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About 5 million Nigerians are hypertensive. Surprisingly, just about one-third of these people are adequately managed medically. Hypertension is a lifelong disorder but optimum control can be achieved by commitment to lifestyle modification and pharmacological therapy. Anyone above the age of 55 years has a lifetime risk of 90% of developing hypertension.

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RISK FACTORS FOR HYPERTENSION INCLUDE:

Obesity

Diabetes mellitus

Sedentary lifestyle: Be active!!!

Diet high in salt and cholesterol: Reduce your salt and cholesterol intake please!!!

Alcohol consumption: Be moderate please!!!

Cigarette smoking and illicit drug use: Avoid this completely please!!!

Race (commoner in black)

SIGN AND SYMPTOMS

There are usually NO symptom for this deadly disease; only when complications have almost or even risen, that’s when patient often has symptoms.

Patients with symptoms of hypertension.

SIGN AND SYMPTOMS RELATED TO COMPLICATIONS OF HYPERTENSION

Headache

Palpitation (feeling your heartbeat)

Excessive sweating

Pain in the calf

Blurring of vision

Weakness of the limbs

Chest pain

Agitation

Insomnia (poor sleep)

Reduction in urine output

Epistaxis (nose bleeding)

EVENTUAL COMPLICATIONS OF HYPERTENSION INCLUDE:

Blindness

Stroke

Kidney failure

Intracranial hemorrhage

 Death

CLASSIFICATION OF BLOOD PRESSURE IN ADULT

Normal: Systolic blood pressure (less than 120mmHg) while Diastolic blood pressure (less than 80mmHg)

Prehypertension: Systolic blood pressure (120-139mmHg) while Diastolic blood pressure (80-99mmHg)

Stage 1: – Systolic blood pressure (140-159mmHg) while Diastolic blood pressure (90-99mmHg)

Stage 2: – Systolic blood pressure (greater than or equal 160mmHg) while Diastolic blood pressure (greater than or equal 100mmHg)

INVESTIGATION

Your doctor might require for the following investigations for adequate management:

  1. Resting ECG
  2. Exercise/ Stress ECG
  3. Urinalysis/ microscopy
  4. Thyroid function test
  5. Lipid profile
  6. Chest x-ray

MANAGEMENT OF HYPERTENSION WITH JNC 8 RECOMMENDATION

The committee provided 9 graded recommendations to answer the 3 key questions. Grading was performed on the basis of the strength of the available evidence used to make the recommendation: grade A is indicative of strong evidence, grade B of moderate evidence, grade C of weak evidence, and grade E of expert opinion (in lieu of sufficient evidence). Below are the 9 recommendations.

Recommendation 1. The guideline recommends the initiation of drug therapy in order to lower a systolic BP (SBP) of ≥150 mmHg or a diastolic BP (DBP) of ≥90 mmHg for the general population at 60 years of age or older (Grade A). A corollary recommendation is that patients whose achieved SBP on pharmacologic therapy is lower than the new guideline recommendation can be continued at that level of therapy, if well tolerated (Grade E).

Recommendation 2. The target DBP to start pharmacologic therapy for subjects younger than 60 years of age is ≥90 mmHg. On the basis of available evidence, the recommendation for patients aged 30 to 59 years is strong (Grade A). For those between the ages of 18 and 29, the recommendation is on the basis of expert opinion (Grade E).

Recommendation 3. The target SBP to start pharmacologic therapy for subjects younger than 60 years of age is ≥140 mmHg (Grade E).

Recommendation 4. In the population aged 18 years or older with chronic kidney disease, initiate pharmacologic treatment to lower BP at SBP ≥140 mmHg or DBP ≥90 mmHg and treat to a goal of SBP <140mmHg and a goal of DBP <90 mmHg (Grade E).

Recommendation 5. The target blood pressure in beginning pharmacologic therapy for the diabetic population aged 18 years or older is <140 mmHg for SBP and <90 mmHg DBP (Grade E).

Recommendation 6. Initial drug therapy for nonblack patients (including diabetic patients) should include a thiazide-type diuretic, a calcium channel blocker, an angiotensin-converting enzyme (ACE) inhibitor, or an angiotensin receptor blocker (Grade B).

Recommendation 7. Initial drug therapy for black patients should include a thiazide-type diuretic or a calcium channel blocker. This includes patients with diabetes mellitus (Grade B; for diabetic black patients, Grade C).

Recommendation 8. For patients 18 years and older with chronic kidney disease, initial or additional therapy should include an ACE inhibitor or angiotensin receptor blocker, regardless of race or diabetic status (Grade B).

Recommendation 9.An algorithm for managing patients who do not achieve control within one month is recommended. If the goal is not achieved, increase the dose of the initial drug or add a 2nd drug from one of the classes in recommendation 6. A 3rd drug should be added if the goal is not achieved with 2 drugs. Drugs from other classes can be used if the target is not achieved with the recommended classes, or if there is a contraindication to one of the recommended drug classes. ACE inhibitors should not be combined with angiotensin receptor blockers in the same patient. Referral to a hypertension specialist should be considered in complicated cases or in the event of inability to control BP (Grade E).

FURTHER READING

  1. Davidson’s principle and Practice of Medicine
  2. CMDA-S Precis note in Medicine

A review of the JNC 8 blood pressure guideline: Texas Heart Institute Journal

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Dr. Olusola Adeyemo (M.B.Ch.B.; Adv. Dip in Nutri.)

Dr. Adeyemo Olusola is a medical graduate of Olabisi Onabanjo University, Ogun State, Nigeria with certificate in advanced diploma in Principles of Nutrition, Management and Leadership, Dublin and Certificate in Global Health from London School of Hygiene and Tropical Medicine. He is an avid reader of books from different oasis of life, expert in Medical Statistics; an award winner at both local and international level. "So many a time, I have seen people died avoidable death because of lack of knowledge or information leaving them all to fate. A healthy society cannot be detached from informed one hence need to establish healthgist.net. We hope you'll have a wonderful stay on our site."

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