Professional Documents
Culture Documents
Problem Magnitude
Definition
A systolic blood pressure ( SBP) >139
mmHg and/or
A diastolic (DBP) >89 mmHg.
Based on the average of two or more
properly
measured, seated BP
readings.
On each of two or more office visits.
WHY IS HYPERTENSION SO
DANGEROUS?
KNOWN AS THE SILENT KILLER OF
DISEASES BECAUSE MOST OF THE
TIMES IT DOES NOT HAVE ANY
SYMPTOMS
USUALLY INCIDENTAL FINDING
BP Measurement
At least two measurements should be
made and the average recorded.
Clinicians should provide to patients
their specific BP numbers and the BP
goal of their treatment.
Confirmation of diagnosis
Home ambulatory monitoring is done in
patients in whom blood pressure of >140/90
mmhg is measured in 2 or more clinic visits
At home 2 readings are taken, one in
morning the other at night for at least 4 days
(7 days preferably)
Patient is said to hypertensive is BP
>135/85mmhg on the average
www.nhlbi.nih.gov
Classification
www.nhlbi.nih
.gov
Prehypertension
Pre-HTN
Pregnancy induced
hypertension
Systolic Diastolic
HTN
Isolated
Diastolic
HTN
Hypertensive Crises
Hypertensive Urgencies
Severe elevated BP in the upper range of
stage II hypertension.
Without progressive end-organ
dysfunction.
Examples: Highly elevated BP without
severe headache, shortness of breath or
chest pain.
Usually due to under-controlled HTN.
Hypertensive Emergencies
Types of Hypertension
Primary HTN:
also known as
essential HTN.
accounts for 95%
cases of HTN.
no universally
established cause
known.
Secondary HTN:
less common cause
of HTN ( 5%).
secondary to other
potentially rectifiable
causes.
Common
Uncommon
Pheochromocytoma
Glucocorticoid excess
Coarctation of Aorta
Hyper/hypothyroidism
Secondary HTN-Screening
Tests
www.nhlbi.nih.gov
Renovascular HTN
Aortic/renal dissection
Takayasus arteritis
Thrombotic/cholesterol emboli
CVD
Post transplantation stenosis
Post radiation
Complications of Prolonged
Uncontrolled HTN
Changes in the vessel wall leading to
vessel trauma and arteriosclerosis
throughout the vasculature
Complications arise due to the target
organ dysfunction and ultimately failure.
Damage to the blood vessels can be seen
on fundoscopy.
Target Organs
CVS (Heart and Blood Vessels)
The kidneys
Nervous system
The Eyes
COMPLICATIONS OF
UNCONTROLLED HYPERTENSION
Effects On CVS
Ventricular hypertrophy, dysfunction and
failure.
Arrhithymias
Coronary artery
disease, Acute MI
Arterial aneurysm,
dissection, and rupture.
Nervous System
Stroke, intracerebral and subaracnoid
hemorrhage.
Cerebral atrophy and dementia
The Eyes
Retinopathy, retinal hemorrhages and
impaired vision.
Vitreous hemorrhage, retinal detachment
Neuropathy of the nerves leading to
extraoccular muscle paralysis and
dysfunction
Normal Retina
Hypertensive
Retinopathy
A: Hemorrhages
B: Exudates (Fatty
Deposits)
C: Cotton Wool Spots
(Micro Strokes)
AV Nicking
Hypertension
Cigarette smoking
Obesity (body mass index 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 cardiovascular disease (men
under age 55 or women under age 65)
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
History
History-contd.
History-contd.
Family history of DM : Patient may also
be Diabetic
Cigarette smoker: Aggravate HTN,
independently a risk factor for CAD and
stroke
High alcohol: A cause of HTN
High salt intake: Advice low salt intake
Examination
Examination-contd.
Thorough examination of the heart and
lungs
Abdomen for enlarged kidneys, masses,
and abnormal aortic pulsation
Lower extremities for edema and pulses
Neurological assessment
Routine Labs
EKG.
Urinalysis.
Blood glucose and hematocrit; serum potassium,
creatinine ( or estimated GFR), and calcium.
HDL cholesterol, LDL cholesterol, and
triglycerides.
Optional tests
urinary albumin excretion.
albumin/creatinine ratio.
Goals of Treatment
Benefits of Treatment
Reductions in stroke incidence,
averaging 3540 percent
Reductions in MI, averaging 2025
percent
Reductions in HF, averaging >50 percent.
NON PHARMACOLOGICAL
TREATMENT
Lifestyle modifications
www.nhlbi.nih.gov
DASH Diet
Dietary Approaches to Stop Hypertension
Low sodium diet
DASH diet include lots of whole grains, fruits,
vegetables and low-fat dairy products, fish,
poultry and legumes, small amount of nuts
and seeds a few times a week. You can eat
red meat, sweets and fats in small amount
As effective as one medication
Mediterranean diet
obesity
The WHO now considers obesity to
be a global epidemic and a public
health problem as more nations
become "Westernized.
Globally, an estimated 250 million
adults are now obese, and many
more are overweight.
