【高血压精品英文课件】高血压心脏病 hypertensive heart disease

Hypertensive Heart Disease,Ricky M. Kirby, FNP, BC,Lopez Internal Medicine Associates 4250 Lakeside Drive, Suite 204 Jacksonville, FL 32210 (904) 598-1888 rickkirbybellsouth.net,References,JNC 7 Full Report, NIH Publication No. 04-5203,http:/hin.nhlbi.nih.gov/nhbpep_slds/menu.htm#hbpch1,JNC 7 Express, NIH Pub. No. 03-5233 December 2003,JNC 7 Quick reference card, NIH Pub. No. 03-5231,JNC 7,Full ReportComprehensive justification and rationale (87 pages, NIH Pub. No. 04-5203). ExpressSuccinct evidence-based recommendations. Published in JAMA May 21, 2003, and as a Government Printing Office publication (52 pages, NIH Pub. No. 03-5233). Reference Card Quick reference card (2 pages, NIH Pub. No. 03-5231).,Overview,Classification of BP CVD Risk Benefits of Lowering BP BP Measurement TechniquesIn-officeAmbulatory BP MonitoringSelf-measurement CVD Risk Factors Causes of HTN Target Organ Damage Laboratory/Diagnostic Tests,Treatment Goals of Therapy Life Style Modification Algorithm for Treatment of Hypertension Management of BP in Adults Minority Populations HTN in the Elderly Case Study,Factoids,For persons over age 50, SBP is a more important than DBP as CVD risk factor.Starting at 115/75 mmHg, CVD risk doubles with each increment of 20/10 mmHg throughout the BP range. Persons who are normotensive at age 55 have a 90% lifetime risk for developing HTN.Those with SBP 120139 mmHg or DBP 8089 mmHg should be considered prehypertensive who require health-promoting lifestyle modifications to prevent CVD.,Factoids,Thiazide-type diuretics, either alone or combination, should be considered for initial drug therapy. High-risk conditions are a compelling reason to start other drug classes.Most patients will require two or more antihypertensive drugs to achieve goal BP.If BP is >20/10 mmHg above goal, initiate therapy with two agents, one usually should be a thiazide-type diuretic.,Factoids,Hypertension is the most common primary diagnosis in America (35 million office visits as the primary diagnosis).The most effective therapy prescribed by a careful clinician will control HTN ONLY if patients are motivated.Motivation improves when patients have positive experiences with, and trust in, the clinician and the medication.The clinicians judgment remains paramount in determining initial and continuing therapy.,Blood Pressure Classifications,CVD Risk,HTN prevalence 50 million people in the United States.The BP relationship to risk of CVD is continuous, consistent, and independent of other risk factors.Each increment of 20/10 mmHg doubles the risk of CVD across the entire BP range starting from 115/75 mmHg.Prehypertension signals the need for increased education to reduce BP in order to prevent hypertension and therefore reduce the risk of CVD.,Benefits of Lowering BP,In stage 1 HTN achieving a sustained 12 mmHg reduction in SBP over 10 years will prevent 1 death for every 11 patients treated. In the presence of CVD or target organ damage, only 9 patients would require such BP reduction to prevent a death. In clinical trials, antihypertensive therapy has been associated with reductions in stroke incidence averaging 3540 percent; myocardial infarction, 2025 percent; and heart failure, more than 50 percent.,BP Measurement Techniques,Office BP Measurement,Use auscultatory method with a properly calibrated and validated instrument. Patient should be seated quietly for 5 minutes in a chair (not on an exam table), feet on the floor, and arm supported at heart level. Appropriate-sized cuff should be used to ensure accuracy. At least two measurements should be made. Clinicians should provide to patients, verbally and in writing, specific BP numbers and BP goals.,Ambulatory BP Monitoring,ABPM is warranted for evaluation of “white-coat” HTN in the absence of target organ injury. Ambulatory BP values are usually lower than clinic readings.Awake, individuals with hypertension have an average BP of >135/85 mmHg and during sleep >120/75 mmHg.If BP does not drop by 10 to 20% during the night it may indicate a possible increased risk of cardiovascular events.,Self-Measurement of BP,Provides information on: Response to antihypertensive therapy Improving adherence with therapy Evaluating white-coat HTNHome measurement of >135/85 mmHg is generally considered to be hypertensive.Home measurement devices should be checked regularly.,CVD Risk Factors,Hypertension Cigarette smoking Obesity (BMI >30 kg/m2) Physical inactivity Dyslipidemia Diabetes mellitus Microalbuminuria or estimated GFR <60 ml/min Age (older than 55 for men, 65 for women) Family history of premature CVD (men under age 55 or women under age 65),Causes of Hypertension,Some causes of hypertension Sleep apnea Drug-induced or related causes Chronic kidney disease Primary aldosteronism Renovascular disease Chronic steroid therapy and Cushings syndrome Pheochromocytoma Coarctation of the aorta Thyroid or parathyroid disease,Target Organ Damage,HeartLeft ventricular hypertrophyAnginaHeart failure BrainStroke or transient ischemic attack Chronic kidney disease Peripheral arterial disease Retinopathy,