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ΥΠΕΡΤΑΣΗ ΚΑΙ ΣΤΕΦΑΝΙΑΙΑ ΝΟΣΟΣ
• CAD is the largest killer of American males and females
• 13 million Americans have CAD
• 1.1 million MI’s per year
• Every 26 seconds an American will suffer from a coronary event
• Every 60 seconds an American will die because of a coronary event
• 42% of those having a coronary event will die from it
• 350000 people die per year because of a coronary event in the Emergency Department before even being admitted to the hospital
• Death Rate in 2001:
– 177 in 100,000
CAD: Demographics and Statistics
• 84% of those who die from CAD are 65 or older
• Within 1 year of initial MI:
– 25% of men and 38% of women will die
• Within 8 years of initial MI:
• 50% of men and women under 65 will die
• An average of 11.5 years of life are lost due to an MI
– 50% of men and 64% of women who have died suddenly via CAD DID NOT HAVE ANY PREVIOUS SYMPTOMS
• Sudden Death:
– Those with a previous history of MI have a 5-6 times Sudden Death rate compared to the general population
• Hypertension( HTN) is the most common primary diagnosis in America.
• 35 million office visits are as the primary diagnosis of HTN.
• 50 million or more Americans have high BP.
• Worldwide prevalence estimates for HTN may be as much as 1 billion.
• 7.1 million deaths per year may be attributable to hypertension.
The estimated prevalence of hypertension in the United States in 2005 was :
• 35.3 million for men
• 38.3 million for women.
Hypertension is more prevalent in black persons than in Hispanic and non-Hispanic white persons.
This prevalence is increasing.
Data from 1988-1994 and 1999-2002 demonstrated an increased prevalence of hypertension in black individuals from 35.8% to 41.4%.
National High Blood Pressure Education Program Working Group. Arch Intern Med. 1993;153:186-208.
Hypertension: A Significant CV and Renal Disease Risk Factor
Hypertension and CHD : (MRFIT)
Adapted from Neaton JD et al. Arch Intern Med. 1992;152:56-64.
SBP versus DBP in Risk of CHD Mortality
CHD Death Rate
Risk of Cardiovascular Events by Hypertensive Status
36-Year Follow-up in Patients Aged 35-64 Years
3.3 2.4 5.0
Men Women Men Women Men Women Men Women
Coronary Disease Stroke Peripheral Arterial
Disease Cardiac Failure
ia l A
Reprinted with permission from Kannel WB. JAMA. 1996;275:1571-1576.
Disease Relative Risk
Kidney failure (ESRD) 2.8
Heart failure 1.5
Peripheral vascular disease 1.8
Myocardial infarction* =1.6
Coronary artery disease 1.5
ESRD = end-stage renal disease; SBP 165 mm Hg.
Adapted from Kannel WB. Am J Hypertens. 2000;13:3S-10S; Perry HM Jr et al. Hypertension. 1995;25(part 1):587-594;
Klag MJ et al. N Engl J Med. 1996;334:13-18; Nielsen WB et al. Ugeskr Laeger. 1996;158:3779-3783; Neaton JD et al.
Arch Intern Med. 1992;152:56-64.
Elevated SBP Alone Is Associated With Increased Risk of Cardiovascular and Renal Disease
Benefits of Lowering BP
Average Percent Reduction
Stroke incidence 35–40%
Myocardial infarction 20–25%
Heart failure 50%
TROPHY Study ACC 2006:
Even lowering BP in those with pre-HTN appears to reduce incidence of new HTN by up to 60%
About 25% of the
population-attributable risk of a myocardial
infarction can be accounted
for by hypertension
Pathophysiological Association of hypertension
• Endothelial dysfunction, which leads to the
developement of atherosclerosis,
• Increased afterload leading to myocardial
The rate of LVH based on ECG findings
2.9% for men
1.5% for women.
based on echocardiographic findings
33% of patients without LVH have evidence
of asymptomatic LV diastolicdysfunction.
Electrocardiogram from a 46-year-old man with long-standing hypertension showing left atrial abnormality and left ventricular hypertrophy with strain.
Blood Pressure Classification
BP Classification SBP mmHg DBP mmHg
BHS classification of blood pressure levels
Category Systolic blood
(mmHg) Optimal blood pressure
Total Cardiovascular risk in Hypertensive Patients
Treatment modalities in Hypertensive Patients
Non pharmacological Treatment
of hypertension and lifestyle changes
• Lose weight, if overweight
• Increase physical activity
• Reduce salt intake
• Stop smoking
• Limit intake of foods rich in fats and cholesterol
• Increase consumption of fruits and vegetables
• Limit alcohol intake
Modification Approximate SBP reduction (range)
Weight reduction 5–20 mmHg / 10 kg weight loss
Adopt DASH eating plan
Dietary sodium reduction
Moderation of alcohol consumption
Drug therapy for hypertension
Class of drug Example dose Initiating dose Usualmaintenance
Diuretics Hydrochlorothiazide 12.5 mg o.d. 12.5-25 mg o.d.
-blockers Atenolol 25-50 mg o.d. 50-100 mg o.d.
Calcium Amlodipine 2.5-5 mg o.d. 5-10 mg o.d.
-blockers prazosin 2.5 mg o.d 2.5-10mg o.d.
ACE- inhibitors ramipril 1.25-5 mg o.d. 5-20 mg o.d.
Angiotensin-II Losartan 25-50 mg o.d. 50-100 mg o.d.
Pharmacological Treatment in
• In favor
Stewart Lancet 1979
Cruickshank et al Lancet 1987
Miller Hypertension 2000
Farnett et al JAMA 1991
McMahon et al Lancet 1990
J-Curve in HTN plus CAD
HOT Study: Significant Benefit From
Intensive Treatment in the Diabetic Subgroup
Hansson L et al. Lancet. 1998;351:1755-1762.
90 85 80
p=0.005 for trend
Target Diastolic Blood Pressure
. In patients with an elevated DBP and CAD with evidence
of myocardial ischemia, the BP should be lowered slowly,
and caution is advised in inducing decreases in DBP to
60 years of age.
In older hypertensive individuals with wide pulse
pressures, lowering SBP may cause very low DBP values
Treatment of BP in pts with IHD
• Treatment of BP in primary prevention of IHD
• Treatment of BP in secondary prevention of
• Treatment of BP in established IHD
• Treatment of BP in ACS
• Δεν υπάρχει διαφορά μεταξύ των διαφόρων
κατηγοριών αντιυπερτασικών φαρμάκων στην
πρωτογενή πρόληψη, όσον αφορά την
επίπτωση της στεφανιαίας νόσου και των
καρδιαγγειακών επιπλοκών γενικώτερα.
ΕΠΙΛΟΓΗ ΑΝΤΙΥΠΕΡΤΑΣΙΚΩΝ ΦΑΡΜΑΚΩΝ ΣΤΗΝ
ΠΡΩΤΟΓΕΝΝΗ ΠΡΟΛΗΨΗ ΣΤΕΦΑΝΙΑΙΑΣ ΝΟΣΟΥ