2007 guidelines for the management of arterial hypertension课件

RECENT GUIDELINES FOR THE MANAGEMENT OF ARTERIAL HYPERTENSION Apostolos I. Hatzitolios Associate Professor of Internal Medicine 1st Propedeutic Department of Internal Medicine Department of Vascular Diseases and Hypertension Aristotle University of Thessaloniki, AHEPA Hospital Thessaloniki, Central Macedonia, HELLAS Diagnosis, regulation and treatment of hypertension in USA NHANES III (Phase 2) 1991-1994 NHANES III (Phase 1) 1988-1991 51% 73% 68% 31% 55% 54% 10% 29% 27% Diagnosis NHANES II 1976-1980 Treatment Regulation NHANES 1999-2000 70% 59% 34% Hypertensive % Guidelines 2007 o European Society of Hypertension o European Society of Cardiology Journal of Hypertension 2007;25:1105-1187 Definitions and Classification of BP Levels (mmHg) CategorySystolicDiastolic Optimal 160 mmHg with low diastolic BP ( 102 cm; 88 cm Laboratory investigations Routine tests: oHemoglobin and hematocrit oFasting plasma glucose oFasting serum triglycerides oSerum total cholesterol, LDL-cholesterol, HDL-cholesterol oSerum creatinine, potassium, uric acid oUrinalysis (complemented by microalbuminuria dipstick test and microscopic examination) oEstimated creatinine clearance (Cockroft-Gault formula) or glomerular filtration rate (MDRD formula) oElectrocardiogram (ECG) oThorax X-ray Laboratory investigations Recommended tests oEchocardiogram oCarotid ultrasound oQuantitative proteinuria (if dipstick test positive) oAnkle-brachial BP index oFundoscopy oGlucose tolerance test (if fasting plasma glucose 5,6 mmol/l (102 mg/dL) oHome and 24h ambulatory BP monitoring oPulse wave velocity measurement (where available) Laboratory investigations Extended evaluation (domain of the specialist) oFurther search for cerebral, cardiac, renal and vascular disease, mandatory in complicated hypertension oSearch for suspected secondary hypertension suggested by history, physical examination or routine tests: nmeasurement of renin, aldosterone, ncorticosteroids, ncatecholamines in plasma and/or urine; nrenal and adrenal ultrasound; ncomputer-assisted tomography (CT); nmagnetic resonance imaging (MRI); narteriographies Searching for subclinical organ damage Importance of subclinical organ damage as an intermediate stage in the continuum of vascular disease and as a determinant of total CV risk. Heart oElectrocardiography should be part of all routine assessment of hypertensives in order to detect LVH, LV strain, ischemic condition and arrhythmias oEchocardiography is recommended whenever a more sensitive detection of LVH is considered useful. Concentric remodeling and hypertrophy carries the worst prognosis, while LV diastolic dysfunction, consists an early ECHO sign, which can be evaluated by Doppler measurement of transmittal velocities. Searching for subclinical organ damage Blood vessels oUltrasound scanning of extracranial carotid arteries is recommended in symptomatic carotid stenosis (previous TIA), but also in asymptomatic atherosclerosis suspected by carotid murmurs and reveals vascular hypertrophy, increased IMT, thickening of carotid bifurcation and presence of plaques. oPeripheral large artery stiffening (an important vascular alteration leading to isolated systolic hypertension in the elderly), can be measured by pulse wave velocity. This method might be more widely recommended if its availability were greater. oA low ankle-brachial BP index (1gr/24h) oDespite the use of combination treatment, reducing SBP to 3 risk factors, MS or TOD Lifestyle changes Lifestyle changes and consider drug treatment Lifestyle changes + drug treatment Lifestyle changes + drug treatment Lifestyle changes + immediate drug treatment DiabetesLifestyle changes Lifestyle changes + drug treatment Established CV or renal disease Lifestyle changes + immedi