Risk of Developing Hypertension by Daily Intake of Alcohol

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1 JNC 7 ESH/ESC (Guidelines)

2 Guidelines JNC 7 Guidelines ; The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure JAMA. 2003;289: ESH/ESC Guidelines ; 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension* Guidelines Committee** Journal of Hypertension 2003;21: WHO/ISH Guidelines ; 2003 World Health organization (WHO)/ International Society of Hypertension (ISH) statement on management of hypertension World Health Organization, International Society of Hypertension Writing Group Journal of Hypertension 2003;21:

3 (Guideline) Dynasty C.C.

4 JNC 7 Express Succinct evidencebased recommendations. Published in JAMA May 21, 2003, and as a Government Printing Office publication. Full Report comprehensive justification and rationale.

5 Why JNC 7? : Purpose

6 : JNC 6-7 Categorization of hypertension by severity Categroy Systolic Diastolic(mmHg) Optimal < 120 < 80 Normal < 130 <120 and < 85 < 80 High-normal or Prehypertension Hypertension Stage or Stage or Stage or 100 Stage or 110 JNC VI JNC VII

7 : JNC 7 BP Classification Systolic (mmhg) Diastolic (mmhg) Normal < 120 < 80 Prehypertension Stage 1 Hypertension Stage 2 Hypertension

8 : ESH/ESC Definitions and classification of blood pressure levels (mmhg)

9 : WHO/ISH Definitions and classification of blood pressure levels (mmhg) Category Systolic Diastolic Optimal < 120 < 80 Normal High normal Grade 1 hypertension (mild) Subgroup : Borderline Grade 2 hypertension (moderate) Grade 3 hypertension (severe) Isolated systolic hypertension 140 > 90 Subgroup : Borderline

10 JNC 7 : Key Messages(1) 50 SBP DBP CVD CVD risk 115/75 mmhg 20/10mmHg 2 90% 55 (prehypertension) : /80-89 mmhg

11 JNC 7 : Key Messages(2) Thiazide ( ) (compelling indications) : 2 20/10 mmhg 2 : thiazide

12 JNC 7 : Key Messages(3) = + = + (empathy):

13 JNC-7 : < 120/80 mmhg /85-89 mmhg (Prehypertension) : (LSM) /80-89 mmhg : 2 (stage III II )

14 JNC-7 (Lifestyle Modification) (DASH diet) 1 6gm (Na 2.4gm, 100mmol) ( kg/m 2 ), ( 30 ) 2 (100% ethanol 30ml ; 720ml, 300ml, 80 90ml ) ( ) 5-20 mmhg/10 kg 8-14 mmhg 2-8 mmhg 4-9 mmhg 2-4 mmhg

15 JNC-7

16 JNC-7 Thiazide - ALLHAT - -

17 JNC-7 20/10 mmhg

18 JNC-7 : Compelling Indications ACE

19 JNC-7 3 (Stage 3) mmhg 100 mmhg (3 : 180 mmhg 110mmHg) -

20 JNC-7 (Risk Stratification) /80 mmhg - : (NIDDM) - +

21 ESH/ESC Stratification of risk to quantify prognosis

22 Ten-year risk of fatal cardiovascular disease in populations at low cardiovascular disease risk. Chart based on total cholesterol.

23 WHO/ISH Stratification of risk to quantify prognosis

24 JNC-7 /ESH-ESC Cardiovascular Risk Factors and Target Organ Damage(JNC 7) MAJOR RISK FACTORS Hypertension * Cigarette smoking Obesity* (body mass index 30 kg/m 2 ) Physical inactivity Dyslipidemia * Diabetes mellitus * Microalbuminuria or estimated GFR <60 ml/min Age(older than 55 for men, 65 for women) Familly history of premature cardiovascular disease (men under age 55 or women under age 65) TARGET ORGAN DAMAGE Heart Left ventricular hypertrophy Angina or prior myocardial infarction Prior coronary revascularization Heart failure Brain Storke or transient ischemic attack Chronic Kidney disease Peripheral arterial disease Retinopahty GRF, glomerular filtration ratel. * Components of the metabolic syndrome.

