1、Hypertension 2011 update,Salam Ishak AL Sammak.MD,FACP Nephrology associate medical group,Hypertension 2011 update,Epidemiology and Back ground JNC Seven definition and classification Sub classification and types of Hypertension Treatment options Lessons learned from New Trials of hypertension Take
2、home message,Hypertension 2011 update,Types of Hypertension Low Renin Hypertension White coat Hypertension Resistant Hypertension Secondary Hypertension,Hypertension 2011 update,Low Renin Hypertension More common in African American population and Elderly patient Respond well to Calcium channel bloc
3、kers and Diuretics less responsive to ACEi and ARB White coat syndrome Rise of blood pressure during office visit Check blood pressure in quit room after five minutes of relaxation taken by staff other than the doctor Ambulatory blood pressure monitoring or taking blood pressure at home are better m
4、ethods,Hypertension 2011 update,Treatment options Non Pharmacological treatment Diet Weight loss Stress management Class of drugs Diuretics Blockage of the RAAS system Calcium channel blockers Beta Blockers Centrally acting drugs Direct vasodilators,Hypertension 2011 update,RAAS Blockade ACEi ARB Di
5、rect Renin inhibitors Diuretics Thiazide( Chlorthalidone vs HCTZ) Loop diuretic Aldosterone blocking agents Calcium channel blockers Dihydropyridine Non dihydropyridine,Hypertension 2011 update,Beta Blockers Selective Non selective Combined and Blockers are more effective Centrally acting drugs Clon
6、idine Direct Vasodilator Minoxidil:common side effect fluid retention and Tachycardia Hydralazine,Hypertension 2011 update,Resistant Hypertension Blood pressure 140/90 despite using three different drugs including a diuretic Causes Non Adherent to diet, Non Compliance with taking medication Smoking
7、Heavy Alcohol drinking Obesity and Obstructive sleep Apnea Use of drugs like NSAID Contraceptive drugs,Hypertension 2011 update,Secondary causes of Hypertension Renal artery stenosis Hyperaldosternism Pheochromocytoma Cushing syndrome PrimaryHyperparathyroidism,Hypertension2011update,When to suspect
8、 Renal artery stenosis Sudden rise in creatinine level specially after starting ACE or ARB Sudden elevation in a previously well controlled hypertension Flash pulmonary edema Different in size more than 1.5 cm between two kidneys Presence of Abdominal bruit Older Age ,more prominent in white than Af
9、rican American with other Cardiovascular diseases,Hypertension 2011 update,Hyperaldosterniosm Higher percentage in Resistant hypertension 10-15% Hypokalemia with metabolic Alkalosis present in only 50% of cases Screening test: Plasma Aldosterone level /Plasma Renin Activity Ratio 20, Aldosterone lev
10、el 15 Morning specimen with supine position CT scan is more sensitive than MRI Stop Aldosterone blocking Agent prior to the test,Hypertension 2011 update,New trials Lessons learned Accomplish trial First trial to compare combination therapy in hypertensive patients 11,506 pts with high risk for card
11、iovascular events Benazipril/Hctz vs Benazipril/Amlodipine End point was achieved significantly less in the Benazipril/Amlodpine than Benazipril/Hctz Conclusion Combination of ACE/CCB is superior to ACE/Diuretic,Hypertension 2011 update,On Target study 25,620 pts with risk factors for cardiovascular
12、 disease Comparing Telmisatan vs Ramipril or Combination therapy of the two drugs The Combination therapy had more side effects than Monotherapy No difference in out come Conclusion Combination therapy of ACE/ARB is NOT Recommended for treating Hypertension,Hypertension 2011 update,HYVET Trial 3845
13、patients Age 80 or older comparing treatment with Indopamide with or without Perindpril vs Placebo After 1.8 years the treated group had significant reduction in total mortality 21%,stroke 30%,heart failure 64% Conclusion : treating pts with hypertension with cardiovascular risks will be beneficial
14、regardless of Age,Hypertension 2011 update,Take Home message Diet, Exercise, Weight Loss ,Behavior modification is crucial specially in the pre hypertension stage Home blood pressure monitoring should be your guide to start therapy and follow up treatment Blockers should not be first or second line agents Chlorthalidone is a better diuretic than HCTZ Common causes of Resistant Hypertension Lessons learned from New trial Timely and appropriate referral for patients with Secondary Hypertension,Hypertension 2011 update,Thank you for your Attention E mail address ,
