Hypertension- management
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Transcript of Hypertension- management
HYPERTENSION
AND ITS MANAGEMENT
O HYPERTENSION IS A CHRONIC MEDICAL CONDITION IN WHICH THE BLOOD PRESSURE IN THE ARTERIES IS ELEVATED
STAGING OF HYPERTENSION
CATEGORY SYSTOLIC BP DIASTOLIC BP
NORMAL < 120 <80PREHYPERTENSION 120-139
OR80-90
STAGE 1 HYPERTENSION 140-159 OR
90-99
STAGE 2 HYPERTENSION >= 160 OR
>= 100
JNC 7 CLASSIFICATION
O ISOLATED SYSTOLIC HYPERTENSION- SYSTOLIC PRESSURE OF 140 mmHg OR MORE AND A DIATOLIC PRESSURE OF LESS THAN 90 mmHg.
O WHITE COAT HYPERTENSION-
PHENOMENON IN WHICH A PATIENT EXHIBIT A BLOOD PRESSURE LEVEL ABOVE THE NORMAL RANGE IN CLINICAL SETTINGS BUT NOT SO IN OTHER SETTINGS.
CLASSIFICATION OF HYPERTENSION
ESSENTIALHYPERTENSION(90%)
SECONDARY HYPERTENSION(10%)
CAUSES OF SECONDARY HYPERTENSION (10%)
O CHRONIC KIDNEY DISEASEO SLEEP APNEAO PHEOCHROMOCYTOMAO COARCTATION OF THE AORTAO PREGNANCYO ALCOHOL ADDICTIONO THYROID DYSFUNCTION
RISK FACTORS
NON-MODIFIABLE RISK FACTORS
• AGE• SEX• GENETIC FACTORS• ETHNICITY
MODIFIABLE RISK FACTORS
• OBESITY• SALT INTAKE• SATURATED FAT• DIETARY FIBRE• ALCOHOL• PHYSICAL ACTIVITY• ENVIRONMENTAL STRESS• SOCIO-ECONOMIC STATUS• HEART RATE
RULE OF HALVES
1. WHOLE COMMUNITY2. NORMOTENSIVE SUBJECTS3. HYPERTENSIVE SUBJECTS4. UNDIAGNOSED HYPERTENSION5. DIAGNOSED HYPERTENSION6. DIAGNOSED BUT UNTREATED7. DIAGNOSED AND TREATED8. INADEQUATELY TREATED9. ADEQUATELY TREATED
TRACKING OF BLOOD PRESSURE
HYPERTENSIVE URGENCY
O SEVERE HEADACHEO SHORTNESS OF BREATHO NOSEBLEEDSO SEVERE ANXIETY
HYPERTENSIVE EMERGENCYO STROKEO LOSS OF CONSCIOUSNESSO MEMORY LOSSO HEART ATTACKO LOSS OF KIDNEY FUNCTIONO DAMAGE TO EYES AND KIDNEYSO AORTIC DISSECTIONO PULMONARY EDEMA
PREVENTION OF HYPERTENSION
PRIMARY PREVENTION SECONDARY PREVENTION• POPULATION STRATEGY• HIGH-RISK STRATEGY
PRIMARY PREVENTIONO ALL MEASURES TO REDUCE THE
INCIDENCE OF DISEASE IN A POPULATION BY REDUCING THE RISK OF ONSET
POPULATION STRATEGYO NUTRITIONO WEIGHT REDUCTIONO EXERCISE PROMOTIONO BEHAVIOURAL CHANGESO HEALTH EDUCATIONO SELF-CARE
HIGH-RISK STRATEGYO AIM IS TO PREVENT THE ATTAINMENT
OF LEVELS OF BLOOD PRESSURE AT WHICH THE INSTITUTION OF TREATMENT WOULD BE CONSIDERED
SECONDARY PREVENTIONO EARLY CASE DETECTIONO TREATMENTO PATIENT COMPLIANCE
