Resistant Hypertension
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Resistant hypertension is defined as uncontrolled hypertension despite treatment with at least 3 antihypertensive drugs. It is increasingly common in clinical practice. The document outlines its definition, epidemiology, pathogenesis, diagnosis, and management approaches including lifestyle modifications, identifying and treating secondary causes, additional drug therapies, and device-based interventions.
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resistant hypertension -update and management
resistant hypertension is common problem in our clinical practice,
focusing of recent update and management.
Refractory hypertension
The actual prevalence of RH may be lower than what is
perceived in the literature when triple-A (accuracy of BP
measurement, adherence of medications, and adequacy
of anti-HTN medications) are ensured. It is important to
emphasize that the sea of RH starts when the shore of secondary
HTN is over and the island of RfH is still uncharted. RfH is
emerging as a novel phenotype, and growing evidence suggest
that these patients have sympathetic hyperactivity. However,
the role of beta-blockers and interventions such as RDN and
baroreceptor activation techniques is yet to be studied.
Refractory hypertension approach
Resistant hypertension is defined as blood pressure that remains above goal despite treatment with three antihypertensive agents of different classes, one being a diuretic. Refractory hypertension is when blood pressure cannot be controlled despite four or more drugs at maximal doses. Pseudoresistant hypertension occurs when poor control is due to non-adherence or suboptimal treatment rather than true treatment resistance. Evaluation of patients with resistant hypertension includes screening for secondary causes like primary aldosteronism or renal artery stenosis through tests of electrolytes, renal function, and imaging studies. Treatment involves optimizing the current three-drug regimen before adding supplementary drugs like beta blockers or aldosterone antagonists.
Resistant hypertension
This document discusses resistant hypertension and its treatment. It defines resistant hypertension as blood pressure that remains above goal despite use of three antihypertensive agents from different classes including a diuretic. Treatment involves identifying and treating secondary causes, adjusting medications that raise blood pressure, monitoring blood pressure outside the office, making lifestyle changes, and using pharmacologic therapies like diuretics, aldosterone antagonists, and catheter-based renal denervation. While renal denervation showed promise in early trials, the SYMPLICITY HTN-3 trial found it did not significantly reduce blood pressure compared to a sham procedure.
HF update 2021
This document discusses heart failure, including its increasing prevalence globally, definitions, classifications, management, and new strategies. Some key points:
- Heart failure prevalence is increasing worldwide and mortality remains high, around 50% within 5 years of diagnosis.
- The universal definition characterizes heart failure as a clinical syndrome caused by structural or functional cardiac abnormalities, accompanied by typical symptoms and signs.
- Management focuses on guideline-directed medical therapies (GDMT) including ACE inhibitors, ARBs, beta-blockers, and MRAs, though utilization remains suboptimal.
- The PARADIGM-HF trial showed the ARNI drug sacubitril/valsartan reduced cardiovascular death and heart failure
Resistant hypertension
Resistant hypertension is defined as uncontrolled blood pressure despite treatment with three or more antihypertensive medications, including a diuretic. Pseudo-resistant hypertension accounts for around 50% of cases due to issues like inaccurate measurements, poor medication adherence, and inadequate treatment regimens. Ambulatory blood pressure monitoring is important for accurately diagnosing and managing resistant hypertension. Treatment involves optimizing medication regimens with medications like chlorthalidone, spiranolactone, and amiloride-hydrochlorothiazide combinations, and considering interventions for refractory cases involving more than five medications.
RESISTANT HYPERTENSION
Resistant hypertension is defined as blood pressure that remains above goal despite treatment with three antihypertensive agents from different classes, with one being a diuretic. Approximately 10% of hypertensive patients have resistant hypertension. Pseudoresistance can occur due to factors like poor medication adherence or white coat effect. Evaluation of resistant hypertension involves assessing for secondary causes, target organ damage, and ensuring true treatment resistance by addressing pseudoresistance factors. Treatment focuses on lifestyle modifications, optimizing medication adherence, addressing secondary causes, and adding additional antihypertensive agents such as mineralocorticoid receptor antagonists.
Heart Failure with Preserved Ejection Fraction(HFpEF).ptx
Heart failure with preserved ejection fraction (HFpEF) is not one disease but a clinical syndrome presenting with symptoms of Heart Failure with a left ventricular ejection fraction (LVEF) ≥50 percent and evidence of cardiac diastolic dysfunction. (abnormal LV filling pattern and elevated filling pressures)
It is more common among older patients and women, and results from abnormalities of active ventricular relaxation and passive ventricular compliance. HFpEF should be part of differential diagnosis in patients with typical symptoms such as fatigue, weakness, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, edema and clinical signs of chronic heart failure. Echocardiography features of normal ejection fraction with impaired diastolic function confirm the diagnosis.
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resistant hypertension -update and management
resistant hypertension is common problem in our clinical practice,
focusing of recent update and management.
Refractory hypertension
The actual prevalence of RH may be lower than what is
perceived in the literature when triple-A (accuracy of BP
measurement, adherence of medications, and adequacy
of anti-HTN medications) are ensured. It is important to
emphasize that the sea of RH starts when the shore of secondary
HTN is over and the island of RfH is still uncharted. RfH is
emerging as a novel phenotype, and growing evidence suggest
that these patients have sympathetic hyperactivity. However,
the role of beta-blockers and interventions such as RDN and
baroreceptor activation techniques is yet to be studied.
