hypertension presentation mechanism and Indian scenario

Indian scenario of HTN

1. VARIOUS GUIDELINES FOR HYPERTENSION, WHICH ONE SUITS BEST FOR INDIA

2. IMPORTANT??

3. ESC GUILDELINES 2024 European Heart Journal (2024) 45 , 3912–4018

4. 2023 ESH Guidelines for the management of arterial hypertension J Hypertens 2023;41:1874-2071

5. 2020 International Society of Hypertension global hypertension practice guidelines. Unger T, et al. J Hypertens . 2020.

6. ACC/AHA GUIDELINES 2017

7. ICMR 2016

8. Indian guidelines on hypertension-IV (2019) Hum Hypertens   34 , 745–758 (2020).

9. NICE GUIDLEINES Confirm diagnosis of hypertension in people with a: clinic blood pressure of 140/90 mmHg or higher  and ABPM daytime average or HBPM average of 135/85 mmHg or higher. 

10. ACC2017 ESC2024 ESH2023 ISH2020 CHL2018 HK2018 INDIA2019 INDONESIA2019 JSH2019 SBP<120. DBP< 70 NON ELAVTED SBP <120 and DBP <80 NORMAL ELVETED OPTIMAL NORMAL OPTIMAL OPTIMAL OPTOMAL NORMAL SBP: 120–129 and DBP <80 ELAVATED HIGH NORMAL BP 120–129 and DBP 80–84 N SBP 120–139 and DBP 80–89 H NORMAL SBP <130 and/or DBP <85 N NORMAL SBP: 130–139 and (or) DBP: 80–89 S 1 SBP 130–139 and/ or DBP 85–89 HIGH N HN HN HN HN SBP: 140–159 and (or) DBP: 90–99 S2 HTN G 1 G1 G1 G1 S1 G1 G1 SBP: 160–179 and (or) DBP: 100–109 G2 G2 G2 G2 S2 G2 G2 SBP ≥180 and/or DBP ≥110 G3 G3 G3 S3 G3 G3 SBP ≥140 and DBP <90 ISH ISH ISH ISH ISH ISH SBP<140 ,DBP>90 IDH

11. ACC ESC ESH IHS INDIAN CHS OFFICE 140/90 140/90 140/90 140/90 HOBP 135/85 135/85 135/85 135/ 85 ABPM 135/85 130/80 130/85 DAYTIME 130/70 135/85 135/80 135/85 NIGHT 120/70 120/70 120/70 120/70 MEAN 130/80 130/80

12. WHICH IS BEST FOR INDIANS?

13. Of the estimated 28% of adults older than 18 years with high blood pressure in India, nearly 2 in 3 remain without a diagnosis across all states and in both urban and rural areas. Among those with a diagnosis, only half were treated; treatment rates were higher in southern and western India and lower in other parts of the country. Among those treated, nearly half did not have their blood pressure under control. . Cumulatively, more than 90% of adults with hypertension in India were either undiagnosed, untreated, or treated but with uncontrolled hypertension. JAMA Network Open. 2023;6(10):

14. ICMR GUIDELINES 2016

15. J Am Coll Cardiol . 2014 Aug 12;64(6):588–597.

16. 2015 Challenge the Guidelines “ Hypertension guidelines: Good-bye to confusion and welcome to clarity ” C. Venkata S. Ram a,b ,* The threshold to treat hypertension should be 140/ 90 mm Hg in all patients <80 years. For individuals >80 years, the threshold to treat hyper- tension should be 150/90 mm Hg. For patients with chronic kidney disease CVD, diabetes, and proteinuria, the blood pressure target should be be- tween 130/80 mm Hg and 140/90 mm Hg. Keep in mind what I stated elsewhere e the issue in pa- tients with hypertension is “high” blood pressure and not “low” blood pressure. No one is asking you to lower the BP levels deliberately to 110/60 mm Hg or 90/50 mm Hg. Common sense is still valid. Do not loosen the goal blood pressure levels but focus on achieving a blood pressure of <140/90 mmHg in persons under the age of 80 years; for individuals older than 80 years, achieve (if possible) the blood pressure level of 150/ 90 mmHg. Simple, no confusion, straight forward, and go for it. Indian heart journal 67 (2015) 18e22

17. What is needed Stick to one guideline Strict follow up Enhance opportunistic Blood pressure measurement Ensure treatment adherence Promote primordial and primary preventive measures

18. OVERCOME CHALLENGES MAKE OUR OWN GUIDLEINES