Hypertension IDiagnosis, causes

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Mean systolic and diastolic blood pressure by age for men and women

Hypertension 19952

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Definition of hypertension

• „There is no dividing line. The relationship between arterial pressure and mortality is quantitative; the higher the pressure, the worse the prognosis.” (Pickering, 1972)

• The operational definition of hypertension is the level at which the benefit …of action exceed those of inaction.” (Rose, 1980)

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Definition of hypertension

• Gauss distribution • No dividing line

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Incidence of hypertension

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Natural course of hypertension

Arteriosclerosis Vasc. dementia

Why is dangerous?

• Complications of hypertension– Cardiac (hypertrphy, failure, infarction)– Cerebral (ischemia, thrombosis, hemorrhage)– Renal (nephrosclerosis, failure)– Large vessel (aneurysm, dissection)– Atherosclerosis

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2007 ESH/ESC(WHO 1999)

Systolic BP

Diastolic BP

JNC VII (2003)

Optimal <120 <80 Normal

Normal 120-129 80-84 Prehypertension

High normal 130-139 85-89

Mild HT (1) 140-159 90-99 HT stage I.

Moderate HT (2) 160-179 100-109

Severe HT (3) >180 >110 HT stage II.

Isolated systolic HT

>140 <90

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Frequency of various diagnoses in hypertensive subjects

Diagnosis Prevalence in population

Prevalence in special ward

Primary hypertension 92-94 65-85

Secunder HT

- renoparenchymal 2-3 4-5

- renovascular 1-2 4-16

-primary aldosteronism 0.3 0.5-12

- Cushing’s sy < 0.1 0.2

-Pheochromocytoma < 0.1 0.2

- Drug induced 0.5-1 1-2

- OSAS n.k. 15-20%

- Thyreoid gl. n.k. n.k.

OSACONTROL

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Cushing syndrome

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Hypertension IIFocus on therapy

Tibor Kovacs MD

2nd Dept. of Internal Medicine

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Alternative blood pressure measurements

ABPM• Much data• Data about the night

BP• Diurnal rythm• Avoid white coat

effect

Home BPM• Improve the patient

compliance• Avoid white coat

effect

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Ambulatory blood pressure monitor (ABPM)

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Recommended Lifestyle Modifications and Their Individual Effects on Blood Pressure

Chobanian AV, et al. JAMA. 2003;289:2560-2572;Blumenthal JA, et al. Arch Intern Med. 2000;160:1947-1958.

Modifications* RecommendationApproximate SBP Reduction

Reduce weight Maintain normal body weight

(BMI of 18.524.9 kg/m2)320 mm Hg

Adopt DASH dietRich in fruit, vegetables, and

low-fat dairy; reduced saturated and total fat content

814 mm Hg

Reduce dietary sodium

<100 mmol (2.4 g)/day 28 mm Hg

Increase physical activity

Aerobic activity >30 min/day most days of the week

49 mm Hg

Moderate alcohol consumption

Men: ≤ 2 drinks/dayWomen: ≤ 1 drink/day

24 mm Hg

*Combining 2 or more of these modifications may or may not have an additive effect on blood pressure reduction.

SBP = systolic blood pressure; BMI = body mass index; DASH = Dietary Approaches to Stop Hypertension

Advantage and disadvantage of the antihypertensive drugsDrug group Indication Possibble

indicationCompelling contraindication

Possibble contraindication

Diuretics HF, elderly, syst. HT, black

Diabetic Gout MS,IGT, Dyslipid. Pregnancy

Beta-blocker Angina, p-AMI, tachyarrh

HF, Pregnancy, Diabetic, Glaucoma

Asthma, COPD, A-V block

PAD, MS, IGT, Sport

ACE-inhib HF, p-AMI, Diabetic, LV dysf., MS, AF, NP

CV prevention, atherosclerosis

Pregnancy, K↑, bilat. ren. a. sten

Dry cough, aortastenosis

ARB Dry cough due ACEI,see : ACEI

CV prevention? Pregnancy, K↑, bilat. ren. a. sten

Stenotic aortic valve

DRI ? ? Pregnancy, K↑, bilat. ren. a. sten

Ca-CB Angina, elderly syst. HT, LV hypertr., black

Diabetic, PAD, Pregnancy, atherosclerosis

A-V block , HF

Alpha-B Prostate hyperplasia IGT, Dyslipidaemia, sexual. dysf.

monotherapy Orthostatic hypotension, HF

27HF-Heart failure, MS- Metabolic sy. IGT- Impaired glucose tolerance AF- atrial fibrillationPAD – peripheral artery disease, NP – nephropathy/proteinuria LV-left ventricular

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Initiation of antihypertensive treatment

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Hypertension in emergency

• Hypertensive urgency BP > 230/130 mmHg without symptoms of

target organ damage • Hypertensive emergencyBP elevation with serious target organ

damageEg. Encephalopathy, acute heart failure,

acute coronaria sy, aortic dissection – acute BP lowering therapy needed

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Therapy of hypertensive urgency and emergency

• Nitroglycerin (sublingual or iv.)• ACEI (captopril, enalapril p.o.)• Urapidil i.v.• Short acting nifedipine (CI: angina, AMI)

• Labetalol• Clonidin• Sodium nitroprussid• In special cases: loop diuretics

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Thank you for your attention!

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METABOLIC SYNDROME

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Conditions favouring use of some antihypertensive drugs versus others I.

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Conditions favouring use of some antihypertensive drugs versus others II.

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