【高血压精品英文课件】老年性高血压 HYPERTENSION IN ELDERLY.ppt

HYPERTENSION IN ELDERLY Dr. Kunal Kothari Emeritus Professor of Medicine and Clinical Cardiology Director Primary Health Care and Strategic initiative  Sphygmanometer- size of the cuffs Food Exercise Caffeine Smoking Guidelines The Seventh Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII) uses the following guidelines to define HTN in adults: Pseudo Hypertension Recording of high B.P. but do not have Common cause of this is brachial artery compression WHITE COAT HYPERTENSION BP recording in office or clinic is high while at home is normotensive white coat hypertension appear to have no greater risk than people with normal blood pressure ( Aug. 2, 2005, American college of cardiology ) MASKED HYPERTENSION Proposed the term masked hypertension Pickering et al (Hypertension 2002;102:1139-44) Documented by Ohkubo et al (N Engl J Medicine 2003;348:2407-15) MASKED HYPERTENSION HYPERTENSION IS NOT DETECTED BY THE ROUTINE METHODS. UNDETECTED AMBULATORY HYPERTENSION UNUSUALLY HIGH AMBULATORY PRESSURE OR A LOW CLINIC PRESSURE ON THAT PARTICULAR OCCASION SHOW MORE EXTENSIVE TARGET ORGAN DAMAGE THAN TRUE NORMOTENSIVE SUBJECTS Blood Pressure in 347,978 men aged 35-57 screened for MRFIT Lifetime Risk of Developing Hypertension in Middle Aged (Vasan et al, JAMA 2002; 287: 1010) Risk for Hypertension in a 55 year old Time, yr Women Men 52% 56% 72% 78% 83% 88% 25 91% 93% Diagnostic Evaluation of the Hypertensive Patient- How much is enough? How high is the blood pressure? Why is it high? What is the risk? Clinical Manifestations I Physical exam: Abdomen Funduscopic Vascular Cardiac Pulmonary Neurological Lab tests: Urinalysis Blood Chemistry ECG Renal ultrasound Echocardiogram Vascular studies Differ