3. HTN
• <1 in 5 under control
• Every 20/10 mmHg higher
BP=X2 death from HD or stroke
4.
5.
6. ACC/AHA:2017
Normal : <120 mmHg /<80 mmHg
Elevated blood pressure – SBP= 120
to 129 ,DBP<80 mmHg
Hypertension:
• Stage 1 – Systolic 130 to 139 mmHg or
diastolic 80 to 89 mmHg
• Stage 2 – Systolic at least 140 mmHg or
diastolic at least 90 mmHg
17. NON PHARMA
• Dietary salt restriction –
• fall in blood pressure in hypertensive :5/2.5
mmHg
• Potassium supplementation: Fruits
• Weight loss :0.5 to 2 mmHg for every 1 kg of
weight lost
• Dietary Approaches to Stop Hypertension
(DASH):4-6mmHg
• Exercise :6/3 mmHg
• Limit alcohol
18.
19. Pharma
• Antihypertensive
• 50% relative risk reduction in the incidence of heart failure
• 30 to 40 percent relative risk reduction in stroke
• 20 to 25 percent relative risk reduction in myocardial infarction
27. hypertensive urgencies
• Blood pressure reduction goal — In adults with severe asymptomatic
hypertension, the shorter-term goal of management is to reduce the
blood pressure to ≤160/≤100 mmHg. However, the mean arterial
pressure should not be lowered by more than 25 to 30 percent over
the first several hours
• In the long-term, the blood pressure should usually be reduced
further (eg, <140/<90 mmHg or <130/<80 mmHg)
• Clonidine ,labetolol ,diuretic ,ACEI/ARB
28. Hypertensive emergencies=Malignant HTN
• mean arterial pressure should be reduced gradually by approximately 10 to 20
percent in the first hour and by a further 5 to 15 percent over the next 23 hours
[8]. This often results in a target blood pressure of <180/<120 mmHg for the first
hour and <160/<110 mmHg for the next 23 hours (but rarely <130/<80 mmHg
during that time frame).
29. • The acute phase of an ischemic stroke – The
blood pressure is usually not lowered unless it is
≥185/110 mmHg in patients who are candidates
for reperfusion therapy or ≥220/120 mmHg in
patients who are not candidates for reperfusion
(thrombolytic) therapy
• Acute aortic dissection – The systolic blood
pressure should be rapidly lowered to a target
of 100 to 120 mmHg (to be attained in 20
minutes) to reduce aortic shearing forces [12
• Intracerebral hemorrhage –
30. Acute heart
failure
• Patients with acute left ventricular dysfunction
and pulmonary edema should usually receive
loop diuretics. A vasodilator that is easy to
titrate (eg, sodium nitroprusside, nitroglycerin)
is often added to reduce afterload. Drugs that
increase cardiac work (eg, hydralazine) or
acutely decrease cardiac contractility (eg,
labetalol or other beta blocker) should be
avoided. The goal of these therapies is
amelioration of volume excess and heart failure
and improvement in pulmonary edema, which
can often be achieved with a 10 to 15 percent
reduction in blood pressure.
32. Acute aortic
dissection
Patients with acute aortic dissection are
treated to rapidly reduce the blood
pressure to a goal systolic of 100 to 120
mmHg within approximately 20 minutes
of diagnosis
An intravenous beta blocker is given first
(usually esmolol, but labetalol,
propranolol, and metoprolol can also be
used) to reduce the heart rate below 60
beats per minute and the shear stress on
the aortic wall
33. Preeclampsia-
eclampsia
• Preeclampsia refers to the syndrome of new
onset of hypertension and proteinuria or new
onset of hypertension and end-organ
dysfunction with or without proteinuria (table
1), most often after 20 weeks of gestation in a
previously normotensive woman. Eclampsia is
diagnosed when seizures have occurred.
34. • Chronic (preexisting) hypertension – Chronic
hypertension is defined as hypertension that
antedates pregnancy, is present before the 20th
week of pregnancy, or persists longer than 12
weeks postpartum
36. Gestational
hypertension
• elevated blood pressure first detected after 20
weeks of gestation in the absence of proteinuria
or other diagnostic features of preeclampsia
