Hypertension Neocare Specialists presentation .pptx

Hypertension basics, causes, labs, complications and management approach

1. HYPERTENSION- Basics By Dr. Yvonne N. Nyatundo Neocare Specialist’s 10/07/24

2. Outline Definition How Classification Risk Factors Causes Workup Management Complications Q & A

3. Definition ACC/AHA >130/80 – Stage 1, >140/90 – Stage 2 NICE guidelines / ESH >140/90 Stage 1, >160/100 Stage 2 HTN, >180/110 -? Urgency /? emergency The HIGHER value determines the STAGE!!!

4. How?

5. Primary HTN Genetic & env factors Secondary HTN Result of medical conditions

6. Others Gestational HTN Chronic HTN in pg Isolated systolic HTN Whitecoat HTN Hypertensive crisis Hypertensive urgency SBP of >180mmHg / DBP of >120mmHg Hypertensive emergency – urgency + EOD (nephropathy, retinopathy, stroke, MI)

7. Primary HTN – R/Fs Age Obesity FHx – 2x more common in 1 with 1 or 2 HTN parents Race – blacks a/w more TOD High sodium diet ->3g/day Excessive alc consumption Physical inactivity Insuff . Sleep <7hrs/night

8. Secondary HTN – causes OCPs- high estrogen doses Chronic NSAID use Antidepressants – TCAs, SSRIs, MAO inhibitors Corticosteroids- GCs & MCs Nasal decongestants – phenylephrine, pseudoephedrine Atypical antipsychotics Some w8 loss medications Stimulants – methylphenidate, amphetamines OSA

9. Secondary HTN – causes Cushing’s syndrome Pheochromocytoma – paroxysmal HTN Endocrine d/o Coarctation of the aorta – major cause of 2 nd HTN in young children

10. Clinical Features?

11. Labs Cr , UA if financial constraints at every visit , screening TFTs Biannual fundoscopy PDT Toxicology screen

12. Management Non-pharmacological Lifestyle modification, DASH diet Pharmacological CCBs Preferred in blacks –sublingual nifedipine is CONTRAINDICATED ACEi /ARBs FIRST choice if has DM Thiazide diuretic – HCTZ, Chlorthalidone NO Beta blockers as initial monoRx unless indication –HF, IHD

13. Choice of initial antihypertensives

14. PRINCIPLES Reduce BPs over hrs to days, slower in the elderly- incr risk of MI, stroke. Longer acting agents preferred eg amlodipine Lower BPs to </=160/100 in severe asymptomatic HTN DO NOT LOWER MAP by >25-30% over the 1 st several hrs Thus short term BP target may need to be >160/100 in pts who p/w very high pressures because MI, stroke or AKI can be induced by rapid and aggressive antiHTN therapy Target BP <130/80, in the elderly <140/80 Titrate one drug to max dose before adding on or switching from 1drug to another

15. Complications IHD – MI LVH HF – rEF & pEF Intracerebral h’age CKD , ESRD HTN retinopathy

16. Follow up Screen for EOD Lifestyle advice at every visit Encourage SMBP and SBGM

17. Question 1 67 YOF came for medical checkup What will you tell the pt?

18. Question 2 73YOM during routine vital signs taking What’s your approach? Why could his BP reading be ___?

19. Question 3 84YOF WITH REDUCED LOC, ONE-SIDED WEAKNESS 1. WHAT WILL YOU WANT TO KNOW? 2. WHAT ARE YOUR TARGET BPs?

20. Question 4 94year old black male with DM AND CKD and a hx of HF 1. What’s your approach? 2. What are your target BPs? 3. What medication will you Discharge them on? BPs of 186/116 pr 117

21. Further reading Side effects or each antihypertensive drug. Nifedipine ? Enalapril ?

22. THANK YOU