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1、Hypertension,Dr Zaka Haq, MBBS, MRCPCardiology RegistrarQueens Hospital Romford,Hypertension,Prevalence (UK) NICEBeta Blockers,ChallengesPrimary Care,Hypertension-Overview,Hypertension itself-Introduction Types Classification Risk Factors Sequels Hypertension in special circumstances Management Foll
2、ow Up Guidelines Referral to Secondary care,Hypertension, Introduction.,Hypertension is one of the most important preventable causes of premature morbidity and mortality in the UK. Hypertension is a major risk factor for stroke (ischemic and haemorrhagic), myocardial infarction, heart failure, chron
3、ic kidney disease, cognitive decline and premature death. Untreated hypertension may result in vascular and renal damage that can culminate in a treatment-resistant state. The risk associated with increasing blood pressure is continuous, with each 2 mmHg rise in systolic blood pressure associated wi
4、th a 7% increased risk of mortality from ischemic heart disease and a 10% increased risk of mortality from stroke.,Hypertension, Introduction.,Diastolic pressure is more commonly elevated in younger people. With ageing, systolic hypertension becomes a more significant problem. The clinical managemen
5、t of hypertension is one of the most common 22 interventions in primary care, accounting for approximately 1 billion in drug costs alone in 2006. Hypertension is often symptom less, so screening is vital - before damage is done. Many surveys continue to show that hypertension remains under diagnosed
6、, undertreated and poorly controlled in the UK,Hypertension, Introduction,In many countries, 50% of the population older than 60 years has hypertension. Overall, approximately 20% of the worlds adults are estimated to have hypertension. UK, 1 in every 4th person has Hypertension and this increases t
7、o 1 in every second person aged over 60.,Types of hypertension,Essential hypertension (Primary) 90% No underlying cause Secondary hypertension 5% Underlying cause,Causes of Secondary Hypertension,Renal diseaseApproximately 75% are from intrinsic renal disease: glomerulonephritis, polyarteritis nodos
8、a, systemic sclerosis, chronic pyelonephritis, or polycystic kidneys. Approximately 25% are due to Reno vascular disease - most frequently atheromatous (e.g. elderly cigarette smokers with peripheral vascular disease) or fibromuscular dysplasia (more common in younger females). Endocrine diseaseCush
9、ings syndrome, Conns syndrome, pheochromocytoma, acromegaly, Hyperparathyroidism Others Coarctation, Preeclampsia, Drugs and toxins, e.g. alcohol, cocaine, ciclosporin, tacrolimus, erythropoietin, adrenergic medications, decongestants containing ephedrine and herbal remedies containing liquorice,Def
10、initions and Classifications of BP Levels,SBP DBP Category* (mm Hg) (mm Hg) Optimal 180 110 ISH 140 60 years Sex (men and postmenopausal women) Family history of cardiovascular disease Smoking High cholesterol diet Co-existing disorders such as diabetes, obesity and hyperlipidaemia High intake of al
11、cohol Sedentary life style Remember all these are predisposing factors for HTN but they all including HTN are risk factors for Cardiovascular disease.,Diseases Attributable to Hypertension,HYPERTENSION,Gangrene of the Lower Extremities,Heart Failure,Left Ventricular Hypertrophy,Myocardial Infarction
12、,Hypertensive Encephalopathy,Aortic Aneurysm,Blindness,Chronic Kidney Failure,Stroke,Preeclampsia/Eclampsia,Cerebral Hemorrhage,Coronary Heart Disease,Adapted from Dustan HP et al. Arch Intern Med. 1996; 156: 1926-1935,Hypertension in special circumstances,HTN in Young-Causes HTN and Pregnancy-Cauti
13、ons HTN and Diabetes - Proteinurea HTN and Renal Failure vice versa Hypertensive Emergencies urgency, Emergency,Management of hypertension: the issues,Measurement Classification Investigations Risk assessment Non-pharmacological measures Treatment thresholds - 1st line - sequencing - beyond BP Treat
14、ment targets Concomitant therapy,Diagnosis and Measurement- 2011,If the first and second blood pressure measurements taken during consultation are 140/90 mmHg or higher, offer 24-hour ambulatory blood pressure monitoring (ABPM) to confirm the diagnosis of hypertension. new 2011 When using ABPM to co
15、nfirm a diagnosis of hypertension, ensure that: Blood pressure is measured for a total of 24 hours. At least two measurements per hour are taken during the day (08:00 to 22:00). At least one measurement per hour is taken during the night (22:00 to 08:00). Use the average daytime blood pressure measu
16、rement, new 2011,Diagnosis and Measurement- 2011,When using home blood pressure monitoring (HBPM) to confirm a diagnosis of hypertension, ensure that: For each blood pressure measurement, two consecutive measurements are taken, at least 1 minute apart and with the person seated. Blood pressure measurements are taken twice daily, ideally in the morning and evening. Blood pressure measurement continues for at least 4 days, ideally for 7 days. Discard the measurements taken on the first day and use the average value of all the remaining measurements to confirm a diagnosis of HTN-2011,
