2. Hypertension By Dr. Nagwa Eid Saad Prof. Of Internal Medicine & Family Medicine In Cairo University

3. 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.

4. 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

5. JNC-7 Classification NormalPrehypertension Stage I hypertension Stage II hypertension SBP (mmHg) DBP (mmHg) BP Classification < 120 120-139140-159 > 160 < 80 80-8990-99 > 100 andororor http://hin.nhlbi.nih.gov/nhbpep_slds/menu.htm

6. 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

7. 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.

8. 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

9. 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

10. Prehypertension: Signals a need for increased education to reduce BP in order to prevent HTN

11. Historical Trends in HTN National Health and Nutrition Examination Survey AwarenessTreatmentControl 1991-199468%54%27%1976-198051%31%10%1988-199173%55%29%1994-200070%59%34% SBP < 140 mmHg and DBP < 90 mmHg Trends in awareness, treatment, and control of high blood pressure in adults ages 18-74 http://hin.nhlbi.nih.gov/nhbpep_slds/menu.htm