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Hypertension By Dr. Nagwa Eid Saad Prof. 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 BP Classification SBP (mmHg) DBP (mmHg) Normal Prehypertension Stage I hypertension Stage II hypertension < 120 120-139 140-159 > 160 and or or or < 80 80-89 90-99 > 100 http://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 Survey Trends in awareness, treatment, and control of high blood pressure in adults ages 18-74 1976-1980 51% 31% 10% 1988-1991 73% 55% 29% 1991-1994 68% 54% 27% 1994-2000 70% 59% 34% Awareness Treatment Control SBP < 140 mmHg and DBP < 90 mmHg http://hin.nhlbi.nih.gov/nhbpep_slds/menu.htm