Saturday, 3 August 2013

Key points from Dr. C. Venkata S Ram’s lecture at Safdarjung Hospital, New Delhi on 26.07.2013

Dr C. Venkata S. Ram, MD, MACP, FACC, FASH
Dr. C. Venkata S. Ram, a world renowned expert in hypertension delivered a guest lecture on “Appraisal and Reappraisal of Hypertension in 2013”. The lecture was attended by the medical staff and students of Safdarjung hospital and the medical college. He outlined the recommendations of the latest guidelines from the European Society of Cardiology/European Society of Hypertension. Dr. Ram synthesized the following major points from the latest European Hypertension Guidelines:

  1. All patients with hypertension should be treated to keep the upper (systolic) blood pressure to 140 mm Hg.
  2. In patients with diabetes the lower (diastolic) BP should be 85 mm Hg.
  3. In older patients < 80 years, the systolic BP can be kept 140-150 mm Hg.
  4. Blood pressure more than 140/90 increases the risk of cardiovascular disease.
  5. Salt consumption recommendation is 5 to 6 gram per day.
  6. Reducing the salt to 5 gram per day can reduce upper blood pressure by up to 2 mm Hg in normal persons and 4 to 5 mm Hg with patients with high blood pressure.
  7. Loosing 5 kg of weight can reduce systolic blood pressure by 4 mm Hg.
  8. Regular aerobic exercise training can reduce the mean blood pressure by 7 mm Hg.
  9. Drug therapy should be started typically within a few weeks
  10. The main aim of treatment is to lower blood pressure rather than how it is lowered.
  11. ACE inhibitors and AR blockers should not be combined for uncomplicated hypertension.
  12. Those people whose blood pressure is not getting controlled, renal denervation therapy should be considered.
  13. Despite overwhelming evidence that hypertension is a major cardiovascular risk, studies show that many are still unaware of the condition, that target blood pressure levels are seldom achieved. They report that hypertension affects 30-45% of people in Europe.
  14. Perhaps the biggest single change in the new document is the adoption of a single systolic blood pressure target for almost all patients: 140 mm Hg, this replaces the previous, more complicated target, which included both systolic and diastolic recommendations for different levels of risk.
  15. The approach to drug therapy for hypertension has also been thoroughly revised. Drugs are no longer suggested for the treatment of high normal blood pressure. No single drug or class is given special preference, since the benefits of treatment are largely based on the blood pressure lowering effect of the drugs. The guidelines recommend an individualized approach to treatment, based on clinical and demographic considerations.
  16. The guidelines provide perspective on the much-discussed new technology of renal denervation for resistant hypertension. The guidelines say that renal denervation is “promising” but that more trials are needed before it can be fully assessed.

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