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![Definition
O Hypertension in adults (stage 1)
O 2017 ACC/AHA: persistent systolic
O blood pressure (SBP
O ) ≥ 130 mm Hg and/or diastolic
O blood pressure (DBP) ≥ 80 mm Hg [1]
O 2020 International Society of Hypertension (ISH) and 2014 JNC 8:
persistent SBP
O ≥ 140 mm Hg and/or DBP ≥ 90 mm Hg [2]
O Hypertension in children (< 13 years of age) (stage 1): blood pressure ≥
95thpercentile
O or ≥ 130/80 mm Hg, whichever is lower
O
O Primary hypertension: hypertension with no identifiable cause
O Secondary hypertension
O : hypertension caused by an identifiable underlying condition
O Resistant hypertension: hypertension that remains uncontrolled (≥
130/80 mm Hg) despite treatment with ≥ 3 antihypertensives
O OR requires ≥ 4 medications to be controlled](https://image.slidesharecdn.com/endorgandamageinhypertensiondarb-220922190232-07b361ed/75/End-Organ-Damage-In-HypertensionDARB-pptx-9-2048.jpg)
![Prevalence
O Hypertension affects between approximately one-third and one-half of adults
in the US.
O Primary hypertension: accounts for ∼ 90% of cases of hypertension in
adults and prevalence
O is increasing in children and adolescents
O .
O Secondary hypertension
O : accounts for ∼ 10% of cases of hypertension in adults [1]
O Prevalence
O increases with age: Approximately 65–75% of adults develop hypertension
by 65–74 years of age.
O [11]
O Rates are highest in African American individuals, followed by white
individuals, and lowest in Asian American and Hispanic individuals.
O ∼ 60–87% of overweight
O and ∼ 73–95% of obese
O patients are affected.](https://image.slidesharecdn.com/endorgandamageinhypertensiondarb-220922190232-07b361ed/75/End-Organ-Damage-In-HypertensionDARB-pptx-10-2048.jpg)
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End Organ Damage In HypertensionDARB.pptx
This document summarizes end organ damage that can result from hypertension. It discusses how hypertension can damage the brain, eyes, heart, kidneys, and arteries. It provides definitions for hypertension, assessments for target organ damage, and lists routine lab tests for evaluating hypertension patients. Specific types of end organ damage are outlined such as retinopathy, coronary heart disease, renal failure, and atherosclerosis. Hypertensive emergencies that require rapid blood pressure reduction are also defined.
In this document
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Introduction to end organ damage in hypertension by Dr. Ihab Suliman.
Study of 21,104 subjects on whether evening or morning BP treatment is better, concluding no significant difference.
Overview of study methods involving decentralized patient tracking over 5+ years for BP treatment outcomes.
Presentation of results demonstrating no significant differences in heart attack, stroke, or vascular death outcomes.
Summary highlighting that BP medication timing does not affect cardiovascular outcomes.
Definitions of hypertension in adults and children, prevalence statistics, and demographics.
Identification of cardiovascular risk factors and end organ damage associated with hypertension.
Data showing a 10% reduction in BP leads to significant decreases in cardiovascular disease risk.
Routine laboratory tests and assessments recommended for patients diagnosed with hypertension.
Classic manifestations of damages due to hypertension affecting various organs including brain and kidneys.
Definitions of hypertensive emergencies and distinguishing features of acute organ dysfunction.
Role of echocardiography in risk evaluation and management of heart conditions in hypertensive patients.
Effects of vascular stiffness on cardiovascular mortality and associated risks.
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End Organ Damage In HypertensionDARB.pptx
- 1. End Organ Damage InHypertension Dr Ihab suliman Sept 2022
- 2. Treatment In theMorning or Evening: The TIME Study Results A large randomised study of 21,104 subjects with treated high BP to find out if taking tablets in the evening is better than in the morning Funded by the British Heart Foundation and BIHS Prof Tom MacDonald, University of Dundee, UK 25th August 2022
- 3. Our study findings OTaking prescribed BP tablets in the evening was no better or worse than taking them in the morning for the prevention of cardiovascular disease. O Taking medication in the evening was not harmful. Patients can take their BP medication in either the O morning or evening as the timing makes no difference to cardiovascular outcomes.
- 4. Methods • A largedecentralised study of patients treated in the UK NHS • 21,104 randomised and followed up for over 5 years (longest 9.3 years) • Outcome tracked from patients, clinicians and UK NHS hospital databases and death records • Independently verified heart attacks, strokes and CV deaths • Intention to treat analysis
- 5. Results –MI, strokeor vascular death
- 6. Results – otheroutcomes not different
- 7. Key messages • Takingtablets for high BP in the evening was not different to morning dosing in prevening heart attacks, strokes and vascular deaths • Evening dosing was not harmful • Patients can take their BP tablets whenever convenient
- 8. O Definitions andepidemiology. O End organ damage in HTN
- 9. Definition O Hypertension inadults (stage 1) O 2017 ACC/AHA: persistent systolic O blood pressure (SBP O ) ≥ 130 mm Hg and/or diastolic O blood pressure (DBP) ≥ 80 mm Hg [1] O 2020 International Society of Hypertension (ISH) and 2014 JNC 8: persistent SBP O ≥ 140 mm Hg and/or DBP ≥ 90 mm Hg [2] O Hypertension in children (< 13 years of age) (stage 1): blood pressure ≥ 95thpercentile O or ≥ 130/80 mm Hg, whichever is lower O O Primary hypertension: hypertension with no identifiable cause O Secondary hypertension O : hypertension caused by an identifiable underlying condition O Resistant hypertension: hypertension that remains uncontrolled (≥ 130/80 mm Hg) despite treatment with ≥ 3 antihypertensives O OR requires ≥ 4 medications to be controlled
- 10. Prevalence O Hypertension affectsbetween approximately one-third and one-half of adults in the US. O Primary hypertension: accounts for ∼ 90% of cases of hypertension in adults and prevalence O is increasing in children and adolescents O . O Secondary hypertension O : accounts for ∼ 10% of cases of hypertension in adults [1] O Prevalence O increases with age: Approximately 65–75% of adults develop hypertension by 65–74 years of age. O [11] O Rates are highest in African American individuals, followed by white individuals, and lowest in Asian American and Hispanic individuals. O ∼ 60–87% of overweight O and ∼ 73–95% of obese O patients are affected.