Refractory hypertension approach
Resistant hypertension is defined as blood pressure that remains above goal despite treatment with three antihypertensive agents of different classes, one being a diuretic. Refractory hypertension is when blood pressure cannot be controlled despite four or more drugs at maximal doses. Pseudoresistant hypertension occurs when poor control is due to non-adherence or suboptimal treatment rather than true treatment resistance. Evaluation of patients with resistant hypertension includes screening for secondary causes like primary aldosteronism or renal artery stenosis through tests of electrolytes, renal function, and imaging studies. Treatment involves optimizing the current three-drug regimen before adding supplementary drugs like beta blockers or aldosterone antagonists.
Resistant hypertension
This document discusses resistant hypertension and its treatment. It defines resistant hypertension as blood pressure that remains above goal despite use of three antihypertensive agents from different classes including a diuretic. Treatment involves identifying and treating secondary causes, adjusting medications that raise blood pressure, monitoring blood pressure outside the office, making lifestyle changes, and using pharmacologic therapies like diuretics, aldosterone antagonists, and catheter-based renal denervation. While renal denervation showed promise in early trials, the SYMPLICITY HTN-3 trial found it did not significantly reduce blood pressure compared to a sham procedure.
HF update 2021
This document discusses heart failure, including its increasing prevalence globally, definitions, classifications, management, and new strategies. Some key points:
- Heart failure prevalence is increasing worldwide and mortality remains high, around 50% within 5 years of diagnosis.
- The universal definition characterizes heart failure as a clinical syndrome caused by structural or functional cardiac abnormalities, accompanied by typical symptoms and signs.
- Management focuses on guideline-directed medical therapies (GDMT) including ACE inhibitors, ARBs, beta-blockers, and MRAs, though utilization remains suboptimal.
- The PARADIGM-HF trial showed the ARNI drug sacubitril/valsartan reduced cardiovascular death and heart failure
Resistant hypertension
Resistant hypertension is defined as uncontrolled blood pressure despite treatment with three or more antihypertensive medications, including a diuretic. Pseudo-resistant hypertension accounts for around 50% of cases due to issues like inaccurate measurements, poor medication adherence, and inadequate treatment regimens. Ambulatory blood pressure monitoring is important for accurately diagnosing and managing resistant hypertension. Treatment involves optimizing medication regimens with medications like chlorthalidone, spiranolactone, and amiloride-hydrochlorothiazide combinations, and considering interventions for refractory cases involving more than five medications.
RESISTANT HYPERTENSION
Resistant hypertension is defined as blood pressure that remains above goal despite treatment with three antihypertensive agents from different classes, with one being a diuretic. Approximately 10% of hypertensive patients have resistant hypertension. Pseudoresistance can occur due to factors like poor medication adherence or white coat effect. Evaluation of resistant hypertension involves assessing for secondary causes, target organ damage, and ensuring true treatment resistance by addressing pseudoresistance factors. Treatment focuses on lifestyle modifications, optimizing medication adherence, addressing secondary causes, and adding additional antihypertensive agents such as mineralocorticoid receptor antagonists.
Heart Failure with Preserved Ejection Fraction(HFpEF).ptx
Heart failure with preserved ejection fraction (HFpEF) is not one disease but a clinical syndrome presenting with symptoms of Heart Failure with a left ventricular ejection fraction (LVEF) ≥50 percent and evidence of cardiac diastolic dysfunction. (abnormal LV filling pattern and elevated filling pressures)
It is more common among older patients and women, and results from abnormalities of active ventricular relaxation and passive ventricular compliance. HFpEF should be part of differential diagnosis in patients with typical symptoms such as fatigue, weakness, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, edema and clinical signs of chronic heart failure. Echocardiography features of normal ejection fraction with impaired diastolic function confirm the diagnosis.
Pulmonary hypertension
This document summarizes pulmonary hypertension and its management. It discusses the pulmonary circulation and pressures, types and classification of pulmonary hypertension, pathogenesis involving various molecular pathways, clinical diagnosis using echocardiography, right heart catheterization, and treatment goals and strategies. The main treatment approaches discussed are calcium channel blockers, prostanoids, endothelin receptor antagonists, phosphodiesterase inhibitors, and soluble guanylate cyclase stimulators. The goals of treatment are to palliate symptoms, improve exercise tolerance and right ventricular function, and strive to improve survival rates.
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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.
Management strategy in HF with ARNI - Recent updates
- The document discusses management strategies for heart failure with reduced ejection fraction (HFrEF), including recent updates.
- It summarizes key differences between Indian and Western HF patients, noting that Indians develop HF at a younger age and with lower ejection fractions. Prognosis is also worse for Indian patients compared to those in the West.
- Core therapies for HFrEF are discussed, including a paradigm shift with the approval of sacubitril-valsartan which has been shown to reduce cardiovascular death compared to ACE inhibitors or ARBs alone in clinical trials.
2019 ESC guidelines on pulmonary embolism
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Hypertension is the most prevalent CV disorder in the world and according to the WHO, it affects 1.28 billion adults aged 30–79 years worldwide, two-thirds living in low-income and middle-income countries.
In 2019, the global age-standardized average prevalence of hypertension in adults aged 30–79 years was reported to be 34% in men and 32% in women.
At younger ages (<50 years), hypertension is more prevalent in men, whereas a steeper increase of SBP in women from their third decade (and more so following menopause) makes the prevalence of hypertension greater in women in older age categories (>65 years).
Rule of Halves
Half the people with high blood pressure are not known (“rule 1”),
Half of those known are not treated (“rule 2”) and
Half of those treated are not controlled (“rule 3”)'
Definition:
Hypertension is defined based on repeated office SBP values ≥ 140 mmHg and/or DBP ≥ 90 mmHg.
