1. Classification of blood pressure for adults Category Blood Pressure (mmHg) Systolic Diastolic OptimalNormalHigh-normalHypertension Stage 1 Stage 1 Stage 2 Stage 2 Stage 3 Stage 3<120<130130-139140-159160-179  >180 <80<8585-8990-99100-109  >110

2. Classification of hypertension Adolescents (13-15) (13-15) Systolic Systolic Diastolic DiastolicAdolescents (16-18) (16-18) Systolic Systolic Diastolic Diastolic Adults (>18) Systolic Systolic Diastolic Diastolic Mild Mild (stage 1) mmHg mmHg 135-13985-89140-14990-94140-14990-99140-14990-94150-15995-99160-179100-109150-15995-99160-179100-109180-209110-119 >160>110>180>110>210>120 Moderate (stage 2) mmHg mmHg Severe Severe (stage 3) mmHg mmHg Very Severe (stage 3) (stage 3) mmHg mmHg

3. HYPERTENSION HYPERTENSION Severe or refractory HTN Severe or refractory HTN Acute rising BP in well-controlled HTN Acute rising BP in well-controlled HTN Age of onset 70 years-old Age of onset 70 years-old Acute rising Cr,especially with ACE-I Acute rising Cr,especially with ACE-I Diffuse atherosclerosis Diffuse atherosclerosis Asymmetric kidneys Asymmetric kidneys Abdominal bruit Abdominal bruit No family history of HTN No family history of HTN NO Essential HTN HTN Severity of blood pressure levels Between 140/90 to 160/105 mmHg >160/105 mmHg Check for target organ damage: Heart, cardiac risk factors,LVH Heart, cardiac risk factors,LVH Retinopathy greater than grade II Retinopathy greater than grade II Renal insufficiency:proteinuria Renal insufficiency:proteinuria H/O TIA, stroke H/O TIA, stroke No Aerobic Exercise Antihypertensive drugs Antihypertensive drugs Treat complications Treat complications Yes Yes Secondary HTN Primary renal Primary renal desease desease Oral contracept. Oral contracept. Pheo. Pheo. Hyperaldost. Hyperaldost. Cushing Cushing Hyperthyroidism Hyperthyroidism Sleep Apnea Sleep Apnea Ao Coarctation Ao Coarctation Treat by medicine or surgery

4. Increase Intravascular blood volume blood volume obesity obesity diet intake diet intake Increase Intravascular blood volume blood volume obesity obesity diet intake diet intake Increase in heart rate heart rate contrctility contrctility Increase in heart rate heart rate contrctility contrctility Increased Adrenergic activity Hyperinsulinemia Hyperinsulinemia Insulin resistence Insulin resistenceIncreased Adrenergic activity Hyperinsulinemia Hyperinsulinemia Insulin resistence Insulin resistence Increase Increase cardiac output Increase Increase cardiac output Neuro-humoral System RAS RAS Atrial reflexes Atrial reflexes Vasopressin Vasopressin ANP ANP Endothelial factors Endothelial factors Neuro-humoral System RAS RAS Atrial reflexes Atrial reflexes Vasopressin Vasopressin ANP ANP Endothelial factors Endothelial factors ResetBaroceptorResetBaroceptor Increase smooth muscle tone and vascular resistence Increase smooth muscle tone and vascular resistence Target organ damage: Brain - Cardiovascular Retina - Kidneys Target organ damage: Brain - Cardiovascular Retina - Kidneys HypertensionHypertension LVHLVH  Cardiac compliance compliance Decrease Decrease cardiac output Decrease Decrease cardiac output

5. 4 -10 -12 -16 -14 2 0 -2 -4 -6 -8 Systolic BP Diastolic BP All 48 All 48comparisons 14 comparisons 14 comparisons In hypertensives In hypertensives 7 comparisons 7 comparisons In Border Line In Border Line hypertensives hypertensives 27 comparisons 27 comparisons In normotensives In normotensives Results of a meta-analysis of controlled trials testing aerobic exercise and blood pressure Net BP effect in intervention compared to control with 95% confidence interval (mmHg) with 95% confidence interval (mmHg)