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HYPERTENSION

What is high blood pressure


(hypertension)?
Hypertension is a blood pressure that is
more than 140/90 mmHg. Hypertension
can also be:
Just a high systolic pressure
Just a high diastolic pressure
Or both

Classification of blood
pressure levels of the British
Hypertension
Society
Category
Systolic blood pressure
Diastolic blood pressure
(mmHg)

Normal
High-normal

<130
130139

Hypertension
Grade 1 (mild)
140159
Grade 2 (moderate) 160179
Grade 3 (severe)
180

(mmHg)

<85
8589
9099
100109
110

Brit Med J 2004 328:634-40.

Type of Hypertension:
Primary hypertension
95% of all cases
Secondary hypertension
5% of all cases
Chronic renal disease most common

Sign and Symptoms


Generally asymptomatic
undetected for many years
headache, BP elevated systolic
beyond 200 mmHg or BP rising rapidly
Chest pain
Breathlessness
Nausea, vomiting
Anxiety, coma

Target Organs Damage


Heart
Left ventricular hypertrophy
Angina or prior myocardial infarction
Prior coronary revascularization
Heart failure
Brain
Stroke or transient ischemic attack
Chronic kidney disease
Peripheral arterial disease
Retinopathy

Treatment
Overview
Goals of therapy
Lifestyle modification
Pharmacologic treatment
Classification and management of BP for adults
Followup and monitoring

Treatment of Hypertension

Diuretic
ACE-Inh
ARB
Beta blocker
Alpha blocker
Direct renin inhibitor

Management of Hypertension
by Blood Pressure
Initial Drug Therapy
Classification
BP Classification
Normal
<120/80 mm Hg

Lifestyle
Modification

Without Compelling
Indication

With Compelling
Indication

Encourage

Prehypertension
120-139/80-89 mm Hg

Yes

Stage 1 hypertension
140-159/90-99 mm Hg

Yes

Thiazide-type diuretics
for most; may consider
ACE-I, ARB, BB, CCB, or
combination

Drug(s) for the compelling


indications; other
antihypertensive drugs
(diuretics, ACE-I, ARB, BB,
CCB) as needed

Stage 2 hypertension
160/100 mm Hg

Yes

2-drug combination for most


(usually thiazide-type diuretic
and ACE-I, ARB, BB, or
CCB)

Drug(s) for the compelling


indications; other
antihypertensive drugs
(diuretics, ACE-I, ARB,
BB, CCB) as needed

No drug indicated

Drug(s) for the


compelling indications

ACE-I = angiotensin-converting enzyme inhibitor; ARB = angiotensin-receptor blocker; BB = beta


blocker; CCB = calcium channel blocker.
.

Lifestyle Recommendations
for Hypertension: Physical
Activity
Should be prescribed to reduce blood pressure
F

Frequency

- Four or five times per week

Intensity

- Moderate

Time

- 45-60 minutes

Type

Dynamic exercise
- Walking
- Cycling
- Non-competitive swimming

For patients who are prescribed pharmacological therapy: Exercise should be prescribed as adjunctive therapy

Goals of Therapy
Reduce CVD and renal morbidity and mortality.
Treat to BP <140/90 mmHg or BP <130/80 mmHg in patients
with diabetes or chronic kidney disease.
Achieve SBP goal especially in persons >50 years of age.

BP TARGETS:
WITHOUT COMPLICATION : <140/80 mmHg
DIABETES

: < 130/80 mmHg

CKD

: < 130/80 mmHg

PROTEINURIA > 1 g/d

: <125/75 mmHg

Lifestyle Modification
Modification
Weight reduction
Dietary sodium
reduction
Physical activity
Moderation of
alcoholconsumption

Approximate SBP
reduction (range)
520 mmHg/10 kg weight loss
28 mmHg
49 mmHg
24 mmHg