How to Manage ?
Erwin Azmar
Cardiology Division Department of Internal Medicine
Faculty of Medicine University of Sriwijaya
2019
Hypertension : USA > 50 million
worldwide : 1 billion
7,1 million †
WHO :62 % CVD, 49 % IHD
CVD Risk Factors Common in Patients With
Hypertension
Modifiable Risk Factors* Relatively Fixed Risk Factors†
Current cigarette smoking, CKD
secondhand smoking Family history
Diabetes mellitus Increased age
Dyslipidemia/hypercholesterolemia Low socioeconomic/educational
Overweight/obesity status
Physical inactivity/low fitness Male sex
Unhealthy diet Obstructive sleep apnea
Psychosocial stress
*Factors that can be changed and, if changed, may reduce CVD risk.
†Factors that are difficult to change (CKD, low socioeconomic/educational status,
obstructive sleep apnea, cannot be changed (family history, increased age, male sex), or,
if changed through the use of current intervention techniques, may not reduce CVD risk
(psychosocial stress).
CKD indicates chronic kidney disease; and CVD, cardiovascular disease.
BP Measurement Definitions
BP Measurement Definition
Clinical ASCVD
Nonpharmacologic
Promote optimal or estimated 10-y CVD risk
therapy
lifestyle habits ≥10%*
(Class I)
No Yes
Reassess in Reassess in
3–6 mo 1 mo
(Class I) (Class I)
1y 3–6 mo therapy
BP-lowering medication BP-lowering medication†
(Class IIa) (Class I) (Class I)
(Class I) (Class I)
Reassess in Reassess in
3–6 mo 1 mo
(Class I) (Class I)
BP goal met
No Yes
Consider
intensification of
therapy
.
BP indicates blood pressure; CKD, chronic kidney disease; DBP, diastolic blood
pressure; eGFR, estimated glomerular filtration rate; NSAIDs, nonsteroidal anti-
inflammatory drugs; and SBP, systolic blood pressure.
Adapted with permission from Calhoun et al.
Refractory Hypertension
Baseline Characteristic of RHTN and RfHTN
take home messages
Treatment of RfHTN
• sympatholytic agent
• renal denervation
• carotis sinus activation