HYPERTENSION

CELESTIAL ANN B. MADRIAGA, MD

HYPERTENSION o Notes: for Dr. Monakil, BP should be

• One of the most common worldwide diseases checked in all extremities
afflicting humans • Based on 2 or more readings on separate
• Major risk factors for: stroke, MI, vascular occasions
disease, CKD o Notes: usually 1-2 weeks apart
• Magic number: • When a patient’s systolic and diastolic
o SBP 140 or higher pressures fall into different categories, the
o DBP 90 or higher higher one should apply
o Notes: 130/90 is already HPN • Notes: good history is needed to elicit
• 2 types: hypertension. Kahit 120/80 ang BP, pwede
o Primary – environmental or genetic siyang hypertensive pero controlled lang. Ask
causes the usual and highest BP.
o Secondary – multiple etiologies:
renal, vascular, endocrine causes MAJOR CARDIOVASCULAR DISEASE (CVD) RISK
FACTORS
EPIDEMIOLOGY • Hypertension
• Affects approximately 50 million individuals in • Obesity (BMI >30 kg/m2)
the U.S. and approximately 1 billion • Dyslipidemia
individuals worldwide • Diabetes mellitus
• In the Philippines: • Cigarette smoking
o 16% (7 million) Filipino adults ≥ 20 y/o • Physical inactivity
in 2003 • Microalbuminemia (est GFR <60 ml/min)
o 21% (10 million) Filipino adults ≥ 20 • Age (>55 for men, >65 for women)
y/o in 2008 • Family history of premature CVD (men aged
<55, women age <65)
HOW TO TAKE THE BLOOD PRESSURE?
• Should be in a quiet and relaxed environment ASSESS FOR IDENTIFIABLE CAUSES OF
• Patients seated comfortably (not slouching) HYPERTENSION
for at least 5 mins in a chair with feet flat on • Sleep apnea
the floor, their back supported, and their arm • Drug-induced/related
supported at heart level • Chronic kidney disease, renovascular disease
• Taken on the bare upper arm with an • Primary aldosteronism
appropriate-sized cuff whose bladder • Coarctation of the aorta
encircles at least 80% of mid-upper arm • Cushing’s syndrome or steroid therapy
circumference
• Pheochromocytoma
o Notes: not a problem with adults, more
• Thyroid/parathyroid disease
on pedia
• Patient should avoid caffeine, cigarettes,
TARGET ORGAN DAMAGE
physical activity for at least 30 mins prior to
• Heart
measurement
o LVH, angina or prior MI, prior
• Patients should be asked to empty the
coronary revascularization, heart
bladder, for BP rises with the urge to urinate
failure
prior to taking the blood pressure
• Brain
• 2-3 measurements taken and the average
o Stroke or TIA
recorded
• Chronic kidney disease
• At 1st visit, BP measured in both arms, and the
• Peripheral arterial disease
arm with the higher BP be used for
• Retinopathy
subsequent measurements
1
ROUTINE TESTS • Serum creatinine
• Notes: if kaya ng patient, all must be done • Estimayed creatinine clearance (Cockroft-
• Fasting plasma glucose Gault formula) or glomerular filtration rate
• Serum total cholesterol (MDRD formula)
• Serum LDL-cholesterol • Hemoglobin and hematocrit
• Serum HDL-cholesterol • Urinalysis (complemented by
• Fasting serum triglycerides microalbuminuria dipstick test and
• Serum potassium microscopic examination)
• Serum uric acid • Electrocardiogram

ANTIHYPERTENSIVE MEDICATIONS

LIFESTYLE CHANGES
• Purpose
o To lower BP, to control other risk factors
o To reduce number or the doses of antihypertensive drugs
• For ALL hypertensive patients
• Those with high normal BP & additional risk factors to reduce risk of developing hypertension
• Include
o Smoking cessation
o Weight reduction (and weight stabilization) – notes: Asia Pacific criteria
o Reduction of excessive alcohol intake
o Physical exercise
§ In general, advise adults to engage in aerobic physical activity to lower BP:

2
 • 3-4 sessions per week, lasting on average 40 minute per session involving moderate-
to-vigorous intensity physical activity (e.g. brisk walking)
• Notes: walking up an inclined plane is already moderate
o Reduction of salt intake
§ Consume no more than 2,400 mg of sodium per day and that a further reduction of sodium
intake to 1,500 mg can result in even greater reduction in BP. Even without achieving these
goals, reducing sodium intake by at least 1,000 mg per day lowers blood pressure.
§ Notes: 1 pinch a day, matabang talaga
o Increase in fruit and vegetable intake and decrease in saturated and total fat intake
§ Consume a dietary pattern that emphasizes intake of vegetables, fruits, and whole grains:
includes low-fat dairy products, poultry, fish, legumes, non-tropical vegetable oils and nuts;
and limits intake of sweets, sugar-sweetened beverages and red meats

ADDITIONAL NOTES
o Set BP goals and start medications. Ex: pwede sabay
o 3 strategies o Keep a record of their blood pressure – tell
1. Increase the dose patient to record everyday
Ex: Amlodipine 5 mg à increase to 10 mg o Home recording > office readings
before starting 2nd line meds o Lifestyle changes should never be omitted!
2. Add another drug o Let’s treat the patient, not the sickness.
Ex: Amlodipine 5 mg à start with o Educate both the patient and the family.
Losartan
3. All of the above

JNC 8 HPN MANAGEMENT ALGORITHM

3
4
Read at your own risk.
Just keep swimming J