1. How Recent Hypertension Trials are going to change our Practice

6. Hypertension: A Significant CV and Renal Disease Risk Factor Peripheral vascular disease  Morbidity  Disability Renal disease CAD CHF LVH Stroke Hypertension National High Blood Pressure Education Program Working Group. Arch Intern Med. 1993;153:186-208.

7. Global Risk Profile and Hypertension

8. Trends in Awareness, Treatment & Control of Hypertension

9. ULTIMATE GOAL OF ANTIHYPERTENSIVE THERAPY PROLONGED SURVIVAL BLOOD PRESSURE REDUCTION PREVENTION OF COMPLICATIONS

12. The correct Approach to Hypertension

14. 2. British Hypertension Society (2003)

21. 5. INDIAN HYPERTENSION GUIDELINES-II Classification www.apiindia.org/hypertensionguidelines

22. Ambulatory blood pressure monitoring www.apiindia.org/hypertensionguidelines

28. Table: Comparison of baselines characteristic of the enrolled populations in the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), the Controlled ONset Verapamil Investigation of Cardiovascular Endpoints(CONVINCE) trial , and the International VErapamil SR/trandolapril Study(INVEST) a Not reported b Reported mean total cholesterol = 5.6mmol/L c Reported combined prior MI/stroke = 23% ALLHAT (%) CONVINCE (%) INVEST (%) Female 47 56 52 Black 36 7 14 Hispanic 19 7 37 Documented CAD 26 8 100 Diabetes 36 20 27 Mean age 67 66 66 Mean BMI 30 a 29 Prior smoking history 40 23 46 Dyslipidemia b 31 53 Prior Stroke c 5 5 Prior MI c 8 32

29. Table: Comparison of treatment goals and strategies associated with the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), the Controlled ONset Verapamil Investigation of Cardiovascular Endpoints(CONVINCE) trial , and the International VErapamil SR/trandolapril Study(INVEST) ALLHAT CONVINCE INVEST SBP goal (mmHg) DBP goal (mmHg) Treatment strategies <140 <90 Step 1 – double blind, randomized: Chlorthalidone vs Amlodipine vs Lisinopril vs doxazosin Step 2 – open label Reserpine or clonidine or atenolol Step 3- open label:hydralazine <140 <90 Step 1 – double blind, randomized; controlled onset extended release verapamil vs physician directed choice of HCTZ or atenolol Step 2 and beyond- includes increase in either dose or number of agents necessary to achieve BP control <140 or < 130 for diabetes and renal dysfunction <90 or <85 for diabetes & renal dysfunction Step 1 – open label, randomized: Verapamil SR vs atenolol Both strategies also contain trandolapril and/or HCTZ which may be prescribed as step 1 as necessary based on patient characteristics Step 2 and beyond – includes an increase in either dose or number of study agents or the addition of nonstudy agents necessary to achieve Bp control

32. Bars represent the percentage of hypertensives on treatment as measured in various studies. Arrows represent published clinical trial findings.

39. Thank You