Hypertension

Hypertension ,[object Object],[object Object],[object Object],[object Object]

Hypertension: The Silent Killer Facts & Figures ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Prevalence Prevalence on hypertension by age Age % Hypertension 18~29 4 30~39 11 40~49 21 50~59 44 60~69 54 70~79 64 80 + 65

Causes of Hypertension ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Hypertension - Guidelines ,[object Object],CATEGORY SBP mm Hg DBP mm Hg Normal <120 & <80 Prehypertension 120-139 or 80-89 Stage-I 140-159 or 90-99 Stage-II >160 or >100

VARIOUS TERMS & DEFINITIONS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Chronic Complications End / Target organ damage Organ Condition Symptoms, signs/events Heart LVH, CAD Angina / MI Artery Atherosclerosis CAD/CVD/PAD Aneurysm Stroke Kidney Nephropathy Microalbuminuria Eye (retina) Retinopathy Blurring of vision Brain CVD TIA/Stroke

Prevalence of Cardiovascular Disease ,[object Object],10 20 30 40 50 60 High BP CAD CHF Stroke Other 50,000,000 12,200,000 4,600,000 4,400,000 2,800,000 Prevalence (millions) BP=blood pressure, CAD=coronary artery disease, CHF=congestive heart failure (24%) American Heart Association® . 2000 Heart and Stroke Statistical Update. 1999

Hypertension Risk Factors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Hypertension : Symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Hypertension - Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Hypertension - Management Pharmacological management Category Drugs Diuretics Hydrochlorothiazide, Indapamide ACE-Is Enalapril, Perindopril ARBs Olmesartan, Valsartan, Losartan Beta blockers Nebivolol, Atenolol Alpha blockers Terazosin, Prazosin CCB Amlodipine, Diltiazem

Hypertension - Management ,[object Object],[object Object],[object Object],[object Object],[object Object]

Ideal Antihypertensive Drug ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

The correct Approach to Hypertension

Anti Hypertensive drug classes The A, B, C, D approach

Anti Hypertensive Drug Classes ,[object Object],[object Object],[object Object],[object Object],[object Object]

AB/CD Rule – HT Treatment AGE Younger (< 55) ACEi, Beta-blocker Ca++-blocker, Diuretic) (AB/CD = Dickerson et al. Lancet 353:2008-11;1999 Older (> 55) ACEi / ARB BB A + B A + B + D Diuretic CCB D + C + A D + C I II III III II I Resistant HT / Intolerance Add / substitute alpha blocker Re-consider 2 0 causes  trial of spironolactone IV: V:

Drugs for Compelling Indications

DIURETICS ,[object Object],[object Object],[object Object],[object Object],Reduce BP

DIURETICS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

BETA BLOCKERS ,[object Object],[object Object],[object Object],[object Object],Reduce BP

BETA BLOCKERS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],ALPHA BLOCKER Mechanism of action:

ALPHA BLOCKER ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

CALCIUM CHANNEL BLOCKERS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

CALCIUM CHANNEL BLOCKERS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

ACE - INHIBITORS ,[object Object],[object Object],[object Object],[object Object]

ACE - INHIBITORS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

ANGIOTENSIN-II RECEPTOR INHIBITOR ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Follow-up and Monitoring ,[object Object],[object Object],[object Object],[object Object],[object Object]

New Features and Key Messages ,[object Object],[object Object],[object Object],[object Object]

Hypertension

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Hypertension

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