Current management of hypertension DR. ANKIT JAIN AIIMS

• 1. CURRENT MANAGEMENT OF HYPERTENSIONDR.ANKIT JAIN DR.G.KARTHIKEYAN

2. EPIDEMIOLOGY Worldwide prevalence is around 20% , and approximately7.1 million deaths per year may be attributable to hypertension The WHO reports that suboptimal BP (>115 mmHg SBP) isresponsible for 62 percent of cerebrovascular disease and 49 percent of ischemic heart disease (IHD) Suboptimal BP is top attributable risk factor for deaththroughout the world Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 19882000. JAMA 2003;290:199-206 3. Global Leading Risks for Death Systolic blood pressure > 115 mmHgGlobal Burden of Disease Study 2010 , Lancet 2012; 380: 222460 4. Attributable Risk 54% stroke47% IHD 25% other CVD 13.5% Total mortality Only half of the burden seen in people with hypertension(BP > 140 mmHg); remainder in prehypertensives (BP > 115mmHg) > 80% of the burden seen in low-income and middle-income regions Over half occurred in people aged 45-69 yrs Study by Int Society of hypertension; Lancet May 2008;371:1513-8 5. Impact of a 5 mmHg Reduction Overall Reduction Stroke14%Coronary Heart Disease9%All Cause Mortality7%Hypertension 2003;289:2560-2572. 6. India- Soon Heading Towards Being Hypertension CapitalNo. of people with hypertension in India (millions)At least 1 out of every 5 adult Indians has hypertension 120107.3106.2100 80 60.457.860Hypertension is responsible for 57% of all stroke deaths 40 and 24% of all CHD deaths in India 20 0 20002025MenWomenAge > 20 yrs J Assoc Physicians India 2007;55:323-4Lancet 2005;365:217-23; JHH 2004;18:73-8 7. The Natural History of Untreated Hypertension Untreated hypertension is a self-accelerating condition Evolvingarteriolar hypertrophy, and endothelial dysfunction facilitate the later increase of BP transition to higher stage A summary of nearly all placebo- controlled early outcomestrials in hypertension indicated that 1493 of 13,342 (11.2%) subjects in the placebo groups progressed in stages of hypertension, Compared with only 95 of 13,389 ( 0.7%) in the drug-treated groups Hansen TW, Staessen JA, Zhang H, et al. Cardiovascular outcome in relation to progression to hypertension in the Copenhagen MONICA cohort. Am J Hypertens. 2007;20: 483-491 8. MAP/PP The BP can be divided into the steady [mean arterialpressure (MAP)] and the pulsatile [pulse pressure (PP)] components The MAP is determined by cardiac output (CO) andvascular resistance and remain same throughout vascular tree PP component is influenced by left ventricular ejection,large artery stiffness, pulse wave reflection, and heart rate and is an independent risk factor 9. Distribution of Hypertension Subtype in the untreated Hypertensive Population in NHANES III b Age ISH (SBP 140 mm Hg and DBP