECONDARY
HYPERTENSION
(10%)

6. CAUSES OF SECONDARY
HYPERTENSION (10%)
O CHRONIC KIDNEY DISEASE
O SLEEP APNEA
O PHEOCHROMOCYTOMA
O COARCTATION OF THE AORTA
O PREGNANCY
O ALCOHOL ADDICTION
O THYROID DYSFUNCTION

7. RISK FACTORS
NON-MODIFIABLE RISK
FACTORS
• AGE
• SEX
• GENETIC FACTORS
• ETHNICITY
MODIFIABLE RISK FACTORS
• OBESITY
• SALT INTAKE
• SATURATED FAT
• DIETARY FIBRE
• ALCOHOL
• PHYSICAL ACTIVITY
• ENVIRONMENTAL STRESS
• SOCIO-ECONOMIC STATUS
• HEART RATE

8. RULE OF HALVES
1. WHOLE COMMUNITY
2. NORMOTENSIVE SUBJECTS
3. HYPERTENSIVE SUBJECTS
4. UNDIAGNOSED HYPERTENSION
5. DIAGNOSED HYPERTENSION
6. DIAGNOSED BUT UNTREATED
7. DIAGNOSED AND TREATED
8. INADEQUATELY TREATED
9. ADEQUATELY TREATED

9. TRACKING OF BLOOD
PRESSURE

10. HYPERTENSIVE URGENCY
O SEVERE HEADACHE
O SHORTNESS OF BREATH
O NOSEBLEEDS
O SEVERE ANXIETY

11. HYPERTENSIVE EMERGENCY
O STROKE
O LOSS OF CONSCIOUSNESS
O MEMORY LOSS
O HEART ATTACK
O LOSS OF KIDNEY FUNCTION
O DAMAGE TO EYES AND KIDNEYS
O AORTIC DISSECTION
O PULMONARY EDEMA

12. PREVENTION OF
HYPERTENSION
PRIMARY PREVENTION SECONDARY PREVENTION
• POPULATION STRATEGY
• HIGH-RISK STRATEGY

13. PRIMARY PREVENTION
O ALL MEASURES TO REDUCE THE
INCIDENCE OF DISEASE IN A
POPULATION BY REDUCING THE RISK
OF ONSET

14. POPULATION STRATEGY
O NUTRITION
O WEIGHT REDUCTION
O EXERCISE PROMOTION
O BEHAVIOURAL CHANGES
O HEALTH EDUCATION
O SELF-CARE

15. HIGH-RISK STRATEGY
O AIM IS TO PREVENT THE ATTAINMENT
OF LEVELS OF BLOOD PRESSURE AT
WHICH THE INSTITUTION OF
TREATMENT WOULD BE CONSIDERED

16. SECONDARY PREVENTION
O EARLY CASE DETECTION
O TREATMENT
O PATIENT COMPLIANCE

17. MANAGEMENT OF
HYPERTENSION
LIFE-STYLE
MODIFICATION
PHARMACOLOGICAL
MANAGEMENT

18. LIFE-STYLE MODIFICATION
MODIFICATION APPRX SBP
REDUCTION
WEIGHT REDUCTION 5 - 20 mmHg
ADOPT DASH EATING PLAN 8 - 14 mmHg
DIETARY SODIUM REDUCTION 2 - 8 mmHg
PHYSICAL ACTIVITY 4 – 9 mmHg
MODERATION OF ALCOHOL
CONSUMPTION
2 - 4 mmHg

19. O WEIGHT REDUCTION –
ACC. TO JNC 7, 5-20 POINTS
REDUCTION IN BP PER 10 KG WEIGHT
LOSS
O DIETARY APPROACHES TO STOP
HYPERTENSION –
DIET RICH IN FRUITS, VEGETABLES AND
LOW-FAT DAIRY PRODUCTS.
HIGH PROTEIN AND FIBRE

20. O SALT REDUCTION-
LESS THAN 2400 mg PER DAY
O PHYSICAL ACTIVITY-
BRISK WALKING ATLEAST 30 MIN/MOST
DAYS OF THE WEEK
O ALCHOL REDUCTION-
NO MORE THAN 2 DRINKS/ DAY

21. GOAL BLOOD PRESSURE
O < 140/90 mmHg FOR PATIENTS WITH
HYPERTENSION
O <130/80 mmHg FOR PATIENTS WITH
DIABETES OR CHRONIC KIDNEY
DISEASE

22. PATIENTS WITH
HYPERTENSION ALREADY ON
TREATMENT
IF SYSTOLIC BP < 140 mmHg
AND DIASTOLIC BP <90mmHg
ADVISE TO CONTINUE SAME
TREATMENT AND LSM
COUNSELLING
IF SYSTOLIC BP >= 140 mmHg
AND DIASTOLIC BP >=90mmHg
REGULAR FOLLOW-UP
FOLLOW THE SAME PROTOCOL
OF NEWLY DETECTED
HYPERTENSIVE PATIENTS
TO ACHIEVE GOAL BLOOD
PRESSURE

23. NEWLY DETECTED STAGE I
HYPERTENSION
ASSESS RISK FACTORS
IF YES IF NO
LSM AND T.AMLODIPINE
2.5 mg Hg
RECHECK BP AFTER
2 WEEKS
IF BP >= 140/90 mm Hg,
INCREASE DOSE OF
AMLO TO MAX- 10 mg/ DAY
LSM ONLY
RECHECK BP AFTER
2 WEEKS
IF BP >= 140/90 mm Hg,
LSM WITH AMLODIPINE
2.5 mg/ day

24. NEWLY DETECTED STAGE II
HYPERTENSION
LSM AND T.AMLODIPINE 5 mg/day
RECHECK BP AFTER 2 WEEKS
IF BP >= 140/90 mmHg
INCREASE DOSE OF AMLODIPINE
TO MAX- 10mg/ day
RECHECK BP AFTER 2 WEEKS
GOAL BP ACHIEVED GOAL BP NOT ACHIEVED
CONTINUE SAME ADD SECOND DRUG

25. SECOND DRUG
ISOLATED HYPERTENSION NOT CONTROLLED
WITH T.AMLO 10 MG/DAY
ADD T.HYDROTHIAZIDE 25 MG OD OR
T.ENALAPRIL 2.5-20 MG PER DAY OR
T.ATENOLOL 25-100 MG PER DAY
HYPERTENSION WITH DIABETES
ADD T.ENALAPRIL 2.5-20 MG PER DAY
(if sr. creatinine is <2mg)

26. SECOND DRUG
HYPERTENSION WITH IHD
ADD T.ATENOLOL 25-100 MG PER DAY
WITH T.ASPIRIN 75 MG OD AND
T.ISOSORBITRATE DINITRATE 5-10 MG TDS
HYPERTESION WITH CKD
AVOID ENALAPRIL IF SR. CREATININE > 2 mg
ADD T.ATENOLOL 25-100 mg PER DAY
(cautious use in PVD)

27. SECOND DRUG
HYPERTENSION WITH BRONCHIAL ASTHMA OR COPD
AVOID ATENOLOL
T.ENALAPRIL 2.5-20 mg PER DAY (OR)
T.HYDROCHLOROTHIAZIDE 25 mg OD