Skv

• Hypertension


  Also known as high or raised blood pressure, is a condition in which the blood vessels have persistently raised pressure

  
• Hypertension diagnosis


  Systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg on two different days

  
• Mild benign hypertension


  Blood pressure <200/<100 mm Hg, no indication for use of hypotensive drugs, continued observation is desirable and conservative treatment consisting of reassurance, mild sedatives, and weight reduction is indicated

  
• Raised blood pressure


  Systolic pressure is 180 or over, and/or the diastolic pressure is 110 or over, on three consecutive examinations, and in the presence of clinical, radiological and cardiographic evidence of cardiovascular hypertrophy

  
• Hypertension definition


  The level of BP at which the benefits of treatment (either with lifestyle interventions or drugs) unequivocally outweigh the risks of treatment, as documented by clinical trials
• The natural history of untreated hypertension is illustrated by the case of President Franklin Delano Roosevelt

  
• In 2010, 31.1% of the world's adults had hypertension, 28.5% in high-income countries and 31.5% in low-and middle-income countries

  
• From 2000 to 2010, the age-standardized prevalence of hypertension decreased by 2.6% in high-income countries, but increased by 7.7% in low- and middle-income countries

  
• In Indonesia, the awareness, treatment, and control of hypertension are 34.1%, 8.8%, and 32.3% respectively (RISKESDAS 2018)

  
• In the US, the hypertension awareness, treatment, and control rates were 69.9%, 84.7%, and 53.8% respectively in 2017-2018 (NHANES)

  
• Hypertension Mediated Organ Damage (HMOD)

  • LVH (LVH with ECG), Moderate-severe CKD (CKD; eGFR <60 ml/min/1.73m2), Any other available measure of organ damage

  
• Cardiovascular disease


  • Previous coronary heart disease (CHD), HF, Stroke, Peripheral vascular disease, Atrial fibrillation, CKD stage 3+
• Other risk factors


  • Age (>65 years), Sex (male>female), Heart rate (>80 beats/min), Increased body weight, Diabetes, High LDL-C/triglyceride, Family history of CVD, Family history of hypertension, Early-onset menopause, Smoking habits, Psychosocial or socioeconomic factors, Unhealthy lifestyle habits (eg, smoking, high alcohol intake, sedentary lifestyle)
• Non-pharmacological therapy and prevention

  Lifestyle advice
• Pharmacological intervention


  When to initiate, What agents, What is the target
• Grade 1 hypertension


  Immediate drug treatment in all patients

  
• Grade 2 hypertension


  Immediate drug treatment in high risk patients or those with CVD, CKD, DM, HMOD

  
• Grade 1 hypertension in low to moderate risk

  1. 6 months lifestyle intervention, then drug treatment

  
• Antihypertensive agents


  ACE inhibitor, ARB, DHP-Calcium Channel Blocker, Thiazide-like Diuretic, Spironolactone, Amiloride, Doxazosin, Eplerenone, Clonidine, Beta blocker
• Ideal characteristics of drug treatment

  Evidence-based, Once-daily regimen, Affordable/cost-effective, Well-tolerated, Benefits in target population
• BP target


  Reduction by at least 20/10 mmHg, ideally to <140/90 mmHg, <130/80 mmHg if <65 y, <140/90 mmHg if ≥65 y
• Resistant hypertension


  Hypertension that remains above goal BP despite concurrent use of 3 antihypertensive agents of different classes, including a diuretic

  
• Hypertensive emergency


  Severe elevation in BP (systolic BP ≥180 mmHg or diastolic BP ≥120 mmHg) with evidence of new or worsening target organ damage