- 13. Assessment of theoverall cardiovascular risk and Search for target organ damage O Brain O Cerebrovascular disease O transient ischemic attacks O ischemic or hemorrhagic stroke O vascular dementia O Eyes O Hypertensive retinopathy O Heart O Left ventricular dysfunction O Left ventricular hypertrophy O Coronary artery disease O myocardial infarction O angina pectoris O congestive heart failure O Kidney O Chronic kidney disease O hypertensive nephropathy (GFR < 60 ml/min/1.73 m2) O albuminuria O Arteries O Peripheral artery disease O intermittent claudication O ankle brachial index < 0.9
- 17. Effect of Long-TermModest Reductions in CV Risk Factors Emberson et al. Eur Heart J. 2004;25:484-491. 10% Reducti on in BP 10% Reduct ion in Total-C + 45% Reducti on in CVD =
- 18. Routine Laboratory Tests PreliminaryInvestigations of patients with hypertension 1. Urinalysis 2. Blood chemistry (potassium, sodium and creatinine) 3. Fasting glucose 4. Fasting or Non Fasting lipid profile 5. Standard 12-leads ECG 6. Optional tests a. Urinary albumin excretion or albumin/creatinine ratio b. Limited Echo for LVH
- 19. O The classicmanifestations of hypertensive end organ damage include the following: vascular and hemorrhagic stroke, retinopathy, coronary heart disease/myocardial infarction and heart failure, proteinuria and renal failure and in the vasculature, atherosclerotic change including the development of stenoses and aneurysms
- 20. Hypertensive Emergencies : Definition OA rapid decompensation of vital organ function secondary to an inapropriately elevated BP O Require lowering of BP within 1 hour to decrease morbidity O Not determined by a BP level, but rather the imminent compromise of vital organ function
- 21. Hypertensive Emergencies O CNS -Hypertensive encephalopathy O CVS O Acute myocardial ischemia O Acute cardiogenic pulmonary edema O Acute aortic dissection O Post-op vascular surgery O Renal - Acute renal failure O Eclampsia O Catechol excess- Pheochrom, Drugs
- 22. Hypertensive Emergencies OHigh BP WITHOUT acuteend-organ dysfunction IS NOT a hypertensive emergency O“Hypertensive Pseudoemergency”
- 23. Schmieder, R E EndOrgan Damage In Hypertension Dtsch Arztebl Int 2010; 107(49): 866-73; DOI: 10.3238/arztebl.2010.0866
- 24. Echocardiography 2013 ESH/ESC Guidelines.J Hypertens 2013
- 25. Echocardiography should beconsidered in hypertensive patients in different clinical contexts and with different purposes: • in hypertensive patients at moderate total CV risk, it may refine the risk evaluation by detecting LVH undetected by ECG • in hypertensive patients with ECG evidence of LVH it may more precisely assess the hypertrophy quantitatively and define its geometry and risk • in hypertensive patients with cardiac symptoms, it may help to diagnose underlying disease. 2013 ESH/ESC Guidelines. J Hypertens 2013 Cardiac Damage
- 26. Schmieder, R E EndOrgan Damage In Hypertension Dtsch Arztebl Int 2010; 107(49): 866-73; DOI: 10.3238/arztebl.2010.0866
- 27. Schmieder, R E EndOrgan Damage In Hypertension Dtsch Arztebl Int 2010; 107(49): 866-73; DOI: 10.3238/arztebl.2010.0866
- 28. Schmieder, R E EndOrgan Damage In Hypertension Dtsch Arztebl Int 2010; 107(49): 866-73; DOI: 10.3238/arztebl.2010.0866
- 29. Atherosclerosis and VascularStiffness Ng et al. Am J Physiol Renal Physiol 2011 Wikipedia.org
- 30. Vascular Stiffness andMortality Relative Risk of Cardiovascular Mortality According to PWV and Cardiovascular Risk Factors: Univariate Analysis Parameters OR Lower 95% CI Higher 95% CI P PWV, 5 m/s 2.35 1.76 3.14 <0.0001 Previous CVD, yes/no 14.81 7.98 27.47 <0.0001 Age, 10 y 2.32 1.78 3.01 <0.0001 PP, 10 mm Hg 1.53 1.31 1.80 <0.0001 SBP, 10 mm Hg 1.26 1.12 1.42 <0.001 Diabetes, yes/no 4.23 1.96 9.15 <0.001 Laurent S et al. Hypertension 2001