Algorithm in Hypertension-pdui
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ALGORITHM IN HYPERTENSION
LUSIANI , MD
CARDIOVASCULAR DIVISION, INTERNAL MEDICINE DEPARTMENT
FACULTY OF MEDICINE, UNIVERSITY OF INDONESIA
PIT PDUI
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Guidelines for Hypertension
NICEESH
ASH/ISHJNC 7, JNC 8
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NICE Guideline 2011
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Care pathway
CBPM ≥160/100 mmHg & ABPM/HBPM ≥ 150/95 mmHg
Stage 2 hypertension
Consider specialist referral
Offer antihypertensive drug treatment
Offer lifestyle interventions
If younger than 40 years
If target organ damage present or 10-year cardiovascular risk > 20%
Offer annual review of care to monitor blood pressure, provide support and discuss lifestyle, symptoms and medication
Offer patient education and interventions to support adherence to treatment
CBPM ≥140/90 mmHg & ABPM/HBPM ≥ 135/85 mmHg
Stage 1 hypertension
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Heartscore.org
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Step 4
Summary of antihypertensive drug treatment
Aged over 55 years or black person of African or Caribbean family origin of any age
Aged under
55 years
C2A
A + C2
A + C + D
Resistant hypertension
A + C + D + consider further diuretic3, 4 or alpha- or
beta-blocker5
Consider seeking expert advice
Step 1
Step 2
Step 3
KeyA – ACE inhibitor or low-cost angiotensin II receptor blocker (ARB)1 C – Calcium-channel blocker (CCB) D – Thiazide-like diuretic
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10
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European Society of Hypertension (ESH) 2013
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2013 ESH/ESC Guidelines for the management of arterial hypertension. Journal of Hypertension 2013, 31:1281–1357
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CV Risk Stratification
2013 ESH/ESC Guidelines for the management of arterial hypertension
2013 ESH/ESC Guidelines for the management of arterial hypertension. Journal of Hypertension 2013, 31:1281–1357
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2013 ESH/ESC
Guidelines for the
management of
arterial hypertensi
on
2013 ESH/ESC Guidelines for
the management
of arterial hypertension.
Journal of Hypertension
2013, 31:1281–1357
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2013 ESH/ESC Guidelines for the management of arterial hypertension. Journal of Hypertension 2013, 31:1281–1357
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2013 ESH/ESC Guidelines for the management of arterial hypertension. Journal of Hypertension 2013, 31:1281–1357
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2013 ESH/ESC Guidelines for the management of arterial hypertension. Journal of Hypertension 2013, 31:1281–1357
Monotherapy vs Combination
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Recommendations
SBP goal for “most”•Patients at low–moderate CV risk•Patients with diabetes•Consider with previous stroke or TIA•Consider with CHD•Consider with diabetic or non-diabetic CKD
<140 mmHg
SBP goal for elderly•Ages <80 years•Initial SBP ≥160 mmHg
140-150 mmHg
SBP goal for fit elderlyAged <80 years
<140 mmHg
SBP goal for elderly >80 years with SBP•≥160 mmHg
140-150 mmHg
DBP goal for “most” <90 mmHg
DB goal for patients with diabetes <85 mmHg
Blood pressure goals in hypertensive patients
2013 ESH/ESC Guidelines for the management of arterial hypertension. Journal of Hypertension 2013, 31:1281–1357
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2013 ESH/ESC Guidelines for
the management
of arterial hypertension.
Journal of Hypertension
2013, 31:1281–1357
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2013 ESH/ESC Guidelines for
the management
of arterial hypertension.
Journal of Hypertension
2013, 31:1281–1357
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ASH / ISH 2013
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Michael A. Weber, MD et al. Clinical Practice Guidelines for the Management of Hypertension in the CommunityA Statement by the American Society of Hypertension and the International Society of Hypertension. The Journal of Clinical Hypertension
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Michael A. Weber, MD et al. Clinical Practice Guidelines for the Management of Hypertension in the CommunityA Statement by the American Society of Hypertension and the International Society of Hypertension. The Journal of Clinical Hypertension
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Michael A. Weber, MD et al. Clinical Practice Guidelines for the Management of Hypertension in the CommunityA Statement by the American Society of Hypertension and the International Society of Hypertension. The Journal
of Clinical Hypertension
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Michael A. Weber, MD et al. Clinical Practice Guidelines for the Management of Hypertension in the CommunityA
Statement by the American Society of Hypertension and the International Society
of Hypertension. The Journal of Clinical Hypertension
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JNC 8 2013
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Paul A. James, MD; Suzanne Oparil, MD; et al.2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults, Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). jama.2013.284427
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Paul A. James, MD; Suzanne Oparil, MD; et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults, Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). jama.2013.284427
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Paul A. James, MD; Suzanne Oparil, MD; et al.2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults, Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). jama.2013.284427
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Prehypertension (SBP 120-139 mm Hg or DBP 80-89 mm Hg)
Not at Goal BP (<140/90 mm Hg, or <130/80 mm Hg for patients with diabetes or chronic kidney disease)
With Compelling Indications
Prehypertension
Stage 1 Hypertension (SBP 140-159 or DBP 90-99 mm Hg)
Thiazide-type diuretics for most; may consider ACEI, ARB, BB, CCB, or combination.
Stage 2 Hypertension (SBP 160 or DBP 100 mm Hg)
2-drug combinations for most(usually thiazide-type diuretics andACEI, or ARB, or BB, or CCB).
Drug(s) for compelling indications
Other antihypertensive drugs (diuretic, ACEI, ARB, BB, CCB)as needed.
LIFESTYLE MODIFICATIONS
If not at goal BP, optimize dosages or add additional drugs until goal BP is achieved. Consider consultation with hypertension specialist.
Without Compelling Indications
JNC 7
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Which guidelines should we use?
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JNC VII vs JNC VIII
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THANK YOU