Transcript Hypertension

Hypertension
ARWA A. AL-KHATIB
ARWAA@PHARMACY -1.COM
 BB
Benefits of Lowering BP
Complication
Percent Reduction
Stroke Incidence
35–40%
Myocardial Infarction
20–25%
Heart Failure
50%
Comparison of HTN surveys in 3
countries
Country
Prevalen Awarene Treated Controll
ce%
ss%
%
ed %
Egypt
26.3
37
24
8
Canada
22
58
39
16
China
13.6
25
13
3
BP measurement
 Use auscultatory method with a properly calibrated
and validated instrument.
 Patient should be seated quietly for 5 minutes in a
chair
(not on an exam table), feet on the floor, and arm
supported at heart level.
 Appropriate-sized cuff should be used to ensure
accuracy.
 At least two measurements should be made.
What may induce or aggravate HTN??
 Prescription Drugs:





NSAIDs, including Coxibs
Steroids
Oral contraceptive and sex hormones
Calcineurin inhibitors (cyclosporin, tacrolimus)
Erythropoietin and analogues
 Other:



Licorice root
Salt
Excessive alcohol use
HTN management
Goals of therapy
II. Prevention of Hypertension
I.
III. Lifestyle modification
IV. Classification and management of BP for adults
V.
Pharmacologic treatment
I. Goals of therapy
 Reduce CVD and renal morbidity and mortality.
 Treat to BP <140/90 mmHg or BP <130/80 mmHg
in patients with diabetes or chronic kidney disease.
II. Prevention of hypertension
To reduce the possibility of becoming hypertensive,
1.
2.
3.
4.
5.
6.
7.
Healthy diet: high in fresh fruits, vegetables and low fat dairy products,
low in saturated fat and salt
Regular physical activity: accumulation of 30-60 minutes of moderate
intensity dynamic exercise 4-7/week
Low risk alcohol consumption (≤2 standard drinks/day and less than
14/week for men and less than 9/week for women)
Maintenance of ideal body weight (BMI 18.5-24.9 kg/m2)
Waist Circumference
< 102 cm for men
< 88 cm for women
Restriction of salt intake to less than 100 mmol/day
Smoke- free environment
III. Lifestyle Recommendations for
Hypertension Physical Activity
F
Frequency
- Four to Seven days per week
I
Intensity
- Moderate
T
Time
- 30-60 minutes
T
Type
- Dynamic exercise
- Walking, jogging
- Cycling
- Non-competitive swimming
IV. Classification and management of BP for
adults
V. Pharmacologic treatment
Compelling Indication
How to choose the best option?
Associated risk factors?
or
Target organ
damage/complications?
or
Concomitant diseases/conditions?
Vascular Protection
Statins are recommended in high-risk hypertensive patients
with established atherosclerotic disease or with at least 3 of
the following criteria
 Male
 age 55 or older
 Smoking
 Type 2 Diabetes
 Total-C/HDL-C ratio of 6 mmol/L or higher
 Family History of Premature CV disease
 Previous Stroke or TIA
 LVH (left ventricular hypertrophy)
 ECG abnormalities
 Microalbuminuria or Proteinuria
 Peripheral Vascular Disease