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

NZ Guidelines on Assessment and Management of Cardiovascular Risk

NZ Guidelines and Emerging Risk Factors

• ApoB- a good risk predictor which might have a role once assays become more standardized. There are some who strongly advocate current use of this assay now in the risk stratification.
• Microalbuminuria- although shown to be a marker of higher risk for future events, but not recommended for routine use in non-diabetic patients until there is more evidence.
• hs-CRP- may have a role in making decisions regarding therapy in patients close to the threshold for pharmacologic therapy. Otherwise, not recommended for routine use or to monitor therapy.
• Lp(a)- regards this test as still being controversial.
• Homocysteine- although elevated levels are associated with higher risk, data on benefit from lowering levels with folic acid is still lacking and thus not yet recommended for routine measurement.
  Two studies presented at a scientific meeting in 2006 found no cardiovascular benefit with folic acid supplementation

I suspect, in patients that are close to the "fifteen percent" threshold for treatment, it is not unreasonable to selectively measure some emerging risk factors, such as hs-CRP, to aid decision making. In hypertensive patients with left ventricular hypertrophy or microalbuminuria we should aim for excellent control and not just lowering of estimated risk below fifteen percent.

Hitesh Patel, Cardiologist
11th July, 2004