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Lessons from Hypertension guidelines :

Lessons from Hypertension guidelines :. Treatment Of Hypertension. BY PROF.DR . KAMAL MAHMOUD AHMAD. HEAD OF THE CARDIOLGY UNIT MEDICAL RESEARCH INSTITUTE ALEX. UNIVERSITY. Easy to diagnose OFTEN remains undetected Simple to treat OFTEN remains untreated

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Lessons from Hypertension guidelines :

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  1. Lessons from Hypertension guidelines : Treatment Of Hypertension

  2. BY PROF.DR. KAMAL MAHMOUD AHMAD

  3. HEAD OF THE CARDIOLGY UNIT MEDICAL RESEARCH INSTITUTE ALEX. UNIVERSITY

  4. Easy to diagnose OFTEN remains undetected Simple to treat OFTEN remains untreated Despite availability of potent drugs, treatment is too OFTEN ineffective Hypertension even today is a triple paradox which is:

  5. Guidelines • European Society of Hypertension • European Society of Cardiology • JNC 7 • Canadian Guidelines • Egyptian Guidelines

  6. Relationship of Hypertensionto Its Comorbidities Rosamond W, et al. Circulation. 2007;115:69-171;

  7. · Hypertension is a major health problem in Egypt with a prevalence rate of 26.3% among the adult population (> 25 years) . Its prevalence increases with aging, pproximately 50% of Egyptians above the age of 60 years suffer from hypertension. . MAGNITUDE OF THE PROBLEM IN EGYPT

  8. EgyptianHTN Physician & Patient Survey* 1940 patients *M. Mohsen Ibrahim -

  9. Poor understanding of the magnitude of the risk. Poor communication (doctor-patient) Patient forgetfulness. Lack of motivation. Logistic barrier ..Cost. Side effects. Complex regimen. Poor follow up. Causes of Discontinuation of The Drugs

  10. Blood Pressure Classification

  11. BHS classification of blood pressure levels

  12. Appropriate BP measurement 2008 • Allow the patients to relax for several minutes • Take at leasttwo measurements spaced by 1-2 min and additional measurements if the first two are quite different [use phase I and V (disappearance) Korotkoff sounds to identify SBP and DBP] • Use a standard bladder but have a larger for fat arms and a smaller one for thin arms and children • Have the cuff at the heart level • Measure BP in both arms at first visit to detect possible differences due to peripheral vascular disease. In this instance, take the higher value as the reference one • Measure BP 1 and 5 min after assumption of the standing position in elderly subjects, diabetic patients and in other conditions in which postural hypotension may be frequent or suspected (e.g. heart, renal failure, SNS dysfunction, use of vasodilative agents)

  13. Home BP measurements • Self-measurement of BP at home should be encouraged • Response to antihypertensive therapy • Improving adherence with therapy • Evaluating white-coat HTN • On the contrary, Self-measurement of BP should be discouraged when: • it causes anxiety to the patient • it induces self-modification of the treatment regimen

  14. Ambulatory BP Monitoring • ABPM is warranted for evaluation of “white-coat” HTN in the absence of target organ injury. • Ambulatory BP values are usually lower than clinic readings. • Awake, individuals with hypertension have an average BP of >135/85 mmHg and during sleep >120/75 mmHg. • BP drops by 10 to 20% during the night; if not, signals possible increased risk for cardiovascular events.

  15. 24-Hour Blood Pressure (n = 19)

  16. Physical examination for secondary hypertension Signs suggesting secondary hypertension • Features of Cushing syndrome • Skin stigmata of neurofibromatosis (phaeochromocytoma) • Palpation of enlarged kidneys (polycystic kidneys) • Auscultation of abdominal murmurs (renovascular hypertension) • Auscultation of precordial or chest murmurs; Diminished and delayed femoral pulses femoral BP (aortic coarctation or aorticdisease)

  17. Laboratory Tests • Routine Tests • Electrocardiogram • Urinalysis • Blood glucose, and hematocrit • Serum potassium, creatinine, or the corresponding estimated GFR, and calcium • Lipid profile, after 9- to 12-hour fast, that includes high-density and low-density lipoprotein cholesterol, and triglycerides • Optional tests • Measurement of urinary albumin excretion or albumin/creatinine ratio • More extensive testing for identifiable causes is not generally indicated unless BP control is not achieved

  18. Blood pressure target values for treatment of hypertension II. Goals of Therapy

  19. Lifestyle Recommendations for Prevention and Treatment of Hypertension

  20. To reduce the possibility of becoming hypertensive, Reduce sodium intake to less than 2300 mg / day Healthy diet:high in fresh fruits, vegetables, low fat dairy products, dietary and soluble fiber, whole grains and protein from plant sources, low in saturated fat, cholesterol and salt in accordance with Canada's Guide to Healthy Eating. Regular physical activity:accumulation of 30-60 minutes of moderate intensity cardiorespiratory activity (e.g. a brisk walk) 4-7/week in addition to routine activities of daily living Maintenance of ideal body weight (BMI 18.5-24.9 kg/m2) Waist Circumference Men Women - Europid, Sub-Saharan African, Middle Eastern <94 cm <80 cm - South Asian, Chinese <90 cm <80 cm - Japanese <85 cm <90 cm Smoke free environment

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