Maintain blood pressure presentation Blood-Pressure.pdf

Blood pressure

1. Blood Pressure - What to know
for daily practise?
Dr. Vishal Vanani
- Sources: ICMR, ACC/AHA, ESC, ISH Guidelines

2. Normal BP Readings
Healthy Adult (g18 years)
Method Normal BP Notes
Clinic/Office <120/80 mmHg Quiet room, seated g5 min
Home BP Monitoring (HBPM) <115/75 mmHg Twice daily, 7 day s avg
Ambulatory BP Monitoring (ABPM) 24h avg <115/75 mmHg D aytime <120/80, Nighttime <110/65

3. BP Measurement Criteria
Before Measurement:
Rest g5 min, empty bladder
No caffeine, smoking, exercise for 30 min prior
During Measurement:
Back supported, feet flat, arm at heart level
Use appropriate cuff size
Take g2 readings, 132 min apart, average them

4. Diagnostic Cut-offs for Hypertension
Method Threshold for Hypertension
Office BP g140/90 mmHg
HBPM g135/85 mmHg
24h ABPM avg g130/80 mmHg
Daytime ABPM g135/85 mmHg
Nighttime ABPM g120/70 mmHg

5. Grades of Hypertension
125
75
150
95
170
105
110
150
85
Elevated BP
Grade 1
Grade 2
Grade 3
Isolated Systolic
0 60 120 180
Systolic Range (mmHg) Diastolic Range (mmHg)
Grade Systolic (mmHg) Diastolic (mmHg)
Elevated BP 1203129 <80
Grade 1 1403159 90399
Grade 2 1603179 1003109
Grade 3 g180 g110
Isolated Systolic g140 <90

6. Types & Mimics of Hypertension
White Coat Hypertension
High in clinic, normal at home/ABPM
Masked Hypertension
Normal in clinic, high at home/ABPM
Secondary Hypertension
Renal, endocrine, drug-induced
Resistant Hypertension
Uncontrolled on g3 drugs
Pseudohypertension
Calcified arteries, falsely high
readings

7. Ideal Home BP Monitoring
Device
Device:
Upper-arm, automated oscillometric monitor
Accuracy:
Validated by AAMI/BHS/ESH criteria
Avoid:
Wrist/finger devices (less accurate)
Recommended Brands:
Brands with proven validation in India: Omron, Beurer, Circa

8. Quick Reference 3 Diagnosis
Confirm with repeat readings
Always confirm with repeat readings on g2 occasions
Rule out white coat effect
Rule out white coat effect via HBPM/ABPM
Assess risk factors
Assess risk factors: diabetes, dyslipidemia, smoking, family history
Check for end-organ damage
Check for end-organ damage: eyes, kidneys, heart, brain

9. Quick Reference 3 Management
Lifestyle First
Salt <5 g/day
Weight loss
Physical activity
Alcohol moderation
Drugs
Start if persistent Grade 1 with risk factors or gGrade 2
Choice based on comorbidities:
ACEI/ARB for diabetics, CKD
CCB for elderly, ISH
Thiazides for volume control
Monitor electrolytes, renal function

10. Take-home Messages
1Measure BP correctly
Measure BP correctly 3 method matters
2Use home/ABPM for accuracy
Use home/ABPM for accuracy & diagnosis confirmation
3Treat based on severity
Treat based on severity + overall cardiovascular risk
4Lifestyle changes are cornerstone
Lifestyle changes are cornerstone in all grades
5Regular follow-up is essential
Regular follow-up is essential to prevent complications