1 / 78

Lebanese Society of Family Medicine 5 th Annual Conference Chronic Disease: An Update Hypertension Guidelines and Pract

Lebanese Society of Family Medicine 5 th Annual Conference Chronic Disease: An Update Hypertension Guidelines and Practice. Adel E. Berbari, MD, FAHA, FACP Professor of Medicine and Physiology Head, Division of Hypertension and Vascular Medicine American University of Beirut- Medical Center

ninon
Download Presentation

Lebanese Society of Family Medicine 5 th Annual Conference Chronic Disease: An Update Hypertension Guidelines and Pract

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Lebanese Society of Family Medicine5th Annual ConferenceChronic Disease: An UpdateHypertensionGuidelines and Practice Adel E. Berbari, MD, FAHA, FACP Professor of Medicine and Physiology Head, Division of Hypertension and Vascular Medicine American University of Beirut- Medical Center Venue: Crown Plaza Hotel Hamra-Beirut-lebanon Date: Saturday, Nov 11, 2006

  2. Introduction

  3. Hypertension guidelines published in 2003 (JNC VII and ESH/ESC/generally still valid • In light of recent findings initiation of process of changing guidelines.

  4. Hypertension major risk for • Cardiovascular events • Myocardial infarction • Heart failure • Stroke • Renal failure • Impaired quality of life • Impaired cognitive function • Memory loss • Dementia • Sexual dysfunction • Decreased general well being. • BP reduction associated with • Reduction in cardiovascular events • Improvement in quality of life

  5. Reduction of cardiovascular events by active antihypertensive treatment.

  6. -12-4-5 About mmHg Benefits of Lowering BP by Average Percent Reduction Stroke incidence 35–40% Myocardial infarction 20–25% Heart failure 50%

  7. Despite evidence that BP control associated with reduction in risk of cardiovascular events, hypertension control remains poor.

  8. Determinants of Poor Hypertension Control

  9. Prognostic Importance of Different BP Components

  10. Systolic BP vs Diastolic BP

  11. Systolic hypertensionrecently recognized as more important than diastolic hypertension: - Cardiovascular risk factor - Therapeutic decision making in older subjects

  12. SBP, rather than DBP, of greater importance in long-term risk of CVD in middle aged patients. • CVD risk associated with DBP dependent on • SBP level • Low CVD risk/similar to Normotension in SBP<140 even when DBP> 90 mm Hg • Increased CVD risk with SBP>140/DBP<90 mm Hg

  13. Predictive Power of Systolic Blood Pressure on Overall Cardiovascular Outcomes Systolic Blood Pressure Diastolic Blood Pressure DBP (mm Hg) SBP(mm Hg) <140 <90 Total Mortality 140-159 90-99 160-179 ≥100 ≥180 0.5 0.5 2 1 1.5 2.5 2.5 1 1.5 2 Relative Risk Relative Risk Prognosis better Prognosis worse Prognosis better Prognosis worse <140 <90 Cardio-vascular Mortality 140-159 90-99 160-179 ≥100 ≥180 0.5 1 1.5 2 2.5 2.5 1 1.5 0.5 2 Relative Risk Relative Risk Alli C et al. Arch Intern Med. 1999;159:1205-1212.

  14. SBP, rather than DBP, of greater importance in long-term risk of CVD in middle aged patients. • CVD risk associated with DBP dependent on • SBP level • Low CVD risk/similar to Normotension in SBP<140 even when DBP> 90 mm Hg • Increased CVD risk with SBP>140/DBP<90 mm Hg

  15. Relation between SBP and DBP and risk of cardiovascular disease

  16. Compelling evidence that benefits of hypertension reduction related primarily to extent of SBP reduction not to DBP reduction

