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“Practical Update on Hypertension”

“Practical Update on Hypertension”. health with us. Dr. Babu Shersad, MD, MACP (USA) Specialist Internal Medicine & Nephrologist Date: 5 th December 2006 Venue : Renaissance Hotel Time : 12:30 PM. Contents:. What is Hypertension? Classification of Hypertension. Detection. Evaluation.

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“Practical Update on Hypertension”

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  1. “Practical Update on Hypertension” health with us Dr. Babu Shersad, MD, MACP (USA) Specialist Internal Medicine & Nephrologist Date: 5th December 2006 Venue : Renaissance Hotel Time : 12:30 PM FIRST MEDICAL CENTER

  2. Contents: • What is Hypertension? • Classification of Hypertension. • Detection. • Evaluation. • Treatment. • The JNC Algorithm. • Hypertension in Diabetes. • Resistant Hypertension. FIRST MEDICAL CENTER

  3. What is Hypertension? Pre Hypertension: • blood pressure 120/80 mmHg to 139/89 mmHg • not a disease category Hypertension: • blood pressure of 140/90 mmHg or above • The diagnosis of hypertension should be made only after noting a mean elevation on three readings 6 hours apart FIRST MEDICAL CENTER

  4. Classification of Hypertension FIRST MEDICAL CENTER

  5. Detection of Hypertension A. Symptoms of Hypertension • No symptoms • Non-specific symptoms • Headache • Morning headache • Tinnitus • Dizziness • Confusion • Sleepiness • Vision problems • Angina • Difficulty breathing • Irregular heartbeat • Blood in the urine • Epistaxis • Many symptoms occur from complications of hypertension FIRST MEDICAL CENTER

  6. Contd. B. Signs of Hypertension • Vital Signs - Elevated blood pressure, bradycardia, bounding pulse • Skin - Flushed, diaphoresis, pallor • Cardio-Vascular - Distended neck veins, extremity edema, pulmonary edema • Neurologic - Decreased level of consciousness, impaired movement, symmetry of face and extremities, seizures, unequal pupils FIRST MEDICAL CENTER

  7. Evaluation of Hypertension Three main objectives: • To asses lifestyle and other cardiovascular risk or concomitant disorders that may affect prognosis and guide treatment. • To reveal identifiable causes of BP • To asses the presence or absence of target organ damage and CVD FIRST MEDICAL CENTER

  8. FIRST MEDICAL CENTER

  9. Identifiable causes of hypertension • Sleep apnea • Drug induced or related disease • Primary aldosteronism • Chronic kidney disease • Reno-vascular diseases • Chronic steroid therapy • Cushing’s syndrome • Pheochromocytoma • Coarctation of aorta FIRST MEDICAL CENTER

  10. Physical Evaluation • Appropriate BP measurement • With verification in the contra-lateral arm • Examination of optic fundi • BMI • Auscultation of carotid, abdominal and femoral bruits • Examination of heart, lungs and kidneys • Seek abnormal aortic pulse • Examination of edema and abnormal pulses in the lower extreme ties • Neurological examination FIRST MEDICAL CENTER

  11. Laboratory tests and diagnostics These are a must (Rule of 9) • ECG • Urine analysis • Blood glucose (9 to 12 hr fasting) • Hematocrit • Serum potassium • Serum creatinine • Serum calcium • Lipid profile (LDL & HDL with triglycerides) (9 to 12 hr fasting) • Albumin creatinine ratio FIRST MEDICAL CENTER

  12. Treatment of hypertension 1. Non pharmacological management: Life Style changes: • reducing salt intake: reduce dietary sodium intake to no more than 100 m mol per day (2.4gm sodium of 6 gm sodium chloride) • reducing fat intake • losing weight : maintain normal body weight (BMI 18.5-24.5 kg/meter square) • getting regular exercise : 30 minutes of daily aerobic exercise • quitting smoking : strictly • reducing alcohol consumption : not more than 2 drinks / day for men and 1 drink per day for women • managing stress DASH Diet:Dietary Approaches to Stop Hypertension - low in saturated fat, cholesterol, and total fat, and that emphasizes fruits, vegetables, and low fat dairy foods, whole grain products, fish, poultry, and nuts FIRST MEDICAL CENTER

  13. 2. Pharmacological management of Hypertension • diuretics • beta-blockers • calcium channel blockers • angiotensin converting enzyme inhibitors (ACE inhibitors) • alpha-blockers • alpha-beta blockers • vasodilators • peripheral acting adrenergic antagonists • centrally acting agonists FIRST MEDICAL CENTER

  14. Hypertension in Diabetes Diabetes considerably increases the risk of cardiovascular disease if hypertension is also present, so the targets for blood pressure control in diabetes are tighter. • For people who don't have diabetes, the treatment goals for blood pressure– 140 / 85 mmHg • For people with diabetes, the goals are: if proteinuria is less than 1 gm/24 hrs. – 130 / 80 mmHg if proteinuria is greater than 1 gm/24 hrs. – 125 / 75 mmHg FIRST MEDICAL CENTER

  15. Algorithm of Management FIRST MEDICAL CENTER

  16. What is resistant hypertension? “Failure to reach goal BP in patients who are adhering to full doses of an appropriate three drug regimen that includes a diuretic ” Note: This is very common and less tried by clinicians and paramedics. FIRST MEDICAL CENTER

  17. Causes of resistant hypertension FIRST MEDICAL CENTER

  18. At the Clinician’s consulting room: Doctor: I have some bad news and some very bad news. Patient: Well, might as well give me the bad news first.Doctor: The lab called with your test results. They said you have 24 hours to live.Patient: 24 HOURS! That's terrible! WHAT could be WORSE? What's the very bad news?Doctor: I've been trying to reach you since yesterday. “ I Hope that I conveyed the message” – Dr. Babu Shersad All references from: Joint National Committee’s 7th Report FIRST MEDICAL CENTER

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