management of systemic hypertension update 2012

MANAGEMENT OF SYSTEMIC HYPERTENSION: UPDATES 2012 Prof Pham Nguyen Vinh, MD PhD FACC Pham Ngoc Thach University of Medicine Tam Duc Heart Hospital Heart Institute of HCM city Management of systemic hypertension: updates 2012 Milions Prediction of HTN prevalence on 2025* > 500 million hypertensive individuals by 2025 * Estimated Number of Individuals Aged 20 Years With Blood Pressure >140/90 mm Hg in 2000 and Predicted Number of Affected Individuals in 2025 Perkovic V, et al Hypertension 2007;50:991-7 Management of systemic hypertension: updates 2012 Definition and Classification of HTN TL: Mancia G et al European Heart Journal June 11, 2007 Management of systemic hypertension: updates 2012 Threshold of HTN definition based on technique of measurement TL: Mancia G et al European Heart Journal June 11, 2007 Management of systemic hypertension: updates 2012 Laboratory examinations (1)          Screening tests: Glycemia Total cholesterol, HDL-C, LDL-C, Triglyceride K+/maùu Blood acid uric Creatinemia; eGFR (Cockcroft-Gault) Hb, Hct TPTNT, Microalbuminemia ECG TL: Mancia G et al European Heart Journal June 11, 2007 Management of systemic hypertension: updates 2012 Laberatory examinations (2)           Laboratory check of necessity Echocardiography Carotid ultra sound Urine microalbumine/ urine creatinine ABI score Fo examination Glucose tolerance test Ambulatory BP monitoring Home check BP Pulse wave velocity TL: Mancia G et al European Heart Journal June 11, 2007 Management of systemic hypertension: updates 2012 Blood pressure targets Condition Target SBP and DBP mmHg Isolated systolic hypertension [...].. .Management of systemic hypertension: updates 2012 Meta analysis of benefits of natri reduction Average Reduction of sodium in Hypertensives Reduction of BP mg/day 5.1 / 2.7 mmHg 1800 mg/day 2300 mg/day 7.2/3.8 mmHg Average Reduction of sodium in Normotensives Reduction of BP mg/day 1700 mg/day 2.0 / 1.0 mmHg 2300 mg/day The Cochrane Library 2006;3:1-41 3.6/1.7 mmHg 11 Management of systemic hypertension: ... 13;291(6488):97-104 TL: 2010 Canadian Hypertension Education Program (CHEP) 28 Management of systemic hypertension: updates 2012 Algorithm for choosing of HTN drugs in NICE 2011 (UK) 29 Management of systemic hypertension: updates 2012 Algorithm for management of elderly HTN patients (The 2011 ACC/AHA Recommendation) (1) Principles of Hypertension Treatment Target systolic blood pressure is ≤ 140 mmHg in patients... of compelling indications for specific therapies YES Individualized Treatment (and compelling indications) TL: 2010 Canadian Hypertension Education Program (CHEP) 19 Management of systemic hypertension: updates 2012 Majority of patients needs > 1 drug to attain target of BP 5 3 2 P 0 D A S B C D M D R D H O T A A S K ID N T A LL H A T 1 U K Số lượng thuốc 4 20 Management of systemic hypertension: updates... pharmacological therapy 13 TL: 2010 Canadian Hypertension Education Program (CHEP) Management of systemic hypertension: updates 2012 Lifestyle change: reduction of body weight Height, weight, and waist circumference (WC) should be measured and body mass index (BMI) calculated for all adults CMAJ 2007;176:1103-6 14 Management of systemic hypertension: updates 2012 Method of abdomen contour measurement Last rib... 27 Management of systemic hypertension: updates 2012 Treatment of HTN on tobacco smoking patients Smoking Beta-blocker The benefits of treating smokers with beta-blockers remain uncertain in the absence of a specific indication like angina or post-MI MRC Working Party MRC trial of treatment of mild hypertension: 1985 Jul 13;291(6488):97-104 TL: 2010 Canadian Hypertension Education Program (CHEP) 28 Management. .. (7) 749751 17 Management of systemic hypertension: updates 2012 Efficacy of HTN reduction on mortality After Before Intervention Prevalence % Intervention Reduction Reduction in SBP in BP % Reduction in Mortality (mmHg) Stroke CHD Total 2 -6 -4 -3 3 -8 -5 -4 Adapted from Whelton, 5 -14 P K et al JAMA -9 2002;288:1882-1888 -7 18 Management of systemic hypertension: updates 2012 Choice of HTN drugs in... Hypertension Education Program (CHEP) Management of systemic hypertension: updates 2012 The 2011 CHEP recommendations on drugs combination HTN associaled with diabetes mellitus ACE –I or ARB combined with DHP calcium antagonists better than ACE- I+ Diuretic 34 Management of systemic hypertension: updates 2012 New points of NICE Guideline for Management of Hypertension 2011 BP targets 1 1  < 80 years old:... TL: 2010 Canadian Hypertension Education Program (CHEP) 15 Management of systemic hypertension: updates 2012 Lifestyle change: alcohol Low risk alcohol consumption 0-2 standard drinks/day Men: maximum of 14 standard drinks/week Women: maximum of 9 standard drinks/week A standard drink is about 142 ml or 5 oz of wine (12% alcohol) 341 mL or 12 oz of beer (5% alcohol) 43 mL or 1.5 oz of spirits (40% alcohol)... Canadian Hypertension Education Program (CHEP) 32 Management of systemic hypertension: updates 2012 The 2011 CHEP recommendations of HTN in stroked patients (2) Proportion of patients who died within 14 days (solid lines) or were dead or dependent at 6 months (dashed lines) by baseline SBP Leonardi-Bee, J et al Stroke 2002;33:1315-1320 33 TL: 2011 Canadian Hypertension Education Program (CHEP) Management of. .. 3.6/1.7 mmHg 11 Management of systemic hypertension: updates 2012 Source of ingested natrium 1 2 3 12% natural content of foods “Hidden“ sodium: 77% from processing of food -manufacturing and restaurants “Conscious“ sodium: 11% added at the table (5%) and in cooking (6%) J Am College of Nutrition 1991;10:383-93 12 Management of systemic hypertension: updates 2012 Lifestyle change: exercise Should be prescribed