Pulmonary Hypertension Overview 2022.pptx
Pulmonary hypertension is elevated pressures in the pulmonary vascular bed defined as a mean pulmonary artery pressure of ≥20 mmHg. The document discusses the pathophysiology, categorization, risk stratification, diagnosis and treatment of pulmonary hypertension. Risk stratification considers a mPAP ≥25 mmHg, PVR >3 Woods Units and PAWP ≤15 mmHg to determine who warrants treatment. Treatment includes vasodilator therapy targeting the prostacyclin, endothelin, and nitric oxide pathways.
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Cardiorenal Syndrome
Cardiorenal syndrome (CRS) refers to conditions where acute or chronic dysfunction of the heart or kidneys induces dysfunction of the other organ. CRS is classified into 5 subtypes depending on whether cardiac or renal dysfunction occurs first, and whether it is acute or chronic. Type 1 involves acute cardiac dysfunction leading to acute kidney injury. Type 2 involves chronic cardiac dysfunction resulting in worsening chronic kidney disease. Type 3 involves acute kidney injury leading to cardiac issues. Type 4 involves chronic kidney disease contributing to cardiac problems. Type 5 involves systemic conditions affecting both organs. Early diagnosis and treatment tailored to the CRS subtype is important for improving outcomes.
Diuretic resistence
WHAT IS DIURETIC RESISTANCE?How to Tackle Congestion in Heart Failure?Renal handling of sodium and water.Adverse effects of major diuretics.There are two forms diuretic tolerance
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Hepatorenal syndrome
Hepato Renal Syndrome (HRS) is a form of kidney failure that occurs in patients with advanced chronic liver disease. It results from intense renal vasoconstriction caused by interactions between the systemic and portal circulatory systems. HRS has no underlying kidney pathology and typically develops spontaneously or in response to precipitating events like infections, bleeding, or large volume paracentesis. Diagnosis is based on criteria and HRS carries the worst prognosis of all liver disease complications. Treatment involves terlipressin and liver transplantation provides a definitive cure.
HFPEF
This document discusses heart failure with preserved ejection fraction (HFpEF), formerly known as diastolic heart failure. It provides background on HFpEF versus systolic heart failure and explores the pathophysiology and management of HFpEF. Key points include:
1) HFpEF is a distinct clinical syndrome from heart failure with reduced ejection fraction (HFrEF), with normal ejection fraction but evidence of diastolic dysfunction.
2) Impaired systolic function can be detected in HFpEF patients using strain imaging, despite preserved global ejection fraction.
3) The pathophysiology of HFpEF is complex and multifactorial, involving microvascular inflammation, cardiomyocyte stiff
Secondary hypertension by dr Raj kishor
1. Secondary hypertension accounts for 5-20% of hypertension cases and has an identifiable underlying cause. Common causes include renal parenchymal disease, renovascular hypertension, primary aldosteronism, Cushing's syndrome, pheochromocytoma, and coarctation of the aorta.
2. Renal disease is the most common cause of secondary hypertension. Renovascular hypertension, usually caused by atherosclerosis or fibromuscular dysplasia, can lead to renal artery stenosis and impaired renal function.
3. Other hormonal causes include primary aldosteronism, characterized by excessive aldosterone secretion leading to hypokalemia, and Cushing's syndrome, where excess cort
Resistant hypertension
Resistant hypertension is defined as blood pressure that remains above goal despite concurrent use of three antihypertensive agents of different classes, one of which should be a diuretic. It has a prevalence of 0.5-24.7% depending on the population. Causes include nonadherence, lifestyle factors like obesity and sleep apnea, secondary causes like primary aldosteronism and renal artery stenosis, and drug interactions. Evaluation involves assessing medication adherence, lifestyle behaviors, screening for secondary causes with tests like the aldosterone-renin ratio, and imaging of the kidneys and arteries. Management consists of optimizing lifestyle modifications, adjusting medications like adding mineralocorticoid receptor antagonists, and treating any identified
Blood pressure control in diabetes
Hypertension is very common in patients with type 2 diabetes, affecting around half of patients at diagnosis. Strict control of blood pressure, with a target of below 130/80 mmHg, is important for reducing cardiovascular risks in diabetic patients. Several classes of antihypertensive drugs can be used effectively for this purpose, including diuretics, beta-blockers, calcium channel blockers, ACE inhibitors, and angiotensin receptor blockers. Aggressive treatment of hypertension is recommended for diabetic patients, especially those with kidney disease, in order to prevent complications and disease progression.
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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.
newer oral anticoagulents
there are several limitation in VKA,to over come these problem NOACs came in picture but still limited indication for NOACs currently,required further study inter and intra comparison between anticoagulants.
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This case report describes a 17-year-old male college student presenting with occipital headache, blurred vision, and vomiting for two days. His history revealed similar complaints three months prior when he was diagnosed with hypertension but did not take medications regularly. On examination, his blood pressure was elevated at 210/120 mmHg and fundoscopy showed grade 1 hypertensive retinopathy. Investigations showed abnormal renal function and echocardiogram revealed left ventricular hypertrophy. CT brain showed findings suggestive of posterior reversible encephalopathy syndrome. Based on his history of poorly controlled hypertension, family history, examination findings, and investigation results, he was diagnosed with secondary hypertension likely due to chronic kidney disease.
Htn in ckd tarek
This document discusses hypertension in patients with chronic kidney disease. It begins by noting that hypertension and diabetes are leading causes of end-stage renal disease. It then discusses how poorly controlled hypertension can cause or accelerate renal failure. The document provides an overview of diseases attributable to hypertension and outlines the paradigm shift in hypertension therapy to focus on more than just lowering blood pressure. It also discusses lifestyle modifications, target organ damage, left ventricular hypertrophy, dipping patterns, morbidity and mortality related to hypertension, and approaches to hypertension treatment and management.
