Embed Size (px)
DESCRIPTION
HTN GUIDELINES
Citation preview
JNC 8 2014 V/S ESC 2013HYPERTENSION GUIDELINES- OVERVIEW
DR SUHAIL, KIMS,TRIVANDRUM
SALIENT FEATURESESC JNC8• Importance of ABPM/HBPM.• White coat htn/ masked htn.• Target goal ˂ 140/90 mm hg.• Relaxation of target BP in
elderly. (>80 YRS)• No intervention in high
normal (pre htn) BP.• BB as first line drug.• Position of diuretics- first
line• Search for asymptomatic OD• Special population
stratifications
• DEFINITION = JNC7• NO GRADING OF HTN• TARGET GOAL<140/90• RELAXATION OF BP IN
ELDERLY (>60 YRS)• NO pre HTN group
• BB degraded as fourth line• Diuretic retained as first line
& FIRST• NO COMMENTS ON SPECIAL
POPULATION- INDIVIDUALISED TREATMENTS!.
ESC – Class of evidences
JNC8
ESC- Definitions and classification of office bloodpressure levels (mmHg)
JNC8
Stratification of total CV risk in categories of low, moderate, high and very high risk according to SBP and DBP and prevalence of RFs, asymptomatic OD, diabetes, CKD stage or symptomatic CVD. Subjects with a high normal office but a raised out-of-office BP (masked
hypertension) have a CV risk in the hypertension range.
Authors/Task Force Members et al. Eur Heart J 2013;eurheartj.eht151
© The European Society of Hypertension (ESH) and European Society of Cardiology (ESC) 2013. All rights reserved. For permissions please email: [email protected].
ESC
Comparison with JNC 7
Contd…
Initiation of lifestyle changes and antihypertensive drug treatment.
Authors/Task Force Members et al. Eur Heart J 2013;eurheartj.eht151
© The European Society of Hypertension (ESH) and European Society of Cardiology (ESC) 2013. All rights reserved. For permissions please email: [email protected].
ESC
JNC8
Initiation of antihypertensive drug treatmentESC
when weighing the risks and benefits of a lower BP goal for people aged 70 years or older with estimated GFR less than 60 mL/min/ 1.73m2, antihypertensive treatment should be individualized, taking into consideration factors such as frailty, comorbidities, and albuminuria
Blood pressure goals in hypertensive patients
Initiation of antihypertensive treatment at a DBP threshold of 90 mmHg or higher.
Treatment to a DBP goal of lower than90mm Hg reduces cerebrovascular events, heart failure, and overall mortality.
there is no benefit in treating patients to a goal of either 80mmHg or lower or 85mmHg or lower compared with90mmHg or lower.
BETA BLOCKERS
• Though Cochrane meta-analysis has reported that beta-blockers may be inferior to some—but not all—other drug classes for some outcomes;
• the large meta-analysis by Law et al. has shown beta-blocker-initiated therapy to be equally as effective as the other major classes of antihypertensive agents in preventing coronary outcomes and
• highly effective in preventing CV events in patients with a recent myocardial infarction and those with heart failure.
ESC
The panel did not recommend β-blockers for the initial treatment of hypertension because in one study use of β-blockers resulted in a higher rate of the primary composite outcome of cardiovascular death,myocardial infarction, or stroke compared to use of an ARB, a finding that was driven largely by an increase in stroke.
In the other studies that compared a β-blocker to the 4 recommended drug classes, the β-blocker performed similarly to the other drugs or the evidence was insufficient to make a determination
JNC8
Drugs to be preferred in specific conditionsESC
any of these 4 classes would be good choices as add-on agents .
this recommendation is specific for thiazide-type diuretics, which include thiazide diuretics, chlorthalidone, and indapamide; it does not include loop or potassium- sparing diuretics.
it is important that medications be dosed adequately to achieve results similar to those seen in the RCTs.
RCTs that were limited to specific non hypertensive populations, such as those with coronary artery disease or heart failure,were not reviewed for this recommendation.
Therefore, recommendation should be applied with caution to these populations.
JNC8
ESC
Strategies to Dose Antihypertensive Drugs
JNC8
JNC8
SPECIAL POPULATIONS
any of these 4 classes would be good choices as add-on agents .
this recommendation is specific for thiazide-type diuretics, which include thiazide diuretics, chlorthalidone, and indapamide; it does not include loop or potassium- sparing diuretics.
it is important that medications be dosed adequately to achieve results similar to those seen in the RCTs.
RCTs that were limited to specific non hypertensive populations, such as those with coronary artery disease or heart failure,were not reviewed for this recommendation.
Therefore, recommendation should be applied with caution to these populations.
Treatment strategies in white-coat and maskedhypertension
Antihypertensive treatment strategies in the elderly
Treatment strategies in hypertensive women
Treatment strategies in patients with diabetes
JNC & ESC• NO PRE HTN• LIBERAL IN ELDERLY
ACEI, ARB & CCB- FIRST LINE
Treatment strategies in hypertensive patients withmetabolic syndrome
Therapeutic strategies in hypertensive patients withnephropathy
Therapeutic strategies in hypertensive patients withcerebrovascular disease
Therapeutic strategies in hypertensive patients withheart disease
Therapeutic strategies in hypertensive patients withatherosclerosis, arteriosclerosis, and peripheral artery
disease
Therapeutic strategies in patients with resistanthypertension
Treatment of risk factors associated with hypertension
