HYPERTENTIONTrends in awareness, treatment, and control of high BP7680 8891 9194 99-00Awareness 51 73 68 70Treatment 31 55 54 59Control 10 29 27 34Benefts of owering BP In clinical trials, antihypertensive therapy has been associated ith 1!35" to 40" #ean red$ctions in stro%e incidence& 2!20" to 25" in #yocardial in'arction& and 3!50" in ()! It is esti#ated that in patients ith sta*e 1 hypertension and additional cardiovasc$lar ris% 'actors, achievin* a s$stained 12-## (* decrease in systolic +, 'or 10 years ill prevent 1 death 'or every 11 patients treated! In the presence o' -./ or tar*et-or*an da#a*e, only 9 patients o$ld re0$ire this +, red$ction to prevent a death Acc!rate BP "eas!rement in the O#ce ,atients sho$ld be seated 0$ietly 'or at least 5 #in$tes in a chair rather than on an e1a#ination table, 2n appropriate-si3ed c$4 5c$4 bladder encirclin* at least 80" o' the ar#6 sho$ld be $sed! 2t least 2 #eas$re#ents sho$ld be #ade!,hysicians sho$ld provide to patients, verbally and in ritin*, their speci7c +, n$#bers and +, *oals! Am$!lator% BP "onitoring 8$spected hite-coat hypertension in patients ith hypertension and no tar*et or*an da#a*e2pparent dr$* resistance 5o9ce resistance6(ypotensive sy#pto#s ith antihypertensive #edication:pisodic hypertension2$tono#ic dys'$nctionPatient E&al!ation to assess li'estyle and identi'y other cardiovasc$lar ris% 'actors or conco#itant disorders that #ay a4ect pro*nosis and *$ide treat#ent to reveal identi7able ca$ses o' hi*h +,6& to assess the presence or absence o' tar*et-or*an da#a*e and -./! ;he data needed are ac0$ired thro$*h #edical history, physical e1a#ination, ro$tine laboratory tests, and other dia*nostic proced$res! Target'Organ (amage (eart ptional tests incl$de #eas$re#ent o' $rinary alb$#in e1cretion or alb$#in?creatinine ratio!@ore e1tensive testin* 'or identi7able ca$ses is not indicated *enerally $nless +, control is not achieved! Benefts of owering BP In clinical trials, antihypertensive therapy has been associated ith 1!35" to 40" #ean red$ctions in stro%e incidence& 2!20" to 25" in #yocardial in'arction& and 3!50" in ()! *oals of Thera)% ;he $lti#ate *oal o' antihypertensive therapy is the red$ction o' cardiovasc$lar and renal #orbidity and #ortality! ;reatin* systolic +, and diastolic +, to tar*ets that are less than 140?90 ## (*! +eca$se #ost patients ith hypertension ill reach the diastolic +, *oal once systolic +, is at *oal, the pri#ary 'oc$s sho$ld be on achievin* the systolic +, *oal ! In patients ith hypertension ith diabetes or renal disease, the +, *oal is less than 130?80 ## (* Copyright restrictions may apply.Achie&ing BP Control in Indi&id!al Patients @ost patients ill re0$ire 2 or #ore antihypertensive #edications to achieve their +, *oals!2ddition o' a second dr$* 'ro# a di4erent class sho$ld be initiated hen $se o' a sin*le dr$* in ade0$ate doses 'ails to achieve the +, *oal! Ahen +, is #ore than 20?10 ## (* above *oal, consideration sho$ld be *iven to initiatin* therapy ith 2 dr$*s! ;he initiation o' dr$* therapy ith #ore than 1 a*ent #ay increase the li%elihood o' achievin* the +, *oal in a #ore ti#ely 'ashion, b$t partic$lar ca$tion is advised in those at ris% 'or orthostatic hypotension, s$ch as patients ith diabetes, a$tono#ic dys'$nction, and so#e older persons! Bse o' *eneric dr$*s or co#bination dr$*s sho$ld be considered to red$ce prescription costs! (ia$etic H%)ertension -o#binations o' 2 or #ore dr$*s are $s$ally needed to achieve the tar*et +, *oal o' less than 130?80 ## (*! ;hia3ide di$retics, b -bloc%ers, 2-: inhibitors, 2=+s, and --+s are bene7cial in red$cin* -./ and stro%e incidence in patients ith diabetes!;he 2-: inhibitor or 2=+-based treat#ents 'avorably a4ect the pro*ression o' diabetic nephropathy and red$ce alb$#in$ria, 2=+s have been shon to red$ce pro*ression to #acroalb$#in$ria! Ischemic Heart (isease In patients ith hypertension and stable an*ina pectoris, the 7rst dr$* o' choice is $s$ally a b -bloc%er& alternatively, lon*-actin* --+s can be $sed! In patients ith ac$te coronary syndro#es 5$nstable an*ina or #yocardial in'arction6, hypertension sho$ld be treated initially ith b -bloc%ers and 2-: inhibitors, ith addition o' other dr$*s as needed 'or +, control! In patients ith post#yocardial in'arction, 2-: inhibitors,-bloc%ers, and aldosterone anta*onists have proven to be #ost bene7cial!Intensive lipid #ana*e#ent and aspirin therapy are also indicated! Heart +ail!re (eart 'ail$re, in the 'or# o' systolic or diastolic ventric$lar dys'$nction, res$lts pri#arily 'ro# systolic hypertension and ische#ic heart disease! )astidio$s +, and cholesterol control are the pri#ary preventive #eas$res 'or those at hi*h ris% 'or ()! In asy#pto#atic individ$als ith de#onstrable ventric$lar dys'$nction, 2-: inhibitors and b -bloc%ers are reco##ended! )or those ith sy#pto#atic ventric$lar dys'$nction or end-sta*e heart disease, 2-: inhibitors, b -bloc%ers, 2=+s, and aldosterone bloc%ers are reco##ended alon* ith loop di$retics! Chronic ,idne% (isease In patients ith chronic %idney disease, de7ned by either 516 red$ced e1cretory '$nction ith an esti#ated *lo#er$lar 7ltration rate o' less than 60 #