Jnc8 2014
The panel recommends the following for treatment of hypertension in adults:
- For those aged 60 years and older, treat to a blood pressure goal of less than 150/90 mm Hg.
- For those aged 30-59 years, treat to a blood pressure goal of less than 140/90 mm Hg.
- For those younger than 60 years with diabetes or chronic kidney disease, treat to a blood pressure goal of less than 140/90 mm Hg.
- Initiate treatment with one of four classes of antihypertensive drugs (angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic). The most appropriate first
Guia de manejo de hta adultos 2014
The panel recommends the following for treatment of hypertension in adults:
- For ages 60 years and older, treat to a blood pressure goal of less than 150/90 mm Hg.
- For ages 30-59 years, treat to a blood pressure goal of less than 140/90 mm Hg.
- For those under 30, or ages 60 or older with diabetes or kidney disease, treat to a goal of less than 140/90 mm Hg.
- Initial drug treatment should include a thiazide-type diuretic, calcium channel blocker, angiotensin-converting enzyme inhibitor, or angiotensin receptor blocker.
- For nonblack populations, including those with diabetes, consider a
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Hypertension guidelines comparison.pptx
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.
Management strategy in HF with ARNI - Recent updates
- The document discusses management strategies for heart failure with reduced ejection fraction (HFrEF), including recent updates.
- It summarizes key differences between Indian and Western HF patients, noting that Indians develop HF at a younger age and with lower ejection fractions. Prognosis is also worse for Indian patients compared to those in the West.
- Core therapies for HFrEF are discussed, including a paradigm shift with the approval of sacubitril-valsartan which has been shown to reduce cardiovascular death compared to ACE inhibitors or ARBs alone in clinical trials.
2019 ESC guidelines on pulmonary embolism
The document provides an overview of the updates in the 2019 guidelines for pulmonary embolism (PE) diagnosis and treatment. Key changes include adjusted D-dimer cut-off values based on age and probability; revised algorithms for diagnosing high-risk PE and assessing severity; recommending non-vitamin K antagonist oral anticoagulants as first-line treatment for eligible patients; classifying recurrence risk factors and extending treatment duration indications; and proposing a comprehensive post-PE patient follow-up algorithm. The guidelines aim to improve PE risk stratification, optimize acute care, determine chronic anticoagulation regimens, and ensure long-term management and surveillance for complications.
Updated Hypertension Management – ESH 2023.pdf
Hypertension is the most prevalent CV disorder in the world and according to the WHO, it affects 1.28 billion adults aged 30–79 years worldwide, two-thirds living in low-income and middle-income countries.
In 2019, the global age-standardized average prevalence of hypertension in adults aged 30–79 years was reported to be 34% in men and 32% in women.
At younger ages (<50 years), hypertension is more prevalent in men, whereas a steeper increase of SBP in women from their third decade (and more so following menopause) makes the prevalence of hypertension greater in women in older age categories (>65 years).
Rule of Halves
Half the people with high blood pressure are not known (“rule 1”),
Half of those known are not treated (“rule 2”) and
Half of those treated are not controlled (“rule 3”)'
Definition:
Hypertension is defined based on repeated office SBP values ≥ 140 mmHg and/or DBP ≥ 90 mmHg.
Pulmonary Hypertension Overview 2022.pptx
Pulmonary hypertension is elevated pressures in the pulmonary vascular bed defined as a mean pulmonary artery pressure of ≥20 mmHg. The document discusses the pathophysiology, categorization, risk stratification, diagnosis and treatment of pulmonary hypertension. Risk stratification considers a mPAP ≥25 mmHg, PVR >3 Woods Units and PAWP ≤15 mmHg to determine who warrants treatment. Treatment includes vasodilator therapy targeting the prostacyclin, endothelin, and nitric oxide pathways.
Surviving Sepsis Guidelines Updated
The document summarizes updated guidelines from the 41th Society of Critical Care Medicine Meeting for treating sepsis. Key changes include recommending crystalloids like saline for initial fluid resuscitation; using norepinephrine as the first choice vasopressor; considering corticosteroids for refractory shock; using higher PEEP and recruitment maneuvers for ARDS; and considering procalcitonin to determine if antibiotics can be stopped. The Surviving Sepsis guidelines were previously criticized for being funded primarily by Eli Lilly without disclosure.
Cardiorenal Syndrome
Cardiorenal syndrome (CRS) refers to conditions where acute or chronic dysfunction of the heart or kidneys induces dysfunction of the other organ. CRS is classified into 5 subtypes depending on whether cardiac or renal dysfunction occurs first, and whether it is acute or chronic. Type 1 involves acute cardiac dysfunction leading to acute kidney injury. Type 2 involves chronic cardiac dysfunction resulting in worsening chronic kidney disease. Type 3 involves acute kidney injury leading to cardiac issues. Type 4 involves chronic kidney disease contributing to cardiac problems. Type 5 involves systemic conditions affecting both organs. Early diagnosis and treatment tailored to the CRS subtype is important for improving outcomes.
Diuretic resistence
WHAT IS DIURETIC RESISTANCE?How to Tackle Congestion in Heart Failure?Renal handling of sodium and water.Adverse effects of major diuretics.There are two forms diuretic tolerance
Pathophysiology and mechanisms of loop diuretic resistance.Combination Diuretic Therapy. IV Diuretic .
Isolated ultrafiltration
Hepatorenal syndrome
Hepato Renal Syndrome (HRS) is a form of kidney failure that occurs in patients with advanced chronic liver disease. It results from intense renal vasoconstriction caused by interactions between the systemic and portal circulatory systems. HRS has no underlying kidney pathology and typically develops spontaneously or in response to precipitating events like infections, bleeding, or large volume paracentesis. Diagnosis is based on criteria and HRS carries the worst prognosis of all liver disease complications. Treatment involves terlipressin and liver transplantation provides a definitive cure.
