Investigations:Investigations:

• Urine examination. Urine examination.

• Serum K.Serum K.

• Serum creatinine.Serum creatinine.

• Blood Sugar.Blood Sugar.

• Hb.Hb.

Investigations:Investigations:• Serum uric acid.Serum uric acid.

• Lipid profile.Lipid profile.

• ECG.ECG.

• Fundus.Fundus.

• More extensive More extensive investigations are needed investigations are needed in secondary hypertension.in secondary hypertension.

BP levels above which BP levels above which hypertension in child should be hypertension in child should be

considered:considered:

Common causes of hypertension Common causes of hypertension according to ageaccording to age

Evaluation of asymptomatic Evaluation of asymptomatic hypertensive child:hypertensive child:

Pediatric doses of anti Pediatric doses of anti hypertensive drugs:hypertensive drugs:

Substances that can elevate Substances that can elevate BPBP

Why to treat HTN? Why to treat HTN?

– 52% 52% in CHF in CHF

– 35-40% 35-40% in stroke morbidity in stroke morbidity and mortalityand mortality

– 35% 35% in LVH in LVH

– 20-25% 20-25% CAD events CAD events

– 21% 21% vascular mortality vascular mortality

Benefits of Lowering BPBenefits of Lowering BP

• Sustaining a 12 mmHg Sustaining a 12 mmHg reduction in SBP over 10 reduction in SBP over 10 years will prevent one death years will prevent one death for every 11 patients treated for every 11 patients treated with Stage I HTN w/additional with Stage I HTN w/additional CVD risk factorsCVD risk factors

JNC-7 Management of BP JNC-7 Management of BP for Adultsfor Adults

BP classificationBP classification

NormalNormal

PrehypertensionPrehypertension

Stage I HTNStage I HTN

Stage II HTNStage II HTN

Lifestyle Lifestyle

EncourageEncourage

YesYes

YesYes

YesYes

No compelling No compelling indication indication

No drug txNo drug tx

Thiazide for mostThiazide for most

2 drug combo 2 drug combo including thiazideincluding thiazide

Compelling indicationCompelling indication

Drugs targeted for the Drugs targeted for the compelling indicationscompelling indications

Drugs targeted for the Drugs targeted for the compelling indicationscompelling indications

Drugs targeted for the Drugs targeted for the compelling indicationscompelling indications

< 120/80< 120/80

120-139 / 80-89120-139 / 80-89

140-159 / 90-99140-159 / 90-99

>> 160 / 160 / >> 100 100

Treatment OutlineTreatment Outline

• Goals of TherapyGoals of Therapy

• Lifestyle modificationLifestyle modification

• Pharmacologic treatmentPharmacologic treatment

• Follow-up and monitoringFollow-up and monitoring

Goals of TherapyGoals of Therapy

• Reduce CVD and renal Reduce CVD and renal morbidity and mortalitymorbidity and mortality

• Treat to BP < 140/90 Treat to BP < 140/90 mmHg or BP <130/80 mmHg or BP <130/80 mmHg in patients with mmHg in patients with DM or less in patients with DM or less in patients with chronic KDchronic KD

Goals of TherapyGoals of Therapy

• Achieve BP goal especially in Achieve BP goal especially in persons persons > > 50 years of age50 years of age

• Maintain QOLMaintain QOL

• Minimize side effectsMinimize side effects

Lifestyle ModificationLifestyle Modification

ModificationModification Approx. SBP reduction (mmHg)Approx. SBP reduction (mmHg)

Weight reductionWeight reduction

Adopt DASH dietAdopt DASH diet

Dietary Na+ restrictionDietary Na+ restriction

Physical activityPhysical activity

Moderation of alcohol Moderation of alcohol consumptionconsumption

5 – 10 / 10 kg5 – 10 / 10 kg

8 – 14 8 – 14

2 – 82 – 8

4 – 9 4 – 9

2 – 42 – 4

http://hin.nhlbi.nih.gov/nhbpep_slds/menu.htmhttp://hin.nhlbi.nih.gov/nhbpep_slds/menu.htm

Lifestyle ModificationLifestyle Modification

• Works best in motivated individualsWorks best in motivated individuals

• Initiate at prehypertension Initiate at prehypertension classificationclassification

• Obesity Obesity risk for HTN and DM risk for HTN and DM

• If > 20% over ideal body weight (IBW) If > 20% over ideal body weight (IBW) – considered obese– considered obese– Decrease intake by 500 cal/dayDecrease intake by 500 cal/day– Increase exercise and activityIncrease exercise and activity

One KG decrease in BW One KG decrease in BW is accompanied by is accompanied by reduction of 1.6 and reduction of 1.6 and 1.3 mmHg in systolic 1.3 mmHg in systolic and diastolic BP. and diastolic BP.

Salt sensitivity is more Salt sensitivity is more common in:common in:

• Elderly. Elderly.

• Blacks.Blacks.

• Type 1 diabetes. Type 1 diabetes.

• Secondary hypertension. Secondary hypertension.

Guidelines for moderate salt Guidelines for moderate salt restriction:restriction:

Dietary potassium:Dietary potassium:

• Diet rich in fruits and vegetables is Diet rich in fruits and vegetables is superior to pills. superior to pills.

• Potassium supplements should be Potassium supplements should be avoided in: renal insufficiency, with avoided in: renal insufficiency, with diuretics, ACE inhibitors or ARBs. diuretics, ACE inhibitors or ARBs.

Food rich in potassium: Food rich in potassium: