Hypertension treatment

1. Hypertension : Treatment
Concepts
Dr Jitendra Ingole, MD Medicine
Associate Professor

2. Health & Happiness is inherent
desire of every living being.

3. Technological advances
have increased
dramatically.

4. But Are We Really Healthy ?

6. Preliminary Findings
• Hypertension Prevalence 12%
• 13 Undergraduate Students
Courtesy : Dept. Of Preventive & Social Medicine , SKNMC , Pune

7. Pressing Need of The Hour to
Identify and Treat Hypertension

8. Concepts

9. What is relevant today, may not be
relevant tomorrow.

10. Don't let the
guidelines
confuse you...

11. Sublingual Nifedipine

13. Dual
Benefit
Drug

14. Dual Benefit
HTn and Migraine Beta Blocker
HTn and Diabetes ACE / ARB

15. Beta Blockers : A Word of Caution

16. Do NOT STOP Beta blockers
abruptly.

17. Paradoxical Use Of Anti-HTn drug

18. Be ready for Surprise !

19. Prazosin
Antihypertensive drug : When used in
Scorpion sting, it (paradoxically)
causes deloading by which BP rises.
The indication is specific to SCORPION
STING.

20. BP 148/98 mmHg

21. Dose & Timing of The Drug

22. The Salt Debate

25. Vadapav : Salt Per serving 400mg

26. Chips : Salt Per serving 500mg

27. Papad : Per serving 200mg

30. Average of 10 gram of Salt in a day !

32. Sodium and Common Salt aren’t
necessarily the same thing
Frassetto LA, et al. Dietary sodium chloride as predictor for
degree of hyperchloremic metabolic acidosis in healthy
humans. Am J Physiol Renal Physiol. 2007 Aug;293(2):F521-
5
Na+ Cl-

33. Hypertension due to Sodium
Bicarbonate Vs Sodium Chloride
Luft FC,Zemel MB, Sowers JA, Sodium bicarbonate and
sodium chloride: effects on blood pressure and electrolyte
homeostasis in normal and hypertensive man. J Hypertens
8:663–670

34. Bone Loss
Barzel US (1995) The skeleton as an ion exchange system:
implications for the role of acid-base imbalance in the genesis of
osteoporosis. J Bone Miner Res 10:1431–1436

35. Muscle (Protein) Loss
Mitch WE, Medina R, Grieber S, et al. Metabolic acidosis
stimulates muscle protein degradation by activating the ATP
dependent pathway involving ubiquitin and proteasomes. J
Clin Invest. 1994; 93:2127–2133.

36. Salt Sensitive and Salt Insensitive

37. The bottom line is: We never
evolved to eat a high salt diet

38. What to use for Taste then ?

39. Salt is Not your Enemy

40. Many Grey areas
Many Grey areas
Many Grey areas
Many Grey areas
Many Grey areas

41. Diuretic drugs

42. Check Electrolyte levels
Periodically

43. Prolonged Diuretic Therapy
Patients may suffer seriously due to
severe Unrecognised
Hyponatremia

44. Stress and Hypertension

45. Can You swim as good
as me in water ?

47. Home Monitoring Of Blood
Pressure

48. Sleep

51. Sleep & Hypertension
Sleep deprivation has been linked to
increases in incidence and prevalence
of hypertension.
Likewise, sleep disruption also
increases the likelihood of having
hypertension.

52. Vitamin D & Hypertension

59. Vitamin D and Hypertension
Data from cross-sectional studies report that
low 25-hydroxy vitamin D is associated with
higher systolic blood pressure and higher
incidence of hypertension.
Tamez H, Thadhani RI. ; Vitamin D and hypertension: an update and review : Curr Opin
Nephrol Hypertens. 2012 Sep;21(5):492-9.

63. Treatment

71. Exercise

73. Drug Compliance

77. Prescription Writing

79. Checklist
• Starting Proper drug
• In Proper dose
• At Proper Interval
• Sleep
• Stress
• Drug Compliance
• Home BP monitoring
• Creative Reminders
• Periodic Evaluation
• Diet
• Exercise
• Obese patients :
Reduce body weight
• Salt restriction
• Electrolytes evaluation
• Vitamin
• Check for side effects
• Modifying drug dosage
if required

81. Patient Story

86. Thanks
To
All Of You

87. T H A N K S
Dr Jitendra Ingole, MD
Associate Professor, Medicine