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Uncontrolled hypertension

Uncontrolled hypertension. Case history.

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Uncontrolled hypertension

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  1. Uncontrolled hypertension

  2. Case history • Edmond 75 years presented with ‘shocking” blood pressure recordings of 184/102 in the morning. His afternoon and night readings were in the ‘acceptable target ranges”He has atrialfibrilliation and is on warfarin 5 mg daily. In addition he is on prazosin 5 mg, atenolol 50 mg , coversyl 10 mg and valsaltan

  3. Questions • What is the prevalence rate of under achieving target blood pressures? • List 5 cause of failure to achieve target blood pressures? How can we reach blood pressure targets? • What is the choice of antihypertensives in angina, post myocardial infarct, post stroke, heart failure, diabetes with proteinuria or microalbuminuria,gout, chronic kidney disease, atrialfibrilliation ? • What are the potentially harmful antihypertensives in asthma/COPD, bradycardia 2nd or 3rdatrioventricularfailure,depresion,gout,heart failure, bilatral renal artery stenosis + diabetes with proteinuria or microalbuminuria? • List 3 effective antihypertensive combination therapies + 3 combinations to avoid.

  4. Blood pressure treatment targets

  5. Prevalence of underachieving

  6. Reaching blood pressure targets • Lifestyle factors not implemented • Adherence medication poor: costs, side effects • Substances increasing BP: NSAIDs, prednisolone, alcohol, caffeine, salt intake • Systems issues: social or economic barriers, recall or reminder systems • Secondary hypertension: • Therapeutic inertia: need to increase a current agent or add another agent • Measurement issues: white coat effect, inappropriate cuff size

  7. Choice of Antihypertensives

  8. Potentially harmful Antihypertensives

  9. Effective combination therapies

  10. Combinations to avoid

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