Hypertension April 2008

HYPERTENSION : 

HYPERTENSION Healthcare Village Doctors Programme April 2008

HYPERTENSION : 

Definition The simplest and most widely accepted definition of hypertension in an adult is that hypertension is present when the systolic pressure exceeds 140 mmHg and/or the diastolic pressure exceeds 90 mmHg. HYPERTENSION

MEASURING BLOOD PRESSURE: 

MEASURING BLOOD PRESSURE Mercury Sphygmomanometer Digital Sphygmomanometer Types Aneroid Sphygmomanometer Cuff size Position of arm Postural hypotension – measure sitting and standing

Physiology of Blood Pressure: 

Physiology of Blood Pressure BLOOD PRESSURE = Cardiac Output x Peripheral resistance COMPONENTS OF BLOOD PRESSURE Systolic pressure Diastolic pressure

MEASURING BLOOD PRESSURE: 

The systolic reading is the reading when the heart sounds are first heard The diastolic reading is either when the hearts sounds disappear or when the sound become muffled MEASURING BLOOD PRESSURE

Guidelines: 

Guidelines Category Systolic Diastolic Normal <120 and <80 Pre-hypertension 120-139 or 85-89 Stage 1 hypertension 140-159 or 90-99 Stage 2 hypertension > 160 or > 100 The Seventh Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII) uses the following guidelines to define HTN in adults: (Brashers, 2006, p.1)

White Coat Hypertension: 

White Coat Hypertension 10% of the population patient has a raised BP at the doctors surgery but not at home can watch and watch unless there is any underlying disease (e.g. diabetes)

Home Blood Pressure Monitoring: 

Home Blood Pressure Monitoring Now very popular in the West Measuring the patients blood pressure in their home situation Either using patients own machine Or using hospital ambulatory monitor Gives a more accurate reflection of true BP levels

Epidemiology : 

Epidemiology Hypertension is the biggest risk factor for cardiovascular disease (CVD) in China, and in 2005, CVD accounted for one-third of all deaths.(1) 27% of adult Chinese may have hypertension (2) 1. Hypertension in China ;Decision Resources 2005 2. Hypertension. 2002;40:920. © 2002 American Heart Association, Inc

Epidemiology : 

Cardiovascular risk increases two-fold for each 20mm/Hg rise in systolic pressure or each 10mm/Hg rise in diastolic pressure Risk factors in all populations include age, obesity, sedentary life-style, family history, smoking, alcohol, high sodium intake, diabetes and the use of NSAIDS Epidemiology

Epidemiology – other factors : 

Hypertension increases the risk of heart attacks, strokes, heart failure and kidney failure Hypertension is commoner in Africans and results is more Left Ventricular Failure and strokes in this group Occurs less in women before the menopause , but incidence increases in older women. Epidemiology – other factors

Epidemiology – other factors : 

Higher in smokers Higher where there is family history Higher with high alcohol intake Higher in those with stressful jobs Higher in the obese Higher in diabetics Epidemiology – other factors

Secondary Hypertension: 

Secondary Hypertension Renal disease Cushing's disease Pheochromocytoma Hyperthyroidism Hyperparathyroidism

Secondary Hypertension: 

Medication Steroids Non- steroidal anti-inflammatory drug Contraceptive pill Secondary Hypertension

Clinical Examination : 

Clinical Examination Check BP, pulse and heart sounds, looking for any cardiac enlargement Look for signs of cardiac failure – pulmonary oedema or ankle swelling, raised JVP Check for renal or carotid bruit

Investigations : 

Investigations Urinalysis Looking for proteinuria, or sugar Blood tests Check full blood count Check renal function Check blood sugars Check blood lipids ECG looking for Left ventricular hypertrophy

Management: 

Management Primary goal is to reduce cardiovascular and renal morbidity and mortality. Other keys to management are: Prevention Patient education Life-style modification Medication

Management: 

Management Weight reduction Increase regular exercise Low salt diet Stop smoking Reduce alcohol intake Reduce saturated fats in the diet Increase fruit and vegetables in diet

Medications: 

Medications Several recent studies have lead to the following conclusions about Blood pressure treatment One tablet is rarely sufficient to treat blood pressure Younger hypertensives and non – Africans respond to different tablets than older people and Africans

Types of Medication : 

Types of Medication A . ACE inhibitors or angiotensin receptor blockers B . B blockers C . Calcium Channel Blockers D . Diuretics

Guidelines: 

Guidelines Category Systolic Diastolic Normal <120 and <80 Pre-hypertension 120-139 or 85-89 Stage 1 hypertension 140-159 or 90-99 Stage 2 hypertension > 160 or > 100 The Seventh Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII) uses the following guidelines to define HTN in adults: (Brashers, 2006, p.1)

British Hypertension Society Recommendations: 

British Hypertension Society Recommendations Younger( under 55) and not African Older (over 55) and Africans Stage 1 Stage 2 Resistant Hypertension A or B C or D A or B + C or D A or B + C + D A. ACE inhibitor or Angiotensin receptor blocker B. Beta blocker C. Calcium channel blocker D. Diuretic

Follow up: 

Follow up Regular blood pressure checks Regular monitoring of renal function Blood lipid monitoring

Complications: 

Complications Complications as a result of Hypertension include: Stroke Dementia Myocardial Infarction Congestive Heart Failure Retinal Vasculopathy Aortic Dissection Renal Disease or Failure

Referral: 

Referral A patient should be referred when: BP remains uncontrolled after three concurrent medications Uncontrolled BP and signs and symptoms of end-organ damage