Post on 02-Jan-2016
description
BELGIUM 27th !!!
1) HTA DE GRADE 3 = TOUJOURS RISQUE > ELEVE
2) PREVENTION SECONDAIRE ou DIABETE + ATTEINTE ‘ORGANE CIBLE’/FACTEUR DE RISQUE
= RISQUE ELEVE PEU IMPORTE LA PA
4
3
3) Si PAS >140 et/ou 90 mmHg et >3 facteurs de risque CV ou atteinte ‘organe cible’ ou diabète
= RISQUE ELEVE
LIFE EXPECTANCY AT 60 YRS IN 2012
Ph van de Borne, L Missault, A Persu, W Van Mieghemfor the COME STAI INVESTIGATORS
Parameters > 2 medications
1 medication
0 medication
Systolic BP (mmHg)
139±19 139±18 143±21*
Diastolic BP (mmHg)
80±11 81±11 83±13*
Age (years)
68±12 62±13 55±15*
Heart rate (bpm)
72±10 73±9 75±10*
Body mass index (kg/m²)
29.0±5.8 27.2±5.0 26.7±5.2*
S: systolic; D: diastolic; BP: Blood pressure; bpm: beat per minute; * p<0.0001
RESULTS (2): Nr of medications reportedin n:7961 patients (0 vs. 1 vs. 2 or more drugs)
Less intense treatment in the elderly : Among 495 patients aged ≥80
years, and SBP> 140 mmHg, therapy was
intensified:
in 57% when SBP > 160 mmHg (n=130)
in 17% when 140 <SBP<159 mmHg* (n=365)
*p Chi² <0.0001
Blood pressure in mm Hg
ESH/ESC 2013[3]
ASH/ISH 2014 [4]
Go A. et al. AHA/ACC/CDC 2013 [5]
2014 Hypertension guidelines, US “JNC 8”
[6]Definition ofHypertension
≥140/90 ≥140/90 ≥140/90 Not addressed
Drug therapy in low risk patients after non-
pharmacologic treatment
≥140/90 ≥140/90 ≥140/90 < 60 y. ≥140/90
≥ 60 y. ≥150/90
Beta-blockers as first line drug
Yes No(Step 4)
No(Step 3)
No (Step 4)
Diuretic thiazideschlorthalidone,
indapamide
thiazides chlorthalidone
indapamide
thiazides thiazides chlorthalidone,
indapamideInitiate drug therapy with
two drugsIf markedly elevated BP
≥160/100 ≥160/100 ≥160/100
Blood pressure targets <140/90 Elderly < 80 y. SBP 140-150
SBP <140 in fit patients
Elderly ≥ 80 y. SBP 140-150
<140/90
≥ 80 y. < 150/90
<140/90Lower targets may be appropriate in some
patients, including the elderly
< 60 y. <140/90
≥ 60 y. <150/90
Blood Pressure target in patients with diabetes
mellitus
< 140/85 <140/90 <140/90 Lower targets may be
considered
<140 /90