Masked Hypertension

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Presentation Description

In combination of BP readings at office and at home or using 24 hours ambulatory BP monitoring, we can find one of four patterns of BP; normotension, sustained hypertension, white coat hypertension and masked

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MH: What is this?:

MH: What is this? By Dr.Abdelsalam Sherif MD Cardiology

Introduction:

Introduction

CLASSIFICATION OF BLOOD PRESSURE FOR ADULTS:

CLASSIFICATION OF BLOOD PRESSURE FOR ADULTS BP CLASSIFICATION SBP (MM HG) DBP (MM HG) Normal < 120 <80 Prehypertension 120--139 80--89 Stage 1 hypertension 140—159 90--99 Stage 2 hypertension >160 >100

Systolic BP In Population :

Systolic BP In Population

Diastolic BP In Population:

Diastolic BP In Population

Incidence of hypertension:

Incidence of hypertension About 25% of adult population. According to diagnosis, treatment and control of HPN, hypertensive patients can be categorized into

COMPLICATIONS:

COMPLICATIONS Leads to Ischemia, angina, MI, Heart failure

CONTD…:

CONTD…

CONTD…:

CONTD…

Proportion of diseases attributable to hypertension:

Proportion of diseases attributable to hypertension Disease % attributable to hypertension Myocardial Infarctions Heart failure A . F. Strokes Renal failure 30 – 40 % Up to 50 % Up to 50 % 30 – 40 % 25 – 30 %

Types OF BP:

Types OF BP

Measurement of Hypertension:

Measurement of Hypertension BP can be measured in:- Doctor`s office. Home BP measurement. 24-hour ambulatory BP monitoring. Using both In-office and out of office measurements, the patients can be classified into 4 categories types In-office BP Out of office BP Normal Normal Normal HPN ↑ ↑ White coat HPN ↑ Normal Masked HPN Normal ↑

Masked Hypertension:

Masked Hypertension Definition: Office BP <140/90 mmHg and a mean daily BP on 24-hour monitoring or a mean of home measurement ≥135/ 85 mmHg. ( average of 3 OBP and 15 HBP) Synonymous: 1. Isolated ambulatory HPN. 2. Reverse white coat HPN. 3. White coat normotension. Prevalence : ( varies according to the population studied criteria used) - MH affects both sexes and all ages, more in treated hypertensive patients and more prevalent in smoking patients and those with coffee consumption. * Adult: 9- 23% * Children: 7.6% * Elderly : 14%

Prevalence Of MH(in various studies):

Prevalence Of MH(in various studies) author population N ABP criterion Prevalence (%) Imai et al. (1996) Sega et al. (2001) Björklund et al. (2003) Liu et al. (1999) Selenta et al. (2000) Population Ohasama Population PAMELA Population 70-year-old men Healthy volunteers Healthy volunteers 969 3,200 578 234 319 133/78 125/79 135/85 135/85 135/85 10 9 14 21 23

Characteristics of MH :

Characteristics of MH There are currently no specific characteristics for patients with MH. According to ESH , MH may be more common in:- 1. Younger individuals who have a high normal OBP and early LVH. 2. People who at some points in time have had hypertensive range in OBP readings. 3. People who have family H/O of HTN for both parents. 4. People who have multiple risk factors for CVD. 5. Diabetic patients. In addition , the following patients may show high incidence of MH; patients with obesity, impaired baroreflex sensitivity, current or past smoking, ↑s.creatinine levels, ↑urinary albumin execretion, ↑HR and ↑alcohol consumption.

Causes Of Factors To MH:

Causes Of Factors To MH Multifactorial factors 1.Random BP fluctuations. 2.Factors that ↓OBP ( atmosphere of trust and safety) 3.Factors that ↑ ABP or HBP; *More smoking cigarettes. *Drinking coffee *More physical activities *Job or home strain *Insufficient duration of action of antihypertensive medications. 4.Differences in the quality of automated out of office VS conventional OBP measurements. 5.Differences in the selection of cut-off points for defining HTN.

Prognostic Value Of MH:

Prognostic Value Of MH Target Organ damage Normotension MH HPN LVM 73gm/m2 86gm/m2 90 gm/m2 Atheromatous plaque in carotids 15% 28% 28%

Prognostic Value OF MH:

Prognostic Value OF MH

PowerPoint Presentation:

Copyright ©2005 American College of Cardiology Foundation. Restrictions may apply. Ohkubo, T. et al. J Am Coll Cardiol 2005;46:508-515 Relative hazards (RH) and 95% confidence intervals (CI) of sustained normal blood pressure (SNBP), white-coat hypertension (WCHT), masked hypertension (MHT), and sustained hypertension (SHT) for cardiovascular disease (CVD) mortality, stroke morbidity, and the composite of CVD mortality/stroke morbidity

PowerPoint Presentation:

Copyright ©2005 American College of Cardiology Foundation. Restrictions may apply. Ohkubo, T. et al. J Am Coll Cardiol 2005;46:508-515 Relative hazards (RH) and 95% confidence intervals (CI) of sustained normal blood pressure (SNBP), white-coat hypertension (WCHT), masked hypertension (MHT), and sustained hypertension (SHT) for risk of the composite of cardiovascular disease (CVD) mortality/stroke morbidity by gender

Management Of MH:

Management Of MH

PowerPoint Presentation:

SBP Reductions as Little as 2 mm Hg Reduce the Risk of CV Events by Up to 10% Meta-analysis of 61 prospective, observational studies 1 million adults 12.7 million person-years Lewington S et al. Lancet. 2002;360:1903-1913. 2 mm Hg decrease in mean SBP 10% reduction in risk of stroke mortality 7% reduction in risk of ischemic heart disease mortality

Management Of MH:

Management Of MH The benefits of MH therapy documented at least in one study which stated that significant improvement in LVMI and microalbuminuria were found in patients with MH who well controlled according to ABP. Imitations : 1.Screening for MH. 2.Documentation for proper management ( Control of HTN based on the OBP alone is not sufficient). The specific therapy for MH is not fully proven yet but suggest ( life style modification and antihypertensive medications should be initiated as in sustained HTN esp. in presence of target organ damage.

Thank You:

Thank You

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