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Hypertension I Diagnosis, causes

Hypertension I Diagnosis, causes. Mean systolic and diastolic blood pressure by age for men and women. Hypertension 1995. Definition of hypertension.

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Hypertension I Diagnosis, causes

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  1. Hypertension IDiagnosis, causes

  2. Mean systolic and diastolic blood pressure by age for men and women Hypertension 1995

  3. 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)

  4. Definition of hypertension • Gauss distribution • No dividing line

  5. Incidence of hypertension

  6. Natural course of hypertension Arteriosclerosis Vasc. dementia

  7. Why is dangerous? • Complications of hypertension • Cardiac (hypertrphy, failure, infarction) • Cerebral (ischemia, thrombosis, hemorrhage) • Renal (nephrosclerosis, failure) • Large vessel (aneurysm, dissection) • Atherosclerosis

  8. Frequency of various diagnoses in hypertensive subjects

  9. CONTROL OSA

  10. Cushing syndrome

  11. Hypertension IIFocus on therapy Tibor Kovacs MD 2nd Dept. of Internal Medicine

  12. ABPM Much data Data about the night BP Diurnal rythm Avoid white coat effect Home BPM Improve the patient compliance Avoid white coat effect Alternative blood pressure measurements

  13. Journal of Hypertension 2007, 25:1105-1187

  14. Ambulatory blood pressure monitor (ABPM)

  15. Journal of Hypertension 2007, 25:1105-1187

  16. Journal of Hypertension 2007, 25:1105-1187

  17. Recommended Lifestyle Modifications and Their Individual Effects on Blood Pressure *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 Chobanian AV, et al. JAMA. 2003;289:2560-2572; Blumenthal JA, et al. Arch Intern Med. 2000;160:1947-1958.

  18. Advantage and disadvantage of the antihypertensive drugs HF-Heart failure, MS- Metabolic sy. IGT- Impaired glucose tolerance AF- atrial fibrillation PAD – peripheral artery disease, NP – nephropathy/proteinuria LV-left ventricular

  19. Initiation of antihypertensive treatment Journal of Hypertension 2007, 25:1105-1187

  20. Hypertension in emergency • Hypertensive urgency BP > 230/130 mmHg without symptoms of target organ damage • Hypertensive emergency BP elevation with serious target organ damage Eg. Encephalopathy, acute heart failure, acute coronaria sy, aortic dissection – acute BP lowering therapy needed

  21. 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

  22. Thank you for your attention!

  23. Journal of Hypertension 2007, 25:1105-1187

  24. Journal of Hypertension 2007, 25:1105-1187

  25. Journal of Hypertension 2007, 25:1105-1187

  26. Journal of Hypertension 2007, 25:1105-1187

  27. METABOLIC SYNDROME Journal of Hypertension 2007, 25:1105-1187

  28. Journal of Hypertension 2007, 25:1105-1187

  29. Conditions favouring use of some antihypertensive drugs versus others I. Journal of Hypertension 2007, 25:1105-1187

  30. Conditions favouring use of some antihypertensive drugs versus others II. Journal of Hypertension 2007, 25:1105-1187

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