Hypertensin CPG IN THE PHILIPPINES REPORTING.pptx

CPG

1. CLINICAL PRACTICE GUIDELINE HYPERTENSION

2. HYPERTENSION

3. HYPERTENSION CLASSIFICATION: Primary/ Essential: most common Secondary Hypertension

4. HYPERTENSION

5. DIAGNOSIS OF HYPERTENSION Two or more elevated readings on at least 2 clinic visits over a period of one to several weeks Definition – adults with: SBP > 140 mmHg, or DBP > 90 mmHg

6. Complications, Management Health Education

7. Possible Complications Hypertensive Crisis: Types of Uncontrolled Hypertension HYPERTENSIVE
URGENCY HYPERTENSIVE
EMERGENCY BP SBP >180 and/or DBP > 120 mmHg Acute HMOD NONE PRESENT Management Reinstitute or intensify oral drug therapy & arrange close outpatient follow-up Admit to ICU & manage based on the presence of compelling conditions *HMOD -Acute Hypertensive Mediated Organ Damage.

8. MANAGEMENT 1) Among Filipinos with hypertension, what are the general treatment recommendations? 2) What non-pharmacologic approaches are recommended for persons with hypertension?

9. Lifestyle Modification Cornerstone for the management of HPN Can prevent or delay the onset of high BP and can reduce cardiovascular risk. Synergistic to the effects of antihypertensive medications

10. Lifestyle Modification Sodium restriction: 1500 mg/day (people with prehypertension or hypertension); 2300 mg/day, about roughly ½ teaspoon of table salt (most healthy individuals) DASH (Dietary Approaches to Stop Hypertension) – low in sodium, high in potassium (for patients without renal insufficiency) Fruits, vegetables, low-fat dairy, fish, whole grains, fiber, potassium, and other minerals at recommended levels Low in red and processed meat, sugar sweetened food and drinks, saturated fat, cholesterol, and sodium.

11. Lifestyle Modification Aerobic physical activity & dynamic resistance exercises ABSTINENCE from alcohol or moderate alcohol intake Significant weight loss of ≥ 5% of the baseline weight (OW and Obese) Smoking cessation

12. PHARMACOLOGIC MANAGEMENT ACE inhibitors or ARBs, CCB, thiazide/thiazide-like diuretics – FIRST-LINE antihypertensives, can be monotherapy or combination Combination therapy: RAS blocker with CCB or thiazide/thiazide-like diuretics. *Other combinations depends on individual’s indications of specific drug class *ACE and ARBs – not recommended * Use of combinations recommended if single-pill therapy is not available or not affordable 3) Beta-blockers – patients with CAD, acute coronary syndrome, high sympathetic drive, pregnant. BBs for CHF – Bisoprolol, Carvedilol, metoprolol succinate or nebivolol. ≥

13. PHARMACOLOGIC MANAGEMENT 4) Patients with BP >150/100 mmHg (or >160/100 mmHg in the elderly) – combination: 2 agents, RAS inhibitor/ ACEi + CCB or diuretic * no single agent would be sufficient to achieve BP target

14. Algorithm for the Management of Hypertension among Adults

15. SOURCE: Philippine Society on Hypertension: CPG on Hypertension