| Primary Arterial Hypertension: Classification | Classification:
- Optimal: Systolic <120, Diastolic <80
- Normal: Systolic 120-129, Diastolic 80-84
- High Normal: Systolic 130-139, Diastolic 85-89
- Hypertension grade 1: Systolic 140-159, Diastolic 90-99
- Hypertension grade 2: Systolic 160-179, Diastolic 100-109
- Hypertension grade 3: Systolic >180, Diastolic >110
- Isolated systolic hypertension: Systolic >140 but diastolic <90 |
| Primary Arterial Hypertension: Risk factors | - Hereditary & Age >35 years
-↑ BMI
- Excess Na+ intake
- Alcohol abuse & Smoking
- Dislipidemia
- Chronic stress
- Diabetes Mellitus
- Drugs: NSAIDs, Glucocorticoids, Amphetamines, Oral contraceptives, Adrenomimetics |
| Primary Arterial Hypertension : Risk stratification | table |
| Primary Arterial Hypertension: Treatment principles | Treatment plan according to grade:
- High normal: Lifestyle advice, Consider drug treatment in high risk patients with CVD
- Grade 1: Lifestyle advice, Immediate drug treatment in high (or >) risk patients with CVD, Renal disease or HMOD/ Drug treatment in low risk patients if 3-6 months lifestyle change does not work
- Grade 2: Lifestyle advice, Immediate drug treatment and control within 3 months
- Grade 3: Lifestyle advice, Immediate drug treatment and control within 3 months |
| Primary Arterial Hypertension: Lifestyle changes | -Exercise
-Reduce salt
-Reduce alcohol intake (<14U for men, <8U for females)
-Stop smoking
-Fruits and vegetables intake
-Weight control (BMI <30kg/m2)
-Reduce stress |
| Primary Arterial Hypertension: Medications | Mono-therapy: considered for low risk G1HTN or very old >80yrs/ frail patients
ACE I or ARB or B-blocker or CCB or Diuretic
Dual Combination: if high risk ie many risk factors ; start immediately at FULL dose
ACEI or ARB + CCB or Diuretics
TRIPLE combination: if BP is not controlled
ACEI or ARB +CCB +Diuretic
For RESISTANT HTN; add B-blocker or Spironolactone 25-50mg or a-blocker (consider referral) |
| Primary Arterial Hypertension: Drug classes and representatives | - ACEI: Perindopril 5-10mg/day
- ARB: Valsartan 160-300 mg/day
- Thiazide diuretics: Hydrochloride thiazide 12.5-50mg/day;
- Thiazide-like: Indapamide 1.5-2.5mg/day
- B-blocker: Metoprolol 25-200mg
- Central acting agents: Doxazosin 4-16mg/day ; Moxonidine 0.2-0.6 mg/day
- Ca2+ blocker: Amlodopine 5-10mg/day; Verapamil 40-320mg/day |
| Primary Arterial Hypertension: Drug principles | - B-blockers should be considered at any step where there is a specific indication: HF, angina, post MI, atrial fibrillation, younger women planning on/are pregnant
- ACEI & ARBs should not be administered together-> Orthostatic hypotension |
| Primary Arterial Hypertension: target values | -CKD -> SBP <140/90 (130 if tolerated)
-HTN, DM CAD+ Stroke:
SBP: 18-65yrs <130 (not <120) ; >65yrs: 130-39
& DBP: 70-79mmHg |
