Hypertension Diagnosis and Treatment  Based on JNC 7 – published in 2003  Goal: BP <140/90 general population <130/80 pts w/ DM or renal dz <130/80 pts w/ DM or renal dz  Risk of CVD doubles with each 20mm Hg  of SBP and  of 10mm Hg DBP above 115/75

Hypertension Guidelines BP Classification Systolic BP measurement Diastolic BP Measurement Normal < 120mm Hg AND < 80mm Hg Prehypertension 120 – 139mm Hg OR mm Hg Stage I Hypertension 140 – 159mm Hg OR 90 – 99mm Hg Stage II Hypertension  160 mmHg OR  100mm Hg

Hypertension Treatment  Most patients will require TWO OR MORE antihypertensive medications  New clinical condition being targeted: PREHYPERTENSION - defined as systolic blood pressure (SBP) of OR diastolic blood pressure (DBP) of and requires lifestyle modification to prevent incidence of CVD

Medications to Treat Hypertension  Thiazide-type Diuretics - Examples: hydrochlorothiazide, metalozone, chlorothiazide  Angiotensin Converting Enzyme Inhibitors (ACEI) - Examples: lisinopril, captopril, enalapril  Angiotensin Receptor Blockers (ARB) - Examples: losartan, valsartan, irbesartan  Calcium Channel Blockers (CCB) – Examples: nifedipine, amlodipine, diltiazem  Beta Blockers (BB) - Examples: atenolol, metoprolol, propranolol

Lifestyle Treatment of Hypertension  Lifestyle Changes Recommended for all Patients - Physical Activity - Physical Activity - Smoking cessation - Smoking cessation - Weight Loss - Weight Loss - Dietary Sodium Reduction - Dietary Sodium Reduction - Dietary Modifications - Dietary Modifications - Moderation of Alcohol Consumption - Moderation of Alcohol Consumption