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HYPERTENSION
Hypertension Syndrome
Giles,TD, JCI Suppl,2005
Proportion of deaths attributable to leading
risk factors worldwide (2000)
High blood pressure
Tobacco
High cholesterol
Underweight
Unsafe sex Systolic blood pressure
High BMI greater than 115 mmHg
Physical inactivity
Alcohol
Indoor smoke from solid fuels
Iron deficiency
0 1 2 3 4 5 6 7 8
Attributable Mortality
4
4X
risk
2
2X
1X risk risk
0
115/75 135/85 155/95 175/105
Systolic BP/Diastolic BP (mmHg)
CV
Disease
Oxidative Stress
Vascular Lesion
Vasoconstriction Thrombosis Inflammation Plaque Rupture and Remodeling
Obesity LVH
Diabetes Diastolic
Dysfunction
Hypertension CHF
Smoking
Systolic
Dyslipidemia
MI Dysfunction
Diabetes
Non-pharmacological/ lifestyle
Pharmacological
Lifestyle Modifications
Modification Approximate SBP reduction
(range)
salt intake
alcohol consumption
physical exercise
Beta-blocker (Alpha-blocker)
CCB
· Arteriodilation
· Peripheral oedema
· Effective in low-renin patients
· Reduces cardiac ischaemia
BP
CCB
Synergistic · RAS activation
BP reduction · No renal or CHF
Complementary benefits
clinical benefits
CCB
· Arteriodilation ACEi/ARB
· Peripheral oedema · RAS blockade
· Effective in low-renin patients · CHF and renal
· Reduces cardiac ischaemia benefits
BP
ACEi/ARB CCB
· Venodilation Synergistic · RAS activation
· Attenuates peripheral oedema BP reduction · No renal or CHF
· Effective in high-renin patients benefits
Complementary
· No effect on cardiac ischaemia
clinical benefits
Opie et al. In: Opie LH, editor. Drugs for the Heart. 3rd ed. 1991:42–73; White et al. Clin Pharmacol Ther.
1986;39:43–48; Gustaffson. J Cardiovasc Pharmacol. 1987;10:S121–S131.
… Gets Reduced by Co-administration of ACEI/ARBs
Opie et al. In: Opie LH, editor. Drugs for the Heart. 3rd ed. 1991:42–73; White et al. Clin Pharmacol Ther. 1986;39:43–48; Gustaffson. J Cardiovasc
Pharmacol. 1987;10:S121–S131; Messerli et al. Am J Cardiol. 2000;86:11821187.
ACE inhibitors are recommended in a wide majority of
patients - JNC 7 Guideline -
Recommended
Drugs
Compelling
Aldo Ant
Clinical trial basis
Diuretic
Indication*
ACEI
ARB
CCB
BB
Heart Failure ACC/AHA Heart Failure Guideline, MERITHF,
COPERNICUS, CIBIS, SOLVD, AIRE, TRACE,
ValHEFT, RALES, CHARM