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HYPERTENSION AND

THE KIDNEYS
Tama ba sila?

 Lagi naman 160/80 and BP ko at wala naman


akong nararamdaman. Siguro hiyang na ang
katawan ko sa ganoong BP.

 Matanda na naman ako. OK na siguro yung


BP na 160/80 sa edad ko.

 Hindi ako puedeng maging high blood. Anemic


nga ako eh.
What level of blood pressure is considered elevated?

Blood pressure classification (JNC 7 report)

Normal <120 <80

Prehypertension 120-139 80-89

Stage 1 hypertension 140-159 90-99

Stage 2 hypertension >160 >100

Elevated BP must be documented on


at least 2 separate visits
Who are at risk for developing hypertension?

 Older people over 35 years of age

 Males and post-menopausal females

 Those with family history of hypertension

 Those who are overweight


Who are at risk for developing hypertension?

 Those who take alcohol excessively

 Smokers

 Those who consume a high-salt diet

 People taking some medications such birth control pills


or steroids
Why do we have to treat hypertension
even if the patient is asymptomatic?

 Hypertensives are at higher risk for heart attacks


 Treatment reduces the risk for myocardial
infarctions by 20-25%

 Hypertensives are at higher risk for strokes


 Treatment reduces the risk for strokes by 35-40%
Why do we have to treat hypertension
even if the patient is asymptomatic?

 Hypertensives are at higher risk for renal


failure

 Hypertensives are at higher risk for


DEATH!
What are the “must-do’s” for all newly diagnosed
hypertensives?

 Assess lifestyle and other CV risk factors or


concomitant disorders that may affect prognosis and
guide treatment

 Look for identifiable causes of secondary hypertension


and assess the presence of target organ damage
What are the “must-do’s” for all newly diagnosed
hypertensives?

 ECG
 Urinalysis
 FBS
 Lipid profile
 Creatinine
 Calcium
 Potassium
 CBC

JNC 7
Resources limited?
Do not compromise for known diabetics

 ECG *
 Urinalysis *
 FBS *
 Lipid profile *
 Creatinine
*
 Calcium
 Potassium
 CBC
Resources limited?
Do not compromise for those with onset of
hypertension at age<35 years

 ECG
 Urinalysis *
 FBS
 Lipid profile
 Creatinine *
 Calcium
 Potassium
*
 CBC
Who should be suspected of having secondary
hypertension and should be referred for work-up?

 With early onset of hypertension

 BP difficult to control, requiring 3 drugs or more

 With elevated serum creatinine

 With high or low serum potassium

 With abnormal urinalysis


How should hypertensive patients be treated?

 TLC Therapeutic lifestyle change

 Weight loss

 Exercise

 Low salt, low fat diet

 Stop smoking
How should hypertensive patients be treated?

 TLC Therapeutic lifestyle change

 Minimize alcohol consumption

 Learn strategies to cope with stress

 Regular intake of antihypertensive medications


How should hypertensive patients be treated?

 Pharmacologic treatment

 Diuretics
 Beta blockers
 Calcium antagonists
 ACE inhibitors
 Alpha blockers
 Central alpha2 antagonists
 Direct vasodilators
How should hypertensive patients be treated?

 Clinical trials have shown that lowering


blood pressure with any class of agent all
reduce the complications of hypertension

BUT

 Some drugs are better than others in


particular situations

Compelling indications
Compelling indications

Diabetes Chronic kidney


disease
Diuretic ♪
Beta blocker ♪
ACE inhibitor ♪ ♪
ARB ♪ ♪
CCB ♪
Aldosterone
antagonist
Compelling indications

CHF Post MI High CAD


risk
Diuretic ♪ ♪
Beta blocker ♪ ♪ ♪
ACE inhibitor ♪ ♪ ♪
ARB ♪
CCB ♪
Aldosterone ♪ ♪
antagonist
How should hypertensive patients be treated?

 What should your blood pressure goals be?

< 140/80 mm Hg

<130/80 mm Hg
for all patients with DM or CKD

No ifs, no buts!
Take home messages

 Blood pressure check to screen for hypertension is


recommended every two years for all adults

 All hypertensives should be treated to reduce long


term complications

 Patients should be treated with a combination of


lifestyle modification and pharmacologic treatment
Take home messages

 For patients with chronic kidney disease, the drugs of


choice are ACE inhibitors and angiotensin receptor
blockers

 For patients with chronic kidney disease and


proteinuria and all patients with diabetes, the blood
pressure goal should be <130/80 mm Hg
Barangay, Municipal and District Level

 Screen all patients for hypertension

 Refer all newly diagnosed hypertensives for initial


work-up

 Reinforce compliance with therapeutic lifestyle changes


Barangay, Municipal and District Level

 Monitor and encourage compliance with prescribed


antihypertensive medications

 Monitor patient to check whether therapeutic goals are


being achieved

 Refer patient if therapeutic goals are not achieved or


patient develops new symptoms
Provincial Level

 Perform initial laboratory work-up recommended for


all newly diagnosed hypertensives

 Refer patients suspected of secondary hypertension to


the appropriate specialist

 Refer patients identified to have target organ damage


to the appropriate specialist
Regional and Specialty Hospital Level

 Assess for presence of and severity of target organ


damage

 For those with renal abnormalities, a nephrologist


should formulate a management plan to improve renal
status and/or prevent further kidney damage
THANK YOU!