HypertensionBy

Dr. Nagwa Eid SaadProf. Of Internal Medicine

&

Family Medicine

In

Cairo University

Objectives:by the end of this session the family doctor should

know:

•Prevalence of hypertension in Egypt & other countries .

•Diagnosis, proper medical history, examination & investigations of hypertension.

•Risk & TOD in hypertensive patients.•Secondary hypertension.•Referrals.•Cost minimization.

What is Blood Pressure?

BP = CO x TPR (CO = HR x SV)–Stroke volume – affected by contractility

and venous return–TPR is regulated by

•Norepinephrine, Epinephrine, Angiotensin II

JNC-7 Classification

NormalNormal

PrehypertensionPrehypertension

Stage I hypertensionStage I hypertension

Stage II hypertensionStage II hypertension

SBP (mmHg)SBP (mmHg) DBP (mmHg)DBP (mmHg)BP ClassificationBP Classification

< <120120

120-139120-139

140-159140-159

>> 160160

< <8080

80-8980-89

90-9990-99

>> 100100

andand

oror

oror

oror

http://hin.nhlbi.nih.gov/nhbpep_slds/menu.htmhttp://hin.nhlbi.nih.gov/nhbpep_slds/menu.htm

Isolated systolic hypertension•ISH:

Grade1 SBP 140-159 & DBP < 80mmHg Grade2 SBP > 160 & DBP< 80mmHg

•Strong predictor of CV complications•Lowering SBP is associated with significant reduction

in: –CV mortality–Stroke–HF –MI –Dementia

•Prevalence rate is of 26.3% among

adult Egyptians population ≥ 25 years.

•Its prevalence increases with age ,

50% of Egyptians above the age of

6o years are hypertension.

•Only 8% of hypertensive Egyptians

have their blood pressure controlled .

Epidemiology and CVD Risk

•Over 50 million Americans have HTN–30% are unaware they have HTN–Only 60% receive treatment–Only 34% of those treated, achieve goal

•Prevalence increases with age

Epidemiology and CVD Risk

•The relationship between BP and CVD is continuous, consistent and independent of

other risk factors–MI–Heart failure–Stroke–Kidney disease

Prehypertension:

Signals a need for increased education

to reduce BP in order to prevent HTN

Historical Trends in HTN

National Health and Nutrition Examination SurveyNational Health and Nutrition Examination Survey

AwarenessAwareness

TreatmentTreatment

ControlControl

1991-19941991-1994

68%68%

54%54%

27%27%

1976-19801976-1980

51%51%

31%31%

10%10%

1988-19911988-1991

73%73%

55%55%

29%29%

1994-20001994-2000

70%70%

59%59%

34%34%

SBP > 140 mmHg and DBP > 90 mmHgSBP > 140 mmHg and DBP > 90 mmHg

Trends in awareness, treatment, and control of high blood Trends in awareness, treatment, and control of high blood pressure in adults ages 18-74pressure in adults ages 18-74

http://hin.nhlbi.nih.gov/nhbpep_slds/menu.htmhttp://hin.nhlbi.nih.gov/nhbpep_slds/menu.htm