MANAGEMENT OF HYPERTENSION
LIFE-STYLE MODIFICATION
PHARMACOLOGICAL MANAGEMENT
LIFE-STYLE MODIFICATIONMODIFICATION APPRX SBP
REDUCTIONWEIGHT REDUCTION 5 - 20 mmHgADOPT DASH EATING PLAN 8 - 14 mmHgDIETARY SODIUM REDUCTION 2 - 8 mmHgPHYSICAL ACTIVITY 4 – 9 mmHgMODERATION OF ALCOHOL CONSUMPTION
2 - 4 mmHg
O WEIGHT REDUCTION – ACC. TO JNC 7, 5-20 POINTS REDUCTION IN BP PER 10 KG WEIGHT LOSS
O DIETARY APPROACHES TO STOP HYPERTENSION –
DIET RICH IN FRUITS, VEGETABLES AND LOW-FAT DAIRY PRODUCTS.HIGH PROTEIN AND FIBRE
O SALT REDUCTION-LESS THAN 2400 mg PER DAY
O PHYSICAL ACTIVITY-BRISK WALKING ATLEAST 30 MIN/MOST DAYS OF THE WEEK
O ALCHOL REDUCTION-NO MORE THAN 2 DRINKS/ DAY
GOAL BLOOD PRESSURE
O < 140/90 mmHg FOR PATIENTS WITH HYPERTENSION
O <130/80 mmHg FOR PATIENTS WITH DIABETES OR CHRONIC KIDNEY DISEASE
PATIENTS WITH HYPERTENSION ALREADY ON TREATMENT
IF SYSTOLIC BP < 140 mmHgAND DIASTOLIC BP <90mmHg
ADVISE TO CONTINUE SAME TREATMENT AND LSM COUNSELLING
IF SYSTOLIC BP >= 140 mmHgAND DIASTOLIC BP >=90mmHg
REGULAR FOLLOW-UP
FOLLOW THE SAME PROTOCOLOF NEWLY DETECTED HYPERTENSIVE PATIENTS TO ACHIEVE GOAL BLOOD PRESSURE
NEWLY DETECTED STAGE I HYPERTENSION
ASSESS RISK FACTORSIF YES IF NO
LSM AND T.AMLODIPINE2.5 mg Hg
RECHECK BP AFTER 2 WEEKS
IF BP >= 140/90 mm Hg,INCREASE DOSE OF AMLO TO MAX- 10 mg/ DAY
LSM ONLY
RECHECK BP AFTER 2 WEEKS
IF BP >= 140/90 mm Hg,LSM WITH AMLODIPINE 2.5 mg/ day
NEWLY DETECTED STAGE II HYPERTENSION
LSM AND T.AMLODIPINE 5 mg/day
RECHECK BP AFTER 2 WEEKS
IF BP >= 140/90 mmHg
INCREASE DOSE OF AMLODIPINE TO MAX- 10mg/ day
RECHECK BP AFTER 2 WEEKS
GOAL BP ACHIEVED GOAL BP NOT ACHIEVED
CONTINUE SAME ADD SECOND DRUG
SECOND DRUGISOLATED HYPERTENSION NOT CONTROLLED WITH T.AMLO 10 MG/DAYADD T.HYDROTHIAZIDE 25 MG OD ORT.ENALAPRIL 2.5-20 MG PER DAY ORT.ATENOLOL 25-100 MG PER DAY
HYPERTENSION WITH DIABETESADD T.ENALAPRIL 2.5-20 MG PER DAY(if sr. creatinine is <2mg)
SECOND DRUGHYPERTENSION WITH IHDADD T.ATENOLOL 25-100 MG PER DAYWITH T.ASPIRIN 75 MG OD ANDT.ISOSORBITRATE DINITRATE 5-10 MG TDS
HYPERTESION WITH CKDAVOID ENALAPRIL IF SR. CREATININE > 2 mgADD T.ATENOLOL 25-100 mg PER DAY(cautious use in PVD)
SECOND DRUG
HYPERTENSION WITH BRONCHIAL ASTHMA OR COPDAVOID ATENOLOLT.ENALAPRIL 2.5-20 mg PER DAY (OR)T.HYDROCHLOROTHIAZIDE 25 mg OD