© 2017 VitalityCardiology

David Freedman Medicine Professional Corporation

6633 Highway #7 East, Markham

Tel: 905.472.7127   email: Ashgrove@cardiomatters.com

398 Steeles Ave West, Thornhill

Tel: 905.881.0334  email: Steeles@cardiomatters.com

BP Target:

<140/90 mmHg should be attained in most hypertensive patients.

<130/80 mmHg is recommended in diabetic patients.

<120/-  mmHg should be considered in high risk 'sprint' patient

ie The +50 yr old with one of: (FLAVR)

  • FRS>15%

  • LVH

  • Age>75

  • Cardiovascular disease (stroke not included)

  • Renal: mild nonDM CKD (<1g/l proteinurea, eGFR 20-60mmHg)

  • But limited evidence with: 

    • prior Stroke (excluded from Sprint)

    • DM (excluded from Sprint)

    • CHF (excluded from Sprint)

    • bad CKD (eGFR<20)​ (excluded from Sprint)

    • Contraindications​

      • Standing SBP <110 mm Hg

  • Must monitor for increased risk of dizzy spells, or worsening renal function

Caution should be taken for patient with:

  • Combo CAD+ LVH: avoid excessive DBP lowering<60mmHg (might ppt ischemia)

  • nonDM CKD Renal disease

  • ​Overall, there is no compelling evidence to support a low BP target of < 130/80 mm Hg in all patients with hypertension and nondiabetic CKD. Therefore, the general BP target (< 140/90 mm Hg) is recommended for many patients with CKD and hypertension.  However, the results of the SPRINT study suggest that high-risk patients with CKD may benefit from intensive BP lowering (see Global Vascular Protection Section).  Please refer to this section for further detail.

BP DIAGNOSIS

ABPM

Definition of hypertension — The definition of hypertension based upon data obtained from ABPM is discussed elsewhere but is summarized here. Meeting one or more of these criteria using ABPM qualifies as hypertension (see "Overview of hypertension in adults", section on 'Definitions based upon ambulatory and home readings' and "Blood pressure measurement in the diagnosis and management of hypertension in adults", section on 'Interpretation of blood pressure measurements'):

A 24-hour average of 125/75 mmHg or above

●Daytime (awake) average of 130/80 mmHg or above

●Nighttime (asleep) average of 110/65 mmHg or above

 

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