Hypertension

BP ≥140/90 (WHO/ISH,1993)

Isolated systolic hypertension: BP syst ≥ 140 mm Hg, BP diast. < 90 mm Hg

Blood pressure measurement (ESH/ESC 2007)

† Allow the patients to sit for several minutes in a quiet room

† Take at least two measurements † Use a standard bladder (12–13 cm long and 35 cm wide)

but have a larger available for fat arms † Have the cuff at the heart level † Use phase I and V (disappearance) Korotkoff sounds to

identify systolic and diastolic BP, respectively † Measure BP in both arms at first visit to detect possible

differences due to peripheral vascular disease † Measure BP after the standing position in elderly subjects,

diabetic patients, and in other suspition of postural hypotension

Hypertension – classification Primary : 90%, per exclusionem Secondary (10%) - renal parenchymal - renovascular - endocrine : phaeochromocytoma,

primary aldosteronism, Cushing´s sy - coarctation of aorta - in pregnancy

Hypertension – classification (ESH/ESC 2007, NHLBI 2003)

Optimal : systolic ≤ 120 and, diastolic ≤ 80 Normal 120–129 and/or 80–84 mm Hg High normal („prehypertension“) 130–139

and/or 85–89 Hypertension ≥ 140/90 Grade 1 hypertension 140–159 and/or 90–99 Grade 2 hypertension 160–179 and/or 100–

109 Grade 3 hypertension ≥ 180 and/or ≥ 110

Routine laboratory tests in hypertension (ESH/ESC 2007, NHLBI 2003)

† Fasting plasma glucose, Serum total cholesterol, Serum LDL-cholesterol, HDL-cholesterol, Fasting serum triglycerides

† Serum potassium, Serum uric acid, Serum creatinine, Estimated creatinine clearance (Cockroft-Gault, MDRD)

† Haemoglobin and haematocrit † Urinalysis (complemented by

microalbuminuria via dipstick, and microscopic examination)

† Electrocardiogram

Recommended tests in hypertension (ESH/ESC 2007, NHLBI 2003)

† Echocardiogram † Carotid ultrasound † Quantitative proteinuria (if dipstick test

positive) † Fundoscopy † Glucose tolerance test (if fasting plasma

glucose >5.6 mmol/L) † Home and 24 h ambulatory BP monitoring

Goals of treatment † reduction in the long term total risk of

CVD † Treatment of the raised BP † BP should be reduced to at least below

140/90 mm Hg † Target BP should be at least 130/80 mm

Hg in diabetics and in high risk patients (stroke, MI, renal dysfunction, proteinuria).

† treatment should be initiated before significant cardiovascular damage develops.

Ambulatory 24-h BP monitoring

should be considered when considerable variability of BP is found

marked discrepancy between BP values measured in the office and at home

resistance to drug treatment is suspected

hypotensive episodes are suspected, particularly in elderly and diabetics

Self-measurement of home BP

provides more information on the BP lowering effect of treatment

improves patient’s adherence to treatment regimens

anxiety of the patient Choice of electron.device (no finger, wrist,

yes arm), certification EU www.dableducational.com, (Omron M4, M6, MIT)

Blood pressure thresholds for definition of hypertension

Office or clinic 140/90 mm Hg Total average 24-hour 125–130/80 Day 130–135/85, Night 120/70 Home 130–135/85

STOP-2: Výsledky

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Patients’ follow-up

† Titration to BP control requires frequent visits in order to modify the treatment regimen in relation to BP changes and appearance of side effects.

† Once target BP has been obtained, the frequency of visits can be considerably reduced.

† Patients at low risk or with grade 1 hypertension may be seen every 6 months

† Visits should be more frequent in high or very high risk patients.

Hypertension - prognosis

† ESC SCORE risk ≥ 5% † DM of 1st type with

microalbuminuria, all diabetics of 2nd type

† Family history of premature CV disease (M at age, 55 years; W at age, 65 years)

† Age (M. 55 years; W. 65 years)

Risk factors

† Carotid wall thickening (IMT 0.9 mm) or plaque † Smoking † Dyslipidaemia- (TC ≥ 5.0 mmol/l: LDL-C ≥ 3.0

mmol/l - HDL-C: M <1.0 mmol/l, W < 1.2 mmol/l - TG ≥1.7 mmol/l)

† Fasting plasma glucose 5.6–6.9 mmol/L, Microalbuminuria 30–300 mg/24 h

† Abnormal glucose tolerance test † Abdominal obesity (Waist circumference 102 cm (M),

88 cm (W)

Risk factors Cerebrovascular disease (ischaemic

stroke; cerebral haemorrhage; TIA) Heart disease: MI; angina; coronary

revascularization; heart failure Renal disease: diabetic nephropathy;

renal impairment Peripheral artery disease Advanced retinopathy: haemorrhages

or exudates, papilloedema

Hypertensive crisis

Life – threatening event with potential failure of important organs (CNS, cardivascular system, kidney)

In severe hypertonics, poor controlled, rebound f.

Emergent, urgent.

Therapy of Hypertensive Crisis

Captopril 12,5-50 mg, furosemide Nitrates : ISDN 2-10 mg/h., NTG 0,5-10

mg/h i.v. Na Nitropruside : 0,3…max.8

μg/kg/min. Urapidil (Ebrantil) : 25 mg i.v. Labetalol : bolus i.v. 20-40 mg 1 min.,

thereafter 1-2 mg/min. Decrease 20%/h

Hypertension in pregnant women

Alfa-metyldopa, betablockers, dihydropyridin Ca blockers, labetalol

Contraindication : ACE inhibitors, AT1 blockers, diuretics