HFPEF
This document discusses heart failure with preserved ejection fraction (HFpEF), formerly known as diastolic heart failure. It provides background on HFpEF versus systolic heart failure and explores the pathophysiology and management of HFpEF. Key points include:
1) HFpEF is a distinct clinical syndrome from heart failure with reduced ejection fraction (HFrEF), with normal ejection fraction but evidence of diastolic dysfunction.
2) Impaired systolic function can be detected in HFpEF patients using strain imaging, despite preserved global ejection fraction.
3) The pathophysiology of HFpEF is complex and multifactorial, involving microvascular inflammation, cardiomyocyte stiff
Secondary hypertension by dr Raj kishor
1. Secondary hypertension accounts for 5-20% of hypertension cases and has an identifiable underlying cause. Common causes include renal parenchymal disease, renovascular hypertension, primary aldosteronism, Cushing's syndrome, pheochromocytoma, and coarctation of the aorta.
2. Renal disease is the most common cause of secondary hypertension. Renovascular hypertension, usually caused by atherosclerosis or fibromuscular dysplasia, can lead to renal artery stenosis and impaired renal function.
3. Other hormonal causes include primary aldosteronism, characterized by excessive aldosterone secretion leading to hypokalemia, and Cushing's syndrome, where excess cort
Resistant hypertension
Resistant hypertension is defined as blood pressure that remains above goal despite concurrent use of three antihypertensive agents of different classes, one of which should be a diuretic. It has a prevalence of 0.5-24.7% depending on the population. Causes include nonadherence, lifestyle factors like obesity and sleep apnea, secondary causes like primary aldosteronism and renal artery stenosis, and drug interactions. Evaluation involves assessing medication adherence, lifestyle behaviors, screening for secondary causes with tests like the aldosterone-renin ratio, and imaging of the kidneys and arteries. Management consists of optimizing lifestyle modifications, adjusting medications like adding mineralocorticoid receptor antagonists, and treating any identified
Blood pressure control in diabetes
Hypertension is very common in patients with type 2 diabetes, affecting around half of patients at diagnosis. Strict control of blood pressure, with a target of below 130/80 mmHg, is important for reducing cardiovascular risks in diabetic patients. Several classes of antihypertensive drugs can be used effectively for this purpose, including diuretics, beta-blockers, calcium channel blockers, ACE inhibitors, and angiotensin receptor blockers. Aggressive treatment of hypertension is recommended for diabetic patients, especially those with kidney disease, in order to prevent complications and disease progression.
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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.
newer oral anticoagulents
there are several limitation in VKA,to over come these problem NOACs came in picture but still limited indication for NOACs currently,required further study inter and intra comparison between anticoagulants.
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This case report describes a 17-year-old male college student presenting with occipital headache, blurred vision, and vomiting for two days. His history revealed similar complaints three months prior when he was diagnosed with hypertension but did not take medications regularly. On examination, his blood pressure was elevated at 210/120 mmHg and fundoscopy showed grade 1 hypertensive retinopathy. Investigations showed abnormal renal function and echocardiogram revealed left ventricular hypertrophy. CT brain showed findings suggestive of posterior reversible encephalopathy syndrome. Based on his history of poorly controlled hypertension, family history, examination findings, and investigation results, he was diagnosed with secondary hypertension likely due to chronic kidney disease.
Htn in ckd tarek
This document discusses hypertension in patients with chronic kidney disease. It begins by noting that hypertension and diabetes are leading causes of end-stage renal disease. It then discusses how poorly controlled hypertension can cause or accelerate renal failure. The document provides an overview of diseases attributable to hypertension and outlines the paradigm shift in hypertension therapy to focus on more than just lowering blood pressure. It also discusses lifestyle modifications, target organ damage, left ventricular hypertrophy, dipping patterns, morbidity and mortality related to hypertension, and approaches to hypertension treatment and management.
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Jnc8 2014
The panel recommends the following for treatment of hypertension in adults:
- For those aged 60 years and older, treat to a blood pressure goal of less than 150/90 mm Hg.
- For those aged 30-59 years, treat to a blood pressure goal of less than 140/90 mm Hg.
- For those younger than 60 years with diabetes or chronic kidney disease, treat to a blood pressure goal of less than 140/90 mm Hg.
- Initiate treatment with one of four classes of antihypertensive drugs (angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic). The most appropriate first
Guia de manejo de hta adultos 2014
The panel recommends the following for treatment of hypertension in adults:
- For ages 60 years and older, treat to a blood pressure goal of less than 150/90 mm Hg.
- For ages 30-59 years, treat to a blood pressure goal of less than 140/90 mm Hg.
- For those under 30, or ages 60 or older with diabetes or kidney disease, treat to a goal of less than 140/90 mm Hg.
- Initial drug treatment should include a thiazide-type diuretic, calcium channel blocker, angiotensin-converting enzyme inhibitor, or angiotensin receptor blocker.
- For nonblack populations, including those with diabetes, consider a
JNC8 2014
The panel recommends the following for treatment of hypertension in adults:
- For those aged 60 years and older, treat to a blood pressure goal of less than 150/90 mm Hg.
- For those aged 30-59 years, treat to a blood pressure goal of less than 140/90 mm Hg.
- For those younger than 60 years with diabetes or chronic kidney disease, treat to a blood pressure goal of less than 140/90 mm Hg.
- Initiate treatment with one of four classes of antihypertensive drugs (angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic).
