Hypertension.pdf

NIM ACADEMY OF HEALTH SCIENCES MENTORSHIP CLINICAL PHARMACY - Pharmacotherapy of HTN Augustine Chona (CertTM, DipEntre, DipPharm, Bpharm, Msc Candidate) OBJECTIVES Define HTN Explain the causes and pathogenetic mechanisms Classify HTN...

NIM ACADEMY OF HEALTH SCIENCES MENTORSHIP CLINICAL PHARMACY - Pharmacotherapy of HTN Augustine Chona (CertTM, DipEntre, DipPharm, Bpharm, Msc Candidate) OBJECTIVES Define HTN Explain the causes and pathogenetic mechanisms Classify HTN Diagnosis Management DEFINITION OF HYPERTENSION BP = CO × TPR Hypertension is defined conventionally as a sustained increase in blood pressure ≥140/90 mmHg. The WHO has identified hypertension as the leading risk factor for death worldwide. Stroke, MI, HF, renal failure and dissecting aortic aneurysm. CVD risk starts at a BP of 115/75 mmHg, and doubles with every 20/10 mmHg increase. PATHOGENETIC MECHANISM High plasma level of catecholamines. Increase in blood volume i.e. arterial overfilling (volume hypertension) and arteriolar constriction (vasoconstrictor hypertension). Increased cardiac output. Low-renin essential hypertension found in approximately 20% patients due to altered responsiveness to renin release. High-renin essential hypertension seen in about 15% cases due to decreased adrenal responsiveness to angiotensin II.  CAUSES Idiopathic, Primary hypertension (90–95%) - Essential hypertension 2. Secondary hypertension (5–10%) –,. -Diseases – renal, endocrine, CVD, and neurological -Drugs – NSAIDS, corticosteroids, vasopressin, etc.., GENETIC BASIS OF HYPERTENSION Gene Defects in enzymes involved in aldosterone metabolism (e.g., aldosterone synthase, 11β-hydroxylase, 17α-hydroxylase), ↑aldosterone secretion, ↑salt and water resorption, and plasma volume expansion Mutations in proteins that affect sodium resorption (as in Liddle syndrome) CLINICAL CLASSIFICATION (mmHg) (mmHg) Normal < 120 and < 80 Prehypertension 120-139 or 80-89 Hypertension: Stage 1 140-159 or 90-99 Stage 2 >160 or >100 Isolated systolic hypertension >140 and < 90 Malignant hypertension > 200 > 140 HYPETENSION CRISES 1. Hypertensive Emergency A hypertensive emergency is a severe increase in blood pressure (usually above 180/120 mmHg) that is accompanied by acute target organ damage. life-threatening and requires immediate medical intervention, often in a hospital setting. 2. Hypertensive Urgency also characterized by a significant elevation in blood pressure (typically >180/120 mmHg), but it is not accompanied by acute target organ damage. it still requires prompt medical attention to prevent progression to a hypertensive emergency. RISK FACTORS 1. NON-Modifiable Age Sex Family Hx Ethnicity 2. Modifiable RF High diet salt intake Diet High in Fat and Low in Nutrients Physical Inactivity Obesity Alcohol Consumption Tobacco Use Stress SYMPTOMS Asymptomatic Severe cases may present with headache, visual disturbances or evidence of target organ damage Consequence of target organ; heart, eyes, kidneys, brain, peripheral vasculature…, DIAGNOSTIC TESTS Well calibrated sphygmomanometer BP when sitted and standing position. The arm should be supported level with the heart BP initially be measured in both arms, and if 20 mmHg difference, sustained after repeat measurement, arm with the highest value to be used for subsequent monitoring readings. 15 mmHg between arms may indicate risk of underlying vascular disease and an increased risk of all-cause and CV mortality Repeat reading for >140/90 mmHg. Confirm HTN via ABPM LAB TESTS KFT LFT Electrolytes Other tests – ECG, Echo, eGFR GENERAL BP TARGETS Clinic BP target ABPM/HBPM target  People younger than 60 yrs