  17. Goal SBP Levels

  18. SBP < 140 mmHg In Uncomplicated Essential Hypertension

  19. SBP < 130 mmHg In High Risk Hypertensive Patients (Diabetes or Chronic Kidney Disease)

  20. Difficulty in Achieving Goal SBP In Contrast to DBP

  21. mmHg Rates of Achieved Goal SBP and DBP with Antihypertensive Treatment.LlOYD JONES (FRAMINGHAM HEART STUDY) Hypertension 2000; 36: 594-599

  22. Blood Pressure Patterns

  23. Classification

  24. Normotension (True / Persistent) • Prehypertension • White coat hypertension • Masked hypertension. • Hypertension (True / Sustained)

  25. Prehypertension

  26. Definition • SBP / DBP = 120-139 / 80-89 mmHg Prognostic significance • Progression to hypertension • Cardiovascular events

  27. Increasing increments of blood pressure are associated with increasing risk of cardiovascular mortality. mm Hg mm Hg mm Hg mm Hg mm Hg

  28. Progression Rates to Hypertension in Non-Hypertensive Participants in Framingham Study

  29. Definition • SBP/DBP = 120-139/80-89 mmHg Prognostic Significance • Progression to hypertension • Cardiovascular events Therapy • Lifestyle modification • Antihypertensive medications in patients with • Diabetes Mellitus • Chronic Kidney Disease

  30. Masked Hypertension(Reverse White Coat Hypertension)

  31. Definition • Normal office/clinic BP levels and elevated home / ambulatory BP levels. Prevalence • 10-15% of population (children, adolescent, adults) • Tendency to decrease with age. Prognostic Significance • Increased risk for: • Progression to sustained hypertension • Target organ involvement • Cardiovascular morbidity/mortality.

  32. Relation between office, home, ambulatory blood pressures and cardiovascular / all cause mortality in various BP patients.

  33. Predisposing Factors • Obesity, especially android obesity • Strong family history of hypertension at an early age. Characteristic Clinical Features • Rapid pulse rate • Elevated nocturnal BP levels. Diagnostic Procedure • Ambulatory BP monitoring • Home BP measurement Treatment • Lifestyle modification • Pharmacologic treatment in high CV risk individuals

  34. Groups Blood Pressure Levels Blood Pressure Patterns Diagnostic Procedures

  35. Blood Pressure Patterns Definition, Risk of CV Events, Therapy

  36. NovelCardiovascular Risk Factors

  37. Microalbuminuria

  38. Protein excretionin the urine is a strong predictor of cardiovascular disease in middle-aged men and women. Independent from effects of various well recognized CV risk factors

  39. Relative prognostic value of microalbuminuriain type 2 Diabetes 10.02 10 8 6.52 6 Mortality from CHD (odds ratio) 4 3.20 2.32 2 0 Microalbuminuria Smoking Diastolic BP Cholesterol Eastman RC, Keen H. Lancet 1997;350(Suppl 1):29–32.

  40. Microalbuminuria 1.59 CAD 1.51 Diabetes 1.42 1.4 Creatinine 1.4 mg/dL Male 1.20 WHR (0.1) 1.13 Age (1y) 1.03 Ramipril 0.79 Hazard Ratio Multivariate Hazard Ratios forPrimary Outcome in HOPE 2 0 1 HOPE Study Investigators. N Engl J Med 2000;342:145-53.

  41. Classification (Conventional)

  42. NormoalbuminuriaMicroalbuminuriaMacroalbuminuria (Proteinuria)NormoalbuminuriaMicroalbuminuriaMacroalbuminuria (Proteinuria)

  43. Definition

  44. Increased urinary albumin excretion (UAE) not detected by routine urinalysis (urinary strips detect UAE levels greater than 300mg/D) • Special strips available • Quantitative assessment: • 24 hours urine collection • Timed overnight urinary collection • SPOT urine albumin/creatinine in first morning urine sample (best accurate/practical method). • Special techniques required

  45. Macroalbuminuria (Proteinuria)

  46. Detected by routine urinalysis strips. • Regular 24hr urine collection for Proteinuria.

  47. Threshold Levels for Urinary Albumin Excretion Rates in Various Categories

More Related