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Eighth Joint National Committee (JNC 8) - Blood Pressure in Adults
The panel recommends the following for treatment of hypertension in adults:
- For patients aged 60 years and older, treat to a blood pressure goal of less than 150/90 mm Hg.
- For patients aged 30-59 years, treat to a blood pressure goal of less than 140/90 mm Hg.
- For nonblack patients, including those with diabetes, initially treat with a thiazide-type diuretic, calcium channel blocker, angiotensin-converting enzyme inhibitor, or angiotensin receptor blocker.
- For black patients, including those with diabetes, initially treat with a calcium channel blocker or thiazide-type diuretic.
Jnc 8 guidelines for management of high blood pressure: Lets compare with JNC 7
This guideline from the Eighth Joint National Committee provides evidence-based recommendations for the management of high blood pressure in adults. There is strong evidence that treating hypertensive patients aged 60 years or older to a blood pressure goal of less than 150/90 mm Hg and those aged 30-59 years to a goal of less than 90 mm Hg improves health outcomes. For hypertensive patients under age 60, a goal of less than 140/90 mm Hg is recommended based on expert opinion due to insufficient evidence for specific systolic and diastolic goals. The guideline also recommends initiating drug treatment for hypertension with certain classes of medications, such as angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium
JNC8 - HTA Guideline Dic 18, 2013
The panel recommends the following based on its systematic review of evidence:
1) For most adults aged 60 years or older, treat SBP to a goal of less than 150 mm Hg and DBP to a goal of less than 90 mm Hg.
2) For nonblack adults younger than 60 years, treat SBP to a goal of less than 140 mm Hg and DBP to a goal of less than 90 mm Hg.
3) Initial drug treatment should include thiazide-type diuretics, calcium channel blockers, ACE inhibitors, or ARBs.
Jnc viii
This document summarizes guidelines from the Eighth Joint National Committee for the management of high blood pressure in adults. It recommends treating hypertensive persons aged 60 or older to a blood pressure goal of less than 150/90 mm Hg, and those aged 30-59 to a diastolic goal of less than 90 mm Hg. For those under 60, the recommended goal is less than 140/90 mm Hg based on expert opinion. The same thresholds and goals are recommended for hypertensive adults with diabetes or chronic kidney disease. The guidelines recommend initial drug treatment for nonblack populations with ACE inhibitors, ARBs, calcium channel blockers, or thiazide diuretics. For black populations, calcium channel blockers or th
Effects of candesartan and propranolol combination therapy versus propranolol...
Effects of candesartan and propranolol combination therapy versus propranolol...Arely Valdes Olivares
Efectos de ARA II vs Beta Bloqueador en el tratamiento de la hipertensión portal. Monoterapia ARA II vs Bloqueador Beta. Current management of hypertension DR. ANKIT JAIN AIIMS
This document summarizes current management of hypertension. It begins by stating the high worldwide prevalence of hypertension and its attributable risk for death. It then discusses definitions and classifications of hypertension according to guidelines. Target blood pressure goals for optimal management are outlined, along with evaluating for target organ damage. The importance of lifestyle modifications and pharmacological therapy to reduce cardiovascular events is emphasized.
Current management of hypertension new
This document summarizes current management of hypertension. It begins by stating the high worldwide prevalence of hypertension and its attributable risk for death. It then discusses definitions and classifications of hypertension according to guidelines. Target blood pressure goals for optimal management are outlined, along with evaluating for target organ damage. The importance of lifestyle modifications and pharmacological therapy to reduce cardiovascular events is emphasized.
THE IMPORTANCE OF 24-HOUR BP CONTROL FOR MANAGING CV RISK by dr hendro
THE IMPORTANCE OF 24-HOUR BP CONTROL FOR MANAGING CV RISK
dr. Hendro
PIT VII IDI Kota Bogor, 1-2 November 2014
Jnc8
The document is a summary of evidence-based guidelines for managing high blood pressure in adults. It recommends:
1) Treating hypertensive persons aged 60 or older to a blood pressure goal of less than 150/90 mm Hg, and those aged 30-59 to less than 140/90 mm Hg.
2) Initiating drug treatment for nonblack populations with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, or thiazide-type diuretics. For black populations, recommend calcium channel blockers or thiazide-type diuretics.
3) Treating hypertensive adults with diabetes or chronic kidney disease to
Jnc 8 jama dic 2013
This document provides guidelines for the management of high blood pressure in adults based on a rigorous review of evidence from randomized controlled trials. Some of the key recommendations include:
1) For adults aged 60 years or older, the panel recommends initiating antihypertensive drug treatment when systolic blood pressure is 150 mmHg or higher or diastolic blood pressure is 90 mmHg or higher.
2) For adults aged 30-59 years, the panel recommends initiating antihypertensive drug treatment when systolic blood pressure is 140 mmHg or higher or diastolic blood pressure is 90 mmHg or higher.
3) For all adults, including those with diabetes, the panel recommends a blood pressure treatment goal of
ManejoJnc 8
This document provides guidelines for the management of high blood pressure in adults based on a rigorous review of evidence from randomized controlled trials. Some of the key recommendations include:
1) For adults aged 60 years or older, the guideline recommends initiating antihypertensive drug treatment when systolic blood pressure is 150 mmHg or higher or diastolic blood pressure is 90 mmHg or higher.
2) For adults aged 30-59 years, the guideline recommends initiating antihypertensive drug treatment when systolic blood pressure is 140 mmHg or higher or diastolic blood pressure is 90 mmHg or higher.
