- Learn commonly-used terminology regarding HTN
- Describe basic concepts of HTN
- Identify characteristics of HTN medications
Prefix “A-” = “non,” “not,” “without,” etc. = 非・無など
- Anemia = A + -emia (=blood/血液) = 貧血
- Asymptomatic = A + symptoms (病状) = 無症状
HTN Complications (高血圧の合併症）
- Renal failure (腎不全）
- Coronary heart disease (冠動脈疾患)
- Heart failure (心不全）
- Stroke (脳卒中)
- Dementia (認知症)
Normal, elevated, Stage 1, Stage 2, hypertensive crisis
Essential HTN – 原因不明
Secondary HTN – 他の病気が原因となる
- 利尿薬 – Diuretics
- β遮断薬 – Beta blocker
- クロニジン – Clonidine (US: Catapres)
- アンジオテンシン阻害薬 (Angiotensin blockers, sometimes called “RAAS inhibitors” (Renin-Angiotensin-Aldosterone System) など
Alex section – transcript
So this part of the presentation is going to be in English, and in this slide I mainly wanted to give you the main points from the very end of the chapter describing the outpatient management of hypertension. So this is the very last summary portion of the chapter.
You can divide hypertension into nonpharmacologic and pharmacologic treatment.
With nonpharmacologic treatment the chapter was describing three primary lifestyle changes, so that’s diet, weight loss, and exercise.
Under diet the chapter describes sodium reduction and they even say that the average American diet contains about 200 meq of sodium per day, and it says a reasonable dietary goal is 70-100mEq. In the US we usually measure it in mg, but it’s basically saying we consume too much salt.
The second part it describes is diet, so vegetables, fruits, and whole grains. The chapter didn’t go much into diet; I just put examples of a couple that are popular in the US. The DASH diet and the mediterranean diet are two that are now becoming more and more popular for weight loss and management of BP.
Under pharmacologic treatment, for moderate-severe HTN, it recommends combination therapy to begin with , with the first line treatments being ACE-I, thiazide diuretics, CCBs, and ARBs.
Finally they talk about the debate going on over what the goal BP is. They quoted the SPRINT trial which was a few years ago, which targeted 120/80 for high risk patients and found significantly improved outcomes over standard of care, so that has only furthered the debate over what the goal BP is and in what population.
● SPRINT trial:
What is the most appropriate targets for systolic blood pressure to reduce CV morbidity and mortality?
対象：ハイリスク患者を対象。(at least 1 CVD Risk factor)
● 2017 ACC/AHA CLINICAL PRACTICE GUIDELINES
Hypertension stage 1 (130〜): huge change: was pre-diabetic, start meds depending on the 10 year- risk factor for heart disease and stroke
Hypertension stage 2 (140〜): start with 2 meds of different classes
●Choosing an anti-hypertensive (高血圧治療の選び方）
First line: ACE I, ARB, CCB, Thiazide or 2 drug combination
●Compelling indication for specific pharmacotherapy