HypertensionPrepared by:

Mohammed Hammad AlTemaniSupervised

Dr/hisham Abou Auda

Epidemiology

21.6

29.3

8.1

5.1 3.13.1

malignant neoplasmdisease of the heartcardiovascular diseasechronic lower respiratory Ddiabetes mellitusalzhehimer Daccident

Prevalence

• Increase with age• 25% of the white males vs. 17% in white

females• 44% of black males vs. 37% in black femals• Indifference between sexes at age < 65 y

76%of black vs. 63%of white.

Classification of BP

• Normal BP• Prehypertensive state• Stage I HTN• Stage II HTN

Etiology of Hypertension

• Primary – 90-95% of cases – also termed “essential” of “idiopathic”• Secondary – about 5% of cases

– Renal or renovascular disease– Endocrine disease

• Phaeochomocytoma• Cusings syndrome• Conn’s syndrome• Acromegaly and hypothyroidism

– Coarctation of the aorta– Iatrogenic

• Hormonal / oral contraceptive• NSAIDs

PRINCIPLES OF TREATMENT

• Non-drug treatment

• Thresholds

• Begin with one drug

• Choice based on concomitant disease, risk factors

• Start low and titrate up [GO SLOW!]

• Add a second drug if poor control

TREATMENT THRESHOLDSBHS guidelines for drug treatment of hypertension

Diastolic blood pressure

>110 mm Hg 100 - 109 mm Hg 90 - 99 mm Hg

90 - 99 mm Hg >100 mm Hg

TREAT

TREAT OBSERVE

Higher pressureswithin the range

orolder age > 60 years

orcoexisting risk factors

ortarget organ damage

Lower pressureswithin the range

oryounger age, withoutcoexisting risk factors

ortarget organ damage

TREAT

* *

*Repeated measurements

SBP > 160

Thank You