3) The guideline recommends treating hypertension in adults aged 18-29 based on an overall systolic blood
HTA JNC 8
This document summarizes guidelines from the Eighth Joint National Committee for the management of high blood pressure in adults. It provides evidence-based recommendations for treatment thresholds, goals, and medications. Treatment is recommended to reduce blood pressure below 150/90 mmHg for those aged 60+ and below 140/90 mmHg for others based on evidence from randomized controlled trials. Initial drug treatment should include an ACE inhibitor, ARB, calcium channel blocker, or thiazide diuretic depending on patient characteristics. Lifestyle modifications and medication are important to reduce hypertension and lower risks of health problems like heart attack, stroke, and death.
Ekg
This study assessed the relationship between electrocardiographic (ECG) left ventricular hypertrophy (LVH) and blood pressure (BP) control in 17,312 hypertensive patients from China. 1) 8.1% of patients had ECG-LVH, which was more prevalent in males. 2) Patients with ECG-LVH had a significantly higher rate of unsatisfactory BP control, with an odds ratio of 1.42, compared to those without ECG-LVH. 3) Notable differences in BP control were also seen between males and females and in patients with diabetes, with ECG-LVH patients having poorer control.
Hypertension update 2018
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.
Sprint 2015 nejm
The SPRINT study compared an intensive blood pressure treatment target of less than 120 mm Hg to a standard target of less than 140 mm Hg in 9,361 patients at high risk for cardiovascular events but without diabetes. At 1 year, the mean systolic blood pressure was 121.4 mm Hg in the intensive group and 136.2 mm Hg in the standard group. After a median follow up of 3.26 years, the primary composite outcome of heart attack, acute coronary syndrome, stroke, heart failure or cardiovascular death occurred less frequently in the intensive group compared to the standard group. All-cause mortality was also lower in the intensive group, though rates of some adverse events were higher.
VIII reporte hipertension
This document summarizes the recommendations from an expert panel on the management of high blood pressure in adults. Key recommendations include:
1) Treating all adults aged 60 or older to a blood pressure under 150/90 mm Hg and those aged 30-59 to under 140/90 mm Hg.
2) Initial drug treatment for most nonblack adults should include a thiazide diuretic, calcium channel blocker, angiotensin-converting enzyme inhibitor, or angiotensin receptor blocker. For black adults, initial treatment is a calcium channel blocker or thiazide diuretic.
3) Treatment goals are the same for adults with diabetes or nondiabetic kidney disease as the
The new england journal of medicinen engl j med 373;22 .docx
The new england
journal of medicine
n engl j med 373;22 nejm.org November 26, 2015 2103
established in 1812 November 26, 2015 vol. 373 no. 22
The members of the writing committee
( Jackson T. Wright, Jr., M.D., Ph.D., Jeff
D. Williamson, M.D., M.H.S., Paul K.
Whelton, M.D., Joni K. Snyder, R.N.,
B.S.N., M.A., Kaycee M. Sink, M.D.,
M.A.S., Michael V. Rocco, M.D., M.S.C.E.,
David M. Reboussin, Ph.D., Mahboob
Rahman, M.D., Suzanne Oparil, M.D.,
Cora E. Lewis, M.D., M.S.P.H., Paul L.
Kimmel, M.D., Karen C. Johnson, M.D.,
M.P.H., David C. Goff, Jr., M.D., Ph.D.,
Lawrence J. Fine, M.D., Dr.P.H., Jeffrey A.
Cutler, M.D., M.P.H., William C. Cush
man, M.D., Alfred K. Cheung, M.D., and
Walter T. Ambrosius, Ph.D.) assume re
sponsibility for the overall content and
integrity of the article. The affiliations of
the members of the writing group are
listed in the Appendix. Address reprint
requests to Dr. Wright at the Division of
Nephrology and Hypertension, Univer
sity Hospitals Case Medical Center, Case
Western Reserve University, 1100 Euclid
Ave. Cleveland, OH 441066053, or at
jackson . [email protected] case . edu.
* A complete list of the members of the
Systolic Blood Pressure Intervention
Trial (SPRINT) Research Group is pro
vided in the Supplementary Appendix,
available at NEJM.org.
This article was published on November 9,
2015, at NEJM.org.
N Engl J Med 2015;373:2103-16.
DOI: 10.1056/NEJMoa1511939
Copyright © 2015 Massachusetts Medical Society.
BACKGROUND
The most appropriate targets for systolic blood pressure to reduce cardiovascular
morbidity and mortality among persons without diabetes remain uncertain.
METHODS
We randomly assigned 9361 persons with a systolic blood pressure of 130 mm Hg
or higher and an increased cardiovascular risk, but without diabetes, to a systolic
blood-pressure target of less than 120 mm Hg (intensive treatment) or a target of
less than 140 mm Hg (standard treatment). The primary composite outcome was
myocardial infarction, other acute coronary syndromes, stroke, heart failure, or
death from cardiovascular causes.
RESULTS
At 1 year, the mean systolic blood pressure was 121.4 mm Hg in the intensive-
treatment group and 136.2 mm Hg in the standard-treatment group. The interven-
tion was stopped early after a median follow-up of 3.26 years owing to a signifi-
cantly lower rate of the primary composite outcome in the intensive-treatment
group than in the standard-treatment group (1.65% per year vs. 2.19% per year;
hazard ratio with intensive treatment, 0.75; 95% confidence interval [CI], 0.64 to
0.89; P<0.001). All-cause mortality was also significantly lower in the intensive-
treatment group (hazard ratio, 0.73; 95% CI, 0.60 to 0.90; P = 0.003). Rates of seri-
ous adverse events of hypotension, syncope, electrolyte abnormalities, and acute
kidney injury or failure, but not of injurious falls, were higher in the intensive-
treatment group than in the standard-treatment gro ...
