Unit 2_Classification of BP Measurements.pptx

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1. UNIT 2: CLASSIFICATION OF BLOOD PRESSURE MEASUREMENTS AND TYPES OF HYPERTENSION

2. Objectives: By the end of this session the participants will be able to: Classify BP measurements Identify causes and risk factors for Hypertension Identify Factors which increases cardiovascular events in hypertensive patients. 2

3. I. Grading of Raised Blood Pressure 3 Classification SBP (mmHg) DBP (mmHg) Normal <120 <80 Pre-hypertension 120-139 80-89 Grade 1 HTN 140-159 90-99 Grade 2 HTN 160-179 100-109 Grade 3 HTN(Severe) > 180 > 110 Isolated Systolic Hypertension age >60 > 140 <90

4. Special Groups of hypertension Isolated systolic hypertension : elevated systolic BP with normal diastolic BP, mostly seen in elderly patients. White coat hypertension : Consistently elevated BP in the clinic setting, but reverts to normal BP out of the clinic. Masked Hypertension : This is the opposite of white coat hypertension where patients report to have persistently high blood pressure at home while their clinic measurements are in the normal range. Despite having normal/target blood pressure at clinics they present with evidence of end-organ damages . 4

5. Factors influencing the cardiovascular risk related to hypertension Blood pressure must be seen as a component of a cardiovascular risk profile. The following four factors influence the occurrence of complications related to hypertension: The level of blood pressure The presence of classical CV risk factors Asymptomatic Target Organ Damage Associated Clinical Conditions

6. 1. The level of blood pressure Hypertension is the most commonly identified modifiable CV risk factor in patients presenting with cardiovascular events. The higher the blood pressure the higher the risk. Pre-hypertension was previously found to be common (up to 40%) in a study population and was associated with increased risk of myocardial infarction, stroke, heart failure and CV death. These patients need to be followed up and lifestyle modification advised.

7. 2. Cardiovascular risk factors Any factor which significantly increases the likelihood of developing cardiovascular event is called cardiovascular (CV) risk factor. They are classified as modifiable and non modifiable risk factors( age,sex ,genetics). Majority of people with hypertension have multiple other CV risk factors. Presence of these risk factors in hypertensive patients significantly increases the likelihood of developing cardiovascular events and therefore should be identified and treated. These risk factors include: Diabetes mellitus Smoking Low fruit Intake Excess alcohol consumption Physical inactivity Dyslipidemia Psychosocial stress Obesity Family history of Premature cardiovascular death( Male<55 and Female <65 yrs) 7

8. 3. Asymptomatic T arget Organ Damage Left Ventricular hypertrophy on ECG or echocardiography Proteinuria ( excretion of 30-300mg of albumin/24 hr) Chronic Kidney Disease with estimated GFR between 30-60ml/min/1.73msq. body surface area) Asymptomatic Peripheral vascular disease 8

9. 4. Associated clinical Conditions(ACC) Current or Past history of cardiovascular diseases or other diseases which increase the risk of future cardiovascular events are called Associated Clinical Conditions(ACC) . ACCs include: Chronic kidney disease(GFR<30ml/ min/1.73msq. body surface ) Stroke/Transient Ischemic Attack Myocardial infarction/Angina Heart Failure Peripheral arterial disease Retinopathy(exudates , papiledema ) 9

10. Major Risk factors for CVD 10 The 9 risk factors account for more than 90% of ischaemic heart disease.

11. Table 2:Factors-other than BP-influencing prognosis; used for stratification of total CV risk Risk Factors Diabetes TOD ACC Age (>55 male and >65 female) Male Sex Smoking Dyslipidemia Prediabetes Obesity: abdominal waist circumference: men ≥94 cm; women ≥80 cm or BMI>30. Family history of Premature cardiovascular death (Male<55 and Female <65 yrs) Fasting plasma glucose 126 mg/ dL on two repeated measurements, and/or HbA1c >7% and/or Random plasma glucose >200 mg/dL Left Ventricular hypertrophy on ECG or echocardiography Proteinuria ( excretion of 30-300mg of albumin/24 hr) CKD with eGFR between 30-60ml/min/1.73msq body surface area) Asymptomatic Peripheral vascular disease Chronic kidney disease(GFR<30ml/ min/1.73msq body surface ) Stroke/TIA Myocardial infarction/Angina Heart Failure Peripheral artery disease Retinopathy (exudates , papiledema ) 11

12. Total CV Risk Prediction Chart based on BP levels and presence of other Risk factors Figure 3 : CV risk Prediction Chart based on BP levels and presence of other Risk factors . Adapted From ESC/ESH 2013 guideline. 12

13. Case Study 2 Ato Mulatu is 52 year old male person presented to a clinic for cough , fever and chest pain over the last three days. He is known to have diabetes for the last five years but never told to have hypertension . His father died suddenly while walking to work place with suspected heart problem at age 50 . On physical he had PR of 112/min, temperature of 37.9 o C. His blood pressure was 150/95 on right arm and 155/95 mmHg on his left arm. His calculated BMI was 32. No positive findings in other system examination. 13

14. Case Study 2 Questions 1. How do you interpret the BP values of this patient? 2. Classify the BP reading of this patient. 3. What other CV risk factors is the patient having? 4. Outline your next steps for a patient with these BP values. 14

15. Case Study 2 Answers 1. How do you interpret the BP values of this patient? He has raised BP 2. Classify the BP reading of this patient. If confirmed on different occasions ,he has stage 1 hypertension 3. What other CV risk factors is the patient having? Diabetes, family history of premature death and obesity. 4. Outline your next steps for a patient with these BP values.Such patties with raised BP and multiple risk factors ( more than two) should be referred to higher health facility for evaluation of end organ damages and imitation of antihypertensive. Once diagnosis is established the patient can be followed at health center 15