HYPERTENSION

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HYPERTENSION

• Neil Wilson
• 14.10.02
• Hot Topic

2
Sources

• British Hypertension Society Guidelines (Journal
  of human hypertension 13(9), 1999)
• SIGN guideline 49 (Hypertension in older people,
  2001)
• ABC of hypertension, 1995
• Practice Protocol, 2002

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WHY?

• Diastolic BP of 130-150 gives a 60 2 year
  mortality rate
• Complications of hypertension include
• Stroke
• MI
• Heart Failure
• Renal Failure
• Only ½ hypertensives are known about
• of those known, only ½ are on treatment,
• of those on treatment, only ½ adequately treated

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Investigation

• Screen adults every 5 years until age 75
• If gt75, or BP gt135/85, then screen annually
• If hypertensive check
• -Urinalysis (protein blood) -ECG
• -UE, and glucose -BMI
• -Lipids -FH
• -CHD risk (cardiac risk assessment program)
• If young/severe/uncontrolled renal/endoc

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WHO TO TREAT?

• BP gt220/120 treat immediately
• BP gt160/100 treat if persistant
• BP gt140/90 treat if persistant and diabetic,
  target organ damage or 10 year CHD risk gt15
• BP gt135/85, reassess annually
• TARGETS lt140/85 (140/80 in diabetics)

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MANAGEMENT

• Non pharmacological management for ALL
• Obesity (BMI gt25)
• Salt and fat reduction
• Alcohol
• Exercise
• Smoking
• known to reduce BP

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DRUG THERAPY

• DRUG
• B blocker
• ACEI / ATII
• Thiazide diuretic
• Ca channel blocker
• Alpha blocker

• Compelling indication
• MI, angina, HF
• HF, LVF, IDDM, stroke
• Elderly
• Angina, ISH elderly
• Prostatism

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Compelling possible indications,
contraindications and cautions for the major
classes of hypertensive drugs
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DRUG THERAPY
Younger patients ACEI / ATII B
blocker Older patients Ca channel
blocker Diuretic (thiazide)
REMEMBER combinations of drugs have an additive
effect 1/3 patients need gt3 classes of drugs to
reach target
Dont forget aspirin and statins (for CHD risk
reduction)