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Hypertension: Risks, Diagnosis, and Treatment Options

Learn the importance of managing hypertension to reduce cardiovascular risks and explore diagnostic methods and treatment options. Discover lifestyle changes and medication choices to control high blood pressure effectively.

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Hypertension: Risks, Diagnosis, and Treatment Options

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  1. Hypertension Dr Nidhi Bhargava 8/10/13

  2. Why Treat • Increased risk of cardiovascular death and mortality • Increased systolic, diastolic and pulse pressures (associated with arterial wall and haemodynamic changes)- all equally important • Prevalence of HT increases with age • Initially both systolic and diastolic increase up to 50years of age • Thereafter systolic continues to rise but diastolic plateau • Diastolic HT most prevalent up to 60years and then either isolated systolic or combined HT- Why?

  3. BP, Stroke and CHD • For each reduction of 10mmHg in SBP and 5mmHg of DBP-associated reduction of stroke by 28% and 34% resp. • HT and LVH • Sokolow-Lyon criteria for assessing LVH-ECG-depth of S wave in V1 added to height of R wave in V5 > 35mm- rule applicable to pts > 40years

  4. Diagnosing Hypertension • Clinic BP ≥ 140/90mmHg Repeat after a few minutes Offer ambulatory BP monitoring (ABPM) ABPM- 24hr BP monitor (2 measurements per hour during pt.'s waking hours and at least 14 measurements to get an average) HBPM- 2 consecutive measurements are taken at least 1-2 mins apart, with pt. seated and record lower of the two readings, twice a day for 4-7 days Discard 1st day’s readings and then taken an average

  5. Stages of Hypertension • Stage 1- clinic BP 140/90 or higher And ABPM or HBPM is ≥ 135/85 mmHg Stage 2- Clinic BP ≥ 160/100mmHg And ABPM or HBPM is ≥ 150/95mmHg Stage 3- clinic systolic BP is ≥ 180mmHg or higher or diastolic BP ≥ 110mmHg start treatment immediately

  6. Lifestyle Changes • Weight reduction- age independent correlation between HT and obesity, 3 fold increased risk in pt. with body weight > 20% • Salt intake reduction- recommended intake < 6 g/day of NaCl, salt restriction can result in >5mmHg of diastolic reduction in 30-40% • Exercise-aerobic exercise results in wt. reduction and hence BP reduction • Reduce excess alcohol intake- < 21 units for men and <14 units for women per week • Stop smoking

  7. Use of Antihypertensives-1

  8. Use of Antihypertensives-2

  9. Initiating Treatment • Pts < 80yrs with stage 1 HT with 1 or more of the following • Target organ disease • Established CVD • Renal disease • Diabetes • 10yrs CVD risk ≥ 20%

  10. Offer treatment to pts of any age with stage 2 HT • For pts <40 years with stage 1 HT investigate for secondary causes • For pts >80 yrs. same as above

  11. Assessing Cardiovascular risk • Assess target organ damage • Urine acr and urine dip for haematuria • UEs , lipids , glucose, cholesterol and eGFr • Fundi examination for hypertensive retinopathy • Routine ecg

  12. Secondary causes of HT • Renal US • Renin and aldosterone levels • 3 × 24 hour urine collections for catecholamine • CT/MRI of abdomen to look at adrenals • MRA/MRI for renal artery stenosis • Investigate if BP not controlled on 3 antihypertensive at any age

  13. Treatment options • Step 1 • If ≤ 55years • ACEI or a low cost ARB • If > 55 and pts of AfroCarribean origin CCB • if not suitable or oedema or evidence of HF then thiazides diuretics- prefer indapamide or chlorthalidone

  14. Step 2 • If ≤ 55 years • A+C or A+D • If > 55years or Afrocarribean • C+A or C+ARB • B+C rather than D if increased risk of diabetes • Before adding 3rd medication ensure step 2 treatment is at optimal or best tolerated doses

  15. Step 3 • A+C+D • If BP ≥ 140/90mmHg resistant HT • Step 4 • Add low dose spironolactone 25mgs if K ≤ 4.5 • Higher dose diuretic if K > 4.5, check UEs in a month • If UEs worsening consider α or ß blocker and refer if still not controlled

  16. BP targets • Age < 80years BP<140/90mmHg • Age > 80years BP <150/90mmHg • ABPM/HBPM • Age <80years- BP<135/85 • Age >80years-BP<145/85mmHg

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