Franklin HTN CKD April 2010

Franklin HTN CKD April 2010 - Epidemiology of Hypertension...

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Epidemiology of Hypertension Stanley S. Franklin, MD, FACP, FACC Clinical Professor of Medicine University of California at Irvine Associate Medical Director UCI Heart Disease Prevention Program Irvine, California
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Agenda: epidemiology of hypertension 1 BP measurement 2 Defining hypertension 3 Why an important public health problem 4 Global risk assessment 5 Intervention trials and meta-analyses 6 Management strategies 7 Barriers to treatment 8 Prevention strategies
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1. How to measure blood pressure?
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Nokolai Korotkoff, 1905 Ascultatory method of blood pressure measurement
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Noninvasive Blood Pressure Measurement Methodologies - Auscultatory (K sound) - Mercury - Aneroid - Oscillometric Locations Situations - Upper arm - Clinic - Wris t - Home - Finger - Ambulatory
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2. Defining Hypertens ion: (a) By the numbers ? ≥95 DBP 160/95 140/90 130/85 >120/80 “A number at which the benefits of intervention exceed thos e of inaction”
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2098 Franklin #7 CV Mortality Risk Doubles with Each 20/10 mm Hg BP Increment * *Individuals aged 40-70 years, starting at BP 115/75 mm Hg. CV, cardiovascular; SBP, systolic blood pressure; DBP, diastolic blood pressure Lewington S, et al. Lancet . 2002; 60:1903-1913. JNC 7. JAMA. 2003;289:2560-2572. CV mortality risk SBP/DBP (mm Hg) 0 1 2 3 4 5 6 7 8 115/75 135/85 155/95 175/105
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2098 Franklin #8 JNC Reclassification of BP  Based on Risk Source for JNC VI: Arch Intern Med . 1997;157:2413-2446. Adapted with permission from Chobanian AV et al. Hypertension. 2003;42:1206- 1252. JNC VI SBP (mm Hg) DBP (mm Hg) SBP (mm Hg) DBP (mm Hg) Optimal Normal 80 <120 <120 and 80 and Normal Hi-normal Prehypertension 120-129 130-139 120-139 80-84 or 85-89 and 80-89 or Stage 1 Hypertension Stage 1 140-159 140-159 90-99 or 90-99 or Stage 2 Stage 3 Stage 2 160-179 180 160 100-109 or 110 or 100 or Category Category JNC 7
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BP Category BP Category Prevalence Prevalence Normal Normal 38% 38% Prehypertension Prehypertension 31% 31% Hypertension Hypertension 31% 31% Prevalence of Blood Pressure Categories in  Prevalence of Blood Pressure Categories in  US Adults ≥20 Years of Age  US Adults ≥20 Years of Age  (NHANES 1999-2000) (NHANES 1999-2000) Greenland, Croft, Mensah (CDC). Arch Intern Med. 2004;164:2113f Greenland, Croft, Mensah (CDC). Arch Intern Med. 2004;164:2113f
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Prehypertension … Is  Is  not not  a disease,  a disease, Is  Is  not not  “hypertension”,  “hypertension”, Is  Is  not not  an indication for drug treatment of HTN,  an indication for drug treatment of HTN, Does  Does  not not  have a BP goal,  have a BP goal, Does Does  predict a higher risk for developing CV events,  predict a higher risk for developing CV events, Does Does  predict a higher risk for developing HTN,  predict a higher risk for developing HTN, Should be an incentive to improve lifestyle  Should be an incentive to improve lifestyle 
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Franklin HTN CKD April 2010 - Epidemiology of Hypertension...

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