chep_2007_diagnosis-jan29课件

2007 Part 1: Recommendatio ns for Hypertension Diagnosis Assessment and Follow up January, 2007 2 The Canadian Hypertension Education Program (CHEP) is jointly sponsored by the Canadian Hypertension Society, Blood Pressure Canada, the Public Health Agency of Canada, the Heart and Stroke Foundation of Canada, the Canadian Council of Cardiovascular Nurses, the Canadian Pharmacists Association, the College of Family Physicians of Canada Canadian Hypertension Education Program Recommendations 2007 Canadian Hypertension Education Program Recommendations 3 A red flag has been posted where recommendations were updated for 2007. This slide kit for medical education, health care professional, patient and public information can be downloaded (English and French versions) from the Canadian Hypertension Society website at: http:/www.hypertension.ca The 2007 Canadian Hypertension Education Program 4 The 2007 Canadian Hypertension Education Program Whats New for 2007 Approximately 95% of Canadians will develop hypertension if they live an average lifespan Most overweight patients with high normal blood pressure (130-139/85-89 mmHg) develop within 4 years and almost 1/2 within 2 years. Annual follow-up of patients with high normal blood pressure is recommended. Canadian Hypertension Education Program Recommendations 5 What percent of Canadians have hypertension? CCHS CMAJ 1992 Canadian Hypertension Education Program Recommendations 6 Life time risk of Hypertension in Normotensive Women and Men aged 65 years Risk of Hypertension % 02468101214161820 Years to Follow-up Women Risk of Hypertension % Years to Follow-up 02468101214161820 Men JAMA 2002: Framingham data. 100 80 60 40 20 0 100 80 60 40 20 0 Canadian Hypertension Education Program Recommendations 7 High risk of developing hypertension in those with high normal blood pressure 40% of patients with systolic 130-139 or diastolic 85-89 mmHg developed hypertension in 2 years and 63% in 4 years NEJM 2006;354:1685-97 Annual follow-up of patients with high normal blood pressure is recommended. Canadian Hypertension Education Program Recommendations 8 Reversible risks for developing hypertension Obesity Poor dietary habits High sodium intake Sedentary High alcohol consumption High stress High normal blood pressure Canadian Hypertension Education Program Recommendations 2007 The Canadian Hypertension Education Program: 2007 Recommendation s Whats old but still important? 2007 Canadian Hypertension Education Program Recommendations 10 Assess blood pressure at all appropriate visits. Almost one half of those with blood pressure 130-139/85-89 will develop hypertension within 2 years. They require annual reassessment. Assess global cardiovascular risk in all hypertensive patients. Lifestyle modification is the cornerstone for the prevention and management of hypertension and CVD. Key CHEP messages for the management of hypertension 2007 Canadian Hypertension Education Program Recommendations 11 Key CHEP messages for the management of hypertension Treat to target ( 140/90 or treatment for HTN Vasan. Lancet 2001 Canadian Hypertension Education Program Recommendations 19 Incidence rates of hypertension at 1, 2 and 3 yrs Optimum 180/110? Hypertension Visit 1 BP Measurement, History and Physical examination Hypertensive Urgency / Emergency Diagnosis of HTN No Canadian Hypertension Education Program Recommendations 22 II. Criteria for the diagnosis of hypertension and recommendations for follow-up Hypertension Visit 1 BP Measurement, History and Physical examination Hypertension Visit 2 within 1 month Yes BP 140/90 mmHg and Target organ damage or Diabetes or Chronic Kidney Disease or BP 180/110? Diagnostic tests ordering at visit 1 or 2 Hypertensive Urgency / Emergency Diagnosis of HTN BP: 140-179 / 90-109mmHg No Elevated Out of the Office BP measurement Elevated Random Office BP Measurement Canadian Hypertension Education Program Recommendations 23 II. Criteria for the diagnosis of hypertension and recommendations for follow-up BP: 140-179 / 90-109 24-h ABPM (If available) Diagnosis of HTN Awake BP 135 SBP or 85 DBP or 24-hour 130 SBP or 80 DBP Awake BP 160 SBP or 100 DBP 140 SBP or 90 DBP 135/85 30 mg/mmol is abnormal Canadian Hypertension Education Program Recommendations 34 V. Screening for Renovascular Hypertension Patients presenting with two or more of the following clinical clues listed below suggesting renovascular hypertension should be investigated. sudden onset or worsening of hypertension and age 55 or 135/85 mmHg is considered elevated. Mean 24 h ambulatory blood pressure 130/80 mmHg is considered elevated. How to ? Canadian Hypertension Education Program Recommendations 47 DescriptionBlood Pressure mmHg Home pressure average135 / 85 Daytime average ABP135 / 85 24-hour average ABP130 / 80 A clinic blood pressure of 140/90 mmHg has a similar risk of a: Clinic, Home, Ambulatory (ABP) Blood Pressure Measurement equivalence numbers Canadian Hypertension Education Program Recommendations 48 Follow up algorithm for high Blood Pressure using Ambulatory Blood Pressure Measurement 24-h ABPM Consistent with HTN Awake BP 135 SBP or 85 DBP or 24-hour 130 SBP or 80 DBP Awake BP 135/85 and 24-hour 130/80 Continue to follow-up Patients with high normal blood pressure should be followed annually. Canadian Hypertension Education Program Recommendations 49 IX. The Role of Echocardiography: Specific Roles Echocardiography is not useful for routine evaluation Echocardiography is useful for: Assessment of Left ventricular dysfunction Presence of left ventricular hypertrophy may influence management Canadian Hypertension Education Program Recommendations 50 Assess blood pressure at all appropriate visits. Almost one half of those with blood pressure 130-139/85-89 will develop hypertension within 2 years. They require annual reassessment. Assess global cardiovascular risk in all hypertensive patients. Lifestyle modification is the cornerstone for the prevention and management of hypertension and CVD. K