Hypertension

• Patient assessment- brief overview

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• Guidelines
• New Zealand Guidelines: Threshold for Pharmacologic Treatment
• New Zealand Guidelines: Emerging Risk Factors
• Selected Information From JNC 7

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• Left Ventricular Hypertrophy
• LVH on ECG and prognosis
• LVH with echo and prognosis
• Africans have more LVH
• LVH- more information

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• Hypertension Trials
• Beta-blockers no longer first or second line agents for treatment of hypertension for all patients.
• Review of Hypertension trials- 2005
• ASCOT, LIFE, ALLHAT, ANBP2

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• Ambulatory and Home BP Monitoring
• Introduction

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• Lifestyle Measures
• Impact on Hypertension

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• Resistant Hypertension
• Meet the experts session- ESC 2008

Hypertension- JNC7

The USA's JNC guidelines suggested the following classification of blood pressure:

• Normal- BP <120/80
• Prehypertension- BP 120-139/80-89
  (the Europeans prefer to refer to those with BP of 120-129/80-84 as normal and those with higher pressures as "high-normal")
• Hypertension Stage I- BP 140-159/90-99
• Hypertension Stage II- >160/100

The following are regarded as some of the key messages of JNC7

• In individuals older than age 50 years, SBP is a more important CVD risk factor than DBP.
• Beginning at 115/75 mm Hg, CVD risk doubles for each increment of 20/10 mm Hg throughout the BP range (the absolute increase in risk rises with age).
• Those who are normotensive at 55 years of age will have a 90% lifetime risk of developing hypertension.
• Those with SBP 120 to 139 mm Hg or DBP 80 to 89 mm Hg should be considered prehypertensive and require health-promoting lifestyle modifications to prevent a progressive rise in blood pressure and CVD.
• Thiazide-type diuretics should be initial drug therapy for most, either alone or combined with drugs from other classes.
• Certain specific high-risk conditions are compelling indications for the use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers).
• Two or more antihypertensive medications will be required to achieve goal BP in most hypertensive patients.
• For patients with BP >20/10 mm Hg above the BP goal, initiation of therapy using two agents, one of which will usually be a thiazide diuretic, should be considered.
• Hypertension will be controlled only if patients are motivated to stay on their treatment plan. Positive experiences, trust in the clinician, and empathy improve patient motivation and satisfaction.

Hitesh Patel, Cardiologist

5th May, 2005

Reference:
Franco V et al. Review: Clinical Cardiology: New Frontiers. Hypertensive Therapy: Part I.Circulation. 2004;109:2953-2958.