1 gram of Carbohydrate
contains
6 Calories
1 gram of Protein contains
6 Calories
1 gram of Fat contains
9 Calories
Height
Standard Weight
5 ft 1 inch
49 to 54 Kg
5 ft 2 inch
55 to 60 Kg
5 ft 3 inch
56 to 62 Kg
5 ft 4 inch
57 to 63 Kg
5 ft 5 inch
59 to 65 Kg
5 ft 6 inch
61 to 67 Kg
5 ft 7 inch
63 to 69 Kg
5 ft 8 inch
64 to 71 Kg
5 ft 9 inch
66 to 73 Kg
5 ft 10 inch
68 to 75 Kg
5 ft 11 inch
70 to 77 Kg
6 ft
72 to 79 Kg
6 ft 1 inch
77 to 82 Kg
6 ft 2 inch
76 to 84 Kg
6 ft 3 inch
78 to 86 Kg
Height
Standard Weight
4 ft 8 inch
44 to 49 Kg
4 ft 9 inch
45 to 50 Kg
4 ft 10 inch
46 to 51 Kg
4 ft 11 inch
47 to 53 Kg
5 ft
49 to 54 Kg
5 ft 1 inch
50 Kg
5 ft 2 inch
51 to 52 Kg
5 ft 3 inch
53 to 59 Kg
5 ft 4 inch
54 to 61 Kg
5 ft 5 inch
56 to 63 Kg
5 ft 6 inch
58 to 65 Kg
5 ft 7 inch
60 to 67 Kg
5 ft 8 inch
62 to 68 Kg
5 ft 9 inch
63 to 70 Kg
5 ft 10 inch
65 to 72 Kg
Calories Contents in
Common Soups
Serving Size: 1Cup
Type of Soup
No. of Calories
100
200
Chicken Yakhni
75
Mushroom Soup
117
Tomato Soup
175
Noodles Soup
117
Daal Soups
130
Calories Contents in
Products/Breakfast
Servings
TypeDairy
of Food
and their serving Size
No. of Calories
Boiled Egg One
75
100
175
45
100
Skimmed Milk
19
65
210
910
750
125
100
140
40
304
68
Calories Content
in Fast Foods
Type of Food and their serving
Size
No. of Calories
360
372
229
317
207
482
344
280
291
50
125
Calories Contents in
Chaat/Namkeen Foods
Type of Food and their
serving Size
No. of Calories
474
182
Samosa One
103
190
82
No. of Calories
200
300
350
350
200
200
325
275
200
200
No. of Calories
125
150
315
200
No. of Calories
188
100
105
225
457
Chicken Bryani
520
Mutton Biryani
644
Nehari
500
400
325
252
250
Calories Contents in
Fresh Fruits
Type of Fruit and their serving
Size
Mango One Medium Size
No. of Calories
125
75
75
75
75
75
75
35
75
65
50
140
75
No. of Calories
Potato
97
Tomato
21
Peas
97
Cabbage
45
Carrot
48
Spinach
26
Onion
50
Cauliflower
30
French Beans
26
Calories Contents in
Dry Fruits
No. of Calories
425
100
100
Dates 6s serving
100
50
75
50
Calories Contents
in Mithaian/Sweet Dishes
Type of
Mithai
Serving Size
No. of Calories
387
Jaleebi
100 grams
494
Laddoo
100 grams
421
Sohan Halwa
100 grams
399
Qalaqand
100 grams
421
Suji ka Halwa
100 grams
263
Gajar ka
Halwa
100 grams
561
Gajar Kheer
100 grams
226
Rice Kheer
100 grams
141
Siwayan
One Cup
125
Custard
One Cup
140
Ice Cream
One Cup
150
Gulab Jaman
Calories Contents in
Soft Drinks
Type of Drink
Serving Size
Calories
Soft Drinks
250 ml Bottle
70-100
250 ml Bottle
Apple Juice
One Cup
150
Pomegranate Juice
One Cup
125
Grape Juice
One Cup
141
One Cup
226
Orange Juice
One Cup
35
75
One Cup
140
One Cup
50
Milk Shake
Serving Size
No. of Calories
Tea with
cream and
Sugar
One Cup
130
Tea without
cream and
Sugar
One Cup
Black Coffee
without sugar
One Cup
Black Coffee
with sugar
One Cup
60
Cream Coffee
with sugar
One Cup
140
Calories Contents in
Sweeteners/Cereals
Sweeteners
Type
Serving Size
Sugar
(Cheeni)
One table
spoon
90
Gurr
One table
spoon
56
Honey
Cereals
One table
No. of
Calories
25
Type
spoon
Serving Size
Rice
100 grams
325
Maize
100 grams
355
Wheat
100 grams
341
No. of
Calories
Serving Size
No. of
Calories
387
One Slice
494
One medium
561
One
263
Calories Consumption
in Daily Routine works
Consumption of Calories in Daily Routine Activities
Per Hour
Type of Work
Calories
Consumed
Type of Work
Calories
Consumed
Office Work
130
Swimming
300
Car Driving
165
Playing Golf
300
Cycling
410
Playing Lawn
Tennis
350
Eating
80
Fast Running
900
Standing a
place
135
Walking
216
Gardening
215
Pressing
250
Sleeping
60
Cooking
195
Calories Consumption
in Daily Routine Activities
At 10 Minutes
Type of Work
Walking downstairs
Walking upstairs
Calories
Consume
d
Type of Work
Calories
Consumed
75
Playing Squash
105
200
Playing
Badminton
65
72
Playing
Volleyball
65
Walking with
moderate pace
40
Standing at
one place
15
Swimming
50
Dancing with
moderate
speed
75
Cleaning
House
40
Health Club
65
Running
Horse Riding
125
75
PHARMACOLOGICAL
TREATMENT
JNC 8 Summary
Joint National Commission 8th Report
PDF File on website
50 page document
Renal denervation
Percutaneous catheter based
radiofrequency ablation of renal nerve
Entered trials in Europe and Asia in 2014
Initial tests have revealed promising
results
Other Resources
Hyperlipedemia Information
www.nhlbi.nih.gov/guidelines/cholesterol/index.htm
Questions???
THANK YOU