1. HYPERTENSION

2. Systemic hypertension
• long-lasting, usually permanent increase of systolic and diastolic
blood pressure
primary (essential) hypertension – unknown cause; usually
coincidence of more factors – neural,
hormonal, kidney dysfunction, ...
secondary (symptomatic) hypertension – symptom (sign)
of other disease

3. SECONDARY HYPERTENSION

4. essential hypertension – 90 to 95 % of high blood pressure
prevalence:
• children...about 4 %, mostly secondary
• middle age ... 11-21 %
• 50-59 years old ... approximately 44 %
• 60-69 years old ... approximately 54 %
• more than 70 years old ... ≥ 64 %
(Standard guidelines, 2nd edition)

5. CLASSIFICATION OF HYPERTENSION
JNC 7
7th report of
Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood
Pressure

6. CLASSIFICATION OF ADULT´S
HYPERTENSION
 Previous classification of hypertension (JNC 6, WHO)

7. REASONS FOR ACTUALISATION
OF CLASSIFICATION JNC 6 (1997):
 Completing of more new clinical studies with substantial
consequences for the treatment of hypertension.
 Need for less complicated classification of hypertension.
 Need for new and clear guidelines suitable for physicians.
 Previous reports didn´t bring expected benefits.

10. RISK OF CARDIOVASCULAR
DISEASES
the higher BP, the higher risk of heart failure, stroke, renal diseases
each increase of systolic BP by 20 and diastolic BP by 10 mm Hg
doubles the risk of CVD

14. BENEFIT OF BP REDUCTION
In clinical studies was during antihypertensive therapy recorded:
 35-40% incidence reduction of stroke
 20-25% incidence reduction of myocardial infarction
 more than 50% share at incidence reduction of heart failure
 it is assumed that among patients at first stage of
hypertension (140-159/90-99 mm Hg) and with other
cardiovascular risk factors, permanent reduction of BP by 12
mm Hg during 10 years prevents one death from 11 treated
patients (when CVS disease or organ affection, it is one from
9)

15. EFFECTIVITY OF BP REDUCTION
 Despite the fact that decreasing of BP below 140/90 mm Hg is successful among
more and more patients, still their number (34%) is less than intention (50%), 30%
still doesn´t know about their disease

16. EVALUATION OF PATIENTS
All of these datas influence the prognosis and therapy selection.
Evaluation of patients with diagnosed hypertension has importance to:
evaluate the way of living + reveal other CVS risk factors and/or associated
diseases

17. Very important is the circadian rhythm of blood pressure.
Physiological profound nocturnal decline, mostly around 4
a.m. ("dipping"), acts as a protection against pathological
lesions of blood vessels, resp. reduces them
Hypertensive patients with significant nightime BP
decrease have a more favorable prognosis ,as patients
whose blood pressure at night compared to daytime values ​
doesn´t decrease (worse prognosis)
-→ according to it are patients diveded to „dippers“ versus
„non-dippers“
Improvement of diagnosis ← broader application of 24-hour
blood pressure monitoring

18. Circadian rythm of BP (dippers vs. non-dippers)

19. WE GAIN INFORMATION ABOUT
PATIENT FROM :
 Anamnesis
 Physical examination (BP measurement, eyeground
examination, BMI calculation, listening to murmurs at
large arteries, detailed examination of heart, lungs,
stomach, searching for enlarged kidneys, palpation of
glandula thyroidea, resistency and abnormal pulsation of
aorta, palpation of lower extremities to search for
oedemas and pulsations, neurologic examination)
 Laboratory examinations (ECG, urine, blood glucose,
haematokrit, kallium, calcium, creatin in serum, lipid
spectrum of serum)

20. TREATMENT
 The final goal of antihypertensive therapy is reduction of mortality
and morbidity to CVS and renal diseases.
 Primary goal is reduction of systolic BP. We want to reach BP less
than 140/90 mm Hg (Torr), or less than 130/80 mm Hg among
diabetic patients and patients with kidney diseases
 Needed is also early detection.

22. NONPHARMACOLOGICAL TREATMENT
Change of life-style:
• intake of salt ... ≤ 5 – 6 g per day
• prevention of obesity – dietetic modification
• alcohol ... ≤ 30 g per day
• smoking – stop
• physical activity
• psychical relaxation

25. PHARMACOLOGIC TREATMENT
Antihypertensives
1st choice drugs:
1. diuretics
2. β-blockers
3. inhibitors of ACE
4. blockers of AT1 receptors (ARB)
5. calcium channel blockers
2nd choice drugs – mainly to drug combinations:
α1-sympatholytics; α2-sympathomimetics; direct
vasodilators; kallium channel openers;
agonists of I1 receptors in CNS; other mechanisms of action

26. Therapeutic algorithm of hypertension treatment
(JNC 7)