Classification of blood pressure for adults Category Blood Pressure (mmHg) Systolic Diastolic...
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Transcript of Classification of blood pressure for adults Category Blood Pressure (mmHg) Systolic Diastolic...
Classification of blood pressure for adults
CategoryCategory
Blood Pressure (mmHg)Blood Pressure (mmHg)
SystolicSystolic DiastolicDiastolic
OptimalOptimalNormalNormalHigh-normalHigh-normalHypertensionHypertension Stage 1Stage 1 Stage 2Stage 2 Stage 3Stage 3
<120<120<130<130130-139130-139
140-159140-159160-179160-179>180>180
<80<80<85<8585-8985-89
90-9990-99100-109100-109>110>110
Classification of hypertension
AdolescentsAdolescents (13-15)(13-15) SystolicSystolic DiastolicDiastolicAdolescentsAdolescents (16-18)(16-18) SystolicSystolic DiastolicDiastolicAdults (>18)Adults (>18) SystolicSystolic DiastolicDiastolic
MildMild(stage 1)(stage 1) mmHgmmHg
135-139135-13985-8985-89
140-149140-14990-9490-94
140-149140-14990-9990-99
140-149140-14990-9490-94
150-159150-15995-9995-99
160-179160-179100-109100-109
150-159150-15995-9995-99
160-179160-179100-109100-109
180-209180-209110-119110-119
>160>160>110>110
>180>180>110>110
>210>210>120>120
ModerateModerate(stage 2)(stage 2) mmHgmmHg
SevereSevere(stage 3)(stage 3) mmHgmmHg
Very SevereVery Severe (stage 3)(stage 3) mmHgmmHg
HYPERTENSIONHYPERTENSION
Severe or refractory HTNSevere or refractory HTN Acute rising BP in well-controlled HTNAcute rising BP in well-controlled HTN Age of onset <20 or >70 years-oldAge of onset <20 or >70 years-old Acute rising Cr,especially with ACE-IAcute rising Cr,especially with ACE-I Diffuse atherosclerosisDiffuse atherosclerosis Asymmetric kidneysAsymmetric kidneys Abdominal bruitAbdominal bruit No family history of HTNNo family history of HTN
NONO
Essential Essential HTNHTN
Severity of blood pressure levelsSeverity of blood pressure levels
Between 140/90 to 160/105 mmHgBetween 140/90 to 160/105 mmHg >160/105 mmHg>160/105 mmHg
Check for target organ damage:Check for target organ damage:Heart, cardiac risk factors,LVHHeart, cardiac risk factors,LVH Retinopathy greater than grade IIRetinopathy greater than grade II Renal insufficiency:proteinuriaRenal insufficiency:proteinuriaH/O TIA, strokeH/O TIA, stroke
No Aerobic Exercise • • Antihypertensive drugsAntihypertensive drugs• • Treat complicationsTreat complications
Yes
YesYes
Secondary HTNSecondary HTNPrimary renalPrimary renal deseasedeseaseOral contracept.Oral contracept. Pheo.Pheo. Hyperaldost.Hyperaldost.CushingCushing HyperthyroidismHyperthyroidism Sleep ApneaSleep Apnea Ao CoarctationAo Coarctation
Treat by medicine or surgery
Increase IntravascularIncrease Intravascular blood volumeblood volume • • obesityobesity • • diet intakediet intake
Increase IntravascularIncrease Intravascular blood volumeblood volume • • obesityobesity • • diet intakediet intake
Increase inIncrease in• • heart rateheart rate• • contrctilitycontrctility
Increase inIncrease in• • heart rateheart rate• • contrctilitycontrctility
Increased Increased Adrenergic activityAdrenergic activity• • HyperinsulinemiaHyperinsulinemia• • Insulin resistenceInsulin resistence
Increased Increased Adrenergic activityAdrenergic activity• • HyperinsulinemiaHyperinsulinemia• • Insulin resistenceInsulin resistence
Increase Increase cardiac outputcardiac output
Increase Increase cardiac outputcardiac output
Neuro-humoral SystemNeuro-humoral System• • RASRAS• • Atrial reflexesAtrial reflexes• • VasopressinVasopressin• • ANPANP• • Endothelial factorsEndothelial factors
Neuro-humoral SystemNeuro-humoral System• • RASRAS• • Atrial reflexesAtrial reflexes• • VasopressinVasopressin• • ANPANP• • Endothelial factorsEndothelial factors
ResetResetBaroceptorBaroceptor
ResetResetBaroceptorBaroceptor
Increase smooth muscle Increase smooth muscle tone and vascular tone and vascular
resistence resistence
Increase smooth muscle Increase smooth muscle tone and vascular tone and vascular
resistence resistence
Target organ damage:Target organ damage:Brain - Cardiovascular Brain - Cardiovascular
Retina - KidneysRetina - Kidneys
Target organ damage:Target organ damage:Brain - Cardiovascular Brain - Cardiovascular
Retina - KidneysRetina - Kidneys
HypertensionHypertensionHypertensionHypertension
LVHLVHLVHLVHCardiacCardiaccompliancecomplianceCardiacCardiaccompliancecompliance
Decrease Decrease cardiac outputcardiac output
Decrease Decrease cardiac outputcardiac output
44
-10-10
-12-12
-16-16
-14-14
22
00
-2-2
-4-4-6-6
-8-8
Systolic BPSystolic BP Diastolic BPDiastolic BP
All 48All 48comparisonscomparisons
14 comparisons14 comparisons In hypertensivesIn hypertensives
7 comparisons7 comparisons In Border LineIn Border Line hypertensiveshypertensives
27 comparisons27 comparisons In normotensivesIn normotensives
Results of a meta-analysis of controlled trials testing aerobic exercise and blood pressure
Net
BP
ef f
ect
in i n
terv
ent i
o n c
omp a
red
to
cont
rol
Net
BP
ef f
ect
in i n
terv
ent i
on c
ompa
red
to
cont
rol
wit
h 95
% c
onf i
denc
e in
terv
al (
mm
Hg)
wit
h 95
% c
onf i
d enc
e i n
t erv
al (
mm
Hg)