Hypertension
Complication & Management

Zulkhair AliDiv. Nephrology & HypertensionDept. of Medicine, Sriwijaya Medical FacultyMoh. Hoesin Hospital Palembang

Hypertension Complication

Risk Factors

Target Organ Damage

CVD Risk Factors

Hypertension*

Cigarette smoking

Obesity* (BMI >30 kg/m2)

Physical inactivity

Dyslipidemia*

Diabetes mellitus*

Microalbuminuria or estimated GFR 20-Fold Increase
OR from 1.9 (HTN only) to 42.3NVP0000901 CADUET Global Speaker Slide Kit Version 2

This figure shows the effect of multiple risk factors on increased risk of MI. The concomitant presence of smoking, hypertension, and diabetes, increased the odds ratio to 13.1, and accounted for 53% of the attributable risk for MI. The presence of all 4 major risk factors increased the odds ratio to 42.3 from 1.9 (HTN only) and accounted for 75.8% of the attributable risk. INTERHEART was a case-control study of acute MI in 52 countries of 15,152 cases and 14,820 controls designed to assess the importance of risk factors for CHD worldwide. The INTERHEART data show the association of risk factors with acute MI in men and women after adjustment for age, sex, and geographic region.

Reference1. Yusuf S, Hawken S, unpuu S, et al, on behalf of the INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:937-952.Please see prescribing information at the end of this slide presentation.

Multiple CV Risk Factors in Addition to Hypertension Result in a High CVD Risk

*Reference=nondiabetic, nonsmoker woman, aged 50 years with total cholesterol (TC)=4.0 mmol/L and HDL-C=1.6 mmol/L.
Jackson R et al. Lancet. 2005;365:434-441.Increasing No. of Additional Risk Factors

051015202530354045505-Year CVD Risk per 100 People+ 60 years+ Diabetes+ Male+ HDL-1 mmol/L+ Smoker+ TC-
7 mmol/LReference

3%6%12%18%24%33%44%

110120130140150160170180BP (mm Hg)NVP0000901 CADUET Global Speaker Slide Kit Version 2

This slide demonstrates the effect on absolute cardiac risk of adding risk factors in patients with different SBP levels. Many factors interact to determine absolute risk, including increasing BP, lipids, smoking, male sex, and renal impairment. Single risk factors have a minor effect on a patients absolute risk in the absence of other risk factors; however, they can have a major effect in the presence of several risk factors, as demonstrated above.The authors outline the rationale for targeting BP and cholesterol-lowering therapy to patients at high CV risk, irrespective of their BP or cholesterol levels. The theory behind this is that specific levels of BP and cholesterol are of little clinical relevance when considered independently of other risk factors. The authors propose that separate management guidelines for elevated BP and blood cholesterol be replaced by integrated CV risk management guidelines.

Reference1.Jackson R, Lawes CMM, Bennett DA, Milne RJ, Rodgers A. Treatment with drugs to lower blood pressure and blood cholesterol based on an individuals absolute cardiovascular risk. Lancet. 2005;365:434-441.

Target end-organs should be assessed by history and physical examinationComponents of Risk Stratification
Target Organ Damage/Clinical Cardiovascular Disease

Brain

Heart

Kidneys

Eyes

Arteries

Adapted from: JNC VI. Arch Intern Med 1997;157: 2413-46

BP directly correlates with risk of stroke

Adapted from He and Whelton, J Hypertens, 1999. 98 mmHg mempunyai resiko stroke 8,2 kali untuk tekanan sistolik dibandingkan 4, 4 kali untuk tekanan diastolik bila dibandingkan tekanan darah < 112 / < 71 mmHg.

Hypertension Linked To Chronic Renal Disease Among 332,544 Men Screened for MRFIT