Hypertension

1. Hypertension is one of the most common disease world-wide affecting human being. It is most common modifiable risk factor for coronary heart diseases stroke, congestive heart failure, end stage renal disease, and peripheral vascular disease Definition Based on recommendation of 7 th report of JNC of preventing, detection, evaluation, and treatment of high blood pressure-

2. HYPERTENSION- AN APPROACH BY- DrAwadhesh Kumar Sharma,SR Medicine,MLB Medical college,jhansi,UP,india

3. * for adults  18 years * Based on 2 or more reading taken at 2 or more visits B.P. classification Systolic B.P. (mmHg) * Diastolic B.P. (mmHg) * Normal <120 <80 Prehypertensive 120-139 80-89 Stage1 140-159 90-99 Stage2  160  100

13. Congenital adrenal hyperrplasia Hypothyroidism and hyperthyroidism Hyperparathyroidism (hypercalcemia) Acromegaly 6. Neurogenic-Brain tumor Bulbar poliomyelitis Raised ICT 7. Pregnancy induced hypertension 8. Drugs and toxins-alcohol, cocaine, cyclosporine, erythropoietin.

14. Initial diagnostic laboratory testing for hypertensive patients-

15. Laboratory evaluation for the secondary causes-

17. Recommendation for management of hypertension- The 2000 Canadian hypertension society recommendation (similar to JNC 7 guidelines) for management of hypertension are as follows-

20. Target values for hypertension control (adopted from JNC7)-

23. Assess elevated BP, Asses other risk factors and target organ damage SBP<180 or DBP <110 mmHg SBP > 180 or DBP > 110 mmHg Initiate lifestyle measures Begin drug treatment add lifestyle measures Stratify absolute risk Medium / low High SBP 130-139 or DBP 85-89 on several occasions Verified SBP 140- 179 or DBP 90-109 mmHg on several occasions Begin drug treatment strongly consider therapy as initial treatment No treatment Monitor BP and other risk factors Begin drug treatment

25. WEIGHT REDUCTON: The prevention and correction of obesity (Body Mass index greater than 25) is a prudent way of reducing the risk of hypertension and indirectly CHD. EXERCISE PROMOTION: Regular physical activity should be encouraged as part of the strategy for risk factor control BEHAVIOURAL CHANGES: Reduction of stress and smoking , modification of personal life-style, yoga and transcendental meditation could be profitable.

26. SECONDARY PREVENTION The goal of secondary prevention is to detect and control high blood pressure in affected individuals. TREATMENT: The aim of treatment should be to obtain a blood pressure below 140/90, and ideally a blood pressure of 120/80. PATIENT COMPLIANCE: The treatment of high blood pressure must normally be life-long and this presents problems of patient compliance. Which is defined as “ the extent to which patient behavior (in terms of taking medicines, following diets or executing other life-style changes) coincides with clinical prescription. The compliance rates can be improved through education directed to patients, families and the community.