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Eighth Joint National Committee (JNC 8) - Blood Pressure in Adults
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Jnc 8 guidelines for management of high blood pressure: Lets compare with JNC 7
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Resistant Hypertension
- 1. Resistant Hypertension Ade Wijaya, MD June 2018
- 2. Outline Introduction Definition Epidemiology Pathogenesis Diagnosis Management (lifestyle modification, secondary etiology, drugs, device therapy) Algorhytm Summary
- 3. Introduction Resistant hypertension is an uncontrolled hypertension with 3 or more antihypertensive agents Increasingly common in clinical practice Look for secondary etiology Vongpatanasin W. Resistant hypertension: a review of diagnosis and management. Jama. 2014 Jun 4;311(21):2216-24.
- 4. Definition JNC 7 The inability to achieve a blood pressure lower than 140/90 mm Hg despite optimal doses of 3 or more antihypertensive drugs, including 1 diuretic AHA 2008 uncontrolled hypertension despite treatment with at least 3 antihypertensive drugs or controlled hypertension with at least 4 drugs Chobanian AV, Bakris GL, Black HR, et al; National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.JAMA. 2003;289(19): 2560-2572. Calhoun DA, Jones D, Textor S, et al; American Heart Association Professional Education Committee. Resistant hypertension: diagnosis, evaluation, and treatment. Circulation. 2008;117 (25):e510-e526.
- 5. Epidemiology Prevalence: 1. USA 28 % of hypertension patients 2. NHNES 13 % of hypertension patients (JNC 7 criteria) 21 % of hypertension patients (AHA 2008 criteria) Egan BM, Zhao Y, Axon RN, Brzezinski WA, Ferdinand KC. Uncontrolled and apparent treatment resistant hypertension in the United States, 1988 to 2008. Circulation. 2011;124(9): 1046-1058. Sarafidis PA, Georgianos P, Bakris GL. Resistant hypertension—its identification and epidemiology. Nat Rev Nephrol. 2013;9(1):51-58
- 6. Pathogenesis Multifactorial Risk factors: older age, obesity, impaired renal function, and diabetes mellitus Elevated systemic vascular resistance and expanded plasma volume in the presence of normal cardiac output Minor elevation in the circulating aldosterone levels and suppression of plasma renin activity Vongpatanasin W. Resistant hypertension: a review of diagnosis and management. Jama. 2014 Jun 4;311(21):2216-24.
- 7. Diagnosis Exclude medication nonadherence and the white coat syndrome Medication nonadherence; prevalence: 50-60 % White coat syndrome: - Isolated elevation of office blood pressure despite normal home blood pressure or 24-hour ambulatory blood pressure - Prevalence: 30 % of resistant hypertension - 20-25 % of white coat syndrome resistant hypertension - White coat syndrome: lower CV risk than resistant hypertension but higher than general population Vongpatanasin W. Resistant hypertension: a review of diagnosis and management. Jama. 2014 Jun 4;311(21):2216-24.
- 8. Management Lifestyle modification Identify and treat secondary etiology Drugs Device therapy Vongpatanasin W. Resistant hypertension: a review of diagnosis and management. Jama. 2014 Jun 4;311(21):2216-24.
- 9. Lifestyle Modification Sodium restriction to 1,1 g / day reduce 9-23 mmHg 30 mins of aerobic exercise 3 times weekly for 8-12 weeks reduce 3-6 mmHg Pimenta E, Gaddam KK, Oparil S, et al. Effects of dietary sodium reduction on blood pressure in subjects with resistant hypertension. Hypertension. 2009;54(3):475-481. Dimeo F, Pagonas N, Seibert F, Arndt R, Zidek W, Westhoff TH. Aerobic exercise reduces blood pressure in resistant hypertension. Hypertension. 2012;60(3):653-658
- 10. Secondary Hypertension Vongpatanasin W. Resistant hypertension: a review of diagnosis and management. Jama. 2014 Jun 4;311(21):2216-24.
- 11. Drugs Vongpatanasin W. Resistant hypertension: a review of diagnosis and management. Jama. 2014 Jun 4;311(21):2216-24.
- 12. Drugs Vongpatanasin W. Resistant hypertension: a review of diagnosis and management. Jama. 2014 Jun 4;311(21):2216-24.
- 13. Drugs Vongpatanasin W. Resistant hypertension: a review of diagnosis and management. Jama. 2014 Jun 4;311(21):2216-24.
- 14. Device Therapy Carotid sinus surgically implanted device Catheter-based renal sympathetic denervation Kontak AC, Wang Z, Arbique D, et al. Reversible sympathetic overactivity in hypertensive patients with primary aldosteronism.J Clin Endocrinol Metab. 2010;95(10):4756-4761. Bisognano JD, Bakris G, Nadim MK, et al. Baroreflex activation therapy lowers blood pressure in patients with resistant hypertension: results from the double-blind, randomized, placebo-controlled rheos pivotal trial. J Am Coll Cardiol. 2011;58(7):765- 773. Esler MD, Krum H, Sobotka PA, Schlaich MP, Schmieder RE, Böhm M; SYMPLICITY HTN-2 Investigators. Renal sympathetic denervation in patients with treatment-resistant hypertension (the SYMPLICITY HTN-2 Trial): a randomised controlled trial. Lancet. 2010;376(9756):1903-1909.
- 15. Algorhytm Vongpatanasin W. Resistant hypertension: a review of diagnosis and management. Jama. 2014 Jun 4;311(21):2216-24.
- 16. Summary Treatment is challenging Selection of additional blood pressure–lowering agents should be based not only on the antihypertensive efficacy but also on the incremental cost, the drugs’ adverse effects, and their potential cardiovascular benefits. Optimization of antihypertensive regimen should be performed prior to extensive investigation for secondary hypertension.