Hypertension Guideline

in Specific Population
Amila Hanifan
 Hypertension

Hypertension-mediated organ damage (HMOD) : structural or functional alteration of the arterial vasculature and/or the organs caused by elevated BP. End
organs include the brain, the heart, the kidneys, central and peripheral arteries, and the eyes.

Thomas Unger. Hypertension. 2020 International Society of Hypertension Global Hypertension Practice Guidelines, Volume: 75, Issue: 6, Pages: 1334-1357.
Hypertension Risk

Thomas Unger. Hypertension. 2020 International Society of Hypertension Global Hypertension Practice Guidelines, Volume: 75, Issue: 6, Pages: 1334-1357.
Reference: James PA, Ortiz E, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: (JNC8). JAMA. 2014 Feb 5;311(5):507-20
Drug Treatment Strategy

Thomas Unger. Hypertension. 2020 International Society of Hypertension Global Hypertension Practice Guidelines, Volume: 75, Issue: 6, Pages: 1334-1357.
ISH 2020 recommendations
(evidence-based standards of care)

Thomas Unger. Hypertension. 2020 International Society of Hypertension Global Hypertension Practice Guidelines, Volume: 75, Issue: 6, Pages: 1334-1357.
Pharmacology Antihypertensive Therapy

Clinical Pharmacology of Antihypertensive Therapy for the Treatment of Hypertension in CKD. Arjun D. Sinha, Rajiv Agarwal.CJASN May 2019, 14 (5) 757-764.
Oral Antihypertensive Drugs
Outline

Hypertension in Pregnancy

Hypertension in Diabetes Mellitus

Hypertension in Chronic Kidney Diseases

Hypertensive and Heart Diseases

Hypertensive and Cerebrovascular Diseases

Hypertension in Cancer Therapy

Perioperative Management
 Hypertension in Pregnancy
Pre-existing hypertension:
precedes pregnancy or develops < 20 weeks of
gestation, persists >6 weeks post-partum and
associated with proteinuria

Gestational hypertension: develops > 20 weeks of

gestation and resolves within 6 weeks post-partum.

Pre-existing hypertension plus superimposed

gestational hypertension with proteinuria.

Pre-eclampsia: gestational hypertension with

significant proteinuria (>0.3 g/24 h or >_30 mg/
mmol ACR)
2018 ESC/ESH Guidelines for the Management of Arterial Hypertention. Eur J Heart 2018;39:3021-3104
 Hypertension in Diabetes Mellitus

• High BP is a common feature of type 1 and,

particularly type 2 diabetes
• ACE inhibitor or ARB  reduce albuminuria and
progression of diabetic nephropathy (more
effectively than other drug classes)
• Combination of an ACE inhibitor with an ARB is
contraindicated because of renal adverse events

2018 ESC/ESH Guidelines for the Management of Arterial Hypertention. Eur J Heart 2018;39:3021-3104
Hypertension in Chronic Kidney Diseases
Hypertension and Heart Disease
Hypertension and Cerebrovascular disease
 The Different Therapeutic Choices with ARBs
Which One to Give? When? Why?

The Different Therapeutic Choices with ARBs Which One to Give? When? Why? Am J Cardiovasc Drugs. 2016; 16: 255–266.
The Different Therapeutic Choices with ARBs Which One to Give? When? Why? Am J Cardiovasc Drugs. 2016; 16: 255–266.
Abraham, H. M. A., White, C. M., & White, W. B. (2014). The Comparative Efficacy and Safety of the Angiotensin Receptor Blockers in the Management of Hypertension
and Other Cardiovascular Diseases. Drug Safety, 38(1), 33–54. doi:10.1007/s40264-014-0239-7 
Abraham, H. M. A., White, C. M., & White, W. B. (2014). The Comparative Efficacy and Safety of the Angiotensin Receptor Blockers in the Management of Hypertension
and Other Cardiovascular Diseases. Drug Safety, 38(1), 33–54. doi:10.1007/s40264-014-0239-7 
Abraham, H. M. A., White, C. M., & White, W. B. (2014). The Comparative Efficacy and Safety of the Angiotensin Receptor Blockers in the Management of Hypertension
and Other Cardiovascular Diseases. Drug Safety, 38(1), 33–54. doi:10.1007/s40264-014-0239-7 
Abraham, H. M. A., White, C. M., & White, W. B. (2014). The Comparative Efficacy and Safety of the Angiotensin Receptor Blockers in the Management of Hypertension
and Other Cardiovascular Diseases. Drug Safety, 38(1), 33–54. doi:10.1007/s40264-014-0239-7 
Spironolactone in CKD
 Hypertension and Cancer Therapy
• Most common CV comorbidity  1/3 patients
• Etiology :
 high prevalence of hypertension at older age
 pressor effect of anticancer drugs
• Therapy :
 RAS blockers and CCBs may be considered the preferred drugs
 RAS blocker-CCB combination is a frequently needed strategy
 CCBs should only be of the dihydropiridine type

note
diltiazem verapamil block the CYP3A4 isoenzyme, involved in the
metabolic pathway of sorafenib  potential toxicity

2018 ESC/ESH Guidelines for the Management of Arterial Hypertention. Eur J Heart 2018;39:3021-3104
 Perioperative Management
of Hypertension

2018 ESC/ESH Guidelines for the Management of Arterial Hypertention. Eur J Heart 2018;39:3021-3104
Mulla S, Siddiqui WJ. Losartan. [Updated 2020 Aug 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-.
Thank you