25 Factors Influencing Prognosis(ESH-ESC) Risk factors for cardiovascular disease used for stratificaton Levels of systolic and diastolic BP Men > 55 years Women > 65 years Smoking Dyslipidaemia (total cholesterol > 250mg/dl * ) or LDL-cholesterol > 155mg/dl * or HDL-cholesterol M < 40, W < 48 mg/dl) Family history or premature cardiovascular disease (at age < 55 years M, < 65 years W) Abdominal obesity (abdominal circumference M 102cm, W 88cm) C-reactive protein 1 mg/dl

26 Factors influencing prognosis(esh-esc) Target organ damage (TOD) Left ventricular hypertrophy (electrocardiogram: Sokolow-Lyons >38 mm; Cornell > 240 mm*ms; echocardiogram: LVMI M 125, W 110 g/m 2 ) Ultrasound evidence of arterial wall thickening (carotid IMT 0.9 mm) or atherosclerotic plaque Slight increase in serum creatinine ( M , W mg/dl) Microalbuminuria ( mg/24 h; albumin-creatinine ratio M 22, W 31 mg/g;)

27 Factors Influencing Prognosis(ESH-ESC) Diabetes mellitus Fasting plasma glucose 126 mg/dl (7.0 mmol/l ) Prostprandial plasma glucose > 198 mg/dl (11.0 mmol/)

28 Factors Influencing Prognosis(ESH-ESC) Associaged clinical conditions (ACC) Cerebrovascular disease: ischaemic stroke; cerebral haemorrhage; transient ischaemic attack Heart disease: myocardial infarction; angina; coronary revascularization;congestive heart failure Renal disease: diabetic nephropathy; renal impaiment (serum creatinine M >1.5, W > 1.4 mg/dl) proteinuria (>300 mg/24 h) Peripheral vascular disease Advanced retinopathy; haemorrhages or exudates, papilloedema

29 JNC-7 : <140/90mmHg ( : <130/80mmHg) 1 Thiazide ACEI, ARB, BB, CCB 2 2 thiazide ACEI, ARB, BB, CCB :, ACEI, ARB, BB, CCB

30 Initiation of Antihypertensive Treatment: ESH-ESC

31 Choice Between Monotherapy and Combination Therapy ESH-ESC Guidelines

32 Possible Combinations of Different Classes of Antihypertensive Agents: ESH-ESC Guidelines

33 JNC 7/ESH-ESC

34 JNC-7 /ESH-ESC (mmhg) - Normal BP : < 120/80 Optimal BP : < 120/80 - Prehypertension : /80-89 Normal : /80-84 High normal : / Stage II = Grade 2 + Grade 3 Hypertension

35 JNC-7 /ESH-ESC JNC 7 : ESH/ESC : Added risk

36 JNC-7 /ESH-ESC JNC 7 : Normal < 120/80 mmhg Prehypertension : Stage III Stage II ESH-ESC :,

37 Patients (%) with BP Controlled Worldwide JNC VI. Arch Intern Med 1997;157:2413 Joffres et al. Am J Hypertens 1997;10:1097 Colhourn et al. J Hypertens 1998;16:747

38 Patients (%) with BP Controlled Worldwide Chamontin et al. Am J Hypertens 1998;11(6 pt 1):1097 Marques-Vidal and Tuomilehto. J Hum Hypertens 1997;11:213

39 JNC-7 Message :

40 : JNC 7 Guidelines Thiazide

41 ESH-ESC Message :

42 JNC 7 ESH-ESC Dynasty C.C. Dynasty C.C 3.5Km Dynasty C.C. Dynasty C.C 16Km Dynasty C.C 34Km

43 FDR

44 Table I. FDR A Case of Untreated Hypertension YEAR BLOOD PRESSURE COMPLICATIONS TREATMENT (MM HG) /78 age /98 Phenobarbital / Low-salt and low-fat diet Massages Digitalis /105 Cardiac enlargment Probable lacunar infarcts /108 Congestive heart failure (CHF) / Renal failure April 12, 1945 cerebral hemorrhage death, age 63 : BP > 300/190 mmhg

45 1. JNC 7/ ESH-ESC guidelines?. 3. guidelines? JNC 7 Guidelines? ESH/ESC Guidelines? WHO/ISH Guidelines?

슬라이드 1

슬라이드 1 National Heart, Lung, and Blood Institute National High Blood Pressure Education Program 1997JNC 6, 1999WHO/ISH Why JNC 7? 50, SBPDBP 115/75 mmhg, 20 / 10 mmhg 2. 55 90%. SBP 120 139 mmhg DBP 80 89 mmhg