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Investigations:

Investigations:. Urine examination. Serum K. Serum creatinine. Blood Sugar. Hb. Investigations:. Serum uric acid. Lipid profile. ECG. Fundus. More extensive investigations are needed in secondary hypertension. BP levels above which hypertension in child should be considered:.

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Investigations:

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  1. Investigations: • Urine examination. • Serum K. • Serum creatinine. • Blood Sugar. • Hb.

  2. Investigations: • Serum uric acid. • Lipid profile. • ECG. • Fundus. • More extensive investigations are needed in secondary hypertension.

  3. BP levels above which hypertension in child should be considered:

  4. Common causes of hypertension according to age

  5. Evaluation of asymptomatic hypertensive child:

  6. Pediatric doses of anti hypertensive drugs:

  7. Substances that can elevate BP

  8. Why to treat HTN? • 52%  in CHF • 35-40%  in stroke morbidity and mortality • 35%  in LVH • 20-25%  CAD events • 21%  vascular mortality

  9. Benefits of Lowering BP • Sustaining a 12 mmHg reduction in SBP over 10 years will prevent one death for every 11 patients treated with Stage I HTN w/additional CVD risk factors

  10. JNC-7 Management of BP for Adults No compelling indication No drug tx Thiazide for most 2 drug combo including thiazide BP classification Normal Prehypertension Stage I HTN Stage II HTN Lifestyle  Encourage Yes Yes Yes Compelling indication Drugs targeted for the compelling indications < 120/80 120-139 / 80-89 Drugs targeted for the compelling indications 140-159 / 90-99 Drugs targeted for the compelling indications > 160 / > 100

  11. Treatment Outline • Goals of Therapy • Lifestyle modification • Pharmacologic treatment • Follow-up and monitoring

  12. Goals of Therapy • Reduce CVD and renal morbidity and mortality • Treat to BP < 140/90 mmHg or BP <130/80 mmHg in patients with DM or less in patients with chronic KD

  13. Goals of Therapy • Achieve BP goal especially in persons > 50 years of age • Maintain QOL • Minimize side effects

  14. Lifestyle Modification Modification Approx. SBP reduction (mmHg) Weight reduction Adopt DASH diet Dietary Na+ restriction Physical activity Moderation of alcohol consumption 5 – 10 / 10 kg 8 – 14 2 – 8 4 – 9 2 – 4 http://hin.nhlbi.nih.gov/nhbpep_slds/menu.htm

  15. Lifestyle Modification • Works best in motivated individuals • Initiate at prehypertension classification • Obesity  risk for HTN and DM • If > 20% over ideal body weight (IBW) – considered obese • Decrease intake by 500 cal/day • Increase exercise and activity

  16. One KG decrease in BW is accompanied by reduction of 1.6 and 1.3 mmHg in systolic and diastolic BP.

  17. Salt sensitivity is more common in: • Elderly. • Blacks. • Type 1 diabetes. • Secondary hypertension.

  18. Guidelines for moderate salt restriction:

  19. Dietary potassium: • Diet rich in fruits and vegetables is superior to pills. • Potassium supplements should be avoided in: renal insufficiency, with diuretics, ACE inhibitors or ARBs.

  20. Food rich in potassium:

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